Quality statement 2: Initial assessment of behaviour that challenges

Quality statement

People with a learning disability and behaviour that challenges have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Rationale

Early and timely assessment of behaviour that challenges can identify and seek to address the factors that lead to the behaviour and help to understand why the person is behaving in that way. In turn, this should help to reduce escalation of the behaviour that challenges.

Quality measures

Structure

Evidence of local arrangements to ensure that people with a learning disability and behaviour that challenges have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Data source: Local data collection.

Process

a) Proportion of people with a learning disability and behaviour that challenges who have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Numerator – the number in the denominator who have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Denominator – the number of people with a learning disability presenting with behaviour that challenges.

Data source: Local data collection.

What the quality statement means for service providers, health and social care practitioners, and commissioners

Service providers (health and social care providers) ensure that systems are in place for people with a learning disability and behaviour that challenges to have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Health and social care practitioners ensure that people with a learning disability and behaviour that challenges have an initial assessment to identify possible triggers, environmental factors and function of the behaviour.

Commissioners (clinical commissioning groups, NHS England and local authorities) ensure that they commission services that provide initial assessments for people with a learning disability and behaviour that challenges to identify possible triggers, environmental factors and function of the behaviour.

What the quality statement means for service users and carers

People who have a learning disability have an assessment when there are signs of behaviour that challenges. The assessment includes the following:

  • a description of the behaviour

  • how often it occurs and for how long

  • how it affects the person

  • what events or situations make the behaviour happen

  • what purpose the behaviour has for the person.

This helps to identify what may be causing the behaviour and any changes that might stop or reduce it.

Source guidance

Definitions of terms used in this quality statement

Initial assessment

An initial assessment should include:

  • a description of the behaviour and its function (including its severity, frequency, duration, purpose for the person and effect on the person and others); the description should be provided by the person (if possible) and a family member, carer or a member of staff (such as a teacher or care worker)

  • an explanation of the personal and environmental factors involved in triggering or maintaining the behaviour; the explanation should be provided by the person (if possible) and a family member, carer or a member of staff (such as a teacher or care worker)

  • any involvement of the service, staff, family members or carers in triggering or maintaining the behaviour.

[Adapted from challenging behaviour and learning disabilities (NICE guideline NG11), recommendation 1.5.4]

Equality and diversity considerations

The communication needs of people with a learning disability, particularly the needs of people who are unable to communicate through speech, should be taken into account in a health assessment. Practitioners may need to provide support for those who have limited speech and for those who have difficulty with English.