Embedding Positive Behavioural Support in a Social Care Organisation Frank Slokan Behaviour Support Advisor

Embedding PBS in Social Care

Background Largest social care provider in Scotland Support over 2000 adults Support needs include learning disability, mental health, autism, dementia, criminal justice In-house PBS team since 2004 Specific PBS and Restrictive Interventions Policies Developed accredited managers’ PBS training 2010

Positive Behavioural Support Team First team of its kind in Scotland Internal specialist resource Take referrals from our services Deliver organisational training Monitor restrictive interventions Provide some external PBS, e.g. Schools

Working in Services Carry out functional assessments Implement behavioural strategies Work with managers and staff Direct support to service users Monitor effectiveness of our intervention Provide evidence-based data

Embedding PBS in Social Care Dedicated PBS policy Monitoring and Auditing Restrictive Interventions Annual Challenging Behaviour Audit PBS expertise in senior positions Commitment to PBS from Directorate Impact so far: High levels of Engagements Positive Staff Contact high Managers’ Knowledge of PBS high

Common Barriers to Implementation Maintenance of proactive strategies at a local level Over reliance on central team Managers receiving input are not able to transfer skills High staff turnover, sessional/agency hard to reach Resource implications Changing needs of individual within a static service

Training Managers in PBS Aim is to achieve skilled local staff teams Natural agents have better outcomes of PBS Better support to frontline staff, reduced turn-over Cost effective approach to training Lessens dependence on central team Proactive approach, rather than fire fighting Raises skill level of whole organisation

Overview of Training 1 year programme 2-day introduction, then 8 workshops, 6 weeks apart Delivered by internal PBS team Small-group workshops, high trainer ratio Based on IABA PBS model Accredited by Edinburgh Napier University 30 credits, Level 9 Practice-based course – homework between sessions

Workshops Session Content 2-day Training Introduction to Positive Behavioural Support Workshop 1 Functional Analysis: Defining & Recording Behaviour Workshop 2 Functional Analysis: Antecedent & Consequence Analysis Workshop 3 Behavioural Support Planning: Reactive Strategies Workshop 4 Behavioural Support Planning: Activity Workshop 5 Behavioural Support Planning: Interpersonal & PSR Workshop 6 Behavioural Support Planning: New Skills Workshop 7 Behavioural Support Planning: Focused Support Workshop 8 Assessment

Evaluating Outcomes

Evaluation Measures ABC Forms Aberrant Behaviour Checklist (Aman et al, 1985) Active Support Measure (Mansell & Elliott, 1996)

ABC forms

Aberrant Behaviour Checklist

Active Support Measure

Lessons Learned Despite positive outcomes, still some difficulties arose: Time commitment of managers (in social care) Frontline managers knowledgeable; not senior managers High staff turn-over (managers moved to new services) Financial pressures Need for close mentoring Skill level of frontline staff varies significantly

How do we roll out PBS across Scotland Recommendations How do we roll out PBS across Scotland

Recommendations Need for a tiered training approach Support Workers Senior Support Workers Managers Development of a skilled workforce Coaching and mentoring at local level Continuous Professional Development

Recommendations National PBS forum Multidisciplinary approach involvement from all sectors Development of agreed definition of PBS Development of agreed monitoring standards Need for regional expertise Internal / External resource Who funds implementation?