FOLLOW ESTABLISHED PERSON CENTRED BEHAVIOUR …...CHCDIS002 FOLLOW ESTABLISHED PERSON _ CENTRED...

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CHCDIS002 FOLLOW ESTABLISHED PERSON CENTRED BEHAVIOUR SUPPORT (Learner Workbook)

Transcript of FOLLOW ESTABLISHED PERSON CENTRED BEHAVIOUR …...CHCDIS002 FOLLOW ESTABLISHED PERSON _ CENTRED...

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CHCDIS002

FOLLOW ESTABLISHED

PERSON CENTRED BEHAVIOUR SUPPORT

(Learner Workbook)

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Instructions to Learner

Assessment instructions

Overview

Prior to commencing the assessments, your trainer/assessor will explain each assessment task and

the terms and conditions relating to the submission of your assessment task. Please consult with

your trainer/assessor if you are unsure of any questions. It is important that you understand and

adhere to the terms and conditions, and address fully each assessment task. If any assessment task

is not fully addressed, then your assessment task will be returned to you for resubmission. Your

trainer/assessor will remain available to support you throughout the assessment process.

Written work

Assessment tasks are used to measure your understanding and underpinning skills and knowledge of

the overall unit of competency. When undertaking any written assessment tasks, please ensure that

you address the following criteria:

Address each question including any sub-points

Demonstrate that you have researched the topic thoroughly

Cover the topic in a logical, structured manner

Your assessment tasks are well presented, well referenced and word processed

Your assessment tasks include your full legal name on each and every page.

Active participation

It is a condition of enrolment that you actively participate in your studies. Active participation is

completing all the assessment tasks on time.

Plagiarism

Plagiarism is taking and using someone else's thoughts, writings or inventions and representing them

as your own. Plagiarism is a serious act and may result in a learner’s exclusion from a course. When

you have any doubts about including the work of other authors in your assessment, please consult

your trainer/assessor. The following list outlines some of the activities for which a learner can be

accused of plagiarism:

Presenting any work by another individual as one's own unintentionally

Handing in assessments markedly similar to or copied from another learner

Presenting the work of another individual or group as their own work

Handing in assessments without the adequate acknowledgement of sources used, including

assessments taken totally or in part from the internet.

If it is identified that you have plagiarised within your assessment, then a meeting will be organised

to discuss this with you, and further action may be taken accordingly.

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Collusion

Collusion is the presentation by a learner of an assignment as their own that is, in fact, the result in

whole or in part of unauthorised collaboration with another person or persons. Collusion involves

the cooperation of two or more learners in plagiarism or other forms of academic misconduct and,

as such, both parties are subject to disciplinary action. Collusion or copying from other learners is

not permitted and will result in a “0” grade and NYC.

Assessments must be typed using document software such as (or similar to) MS Office. Handwritten

assessments will not be accepted (unless, prior written confirmation is provided by the

trainer/assessor to confirm).

Competency outcome

There are two outcomes of assessments: S = Satisfactory and NS = Not Satisfactory (requires more

training and experience).

Once the learner has satisfactorily completed all the tasks for this module the learner will be

awarded “Competent” (C) or “Not yet Competent” (NYC) for the relevant unit of competency.

If you are deemed “Not Yet Competent” you will be provided with feedback from your assessor and

will be given another chance to resubmit your assessment task(s). If you are still deemed as “Not Yet

Competent” you will be required to re-enrol in the unit of competency.

Additional evidence

If we, at our sole discretion, determine that we require additional or alternative

information/evidence in order to determine competency, you must provide us with such

information/evidence, subject to privacy and confidentiality issues. We retain this right at any time,

including after submission of your assessments.

Confidentiality

We will treat anything, including information about your job, workplace, employer, with strict

confidence, in accordance with the law. However, you are responsible for ensuring that you do not

provide us with anything regarding any third party including your employer, colleagues and others,

that they do not consent to the disclosure of. While we may ask you to provide information or

details about aspects of your employer and workplace, you are responsible for obtaining necessary

consents and ensuring that privacy rights and confidentiality obligations are not breached by you in

supplying us with such information.

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Assessment appeals process

If you feel that you have been unfairly treated during your assessment, and you are not happy with

your assessment and/or the outcome as a result of that treatment, you have the right to lodge an

appeal. You must first discuss the issue with your trainer/assessor. If you would like to proceed

further with the request after discussions with your trainer/assessor, you need to lodge your appeal

to the course coordinator, in writing, outlining the reason(s) for the appeal.

Recognised prior learning

Candidates will be able to have their previous experience or expertise recognised on request.

Special needs

Candidates with special needs should notify their trainer/assessor to request any required

adjustments as soon as possible. This will enable the trainer/assessor to address the identified needs

immediately.

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Assessment requirements

Assessment can either be:

Direct observation

Product-based methods e.g. reports, role plays, work samples

Portfolios – annotated and validated

Questioning

Third party evidence.

If submitting third party evidence, the Third Party Observation/Demonstration document must be

completed by the agreed third party.

Third parties can be:

Supervisors

Trainers

Team members

Clients

Consumers.

The third party observation must be submitted to your trainer/assessor, as directed.

The third party observation is to be used by the assessor to assist them in determining competency.

The assessment activities in this workbook assess aspects of all the elements, performance criteria,

skills and knowledge and performance requirements of the unit of competency.

To demonstrate competence in this unit you must undertake all activities in this workbook and have

them deemed satisfactory by the assessor. If you do not answer some questions or perform certain

tasks, and therefore you are deemed to be Not Yet Competent, your trainer/assessor may ask you

supplementary questions to determine your competence. Once you have demonstrated the

required level of performance, you will be deemed competent in this unit.

Should you still be deemed Not Yet Competent, you will have the opportunity to resubmit your

assessments or appeal the result.

As part of the assessment process, all learners must abide by any relevant assessment policies as

provided during induction.

If you feel you are not yet ready to be assessed or that this assessment is unfair, please contact your

assessor to discuss your options. You have the right to formally appeal any outcome and, if you wish

to do so, discuss this with your trainer/assessor.

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Candidate Details

Assessment – CHCDIS002: Follow established person-centred behaviour supports

Please complete the following activities and hand in to your trainer/assessor for marking. This forms

part of your assessment for CHCDIS002: Follow established person-centred behaviour supports.

Name: _____________________________________________________________

Address: _____________________________________________________________

_____________________________________________________________

Email: _____________________________________________________________

Employer: _____________________________________________________________

Declaration

I declare that no part of this assessment has been copied from another person’s work with the

exception of where I have listed or referenced documents or work and that no part of this

assessment has been written for me by another person. I also understand the assessment

instructions and requirements and consent to being assessed.

Signed: ____________________________________________________________

Date: ____________________________________________________________

If activities have been completed as part of a small group or in pairs, details of the learners

involved should be provided below:

This activity workbook has been completed by the following persons and we acknowledge that it

was a fair team effort where everyone contributed equally to the work completed. We declare that

no part of this assessment has been copied from another person’s work with the exception of where

we have listed or referenced documents or work and that no part of this assessment has been

written for us by another person.

Learner 1: ____________________________________________________________

Signed: ____________________________________________________________

Learner 2: ____________________________________________________________

Signed: ____________________________________________________________

Learner 3: ____________________________________________________________

Signed: ____________________________________________________________

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Observation/Demonstration

Throughout this unit, you will be expected to show your competency of the elements through

observations or demonstrations. Your trainer/assessor will have a list of demonstrations you must

complete or tasks to be observed. The observations and demonstrations will be completed as well as

the activities found in this workbook.

An explanation of observations and demonstrations:

Observation is on-the-job

The observation will usually require:

Performing a work based skill or task

Interaction with colleagues and/or customers.

Demonstration is off-the-job

A demonstration will require:

Performing a skill or task that is asked of you

Undertaking a simulation exercise.

Your trainer/assessor will inform you of which one of the above they would like you to do. The

observation/demonstration will cover one of the unit’s elements.

The observation/demonstration will take place either in the workplace or the training environment,

depending on the task to be undertaken and whether it is an observation or demonstration. Your

trainer/assessor will ensure you are provided with the correct equipment and/or materials to

complete the task. They will also inform you of how long you have to complete the task.

You should be able to demonstrate the skills, knowledge and performance criteria required for

competency in this unit, as seen in the Learner Guide.

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Third Party Guide

You should supply details of the third party to the assessor before you commence the activities (see

below), unless the assessor has already selected a third party themselves. The assessor can then

contact the third party in instances where they require more evidence to determine competency, or

they cannot observe certain tasks themselves.

The reasons to use a third party may include:

Assessment is required in the workplace

Where there are health and safety issues related to observation

Patient confidentiality and privacy issues are involved.

If you are not employed, or able to complete demonstrative tasks in the workplace, you will need to

inform the assessor. They will be able to provide you with a simulated environment in which to

complete these tasks.

We would prefer that, wherever possible, these be “live” issues for your industry and require

application of the principles that you are learning as part of your training. Where this is not possible,

you and your third party should simulate the activity tasks and demonstrations that you believe

would be likely to arise in your organisation or job role.

Third party evidence can also be used to provide “everyday evidence” of tasks included in your work

role that relate to the unit of competency but are not a part of the formal assessment process.

The third party is not to be used as a co-assessor – the assessor must make the final decision on

competency themselves.

Documents relevant to collection of third party evidence are included in the Third Party section in

the Observations/Demonstrations document.

Third party details (required information from the learner)

A third party may be required for observations or demonstrations; please provide details below of

your nominated third party and obtain their signature to confirm their agreement to participate. This

information will be required by your trainer/assessor in advance of arranging any future

observations or demonstrations.

Third party name: ______________________________________________________________

Position of third party: ______________________________________________________________

Telephone number: ______________________________________________________________

Email address: ______________________________________________________________

Declaration for nominated third party

I declare my intention to act as third party for (learner’s name here) __________________________

Third party signature: _____________________________________ Date: ___________________

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Assessment Level A

1. Apply a person-centred approach to minimise behaviours of concern

A1: a) What are the seven steps of a functional behavioural analysis? b) Name three elements that a behavioural support plan can support you in your work. c) What are OARS skills? What do they include?

(1.1)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A2: a) What is the strengths-based approach and how does it apply to addressing needs, strengths and

preferences? b) To enable individuals to engage in activities, what qualities should activities possess?

(1.2)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A3: Mike is a 40-year-old client living in disability facility with an intellectual disability. Mike cannot handle too much information at once and he got confused but he can communicate reasonably well. He often forgets where he is up to in his daily routine. Mike came to the facility recently when his mother died and he had no one to look after him. Mike can shower himself but needs prompting to wash himself properly and he needs assistance dressing. He has a pleasant personality but he misses his mother and does not really understand why she is not there anymore.

a) Identify daily activities and enjoyable experiences Mike might be engaged in as part of his daily routine. Provide five examples. For example, assisting with cooking

b) Mike enjoys being with other people and he is usually easy to engage in activities. Despite this, when planting roses was introduced as a new activity, Mike showed great reluctance to participate even though he had enjoyed gardening activities with his mother in the past. Identify five reasons staff might be having difficulties with engaging Mike in the rose planting activities.

c) Describe an appropriate strategy that might be used to encourage Mike to engage in the gardening activity

(1.3)

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Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A4:

a) What are positive and adaptive responses?

b) What kind of environment is conducive to positive and adaptive responses?

(1.4)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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2. Review context of behaviours of concern

A5: a) Name five elements that may be in your behavioural support plan? b) Give five examples of behaviours of concern.

(2.1)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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A6: a) What should you consider in a situation where behaviour of concern has occurred? b) What is your priority in a situation of behaviour that is of concern? c) Give three points that you need to consider when making inclusive communication with your clients.

(2.2)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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A7: a) What are triggers? b) State 10 different triggers. c) Explain why it is important to consider the strength and frequency of behaviour of concern.

(2.3)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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A8: a) Why is the environment a potential trigger for a client? b) Describe a situation where a trigger in the environment has arisen and you have needed to address

this for the needs of the client. (2.4)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A9: What factors help to give a person emotional wellbeing? (2.5)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A10: Provide two examples of how a person’s health status might affect their behaviour. (2.6)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A11: a) Provide two examples of how a person’s medication might affect their behaviour. b) Why should you note any medication that a client is taking when observing behaviour? c) What should you make a note of when recording information about medication taken?

(2.7)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A12: What does recording observations accurately and objectively mean? (2.8)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

3. Provide positive behaviour support according to individualised behaviour support plan

A13: a) Briefly explain how positive and negative reinforcement can be used as an appropriate intervention

when addressing behaviours of concern. b) Why is punishment an inappropriate intervention when addressing behaviours of concern

(3.1)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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A14: a) Name two strategies that can help you to avoid behaviour escalation. b) What strategies may assist in managing behaviour? Name ten.

(3.2)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A15: a) How should you respond to behaviours of concern at an administrative level? b) Name four ways that you can try to minimise behaviour of concern.

(3.3)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A16: List 5 things you should do when a client becomes hostile, aggressive or abusive to ensure the safety of yourself, other people and the person being aggressive.

(3.4)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A17: a) Briefly explain what a critical incident is. b) A person is threatening to hurt themselves and anyone who tries to stop them. Explain how you

should respond to the incident. (3.5)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A18: a) How can you monitor strategies for:

Developing and maintaining positive and adaptive responses

Determining reduction of risk of harm to the person and others

Strategies to determine level of intrusion on person's dignity and self-esteem? b) What factors can strategies be judged on?

(3.6)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A19: What changes to a person's needs may occur during their lifetime? Who may you need to report them to?

(3.7)

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

A20: a) Name three specialist services that you may need to make referrals to? b) Briefly explain the referral process at your place of work (or a place of work that you have previously

worked for or are familiar with).

(3.8)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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4. Complete documentation

A21: Briefly explain how documentation is maintained at your organisation (or a system of how this should be done if not in employment).

(4.1&4.2)

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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Level “A” Competency record to be completed by assessor

This should be used by the trainer/assessor to document the learner’s skills, knowledge and

performance as relevant to the overall unit. Indicate in the table below if the learner is deemed

competent or not yet competent for the unit or if reassessment is required.

Learner’s name

Assessor’s name

Unit of Competence

(Code and Title)

Date(s) of assessment

Has the learner completed all required assessments to a satisfactory standard? Yes No

(Please circle)

Has sufficient evidence and information been provided by the learner to prove their competency across the entire unit?

Yes No

(Please circle)

The learner has been assessed as competent in the elements and performance criteria and the evidence has been presented as:

Authentic Yes No

(Please circle)

Valid Yes No

(Please circle)

Reliable Yes No

(Please circle)

Current Yes No

(Please circle)

Sufficient Yes No

(Please circle)

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Learner is deemed: ☐Not yet competent ☐Competent

If not yet competent, date for re-assessment:

Comments from trainer/assessor:

Learner’s signature

Assessor’s signature

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ASSESSMENT LEVEL B

Summative Assessments

The summative assessments are the major activities designed to assess your skills, knowledge and

performance, as required to show competency in this unit. These activities should be completed

after finishing the Learner Guide. You should complete these as stated below and as instructed by

your trainer/assessor.

Skills, knowledge and performance may be termed as:

Skills – skill requirements, required skills, essential skills, foundation skills

Knowledge – knowledge requirements, required knowledge, essential knowledge,

knowledge evidence

Performance – evidence requirements, critical aspects of assessment, performance

evidence.

Section A: Skills Activity

The Skills Activity is designed to be a series of demonstrative tasks that should be assessed by

observation (by the assessor or third party, depending on the circumstances).

It will demonstrate all of the skills required for this unit of competency – your assessor will provide

further instructions to you, if necessary.

Section B: Knowledge Activity (Q & A)

The Knowledge Activity is designed to be a verbal questionnaire where the assessor asks you a series

of questions to confirm your competency for all of the required knowledge in the unit of

competency.

Section C: Performance Activity

The Performance Activity is designed to be a practical activity performed either in the workplace or a

simulated environment. You should demonstrate the required practical tasks for the unit of

competency and be observed by the assessor and/or third party, as applicable to the situation. If the

third party is required to observe you, you will need to make the required arrangements with them.

If necessary for the activities, you should attached completed written answers, portfolios or any

evidence of competency to this workbook.

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Section A: Skills Activity

Objective: To provide you with an opportunity to show you have the required skills for this unit. The Foundation Skills describe those required skills (such as language, literacy, numeracy and employment skills) that are essential to performance. Foundation skills essential to performance are explicit in the performance criteria of this unit of

competency.

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Section B: Knowledge Activity (Q & A)

Objective: To provide you with an opportunity to show you have the required knowledge for this unit.

The answers to the following questions will enable you to demonstrate your knowledge of:

Principles and practices of positive behaviour support which focuses on the individual

person

The social model of disability

The impact of social devaluation on an individual's quality of life

Positive lifestyle enhancement strategies, including:

positive reinforcement

motivation

stress management

engagement in meaningful activities

support relationships

nutrition

environmental and systems improvement

Organisation policies and procedures relating to behaviour management, including:

critical incidents

accident and incident reporting

restrictions on the use of aversive procedures

Principles of effective communication and ways to implement these to minimise

behaviours of concern

Indicators that people have unmet needs

Factors that may contribute to behaviours of concern, including:

physical

emotional

environmental

medications

Specialist services and referral options

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Legal and ethical considerations for working with people with disability:

codes of conduct

dignity of risk

duty of care

human rights, including the united nations convention on the rights of persons

with disabilities (UNCRPD)

constraint

imprisonment

abuse

practice standards

work safety and health.

Answer each question in as much detail as possible, considering your organisational requirements

for each one.

All answers will vary depending on the learner and the organisation they work for but the learner

should be able to answer each question competently.

B1. Outline the key functions of a behavioural support plan. Why is it important to ensure that all implemented support is designed around the individual?

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B2. Provide four examples of positive behaviour support strategies and explain how they may encourage positive behaviour.

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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B3. Explain the difference between the social model of disability and the medical model of disability.

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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B4. List three negatives effects that social devaluation can have on a disabled person.

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B5. Explain the use of the five following positive lifestyle enhancement strategies: Motivation Stress management Engaging in meaningful activities Support relationships Improvements to the environment and systems.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B6. Outline the importance of making sure that the nutritional needs of the client are being met as part of your care and activity work.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B7. In your own words, explain the meaning of positive reinforcement. Present your answer in no more than 200 words.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B8. What is the primary function of a crisis management plan?

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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B9. Following the event of physical intervention with a client, a meeting should be held to consider any necessary changes to the guidelines for using restrictive practices. In your own words, consider the importance of the constant re-evaluation of the guidelines concerning restrive practices and/or physical intervention. You should present your answer in no more than 500 words.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B10. In what case would it be appropriate to apply restrictive practice?

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B11. Identify three variations of communication strategies that you could apply.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B12. List two examples of positive support strategies which may alleviate any unmet needs of the client.

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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B13. When risk-assessing a client and their environment, what are the four primary factors that you should consider that may contribute to behaviours of concern?

Learner Response

Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B14. When referring a client to a specialist, what are the three main questions that you should consider?

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

B15. Identify an instance when you may need to consider the legal and ethical factors of working with people with a disability. You should consider the policies and procedures of your workplace.

Learner Response

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Assessor Response:

☐ ☐ Satisfactory ☐ Not Satisfactory Resubmission Request (Please read comments)

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Level “B” Competency record to be completed by assessor

This should be used by the trainer/assessor to document the learner’s skills, knowledge and

performance as relevant to the overall unit. Indicate in the table below if the learner is deemed

competent or not yet competent for the unit or if reassessment is required.

Learner’s name

Assessor’s name

Unit of Competence

(Code and Title)

Date(s) of assessment

Has the learner completed all required assessments to a satisfactory standard? Yes No

(Please circle)

Has sufficient evidence and information been provided by the learner to prove their competency across the entire unit?

Yes No

(Please circle)

The learner has been assessed as competent in the elements and performance criteria and the evidence has been presented as:

Authentic Yes No

(Please circle)

Valid Yes No

(Please circle)

Reliable Yes No

(Please circle)

Current Yes No

(Please circle)

Sufficient Yes No

(Please circle)

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Learner is deemed: ☐Not yet competent ☐Competent

If not yet competent, date for re-assessment:

Comments from trainer/assessor:

Learner’s signature

Assessor’s signature

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SUPPLEMENTARY ORAL QUESTIONS (OPTIONAL) – FOR ASSESSOR

The below table is for you to document any supplementary verbal questions you have asked the learner to

determine their competency. For example, if you are unsure of their answer to a question in the Learner

Workbook, you may choose to ask them a supplementary question to clarify their understanding of the

relevant criteria.

Learner’s name

Assessor’s name

Unit of Competence

(Code and Title)

Date of assessment

Question:

Learner answer:

Assessor judgement: Satisfactory Not Satisfactory

Question:

Learner answer:

Assessor judgement: Satisfactory Not Satisfactory

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Question:

Learner answer:

Assessor judgement: Satisfactory Not Satisfactory

Question:

Learner answer:

Assessor judgement: Satisfactory Not Satisfactory

Question:

Learner answer:

Assessor judgement: Satisfactory Not Satisfactory

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Feedback for the learner

I have read, understood, and am satisfied with the feedback provided by the assessor.

Learner’s name

Learner’s signature

Assessor’s name

Assessor’s signature

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