1. Positive Care in Learning Disabilities Positive Behaviour Support: How a Positive & Proactive Support Plan can help to Promote Inclusion, Improve Quality of Life & Reduce Restrictions March 2016 Dr Zillah Webb Consultant Clinical Psychologist

2. Aims Quick reminder of what Positive Behaviour Support means Introduction to the SABP Positive & Proactive Support Plan (PPSP) Look at how it can facilitate positive care  Getting it right  Active watching and listening  Restrictions  Plan evaluation and review

3. Overall Definition - Gore 2013 multicomponent framework Positive Behavioural Support (PBS) is a multicomponent framework for developing an understanding of behaviour that challenges (a) developing an understanding of behaviour that challenges displayed by an individual, based on an assessment of the social and physical environment and broader context within which it occurs, of stakeholder perspectives and involvement (b) with the inclusion of stakeholder perspectives and involvement and personalised and enduring system of support (c) using this understanding to develop, implement and evaluate the effectiveness of a personalised and enduring system of support enhances quality of life (d), that enhances quality of life outcomes for the focal person and other stakeholders.

4. Prevention & Reduction of CB’s occurs within a context Increasing quality of life, inclusion, participation, socially valued roles Constructional approach – building skills / repertoire of adaptive behaviour / creating positive opportunities Explicitly avoids aversive (punishment) / restrictive practices

5. Multi-component intervention Primary prevention Secondary prevention Tertiary prevention - Crisis management

6. The PPSP

7. Developing the PPSP Adapted from a plan shared on the Positive & Safe community page Piloted original by joint working with Maria Hurman – created first local draft Shared with Challenging Behaviour Practice Group Piloted more widely in inpatient & community work Edited to make compatible with elearning PBS training Discussed consent issues at Ethics committee Developed final version

8. Getting it right

9. Pulls together all the information about keeping the individual well and happy help them cope better Looks at what can be done to help them cope better including skills teaching & helping them understand situations Looks at how to reinforce positive behaviours quality of life opportunities effective way of teaching Explores what will need to happen to improve individual’s quality of life opportunities, their wishes, skills they could learn and the most effective way of teaching these

10. Active listening (and watching

11. Active listening (and watching) Actively look for signs that the individual is becoming unsettled Considers signs of both emotional and physical distress (DIS-DAT is very helpful here) Makes explicit the need to be proactive in spotting the early warning signs Identifies how to do this in a person-centred way

12. Examples from April Cottage PPSP’s Watch for signs that I am becoming over-aroused. I may be laughing because I am happy but this is also a sign that I am becoming unsettled (anxious laughing) Listen for changes in the volume of my voice / sounds of me banging things If I am settled e.g. watching a football match, make sure someone interacts with me every 5-10 minutes to check that I am still happy. Always acknowledge and interact with me when you check on me say ‘Hi (name), you OK?’ I don’t like people looking at me.

13. Restrictions

14. Restrictions become invisible when they are normal practice Explicitly challenges staff to identify restrictions  Restrictive physical interventions  Environmental restrictions  Pharmacological restrictions (regular & PRN)  What the individual is being excluded from Are these the least restrictive options? What is being done to reduce them?

15. Plan evaluation & review

16. Looks at  Implementation  Impact on individual’s life  Effectiveness of plan  Safety / safeguarding / risk Option to create person specific monitoring standards

17. Example of simple evaluation of PPSP

18. Conclusions & cautions Using the PPSP promotes a wider PBS approach rather than a narrow focus on ‘managing’ challenging behaviour It is not sufficient on its own to eliminate poor practice Without work to promote PBS framework & curiosity poor practice will simply be recorded on a different piece of paper

19. Reference: Gore, N., McGill, P., Toogood, S., Allen, D., Huges, J., Baker, P., Hastings, R., Noone, S. & Denne, L. (2013). Definitions and scope for positive behavioural support. International Journal of Positive Behavioural Support, 3,2,14-23.