Challenging behaviour and restrictive interventions

Ymddygiad heriol ac ymyriadau cyfyngol

Adverse childhood experience

In health and social care, workers deal with a range of challenging behaviour on a daily basis.

These types of behaviour may challenge the worker to change their approach to the individual and also adapt strategies.

Challenging behaviour may include behaviours that are:

  • repetitive/obsessive
  • withdrawn
  • aggressive
  • self-injurious
  • disruptive
  • anti-social or illegal
  • verbally abusive.

There are several factors that can lead to individuals having difficulties with their behaviour. These need to be considered on a case-by-case basis to ensure that the care worker implements the correct level of support and guidance for the individual.

Factors that can lead to challenging behaviours in individuals include:

  • adverse childhood experiences
  • attachment difficulties
  • sensory loss
  • an acquired brain injury or other neurological conditions
  • physical causes or a response to pain or ill health
  • communication difficulties
  • poor parenting
  • inconsistent or inappropriate responses to behaviour
  • being stereotypical of others
  • unachievable expectations of others
  • environment
  • response to circumstances
  • events or feelings, including fear and anxiety
  • transitions experienced by the individual
  • experience of abuse
  • inappropriate care
  • demands to do something the individual does not want to do
  • being ignored.

Restrictive intervention refers to:

  • physical restraint of an individual
  • mechanical restraint
  • the use of medication
  • psychosocial restraint (Sanctions)
  • time out or time away
  • environmental interventions.

Ethical, values-based approach refers to:

  • person-centred practice
  • inclusion
  • participation
  • asset/strengths-based approach
  • strong networks and relationships
  • choice, dignity and respect
  • the importance of adopting the least restrictive approach.

Ym maes iechyd a gofal cymdeithasol, mae gweithwyr yn ymdrin â phob math o ymddygiad heriol bob dydd.

Gall y mathau hyn o ymddygiad herio'r gweithiwr i newid y ffordd y mae'n ymdrin â'r unigolyn ac i addasu strategaethau hefyd.

Gall ymddygiad heriol gynnwys ymddygiad sy'n:

  • ailadroddus/obsesiynol
  • encilgar
  • ymosodol
  • hunan-niweidiol
  • aflonyddgar
  • gwrthgymdeithasol neu anghyfreithlon
  • camdriniaeth eiriol.

Gall sawl ffactor beri i unigolion gael anawsterau gyda'u hymddygiad. Mae angen i'r rhain gael eu hystyried ar sail achos unigol er mwyn sicrhau bod y gweithiwr gofal yn rhoi'r lefel gywir o gymorth ac arweiniad i'r unigolyn.

Mae ffactorau a all arwain at ymddygiadau heriol ymhlith unigolion yn cynnwys:

  • profiadau andwyol mewn plentyndod
  • anawsterau o ran ffurfio ymlyniad
  • colli synhwyrau
  • anaf i'r ymennydd neu gyflwr niwrolegol arall
  • achosion corfforol neu ymateb i boen neu salwch
  • anawsterau cyfathrebu
  • magu gwael
  • ymatebion anghyson neu amhriodol i ymddygiad
  • stereoteipio eraill
  • disgwyliadau anghyraeddadwy gan eraill
  • yr amgylchedd
  • ymateb i amgylchiadau
  • digwyddiadau neu deimladau, gan gynnwys ofn a gorbryder
  • cyfnodau pontio a brofwyd gan yr unigolyn
  • profiad o gam-drin
  • gofal amhriodol
  • yn mynnu gwneud rhywbeth nad yw'r unigolyn am ei wneud
  • cael eich anwybyddu.

Mae ymyriad cyfyngol yn cyfeirio at:

  • atal unigolyn yn gorfforol
  • atal mecanyddol
  • defnyddio meddyginiaeth
  • atal seicogymdeithasol (Cosbau / Sanctions)
  • cyfnod ymdawelu neu amser i ffwrdd
  • ymyriadau amgylcheddol.

Mae dull gweithredu moesegol yn seiliedig ar werthoedd yn cyfeirio at:

  • ymarfer person-ganolog
  • cynhwysiad
  • cyfranogiad
  • dull yn seiliedig ar asedau/cryfderau
  • rhwydweithiau a pherthnasoedd cadarn
  • dewis, urddas a pharch
  • pwysigrwydd mabwysiadu'r dull lleiaf cyfyngol.

Legislation

Deddfwriaeth

Medical clinic team

As a care worker, it is important to comply with current legislation and policies when dealing with behaviours. Legislation that cover restrictive interventions and practices:

Adults

  • The Human Rights Act 1998
  • The European Convention on Human Rights
  • The Social services and Well-being (Wales) Act 2014
  • The Health and Safety at Work Act 1974
  • Code of Professional Practice for Social Care
  • Social Care Wales (2016) Positive approaches: Reducing Restrictive Practices in Social Care (2016)
  • The Regulation and Inspection of Social Care (Wales) Act 2016 (Regulation 29)

Children and young people

  • The Children’s Act 2004
  • Children and Adoption Act 2006
  • United Nations Convention on the Rights of the Child
  • Regulations and National Minimum standards for children’s services
  • Leaving Care Act Wales
  • Practice guidance for Residential Child Care for Workers Registered with the Social Care Wales
  • Social Care Wales (2016) Positive Approaches: Reducing Restrictive Practices in Social Care
  • The Regulation and Inspection of Social Care (Wales) Act 2016 (Regulation 29)

Fel gweithiwr gofal, mae'n bwysig cydymffurfio â deddfwriaeth a pholisïau presennol wrth ymdrin ag ymddygiadau. Deddfwriaeth sy'n cwmpasu ymyriadau ac arferion cyfyngol:

Oedolion

  • Deddf Hawliau Dynol 1998
  • Y Confensiwn Ewropeaidd ar Hawliau Dynol
  • Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014
  • Deddf Iechyd a Diogelwch yn y Gwaith 1974
  • Cod Ymarfer Proffesiynol ar gyfer Gofal Cymdeithasol
  • Gofal Cymdeithasol Cymru (2016) Dulliau Cadarnhaol: Lleihau Arferion Cyfyngol ym maes Gofal Cymdeithasol
  • Deddf Rheoleiddio ac Arolygu Gofal Cymdeithasol (Cymru) 2016 (Rheoliad 29)

Plant a phobl ifanc

  • Deddf Plant 2004
  • Deddf Plant a Mabwysiadu 2006
  • Confensiwn y Cenhedloedd Unedig ar Hawliau'r Plentyn
  • Rheoliadau a Safonau Gofynnol Cenedlaethol ar gyfer gwasanaethau plant
  • Deddf Gadael Gofal Cymru
  • Canllawiau ymarfer ar gyfer Gweithwyr Gofal Preswyl Plant sydd wedi Cofrestru â Gofal Cymdeithasol Cymru
  • Gofal Cymdeithasol Cymru (2016) Dulliau Cadarnhaol: Lleihau Arferion Cyfyngol ym maes Gofal Cymdeithasol
  • Deddf Rheoleiddio ac Arolygu Gofal Cymdeithasol (Cymru) 2016 (Rheoliad 29)

When and how restrictive practices and restrictive interventions can be used

Pryd a sut y gall arferion cyfyngol ac ymyriadau cyfyngol gael eu defnyddio

Administering treatment

Restrictive practices are activities that stop individuals from doing things that they want to do or encouraging them to do things they don’t want to do. Both of these practices can be obvious or discrete.

They should only be applied to limit choice, reactive response from an incident or an emergency or if the person is at risk of harming themselves or others.

Restrictive interventions are part of restrictive practices and, unless part of an agreed behaviour support plan, should only be used as an immediate and deliberate response to challenging behaviours or to take control of a situation where there is real possibility of harm if no action is taken. This can be useful to help the individual learn to manage their behaviour, when it is planned and reviewed appropriately.

However, they can pose a risk to the individual’s health and safety, can be distressing if used inappropriately and, in some cases, can be abusive. They should never be used to punish the individual, inflict pain, suffering and humiliation or to achieve compliance. Regulation 29 of the Regulation and Inspection of Social Care (Wales) Act 2016 – The appropriate use of control and restraint – has some more information on restrictive practices and interventions.

If there is no other option but to use restrictive interventions in an emergency or if the individual is going to harm themselves or others, they should always:

  • be used for no longer than needed
  • be legally justifiable
  • be the least restrictive option
  • be well thought through when all other options have been tried and impractical
  • be openly acknowledged and never hidden
  • be recorded appropriately
  • be monitored, planned and reviewed
  • include a debrief and support offered.

Types of interventions

The below interventions are also known as reactive strategies which include distraction, diffusion, breakaway techniques and safe holding. They should only be used to establish safe control over behaviours that may cause harm or danger to themselves or others.

Physical restraint

Physical restraint is defined as direct physical contact between persons where reasonable force is positively applied against resistance, either to restrict movement or mobility or to disengage from harmful behaviour displayed by the individual.

Mechanical restraint

Mechanical restraint can be described as the use of a device to prevent, restrict or subdue movement of a person’s body or part of the body, for the primary purpose of behavioural control.

Examples include arms splints, cushioned helmets and wheelchair lap straps.

Use of medication

The use of medication which is prescribed and administered for the purpose of controlling or subduing disturbed/violent behaviour.

Psychosocial restraint (Sanctions)

Use of coercive social or material sanction, or verbal threat of those sanctions in an attempt to moderate a person’s behaviour.

It is very important that these sanctions are used appropriately and are relevant to the behaviour. These should only be used in short response to negative behaviours and not as part of a long-term process.

Seclusion should not be used in any social care setting. Behaviour should be dealt with appropriately, ensuring that the individual’s needs are considered.

The least restrictive option should always be sought when issuing interventions to avoid distress and upset to the individual involved.

Mae arferion cyfyngol yn weithgareddau sy'n atal unigolion rhag gwneud pethau y maen nhw am eu gwneud neu sy'n eu hannog i wneud pethau nad ydyn nhw am eu gwneud. Gall y ddau arfer hyn fod yn amlwg neu'n gynnil.

Dim ond i gyfyngu ar ddewis, i ymateb yn adweithiol i ddigwyddiad neu argyfwng neu os yw'r unigolyn yn mynd i niweidio ei hun neu eraill y dylent gael eu defnyddio.

Mae ymyriadau cyfyngol yn rhan o arferion cyfyngol ac, oni bai eu bod yn rhan o gynllun cymorth ymddygiad y cytunwyd arno, dim ond fel ymateb uniongyrchol a bwriadol i ymddygiadau heriol neu i reoli sefyllfa lle mae posibilrwydd gwirioneddol o niwed oni chymerir camau y dylent gael eu defnyddio. Gall hyn fod yn fuddiol er mwyn helpu'r unigolyn i ddysgu sut i reoli ei ymddygiad, pan gaiff ei gynllunio a'i adolygu'n briodol.

Fodd bynnag, gallant achosi risg i iechyd a diogelwch yr unigolyn, gallant achosi trallod os cânt eu defnyddio'n amhriodol ac, mewn rhai achosion, gallant fod yn gamdriniol. Ni ddylent fyth gael eu defnyddio i gosbi'r unigolyn, achosi poen, dioddefaint a chywilydd na sicrhau cydymffurfiad. Mae rheoliad 29 o Ddeddf Rheoleiddio ac Arolygu Gofal Cymdeithasol (Cymru) 2016 – Y defnydd addas o reolaeth ac ataliad – yn cynnwys mwy o wybodaeth am arferion ac ymyriadau cyfyngol.

Os nad oes unrhyw ddewis arall heblaw defnyddio ymyriadau cyfyngol mewn argyfwng neu os yw'r unigolyn yn mynd i niweidio ei hun neu eraill, dylent bob amser:

  • beidio â chael eu defnyddio am ddim mwy na'r hyn sy'n angenrheidiol
  • fod yn gyfiawnadwy yn gyfreithiol
  • defnyddio'r opsiwn lleiaf cyfyngol
  • fod yn ystyriol ar ôl rhoi cynnig ar bob opsiwn arall a'u bod yn anymarferol
  • gael eu cydnabod yn agored ac ni ddylent fyth gael eu cuddio
  • gael eu cofnodi'n briodol
  • gael eu monitro, eu cynllunio a'u hadolygu
  • cynnwys ôl-drafodaeth a chymorth a gynigir.

Mathau o ymyriadau

Gelwir yr ymyriadau isod yn strategaethau adweithiol hefyd, sy'n cynnwys technegau tynnu sylw, lleihau tyndra, torri'n rhydd a dal yn ddiogel. Dim ond er mwyn sicrhau rheolaeth ddiogel dros ymddygiadau a all achosi niwed neu berygl iddynt hwy eu hunain neu eraill y dylid eu defnyddio.

Atal yn gorfforol

Diffinnir atal yn gorfforol fel cyswllt corfforol uniongyrchol rhwng personau lle defnyddir grym rhesymol yn gadarnhaol yn erbyn gwrthwynebiad, naill ai i gyfyngu ar symudiad neu symudedd neu i ddatgyweddu oddi wrth ymddygiad niweidiol a ddangosir gan yr unigolyn.

Atal mecanyddol

Gellir disgrifio atal mecanyddol fel y defnydd o ddyfais i atal symudiad corff unigolyn neu ran o'i gorff, cyfyngu arno neu ei feistroli at ddiben rheoli ymddygiad yn bennaf.

Mae enghreifftiau yn cynnwys sblintiau braich, clustog mewn helmedau a strapiau glin mewn cadair olwyn.

Defnyddio meddyginiaeth

Defnyddio meddyginiaeth sy'n cael ei rhagnodi neu ei gweinyddu er mwyn rheoli neu feistroli ymddygiad aflonydd/treisgar.

Cyfyngu seicogymdeithasol (Cosbau)

Defnyddio cosb gymdeithasol neu faterol drwy orfodaeth, neu fygwth rhoi'r cosbau hynny ar lafar mewn ymgais i gymedroli ymddygiad unigolyn.

Mae'n bwysig iawn bod y cosbau hyn yn cael eu defnyddio'n briodol a'u bod yn berthnasol i'r ymddygiad. Dim ond mewn ymateb byr i ymddygiadau negyddol y dylai'r rhain gael eu defnyddio ac nid fel rhan o broses hirdymor.

Ni ddylid neilltuo neb mewn unrhyw leoliad gofal cymdeithasol. Dylid ymdrin ag ymddygiad yn briodol, gan sicrhau bod anghenion yr unigolyn yn cael eu hystyried.

Dylid ceisio'r opsiwn lleiaf cyfyngol bob amser wrth ymyrryd er mwyn osgoi trallod a chynnwrf i'r unigolyn dan sylw.

Key principles of the Social Services and Well-being Wales Act

Prif egwyddorion y Deddf Gwasanaethau Cymdeithasol a Llesiant Cymru

Nurse in hospital

Social Services and Well-being (Wales) Act 2014 covers adults, children under the age of 18 and carers. The act is split into three parts:

  • people it affects
  • parts within the Act
  • principles throughout the Act.

The act is based on a series of core principles on how social care settings are run and how care workers work with individuals on a day to day basis.

This act is relevant to dealing with positive approaches to behaviour support because it outlines the support the individual should have and the guidance available for care workers who are dealing with this behaviour.

The core principles and values are:

  • putting an individual and their needs at the centre of their care, having a voice and control over reaching the outcomes that help them achieve well-being
  • being able to access advice and support at an early stage, to retain a good quality of life and reduce or delay the need for longer term care and support
  • supporting individuals to achieve their own well-being in every part of their lives
  • involving people in the design and delivery of services recognising the knowledge and expertise they can bring
  • strong partnership working between all agencies and organisations is essential to improve the well-being of individuals in need of care and support and carers in need of support.

As a result of this act, the approach to behaviour has changed and developed to focus on the individual and their needs.

The principles of the Social Services and Well-being (Wales) Act 2014 form the approach and intent of the Regulation and Inspection of Social Care (Wales) Act 2016. This act replaces the Care Standards Act 2000 and moves the emphasis for registered care providers from just meeting minimum standards to delivering services which maximise the well-being outcomes of people they support.

Mae Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 yn cwmpasu oedolion, plant o dan 18 oed a gofalwyr. Mae'r Ddeddf wedi ei rhannu'n dair adran:

  • y bobl y mae'n effeithio arnynt
  • rhannau o fewn y Ddeddf
  • egwyddorion drwy'r Ddeddf gyfan.

Mae'r Ddeddf yn seiliedig ar gyfres o egwyddorion craidd o ran sut y caiff lleoliadau gofal cymdeithasol eu rhedeg a sut mae gweithwyr gofal yn gweithio gydag unigolion o ddydd i ddydd.

Mae'r Ddeddf hon yn berthnasol i ymdrin â dulliau cadarnhaol o roi cymorth ymddygiad am ei bod yn amlinellu'r cymorth y dylai'r unigolyn ei gael a'r canllawiau sydd ar gael i weithwyr gofal sy'n ymdrin â'r ymddygiad hwn.

Yr egwyddorion a'r gwerthoedd craidd yw:

  • rhoi unigolion a'u hanghenion wrth wraidd eu gofal, a rhoi llais a rheolaeth iddynt er mwyn sicrhau'r canlyniadau sy'n eu helpu i sicrhau llesiant
  • gallu cael gafael ar gyngor a chymorth ar gam cynnar er mwyn cadw ansawdd bywyd da a lleihau neu ohirio'r angen am ofal a chymorth yn y tymor hwy
  • helpu unigolion i sicrhau eu llesiant eu hunain ym mhob rhan o'u bywydau
  • cynnwys pobl yn y broses o ddylunio a darparu gwasanaethau gan gydnabod y wybodaeth a'r arbenigedd y gallant eu cynnig
  • mae gwaith partneriaeth cadarn rhwng pob asiantaeth a sefydliad yn hanfodol er mwyn gwella llesiant unigolion y mae arnynt angen gofal a chymorth a gofalwyr sydd angen cymorth.

O ganlyniad i'r Ddeddf hon, mae'r ffordd yr ymdrinnir ag ymddygiad wedi newid ac wedi datblygu er mwyn canolbwyntio ar yr unigolyn a'i anghenion.

Mae egwyddorion Deddf Gwasanaethau Cymdeithasol a Llesiant (Cymru) 2014 yn ffurfio dull a bwriad Deddf Rheoleiddio ac Arolygu Gofal Cymdeithasol (Cymru) 2016. Mae’r ddeddf hon yn cymryd lle Deddf Safonau Gofal 2000 ac yn symud y pwyslais ar gyfer darparwyr gofal cofrestredig o gwrdd â safonau gofynnol yn unig i ddarparu gwasanaethau sy’n sicrhau’r canlyniadau llesiant gorau i’r bobl maent yn eu cefnogi.

Behavioural models

Modelau ymddygiadol

Meeting

In this section and subsequent sections, we will be introducing a range of ways of working to help you secure positive outcomes for the people you support. Some may be more relevant in some circumstances and many of the approaches can be combined.

Restrictive interventions are part of a continuum of restrictive practices and, unless part of an agreed behaviour plan, should only ever be used as an immediate and deliberate response to challenging behaviours or to manage a situation where there is a real possibility of harm if no action is taken. Restrictive interventions must never be used to punish, to inflict pain, suffering and humiliation or to achieve compliance.

Restrictive interventions, other than those used in an emergency, should always be planned in advance and agreed by a multi-disciplinary team and wherever possible, the individual and included in their behaviour plan.

If restrictive interventions need to be used as the individual is going to harm or injure themselves or others, they should always:

  • be used for no longer than necessary
  • be proportionate to the risk and least restrictive option
  • be legally and ethically justifiable
  • be well thought through and considered when all other options have been tried and are impractical
  • be made in a manner transparent to all with clear lines of accountability in place
  • be openly acknowledged and never hidden
  • be determined by local policy and procedures
  • be recorded accurately and appropriately
  • be monitored, planned and reviewed to find a more positive alternative for the longer term
  • include a debrief
  • support all involved.

Restrictive practice

Restrictive practice means a wide range of activities that stop individuals from doing things that they want to do or encourages them to do things that they don’t want to do.

Understanding behaviour is important when dealing with incidents in care. The worker needs to understand how the behaviour started and progressed.

Challenging behaviour can mask a range of factors the individual is trying to express. For example, they:

  • be a form of communication to others around them
  • be affected by others around them, not being able to understand them or make themselves understood
  • be influenced by your/other people’s response to an individual’s actions
  • be influenced by the environment
  • have underlying physical causes/be a response to pain, ill health, sensory loss, an acquired brain injury or other neurological conditions
  • be a response to circumstances, events and feelings including fear, anxiety, transitions, loss, abuse, inappropriate care or demands to do something that the individual does not want to do.

Yn yr adran hon ac yn yr adrannau sydd i ddod, byddwn yn cyflwyno amrywiaeth o ffyrdd o weithio er mwyn eich helpu i sicrhau canlyniadau cadarnhaol i’r bobl rydych y neu cefnogi. Bydd rhai yn fwy perthnasol mewn rhai sefyllfaoedd ac mae llawer o’r dulliau yn gallu cael eu cyfuno.

Mae ymyriadau cyfyngol yn rhan o gontinwwm o arferion cyfyngol ac, oni bai eu bod yn rhan o gynllun ymddygiad y cytunwyd arno, dim ond fel ymateb uniongyrchol a bwriadol i ymddygiadau heriol neu i reoli sefyllfa lle mae posibilrwydd gwirioneddol o niwed oni chymerir camau gweithredu y dylent gael eu defnyddio. Ni ddylid fyth ddefnyddio ymyriadau cyfyngol i gosbi, achosi poen, dioddefaint a chywilydd na sicrhau cydymffurfiad.

Dylai ymyriadau cyfyngol, heblaw'r rhai a ddefnyddir mewn argyfwng, fod yn rhai sydd bob amser wedi cael eu cynllunio ymlaen llaw, y mae tîm amlddisgyblaethol a, lle bynnag y bo modd, yr unigolyn wedi cytuno arnynt ac yn rhai sydd wedi'u cynnwys yn ei gynllun ymddygiad.

Os oes angen defnyddio ymyriadau cyfyngol am fod yr unigolyn yn mynd i niweidio ei hun neu eraill dylent bob amser:

  • beidio â chael eu defnyddio am ddim mwy na'r hyn sy'n angenrheidiol
  • fod yn gymesur â'r risg a chynnig yr opsiwn lleiaf cyfyngol
  • fod yn gyfiawnadwy yn gyfreithiol ac yn foesegol
  • fod yn ystyriol ar ôl rhoi cynnig ar bob opsiwn arall a'u bod yn anymarferol
  • gael eu gwneud mewn modd tryloyw i bawb gyda llinellau atebolrwydd clir ar waith
  • gael eu cydnabod yn agored ac ni ddylent fyth gael eu cuddio
  • gael eu pennu yn unol â pholisïau a gweithdrefnau lleol
  • gael eu cofnodi'n gywir ac yn briodol
  • gael eu monitro, eu cynllunio a'u hadolygu er mwyn dod o hyd i ddull gweithredu mwy cadarnhaol yn y tymor hwy
  • cynnwys ôl-drafodaeth
  • cefnogi pawb dan sylw.

Arfer cyfyngol

Ystyr arfer cyfyngol yw ystod eang o weithgareddau sy'n atal unigolion rhag gwneud pethau y maen nhw am eu gwneud neu sy'n eu hannog i wneud pethau nad ydyn nhw am eu gwneud.

Mae deall ymddygiad yn bwysig wrth ymdrin â digwyddiadau ym maes gofal. Mae angen i'r gweithwyr ddeall sut y gwnaeth yr ymddygiad ddechrau a datblygu.

Gall ymddygiad heriol guddio nifer o ffactorau y mae'r unigolyn yn ceisio eu mynegi. Er enghraifft:

  • bod yn ffordd o gyfathrebu ag eraill o'i amgylch
  • lle mae eraill o'i amgylch yn effeithio arno, lle nad yw'n gallu eu deall neu lle nad yw'n gallu cael eraill i'w ddeall
  • lle mae eich ymateb chi/pobl eraill i weithredoedd unigolyn yn dylanwadu arno
  • lle mae'r amgylchedd yn dylanwadu arno
  • deillio o achosion corffol sylfaenol/bod yn ymateb i boen, salwch, colled synhwyraidd, anaf i'r ymennydd neu gyflyrau niwrolegol eraill
  • bod yn ymateb i amgylchiadau, digwyddiadau neu deimladau, gan gynnwys ofn, gorbryder, cyfnodau pontio, colled, camdriniaeth, gofal amhriodol neu ymgais i fynnu bod yr unigolyn yn gwneud rhywbeth nad yw am ei wneud.

Active support model

Model cymorth gweithredol

Doctor supervision

Active support model

Active support is a person-centered approach to providing direct support. The goal of active support is to ensure that people with even the most significant disabilities have ongoing, daily support to allow them to engage in a variety of life activities and opportunities of their choice.

By following this model, it values person-centred practice and allows the individual to complete everyday activities with ease.

There are several components of active support:

  • daily plans set by the care worker and individual
  • active participation in everyday routines and activities
  • defined levels of support and assistance
  • positive interaction
  • positive reinforcement
  • valued range of meaningful activities
  • task analysis
  • skills teaching.

Example of the active support model in action:

Model cymorth gweithredol

Dull o roi cymorth uniongyrchol sy'n canolbwyntio ar yr unigolyn yw cymorth gweithredol. Nod cymorth gweithredol yw sicrhau bod pobl sydd â'r anableddau hyd yn oed mwyaf sylweddol yn cael cymorth dyddiol parhaus i'w galluogi i gymryd rhan mewn amrywiaeth o weithgareddau a chyfleoedd bywyd o'u dewis.

Drwy ddilyn y model hwn, mae'n rhoi gwerth ar arfer sy'n canolbwyntio ar yr unigolyn ac yn rhoi cyfle i'r unigolyn gymryd rhan mewn gweithgareddau bob dydd yn hawdd.

Mae sawl elfen i gymorth gweithredol:

  • cynlluniau dyddiol a bennir gan y gweithiwr gofal a'r unigolyn
  • cymryd rhan mewn tasgau beunyddiol a gweithgareddau
  • lefelau penodol o gefnogaeth a chymorth
  • rhyngweithio cadarnhaol
  • atgyfnerthu cadarnhaol
  • amrywiaeth werthfawr o weithgareddau ystyrlon
  • dadansoddi tasgau
  • addysgu sgiliau.

Enghraifft o'r model cymorth gweithredol ar waith:

Restorative approaches

Watch the video as an introduction to restorative approaches.

Dulliau adferol

Gwyliwch y fideo fel cyflwyniad i ddulliau adferol.

Example of restorative approach to deal with conflict:

Enghraifft o ddull adferol i ymdrin â gwrthdaro:

A restorative school is one which takes a restorative approach to resolving conflict and preventing harm. Restorative approaches enable those who have been harmed to convey the impact of the harm to those responsible, and for those responsible to acknowledge this impact and take steps to put it right.

There are six main components to this approach that the care workers need to adopt to implement the approach effectively.

  1. Restoration – the primary aim of a restorative approach is to address and repair harm
  2. Voluntarism – participation is voluntary and is based on informed choice
  3. Neutrality – fair and unbiased towards participants
  4. Safety – processes and practice aim to ensure the safety of all participants and create a safe space for the expression of feelings and views about how harm has been caused
  5. Accessibility – non-discriminatory and available to all those affected by conflict and harm
  6. Respect – respectful of the dignity of all participants and those affected by harm.

Mae ysgol adferol yn un sy'n defnyddio dull adferol o ddatrys anghydfod ac atal niwed. Mae dulliau adferol yn galluogi'r rhai sydd wedi cael eu niweidio i gyfleu effaith y niwed i'r rhai sy'n gyfrifol ac yn galluogi'r rhai sy'n gyfrifol i gydnabod yr effaith hon a chymryd camau i'w hunioni.

Mae chwe phrif elfen i'r dull hwn y mae angen i'r gweithwyr gofal eu mabwysiadu er mwyn defnyddio'r dull yn effeithiol.

  1. Adferiad – prif nod dull adferol yw mynd i'r afael â niwed a'i wella
  2. Gwirfoddoli – dylai pobl gymryd rhan mewn prosesau adfer o'u gwirfodd ac yn seiliedig ar ddewis hyddysg
  3. Niwtraliaeth – yn deg ac yn ddiduedd tuag at y rhai sy'n cymryd rhan
  4. Diogelwch – nod prosesau ac ymarfer yw sicrhau diogelwch pawb sy'n cymryd rhan a chreu man diogel ar gyfer mynegi teimladau a safbwyntiau am y ffordd mae niwed wedi cael ei achosi
  5. Hygyrchedd – ddim yn gwahaniaethu ac ar gael i bawb mae gwrthdaro a niwed wedi effeithio arnynt
  6. Parch - yn parchu urddas pawb sy'n cymryd rhan a'r rhai y mae'r niwed wedi effeithio arnynt.

Positive behaviour support

Watch the video as an introduction to positive behaviour support

Cymorth ymddygiad cadarnhaol

Gwyliwch y fideo fel cyflwyniad i gymorth ymddygiad cadarnhaol

Positive behaviour support is a person-centred approach to support people who display or are at risk of displaying challenging behaviours.

Mae cymorth ymddygiad cadarnhaol yn ffordd o roi cymorth sy'n canolbwyntio ar yr unigolyn i bobl sy'n dangos neu sydd mewn perygl o ddangos ymddygiadau heriol.

Positive behaviour support involves understanding the reasons for the behaviour and considering the person as a whole, including their life history, physical health and emotional needs, to implement ways of supporting them. It focuses on creating physical and social environments that are supportive and capable of meeting people's needs, and teaching people new skills to replace the challenging behaviour.

The components contain:

  • value based approaches
  • theory and evidence-based approaches
  • primary prevention
  • secondary prevention
  • reactive strategies.

Punishment has no place in positive behaviour support and should never be considered. It is important for the care worker to understand what the individual is feeling and why they are behaving as they are.

The four common functions of challenging behaviour is:

  • social attention
  • avoidance/escape
  • access to tangibles
  • sensory stimulation.

Primary prevention strategies and early interventions to support positive behaviour:

  • changing or avoiding triggers that lead to challenging behaviour
  • changing the environment in which individuals live or spending time to meet their needs
  • participation in a valued range of meaningful activities to help individuals achieve outcomes important to them
  • changing reinforcements that maintain challenging behaviour
  • providing support at the right level to assist individuals to increase their independence and ability to cope
  • offering reassurance and support to reduce feelings of anxiety or distress.

Mae cymorth ymddygiad cadarnhaol yn cynnwys deall y rhesymau dros yr ymddygiad ac ystyried yr unigolyn cyfan, gan gynnwys ei hanes bywyd, ei anghenion iechyd corfforol ac emosiynol, er mwyn cynnig ffyrdd o'i gefnogi.Mae'n canolbwyntio ar greu amgylcheddau ffisegol a chymdeithasol sy'n gefnogol ac sy'n gallu diwallu anghenion pobl, ac sy'n addysgu sgiliau newydd i bobl yn lle'r ymddygiad heriol.

Mae'r elfennau yn cynnwys:

  • dulliau sy'n seiliedig ar werthoedd
  • dulliau sy'n seiliedig ar theori a thystiolaeth
  • ataliad sylfaenol
  • ataliad eilaidd
  • strategaethau adweithiol.

Nid oes lle i gosbau mewn cymorth ymddygiad cadarnhaol ac ni ddylid byth eu hystyried. Mae'n bwysig bod y gweithiwr gofal yn deall yr hyn y mae'r unigolyn yn ei deimlo a pham ei fod yn ymddwyn fel y mae.

Pedwar gweithrediad cyffredin ymddygiad heriol yw:

  • sylw cymdeithasol
  • osgoi/dianc
  • cael gafael ar bethau diriaethol
  • ysgogi'r synhwyrau.

Strategaethau atal sylfaenol ac ymyriadau cynnar i gefnogi ymddygiad cadarnhaol:

  • newid neu osgoi ffactorau sy'n ysgogi ymddygiad heriol
  • newid yr amgylchedd lle mae unigolion yn byw neu'n treulio amser er mwyn bodloni ei anghenion
  • cymryd rhan mewn amrywiaeth werthfawr o weithgareddau ystyrlon er mwyn helpu unigolion i gyflawni canlyniadau sy'n bwysig iddynt
  • newid atgyfnerthiadau sy'n cynnal ymddygiad heriol
  • rhoi cymorth ar y lefel gywir er mwyn helpu unigolion i fod yn fwy annibynnol a gallu ymdopi'n well
  • cynnig tawelwch meddwl a chymorth er mwyn lleihau teimladau o bryder neu ofid.

Supporting individuals and workers during incidents of challenging behaviour

Cefnogi unigolion a gweithwyr yn ystod achosion o ymddygiad heriol

Doctors meeting

During incidents of challenging behaviour, it is important that care workers support the individual fully and feel confident to deal with the incident.

When dealing with challenging behaviour it is important to offer support and debriefing to ensure all involved can reflect and review the incident fully. Debriefs should be offered during times of challenging behaviour and also in situations when interventions are used. Both of these incidents can have an impact on the individual and others.

How individuals should be supported following an incident:

  1. returning to a calm state
  2. reflection on how they were feeling prior to and directly before the incident
  3. the behaviour itself
  4. the consequences of the behaviour
  5. how they felt afterwards
  6. what would have helped them to achieve a more positive outcome.

The worker, carers and others involved need to take care of themselves following an incident. The incident can be emotionally and sometimes physically demanding on the individual, which is why it is important to debrief after the incident.

The individual should be offered further support and training after the incident to reflect on the incident, how it went and what could be improved. The team need to review the personal plan and how the incident measured up to the plan. They need to discuss whether the plan needs adapting or altering to fully accommodate the individual’s needs and demands. The incident also needs to be discussed and reviewed with the multi-agency team at the next meeting.

The below levels of support should be offered:

  • emotional support
  • first aid if needed
  • time away
  • quiet time
  • personal reflection
  • opportunities to express how they are feeling
  • further training or CPD.

There are several methods that support the review of positive approaches and restrictive practices and interventions. These can help the team analysis and review. The methods could include:

  • recording the information
  • analysing records of previous incidents
  • behaviour and consequences
  • data informed decision making.

Following the review process, further support can be sought for all involved: individuals, workers and carers.

Yn ystod achosion o ymddygiad heriol, mae'n bwysig bod gweithwyr gofal yn cefnogi'r unigolyn yn llawn ac yn teimlo'n hyderus i ymdrin â nhw.

Wrth ymdrin ag ymddygiad heriol mae'n bwysig cynnig cymorth ac ôl-drafodaeth er mwyn sicrhau y gall pawb dan sylw fyfyrio'n llawn ar yr hyn sydd wedi digwydd a'i adolygu. Dylid cynnig ôl-drafodaethau pan fydd ymddygiad heriol a hefyd mewn sefyllfaoedd lle y defnyddir ymyriadau. Gall y naill a'r llall gael effaith ar yr unigolyn ac eraill.

Sut y dylai unigolion gael eu cefnogi yn dilyn achos o ymddygiad heriol:

  1. cymorth i ymdawelu
  2. myfyrio ar y ffordd roeddent yn teimlo cyn ac yn union cyn yr ymddygiad heriol
  3. yr ymddygiad ei hun
  4. canlyniadau'r ymddygiad
  5. sut roeddent yn teimlo wedyn
  6. beth fyddai wedi eu helpu i sicrhau canlyniad mwy cadarnhaol.

Mae angen i'r gweithiwr, gofalwyr ac eraill dan sylw ofalu amdanyn nhw eu hunain ar ôl achos o ymddygiad heriol. Gall fod yn anodd yn emosiynol, ac yn gorfforol weithiau, i'r unigolyn, a dyna pam ei bod yn bwysig cael ôl-drafodaeth ar ôl achos o ymddygiad heriol.

Dylid cynnig rhagor o gymorth a hyfforddiant i'r unigolyn ar ôl achos o ymddygiad heriol er mwyn myfyrio arno, sut yr aeth a'r hyn y gellid ei wella. Bydd angen i'r tîm adolygu'r cynllun personol a chymharu'r achos o ymddygiad heriol â'r cynllun. Bydd angen iddynt drafod p'un a oes angen addasu neu newid y cynllun er mwyn diwallu anghenion yr unigolyn a bodloni ei ofynion yn llawn. Hefyd, bydd angen trafod ac adolygu'r achos o ymddygiad heriol gyda'r tîm amlddisgyblaethol yn y cyfarfod nesaf.

Dylid cynnig y lefelau o gymorth a nodir isod:

  • cefnogaeth emosiynol
  • cymorth cyntaf os oes ei angen
  • amser i ffwrdd
  • amser tawel
  • myfyrdod personol
  • cyfleoedd i fynegi sut roeddent yn teimlo
  • rhagor o hyfforddiant neu DPP.

Mae sawl dull sy'n cefnogi'r broses o adolygu dulliau gweithredu cadarnhaol ac arferion ac ymyriadau cyfyngol. Gall y rhain helpu'r tîm i ddadansoddi ac adolygu. Gallai’r dulliau gynnwys:

  • cofnodi'r wybodaeth
  • dadansoddi cofnodion o achosion blaenorol
  • ymddygiad a chanlyniadau
  • gwneud penderfyniadau ar sail data.

Ar ôl y broses adolygu, gellir ceisio cymorth i bawb dan sylw: unigolion, gweithwyr a gofalwyr.

Case study

Astudiaeth achos

Sourced from Social Care Wales (2016) Positive approaches: Reducing Restrictive Practices in Social Care

Daw o ‘Gofal Cymdeithasol Cymru (2016) Dulliau Cadarnhaol: Lleihau Arferion Cyfyngol ym maes Gofal Cymdeithasol’

Depression help

Case study

Sarah lives in supported housing accommodation which she shares with Menna. Sarah has moderate learning disabilities and is registered blind as she is partially sighted. Recently, Sarah has been urinating on her floor mat in her bedroom at night.

Sarah’s social care worker goes into her room after breakfast to help her make her bed and notices that her mat is soaking wet again. She is cross with Sarah and asks her why she keeps doing this. Sarah withdraws into herself, sits on her bed, hangs her head and does not respond. The social care worker removes the mat for washing and cleans the floor.

She leaves Sarah in her room whilst she supports Menna to make her bed.

Later that morning, the social care worker notices that Sarah is not wearing her glasses. Sarah tells her that they are broken. The social care worker, still cross about having to wash the mat and floor again, tells Sarah that she will have to wait until the next day to go to the optician to get her glasses fixed as she does not have time to take her that day.

Sarah has virtually no sight without her glasses.

  • Try to put yourself in her shoes and think about why she might be behaving as she is during the night.
  • Consider whether she has control over the situation.
  • Consider what could have been done better.
  • Consider how this situation could have been moved forward.

Astudiaeth achos

Mae Sarah yn byw mewn llety â chymorth y mae'n rhannu gyda Menna. Mae gan Sarah anableddau dysgu cymedrol ac mae wedi'i chofrestru'n ddall am ei bod yn rhannol ddall. Yn ddiweddar, mae Sarah wedi bod yn pasio dŵr ar y mat ar lawr ei hystafell wely yn y nos.

Mae gweithiwr gofal cymdeithasol Sarah yn mynd i mewn i'w hystafell ar ôl brecwast i'w helpu i wneud y gwely ac yn sylwi bod ei mat yn wlyb socian eto. Mae'n ddig gyda Sarah ac yn ei holi pam mae hi'n gwneud hyn o hyd. Mae Sarah'n mynd i'w chragen, yn eistedd ar ei gwely, yn pengrymu ac nid yw'n ymateb. Mae'r gweithiwr gofal cymdeithasol yn codi'r mat i'w olchi ac yn glanhau'r llawr.

Mae'n gadael Sarah yn ei hystafell tra'i bod yn helpu Menna i wneud ei gwely hi.

Yn hwyrach y bore hwnnw, mae'r gweithiwr gofal cymdeithasol yn sylwi nad yw Sarah yn gwisgo'i sbectol. Mae Sarah yn dweud wrthi ei bod wedi torri. Mae'r gweithiwr gofal cymdeithasol, sy'n ddig gyda hi o hyd am ei bod wedi gorfod golchi'r mat a'r llawr unwaith eto, yn dweud wrth Sarah y bydd rhaid iddi aros tan y diwrnod wedyn i fynd i'r optegydd i gael trwsio ei sbectol gan nad oes ganddi amser i fynd â hi'r diwrnod hwnnw.

Nid yw Sarah'n gweld braidd dim heb ei sbectol.

  • Ceisiwch roi eich hun yn ei hesgidiau hi a meddyliwch pam mae hi'n ymddwyn fel hyn yn ystod y nos.
  • Ystyriwch a oes ganddi unrhyw reolaeth dros ei sefyllfa.
  • Ystyriwch beth y gellid bod wedi'i wneud yn well.
  • Ystyriwch sut y gellid bod wedi symud ymlaen o'r sefyllfa hon.

Partnership working

Gweithio mewn partneriaeth

Working together

When dealing with challenging behaviour, team working is vital to ensure the safety and support of others.

The principles of effective team working are:

  • trust between all involved in a person’s care and support
  • consistency of support
  • a clear understanding of one's own and each other's roles and responsibilities
  • a clear understanding of people’s rights and entitlements and that these must be exercised appropriately
  • confidentiality and information sharing
  • effective and appropriate communication between the team.

In order to implement a consistent approach to dealing with behaviour, the worker needs to have a clear and sound understanding of the individual and how the behaviour plan needs to be person-centred.

The content of plans needs to be shared amongst the multi-agency team to ensure consistency and also to ensure all are involved during review changes. Risk assessments also need to be shared with all professionals involved in the individual’s care.

This can be achieved by discussion, reading of care plans and discussion amongst to team to develop a clear understanding of the background and behaviour plan for the individual.

Wrth ymdrin ag ymddygiad heriol, mae gweithio mewn tîm yn hollbwysig er mwyn sicrhau bod eraill yn cael eu diogelu a'u cefnogi.

Egwyddorion gweithio'n effeithiol mewn tîm yw:

  • ymddiriedaeth rhwng pawb sy'n ymwneud â rhoi gofal a chymorth i unigolyn
  • cysondeb cymorth
  • dealltwriaeth glir o'ch rolau a'ch cyfrifoldebau eich hun a rolau a chyfrifoldebau eich gilydd
  • dealltwriaeth glir o hawliau pobl a bod yn rhaid i'r rhain gael eu harfer yn briodol
  • cyfrinachedd a rhannu gwybodaeth
  • cyfathrebu effeithiol a phriodol rhwng y tîm.

Er mwyn defnyddio dull cyson o ymdrin ag ymddygiad, mae angen i'r gweithiwr feddu ar ddealltwriaeth glir a chadarn o'r unigolyn a'r ffordd y mae angen i'r cynllun ymddygiad ganolbwyntio ar yr unigolyn.

Mae angen i gynnwys cynlluniau gael ei rannu ymhlith y tîm amlasiantaethol er mwyn sicrhau cysondeb a hefyd fod pawb yn cymryd rhan wrth wneud newidiadau fel rhan o'r broses adolygu. Mae angen i asesiadau risg hefyd gael eu rhannu â'r holl weithwyr proffesiynol sy'n ymwneud â gofal yr unigolyn.

Gellir cyflawni hyn drwy drafodaeth, darllen cynlluniau gofal a'u trafod ymhlith y tîm er mwyn meithrin dealltwriaeth glir o gefndir a chynllun ymddygiad yr unigolyn.

Meaningful activities

Gweithgareddau ystyrlon

Helping hand

The care worker needs to ensure that the person-centred approach is applied when dealing with proactive approaches to behaviour. The individual needs to feel valued and have a voice in decisions made about them. Some approaches may include showing the relationship between positive and proactive approaches and developing a person-centred approach:

  • getting to know the individual (likes, dislikes, hobbies, interests)
  • respecting and valuing the individual’s background
  • respecting the individual’s preferred communication approach
  • understanding the impact of the environment on the individual and how to support this
  • developing and monitoring plans which outline an individual’s needs, desired well-being outcomes and how they will be supported to achieve these.

We all respond to people who are kind to us, which is important to remember when supporting others.

A value range of meaningful activities refers to the balance between activities that contribute to a good quality of life for individuals, incorporating vocational, domestic, personal, leisure, educational and social activities.

Throughout the communication process with the individual, it is important to include the individual in meaningful activities and everyday routines. The individual needs to have their voice heard and an input into their plan. This will make the individual feel valued and listened to, which may lead to success in implementing the plan.

If the individual does not feel listened to or have any control over events affecting them, this can lead to negative effects on the individual, such as withdrawal, aggression and frustration.

Goals and boundaries are set to ensure the individual understands the expectations and where they need to improve. This sets a clear action plan for the individual and also allows them to reflect on boundaries already set.

The care worker also needs to reinforce to the individual the reasons why they behave in a certain way and how they can improve this. This needs to take place in an honest and professional manner.

The individual needs to understand what behaviour is acceptable in what context. The care worker needs to address any behaviour that is not acceptable with clear reasons why and how they can adapt themselves. The care worker needs to encourage the individual to think about their own behaviour and the consequences and actions this may have on others.

If the individual does not feel they are being listened to and valued, this can lead to increased challenging behaviour, frustration and anger. This may also lead to withdrawal from activities and no communication lines.

Mae angen i'r gweithiwr gofal sicrhau ei fod yn defnyddio'r dull sy'n canolbwyntio ar yr unigolyn wrth ddefnyddio dulliau rhagweithiol o ymdrin ag ymddygiad. Mae angen i'r unigolyn deimlo ei fod wedi'i werthfawrogi a'i fod yn cael lleisio barn mewn penderfyniadau a wneir amdano. Gall rhai dulliau gynnwys dangos y berthynas rhwng dulliau cadarnhaol a rhagweithiol a datblygu dull sy'n canolbwyntio ar yr unigolyn:

  • dod i adnabod yr unigolyn (hoff a chas bethau, hobïau, diddordebau)
  • parchu a gwerthfawrogi cefndir yr unigolyn
  • parchu dewis ddull cyfathrebu'r unigolyn
  • deall effaith yr amgylchedd ar yr unigolyn a sut i gefnogi hyn
  • datblygu a monitro cynlluniau sy'n amlinellu anghenion unigolyn, canlyniadau llesiant a ddymunir a sut y caiff ei gefnogi i sicrhau'r rhain.

Mae pob un ohonom yn ymateb i bobl sy’n garedig i ni, sy’n bwysig cofio wrth gefnogi eraill.

Mae amrywiaeth werthfawr o weithgareddau ystyrlon yn cyfeirio at y cydbwysedd rhwng gweithgareddau sy'n cyfrannu at ansawdd bywyd da i unigolion, gan ymgorffori gweithgareddau galwedigaethol, domestig, personol, hamdden, addysgol a chymdeithasol.

Drwy gydol y broses o gyfathrebu â'r unigolyn, mae'n bwysig cynnwys yr unigolyn mewn gweithgareddau ystyrlon a thasgau beunyddiol. Mae angen i'r unigolyn wybod bod ei lais yn cael ei glywed ac y gall gyfrannu at ei gynllun. Bydd hyn yn gwneud i'r unigolyn deimlo bod eraill yn ei werthfawrogi ac yn gwrando arno, a all arwain at lwyddiant wrth weithredu'r cynllun.

Os na fydd yr unigolyn yn teimlo bod eraill yn gwrando arno neu os bydd yn teimlo nad oes ganddo unrhyw reolaeth dros ddigwyddiadau sy'n effeithio arno, gall hyn arwain at effeithiau negyddol ar yr unigolyn, megis encilio, ymddygiad ymosodol a rhwystredigaeth.

Caiff nodau a ffiniau eu pennu er mwyn sicrhau bod yr unigolyn yn deall y disgwyliadau a ble mae angen iddo wella. Mae hyn yn pennu cynllun gweithredu clir i'r unigolyn ac mae hefyd yn rhoi cyfle iddo fyfyrio ar ffiniau sydd eisoes wedi'u pennu.

Mae angen hefyd i'r gweithiwr cymdeithasol bwysleisio'r rhesymau i'r unigolyn pam ei fod yn ymddwyn mewn ffordd benodol a sut y gall wella ar hyn. Mae angen i hyn ddigwydd mewn ffordd onest a phroffesiynol.

Mae angen i'r unigolyn ddeall pa ymddygiad sy'n dderbyniol ym mha gyd-destun. Mae angen i'r gweithiwr gofal fynd i'r afael ag unrhyw ymddygiad nad yw'n dderbyniol gan roi rhesymau clir pam a sut y gallant addasu eu hunain. Mae angen i'r gweithiwr gofal annog yr unigolyn i feddwl am ei ymddygiad ei hun a'r canlyniadau a'r camau gweithredu a all effeithio ar eraill.

Os na fydd yr unigolyn yn teimlo bod eraill yn gwrando arno ac yn ei werthfawrogi, gall hyn arwain at fwy o ymddygiad heriol, rhwystredigaeth a dicter. Gall hyn hefyd arwain at dynnu'n ôl o weithgareddau a dim llinellau cyfathrebu.

Voice and control

Llais a rheolaeth

Care

In order to support the voice and control of individuals, communication lines and methods need to include:

  • involving the individual in decisions which affect their lives
  • asking individuals what they want in ways they understand
  • having an input into daily choices and routines
  • individuals being allowed to make mistakes and learning from them
  • listening carefully and actively
  • using appropriate non-verbal communication techniques
  • always making time for the individual to respond and communicate
  • managing the environment to facilitate communication
  • speaking clearly and not giving too much information or asking too many questions
  • being reassuring and non-threatening in your expression and tone
  • being supportive and encouraging and avoiding negative statements
  • using the individual’s past experience and life story to support communication
  • understanding how particular conditions may affect communication
  • making sure a detailed description of how best to communicate with individuals is included in their records
  • asking the individual for feedback on the services and ways it could be improved.

Throughout the communication process, the individual needs to feel valued, respected and in control over decisions affecting them. Individuals need to have an input and influence decisions. This includes:

  • being able to make choices about both small day-to-day things as well as life defining decisions
  • having sufficient time to be fully involved in the decision making process
  • positive use of risk assessments to balance rights, responsibilities and perceived risks
  • being able to make mistakes and learn from them
  • influencing advance directives and crisis plans
  • agreeing, where possible, any restrictive practices that can be used
  • being able to speak for themselves about their services and support or to have someone advocate on their behalf
  • having access to advice and information in a format and style they can understand
  • knowing what to expect from workers in relation to their conduct and practice
  • knowing how to make a complaint or compliment about the service.

Er mwyn cefnogi llais a rheolaeth unigolion, mae angen i linellau cyfathrebu a dulliau gynnwys:

  • cynnwys unigolion mewn penderfyniadau sy'n effeithio ar eu bywydau
  • gofyn i unigolion beth maent am ei gael mewn ffyrdd y maent yn eu deall
  • cyfrannu at ddewisiadau a thasgau beunyddiol
  • gadael i unigolion wneud camgymeriadau a dysgu ohonynt
  • gwrando'n ofalus ac yn weithredol
  • defnyddio technegau cyfathrebu di-eiriau priodol
  • rhoi amser i'r unigolyn ymateb a chyfathrebu bob amser
  • rheoli'r amgylchedd i hwyluso cyfathrebu
  • siarad yn glir a pheidio â rhoi gormod o wybodaeth na gofyn gormod o gwestiynau
  • rhoi sicrwydd a pheidio â bod yn fygythiol o ran mynegiant a thôn
  • rhoi cefnogaeth ac anogaeth ac osgoi datganiadau negyddol
  • defnyddio profiad blaenorol a hanes bywyd unigolion er mwyn helpu i gyfathrebu â nhw
  • deall sut y gall amodau penodol effeithio ar gyfathrebu
  • sicrhau bod disgrifiad manwl o'r ffordd orau o gyfathrebu ag unigolion wedi'i gynnwys yn eu cofnodion
  • gofyn i unigolion am adborth ar y gwasanaethau a sut y gellid eu gwella.

Drwy gydol y broses o gyfathrebu, mae angen i unigolion deimlo eu bod yn cael eu gwerthfawrogi, eu parchu a bod ganddynt reolaeth dros benderfyniadau sy'n effeithio arnynt. Mae angen i unigolion gael cyfle i gyfrannu a dylanwadu ar benderfyniadau. Mae hyn yn cynnwys:

  • y gallu i wneud dewisiadau am bethau bach o ddydd i ddydd yn ogystal â phenderfyniadau tyngedfennol mewn bywyd
  • cael digon o amser i chwarae rhan lawn yn y broses gwneud penderfyniadau
  • defnydd cadarnhaol o asesiadau risg er mwyn cydbwyso hawliau, cyfrifoldebau a risgiau canfyddedig
  • gallu gwneud camgymeriadau a dysgu ohonynt
  • dylanwadu ar gyfarwyddiadau ymlaen llaw a chynlluniau yn sgil argyfwng
  • cytuno ar unrhyw arferion cyfyngol y gellir eu defnyddio, lle y bo modd
  • gallu siarad drostyn nhw eu hunain am eu gwasanaethau a'u cymorth neu gael rhywun i fod yn eiriolwr ar eu rhan
  • cyngor a gwybodaeth ar gael iddynt mewn fformat ac arddull y gallant eu deall
  • gwybod beth y gallant ei ddisgwyl gan weithwyr o ran eu hymddygiad a'u hymarfer
  • gwybod sut i wneud cwyn neu roi canmoliaeth am y gwasanaeth.

Case study

Astudiaeth achos

Sourced from Social Care Wales (2016) Positive approaches: Reducing Restrictive Practices in Social Care

Daw o ‘Gofal Cymdeithasol Cymru (2016) Dulliau Cadarnhaol: Lleihau Arferion Cyfyngol ym maes Gofal Cymdeithasol’

Painting

Case study – Professional conduct

Jane a young woman of 23 was referred to her local Community Learning Disability Team (CLDT).

Jane, who has Down’s Syndrome, was bored at home. She was continuously overeating and her weight was starting to cause health problems. Her parents were trying to encourage healthy eating and were restricting her access to food. This however, only resulted in Jane becoming angry and abusive towards her parents.

Jane had been offered traditional day services in the past but had declared that she ‘didn’t like them, and didn’t want to go there’.

The social worker discovered from discussions with Jane and her mum; that she liked art and was good at colouring and painting.

She introduced her to a community art class, first speaking to the tutor and accompanying her. She also introduced her to a local keep-fit class, to try to help her with her weight, and she finally suggested a weekend drama course, that was run locally for young people with and without disabilities.

Three years on, she still attends three activities, and has made friends in the drama class who introduced her to further classes.

The family have short breaks while Jane is at activities and have not needed to contact social services for some time. Jane enjoys her activities and is developing strong friendships in her local community. She has stopped overeating and is losing weight. She also has a better relationship with her family.

  • What has worked well in securing this positive outcome for Jane and her family?

Astudiaeth achos – Ymddygiad proffesiynol

Cafodd Jane, menyw ifanc 23 oed, ei chyfeirio at ei Thîm Anabledd Dysgu Cymunedol lleol.

Roedd Jane, sydd â Syndrom Down, wedi diflasu gartref. Roedd hi'n gorfwyta drwy'r amser ac roedd ei phwysau yn dechrau achosi problemau iechyd. Roedd ei rhieni'n ceisio' hannog i fwyta'n iach ac yn cyfyngu ar ei gallu i gael at fwyd. Fodd bynnag, dim ond cythruddo Jane a gwneud iddi ymddwyn yn ymosodol tuag at ei rhieni wnaeth hyn.

Roedd Jane wedi cael cynnig gwasanaethau dydd traddodiadol yn y gorffennol ond roedd hi wedi dweud ei bod hi 'ddim yn eu hoffi, a ddim eisiau mynd yno'.

Drwy drafod gyda Jane a'i mam, daeth y gweithiwr gofal cymdeithasol i wybod ei bod hi'n mwynhau celf, a'i bod yn gallu lliwio a phaentio'n dda.

Fe gyflwynodd y gweithiwr Jane i ddosbarth celf cymunedol, gan siarad â’r tiwtor yn gyntaf, a mynd gyda hi i'r dosbarth i ddechrau. Mae hi wedi'i chyflwyno i ddosbarth cadw'n heini lleol hefyd, i geisio'i helpu i golli pwysau, ac yn olaf awgrymodd gwrs drama penwythnos, a oedd yn cael ei gynnal yn lleol ar gyfer pobl ifanc ag anableddau a heb anableddau.

Dair blynedd yn ddiweddarach, mae hi wedi dal ati gyda'r tri gweithgaredd, ac mae wedi gwneud ffrindiau yn y dosbarth drama sydd wedi ei chyflwyno i ddosbarthiadau eraill.

Mae'r teulu'n cael seibiannau byr pan fydd Jane yn gwneud ei gweithgareddau, ac nid ydynt wedi gorfod cysylltu â gwasanaethau cymdeithasol ers peth amser. Mae Jane yn mwynhau ei gweithgareddau ac mae'n meithrin cyfeillgarwch cryf gyda phobl yn ei chymuned leol. Nid yw'n gorfwyta mwyach ac mae hi'n colli pwysau. Mae'r berthynas rhyngddi hi a'i theulu wedi gwella hefyd.

  • Beth sydd wedi gweithio’n dda er mwyn diogelu’r canlyniad cadarnhaol hwn i Jane a’i theulu?