In recent years, Positive Behaviour Support has become a hot topic and chances are you have heard about it if you are connected with someone who presents challenging behaviours. Through talking with parents, Support Workers, friends and professionals working with people with mental health issues, learning disabilities, autism and other conditions that lead to behaviours that challenge, we have noticed that although most know about Positive Behaviour Support, it has rarely been properly explained to them in depth.
So, with that in mind, this post is dedicated to Positive Behaviour Support, what it is, what is does, and what Positive Behaviour Support at Happy Futures can do for those with challenging behaviours.
In simple terms, Positive Behaviour Support is, as the name suggests, support surrounding the behavioural aspects of a person. Previously referred to as ‘inappropriate’, ‘abnormal’, ‘disordered’, ‘dysfunctional’ or ‘problem’ behaviours, what we today refer to as challenging behaviour is any sort of behaviour “of such an intensity, frequency or duration as to threaten the quality of life and/or the physical safety of the individual or others,” according to the Royal College of Psychiatrists. These challenging behaviours are not limited to, but often include severe levels of aggression, self-injury or injury to others, destructiveness or other disruptive behaviours. Sadly, challenging behaviours among people with learning disabilities, autism or mental health problems often lead to a range of negative effects, including physical injury to themselves and others, exclusion from activities or society in general, abuse, neglect, restrictive practices, punitive approaches, caregiver stress and increased service costs.
For most of history and up until the late 20th century, support surrounding challenging behaviours was not concerned with any understanding of why the individual might be presenting the behaviour. There was no further thought, study of or analysis into why a person might be presenting a particular challenging behaviour, and treatments such as psychotropic (typically antipsychotic) medication, restraint, or punitive actions, such as the removal of items or activities, were often used but rarely designed to solve or even address a specific behaviour and its causes.
During the 1990’s and into the start of the 21st century, more thought started to go into the nature of challenging behaviour and, based on the moral questioning of the use of antipsychotic medication, restraint and physical punitive measures in modern support based on ethical practice, a sort of revolution started on what we understand about challenging behaviours and how Positive Behaviour Support could become a key intervention strategy that is both ethical and effective.
In recent years, as health and social care progresses, improves and moves away from institutionalised to more community-based models for care and support, Positive Behaviour Support has evolved into a values-led approach to achieving behavioural change. Instead of punishment, restriction and isolation, the goal of modern Positive Behaviour Support is to achieve enhanced community presence, choice, personal competence, respect and community participation. Also, instead of simply being concerned with behavioural change, Positive Behaviour Support is based on an understanding of why, when and how behaviours happen and what purposes they serve. It also focusses on altering triggers for behaviours, in order to reduce the likelihood that the behaviour will occur in the first place.
Most importantly, Positive Behaviour Support is now fundamentally focused on quality of life, and how, through proactive and reactive strategies, Positive Behaviour Support can improve an individual’s quality of life and therefore reduce challenging behaviours as a side effect.
At Happy Futures, we are passionate about Positive Behaviour Support. From an organisational side, we focus on what the behaviours are, why they happen and what these behaviours aim to achieve or communicate. We look at the science behind behaviours to determine the meaning or function of someone’s behaviour which allows for, and leads to better, person-centred support. From a support side, we support individuals to have happy and fulfilled lives, support them to take part in meaningful and fun activities and have positive experiences, and, as a natural consequence, have fewer challenging behaviours or behaviours of concern. Positive Behaviour Support cannot be effective without accomplishing the above, which makes out the key components for Positive Behaviour Support.
As we strive to improve the quality of life for those with more complex challenging behaviours, Happy Futures has a team specifically focussed on Positive Behaviour Support, which includes the Head of Positive Behaviour Support, two Positive Behaviour Support Managers, four Positive Behaviour Support Active Responders and many Positive Behaviour Support Workers. Through this team, Happy Futures focusses on Positive Behaviour Support on three different levels – on the individual, the workforce and leadership.
At the very base of all Positive Behaviour Support at Happy Futures there is a quality of life assessment. As this is Positive Behaviour Support on the first and most individual level, the individual who will be receiving Positive Behaviour Support is involved as much as possible in their own assessment, as this allows for the assessment of where the individual is at in terms of the 8 domains of quality of life and whether there are any issues or concerns in regards to this. Involvement of the individual also allows for the set of personal goals or steps that can help them to achieve a better quality of life in relation to those domains. On the individual’s level there is also a functional behavioural assessment which allows Happy Futures to investigate why the individual is presenting behaviours and understanding what the behaviour’s purpose is, allowing Happy Futures to create a bespoke, person-centred Positive Behaviour Support plan which is very detailed and focussed solely on the needs of the individual.
Positive Behaviour Support plans are based on focussed, proactive and reactive support strategies. Through the quality of life and behavioural assessment, a framework can be created to better understand the individual’s life and past experiences, their health, communication, point of view, and their goals and aspirations for the future. In turn, this formulates the strategies required for successful Positive Behaviour Support, as documented in the plan, to reach the most important quality of life values, including a presence and participation in the community, fulfilling valued roles and gaining social respect, maintaining satisfying personal relationships with friends and family, expressing personal preferences and making choices and gaining skills and competencies – something highly valued at Happy Futures.
Positive Behaviour Support plans usually describe in detail what an individual’s behaviour may look like and what the individual presents at base line, giving clear indications on how to recognise when an individual is moving away from that base line. Following this, based on solid, evidence-based research, the Positive Behaviour Support plan will include both proactive strategies for changing or avoiding certain behaviour, and reactive strategies for managing challenging behaviour and better supporting the individual during a behavioural incident, as even the most effective change strategies may not completely eliminate all challenging behaviours.
When creating Positive Behaviour Support plans, the Happy Futures Positive Behaviour Support team also welcomes the participation of friends and families involved in the individual’s life, as they may already know the meaning or function of challenging behaviours. Feedback from the individual and their Support Workers also forms a crucial part of Positive Behaviour Support and can help judge the effectiveness of support and intervention strategies, as prescribed in the Positive Behaviour Support plan.
On the second level, the workforce level, Positive Behaviour Support is concerned with the Positive Behaviour Support plan and its implementers. Where proper staff training in the principles of Positive Behaviour Support and the implementation of strategies have not taken place, traditional interventions such as medication and restraint are often ineffectively used as behavioural interventions by Support Workers, which is not in line with modern Positive Behaviour Support practices, and definitely not in line with that of Positive Behaviour Support at Happy Futures. Proper training in Positive Behaviour Support must be effective in teaching Support Workers new skills and developing their existing ones as the success of any Positive Behaviour Support plan rests on the abilities of those charged with putting them into practice.
No Positive Behaviour Support plan will produce the desired outcomes for an individual, including the optimum quality of life, greater skills and competencies, social inclusion and behavioural change unless it is implemented fully and consistently, and as Positive Behaviour Support Workers are on the front line working with those presenting challenging behaviours, their training is therefore vital to the successful implementation of any Positive Behaviour Support plan.
In line with upholding the best Positive Behaviour Support practices, all Happy Futures staff are offered the best opportunities in learning about Positive Behaviour Support and other relevant approaches, such as person-centred active support, through a structured internal Positive Behaviour Support pathway. Before undertaking any Positive Behaviour Support, all Support Workers receive active support training and complete internal or external qualifications in Positive Behaviour Support, providing them with the tools required to support individuals and successfully implement their Positive Behaviour Support plans. At Happy Futures we also not only focus on the tools provided to staff, but also in the method they are taught and delivered to Support Workers. Using multimedia concepts in Positive Behaviour Support plans, such as videos, roleplay activities etc. helps make Positive Behaviour Support plans, which could be over 50 pages long, more accessible and easier to digest for Support workers, leading to better retention and implementation.
On the third and final level of Positive Behaviour Support, the concern is with leadership. As mentioned above, there has long been too few people in the health and social care sector properly trained and qualified in Positive Behaviour Support. At Happy Futures, exceptional training and further education is a priority, and the Happy Futures Head of Positive Behaviour Support, Rhiannon Thompson, is currently working towards becoming registered with the Behaviour Analyst Certification Board, the highest achievement for a behavioural analyst, and therefore brings a wealth of knowledge and experience with her as the head of the Positive Behaviour Support team.
Apart from training Support Workers, doing assessments and creating comprehensive Positive Behaviour Support plans, she also has the responsibility of ensuring the goodness of fit between Support Workers, the plans they need to implement and the individual who the plan and Positive Behaviour Support was specifically developed for. It is important to note that Positive Behaviour Support must have a long-term focus, as challenging behaviours are often of a long-term nature, and therefore, Positive Behaviour Support plans, strategies and actions must be reviewed and accordingly adapted on a regular basis by the Happy Futures Head of Positive Behaviour Support and thereafter communicated to the rest of the Positive Behaviour Support team.
Breaking ground in finding new ways to better support those with challenging behaviours, the Happy Futures Positive Behaviour Support team has introduced Tablets which allow Support Workers to instantly complete and send incident forms directly to the Happy Futures Head of Positive Behaviour Support, allowing for a more timely and reactive way to access information regarding challenging behaviour incidents and the reasons for them. Through this, the Positive Behaviour Support team can better and more quickly analyse the behaviour, update the Positive Behaviour Support plan and give better support to the individuals and Support Workers.
As challenging behaviours often include severe levels of aggression, destructiveness, self-injury and other disruptive behaviours, the emotional toll on Support Workers can be high. In order to better support staff as well, staff incident debriefing procedures are in place at Happy Futures, ensuring the wellbeing and mental health of Support Workers are also promoted.
With everything we know, it would make sense if Positive Behaviour Support was the most common form of therapeutic support for people with learning disabilities, mental health issues and/or autism, but sadly this is not the case. Recent studies have indicated that only a small fraction of those in need of Positive Behaviour Support actually receive any sort of behavioural support, which in modern times, is completely unacceptable by any standard.
At Happy Futures, however, it is our sole focus to give each individual the best support based on their needs, including exceptional Positive Behaviour Support from expertly trained Support Workers, under the leadership of our internal Head of Positive Behaviour Support, Rhiannon Thompson. If you know someone who would benefit from Positive Behaviour Support to improve their quality of life, make them more independent and confident and give them a happy future, get in touch with us today!
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