Positive Behaviour Support: What is it? Thursday 17 th November Craig McIver A/Regional Manager (Clinical Psychologist) Positive Behaviour Service South Statewide Specialist Services, Disability Services Commission, WA

Context People who engage in challenging behaviour are far more likely to experience some form of restriction in their lives It can range from limited opportunities for community engagement to regularly experiencing restraint (physical, chemical etc)

Overview Setting the scene: APS guidelines on evidence- based practice that eliminate/reduce the need for restraint Positive Behaviour Support as the tool for understanding challenging behaviour and supporting positive behaviour and a better life for all

Australian Psychological Society Evidence-based psychological interventions that reduce the need for restrictive practices in the disability sector: A practice guide for psychologists 2010

Overview High rates of restraint in Australia (23-28%) compared to other countries like UK (17%) (Emerson, 2002)

Barriers to effective interventions that replace restrictive practice Poor work culture Lack of adequate staffing/education for staff Client stigmatisation/reputation

Prevention versus restriction Preventing challenging behaviour is better than developing management strategies Training of significant others in the environments around people to enable them to support appropriately, and therefore reduce the need to challenging behaviour should be our overriding goal

Practice Guidelines The fundamental human rights of the person must be assured in accordance with relevant legislation Restrictive practices should be used only as a last resort, and the least restrictive option should be adopted Documentation of a restrictive practice after every event – enables monitoring, reporting and review

Positive Behaviour Support (PBS) PBS is an evidence-based approach with the primary goal of increasing the quality of life of the person (and support people/family) Secondary goal to decrease frequency and severity of challenging behaviour

PBS – A collaborative Approach Individualised goals are determined through collaboration between stakeholders (e.g. family, friends, staff members) Increases the likelihood of support & implementation due to: – increased ownership of interventions –Shared understanding of why the behaviour occurs and what can be done to help prevent/reduce it (thorough assessment) Goals are met by: –Changing environment to support appropriate behaviour –Supporting the person to acquire new skills/coping strategies

Lavigna & Willis (1995) Multi-elemental Model of Behaviour Support

Aims of PBS may include… Identifying and teaching new skills Avoiding negative consequences or punishment for behaviour Changing environments to better suit people’s needs Promoting positive activities to increase quality of life Identify triggers for challenging behaviour and develop strategies to avoid these triggers

Assessment Considerations A functional assessment is an essential component of designing an effective intervention to reduce/prevent challenging behaviour Functional Assessment includes: –Definition of challenging behaviour –Observation and information obtained from multiple sources to identify: when and where the behaviour occurs/doesn’t occur and other environmental considerations; bio-medical conditions and potential influence –Hypothesis generation re triggers/preceding events; possible events that may inadvertently encourage the behaviour (e.g. reinforcement presence or absence; communication support)

Assessment continued Sound functional assessment considers: –Behavioural events in detail and context –Functional communication needs/deficits –Systemic/environmental considerations: capacity of a system to support/meet the communication and other needs of the person – includes workplace/organisational culture, training, environmental fit for the person –Sensory needs and functional engagement – how engaged the person is in their environment

Person Centred-Planning Approach Person-centred planning Approach is recommended - involves: –Listening to people and assisting them to determine activities and goals important to them (e.g. using talking mats) –Identifying strategies and people that will help the person engage in activities and meet goals –Providing information & training to staff/others to ensure they can support person to meet their goals –Ongoing reviews with person/significant others to ensure that plan is meeting person’s needs –Update plan as required

Optimal Environmental Fit Environments should be assessed and modified to meet client needs and sensory preferences People should have access to personal space and privacy People with communication difficulties should have an appropriate assessment by a qualified professional and have access to communication aids to support receptive and expressive communication with others Communication partners need to be supported to support communication needs appropriately People need to be functionally engaged in the environments they live and move in (e.g. active support)

Systemic Considerations Client needs and abilities and staff experience be used to determine optimal staff-client ratios Staff at all levels in an organisation should receive training in prevention and appropriate management/responding to challenging behaviour (e.g. mindfulness example) Education be provided regarding safety for staff and individuals Potential burn-out of clinicians (staff) be considered and adequate time and strategies for sound self-care be in place

Behaviour Support Plans A Behaviour Support Plan should guide intervention for challenging behaviour Behaviour Support Plans should be written so easily understood by all people supporting the person An interdisciplinary team approach should be used to develop and implement an intervention plan

Evaluation/Review Intervention outcomes should be regularly evaluated/reviewed Behaviour Support Plans should be modified according to review recommendations to ensure ongoing effective prevention and management of challenging behaviour

References Australian Psychological Society Evidence-based psychological interventions that reduce the need for restrictive practices in the disability sector: A practice guide for psychologists Challenging Behaviour: A Model for Breaking the Barriers to Social and Community Integration. LaVigna.G, and Willis, T. Positive Practices, Volume I Number 1, October 1995.

Questions ?