positive behavioural support: singing from the same hymn sheet dr peter baker
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Positive Behavioural Support:Singing from the same hymn sheet
Dr Peter Baker
Transforming care: A national response toWinterbourne View Hospital Department of Health Review: Final
Report
Positive Response Training & Consultancy 2013©
‘The CQC inspections revealed widespread uncertainty on the use of restraint, with some providers over-reliant on physical restraint rather than positive behaviour support and managing the environment to remove or contain the triggers which could cause someone to behave in a way which could be seen as challenging. In Winterbourne View, bullying, punishment and humiliation were disguised as restraint.’ (para 7.28)
‘With external partners, the Department of Health will publish by the end of 2013 guidance on best practice on positive behaviour support so that physical restraint is only ever used as a last resort where the safety of individuals would otherwise be at risk and never to punish or humiliate.’ (p.44)
‘Providers should have... a whole organisation approach to Positive Behaviour Support training....recruit for values and ensure that staff have training for skills - mandatory training which can include training on value bases when working with people with learning disabilities, positive behaviour support....etc.’ (p.54)
UK Support for PBS
Ensuring quality services Core principles for the commissioning of services for children, young people, adults and older people with learning disabilities and/or autism who display or are at risk of displaying behaviour that challenges
Positive & Proactive Care: reducing the need for restrictive interventions
A positive and proactive workforce. A guide to workforce development for commissioners and employers seeking to minimise the use of restrictive practices in social care and health.
Opportunities
• Clarification
• Development of PBS
• Clarification
• Involvement
• Unity
Vulnerabilities Maintaining processes
Impact
Challenging behaviour
Exclusion, harm to self, harm to others
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
A framework for understanding why challenging behaviours occur
Vulnerabilities Maintaining processes
Impact
Biological
•Sensory/physical health problem
•Genetic vulnerability
Psycho-Social
Negative life events
Communication deficits
Adaptive skills
Impoverished social networks
Lack of meaningful activity
Mental health problems
Challenging behaviour
Exclusion, harm to self, harm to others
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
A framework for understanding why challenging behaviours occur
Maintaining processes
Impact
Pain reduction
Challenging behaviour
Other people’s behaviour
Exclusion, harm to self, harm to others
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
A framework for understanding why challenging behaviours occur
Beliefs and attitudes
Other people’s behaviour
Emotions
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Influences on other people’s behaviour
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Beliefs and attitudes
Other people’s behaviour
Emotions
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Influences on other people’s behaviour
UK DefinitionPositive behavioural support is a multi-component framework for
(a) developing an understanding of the challenging behaviour displayed by an individual, based on an assessment of the social and physical environment and broader context within which it occurs;
(b) with the inclusion of stakeholder perspectives and involvement;
(c) using this understanding to develop, implement and evaluate the effectiveness of a personalised and enduring system of support; and
(d) that enhances quality of life outcomes for the focal person and other stakeholders.
Gore, McGill, Toogood, Allen, Baker, Hastings, Noone & Denne (2013)
Scope for PBS
PBS may be implemented in at least three main ways:• On a case-by-case basis by a single practitioner
coordinating all elements of the framework and leading each stage of the process, (e.g. Emerson et al, 1987; Toogood et al, 1994; Blunden and Allen, 1987).
• By professional teams where different professionals contribute to different elements of the PBS framework or process (e.g. Allen et al, 2005; Hassiotis et al, 2009).
• Through system-wide approaches whereby the PBS framework is implemented at varying levels of intensity via a tiered-model of prevention that covers an entire organisation or geographical area (Allen et al, 2005; Sugai and Horner, 2009; Allen et al, 2012).
Gore, McGill, Toogood, Allen, Baker, Hastings, Noone & Denne (2013)
PBS emerged from several key concepts:
Positive Response Training & Consultancy 2013©
Defining Positive Behavioural Support
(Gore, McGill, Toogood, Allen, Hughes, Baker, Hastings, Noone & Denne l,2013)
PBS VALUES•Prevention and reduction of challenging behaviour occurs within the context of increased quality of life, inclusion, participation, and the defence and support of valued social roles
•Constructional approaches to intervention design build stakeholder skills and opportunities and reject use of aversive and restrictive practices
•Stakeholder participation informs, implements and validates assessment and intervention practicesPositive Response Training & Consultancy
2013©
Theory & Evidence Base
• An understanding that challenging behaviour develops to serve important functions for people
• The primary use of applied behaviour analysis to assess and support behaviour change
• The secondary use of other evidence-based approaches to support behaviour change
PBS PROCESS
•A data-driven approach to decision making at every stage
•Functional assessment to inform function-based intervention
•Multicomponent interventions to change behaviour (proactively) and manage behaviour (reactively)
•Implementation support, monitoring and evaluation of interventions over the long term
Positive Response Training & Consultancy 2013©