Positive Behaviour Support

What is Positive Behaviour Support (PBS)?

Under every behaviour that challenges is an unheard-expressed need, desire, or concern.

Through its person-centred framework, Positive Behaviour Support seeks to understand people as individuals and aims to understand their needs, desires and concerns through their behaviour.

PBS recognises that people displaying behaviours that challenge are vulnerable to:

Everyone deserves to be seen, understood and cared for. The goal of PBS is not limited to the removal or reduction of behaviours that challenge. It seeks to provide the right support and understanding to individuals needing care, families, and friends to enable everyone to live the fulfilled and meaningful life they deserve. PBS comprehends the power of learning new skills and aims to help people needing support develop skills to improve their quality of life.

PBS empowers all involved to adopt more efficient and positive ways to fulfil individual needs. There is a recognition that PBS is most effective when its systems and values are embedded throughout a whole service or organisation that utilises teamwork and collaboration.

What are the Behaviours of Concern?

Behaviours that challenge refer to intense and frequent behaviour that harms the individual or anyone else mentally or physically.

Below is a list of common behaviours that challenge:

Verbal behaviour - shouting, screaming, arguing, name-calling, offensive language
Nonverbal behaviour - clenching fists, invading someone's personal space, pointing fingers, stamping, running away
Withdrawn behaviour - Isolating oneself from their community and support system, deliberate silence
Hurting others - hitting, head-butting, pinching, biting, scratching, kicking, grabbing
Self-injurious behaviour - undereating and overeating, pinching, biting, scratching, hair pulling, eye poking
Destructive behaviour - throwing objects, breaking items

Through a PBS framework, behaviours that challenge can be reduced or eliminated, over time, through a PBS guideline of compassion and care.

What Does a PBS Approach Involve?

The overall aim of the Positive Behaviour Support approach is to provide person-centred support and a framework to improve the quality of a person’s life. It is collaborative and inclusive of all people we support and those supporting them. A PBS approach recognises that the behaviour, not the person, is the problem and avoids blame, punishment, and stigmatising attitudes.

Those supporting the person will understand the person’s unique interests, skills and abilities. Under a PBS approach, the support team will respond compassionately and calmly when the person displays behaviours that challenge. They will understand how to support the person to communicate, have fun and engage in activities. This way, the individual can learn how to meet their needs without using behaviours that challenge.

A PBS approach adapts the environment to meet a person’s needs, support them, and improve their quality of life. It is personalised and expresses the person’s interests, allowing them to live a fulfilled life. For example,

If playing outside is a critical factor in a person’s life, a simple but effective environmental adaptation is to provide them with a trampoline or swing
Or, if the people we support have any sensory needs, we can accommodate low lighting, calm spaces or robust furniture

There will be a clear structure and routine based on the person’s interests, including time to relax, pursue their interests, and learn new skills. This is communicated clearly to the person, and they can be seen to have choice and control.

PBS Behaviour Model Stages

Positive Behaviour Support model stages provide guidelines and frameworks for implementing a person-centred approach to support. PBS model stages aim to increase the overall quality of life, independence, and support of the person. It also maximises the highest success rate possible by providing step-by-step advice. The PBS model stages have three aspects: assess, manage and prevent.

PBS Behaviour Model Stages

Assess Stage

The aims of the assess model stage are designed to identify the person’s needs and abilities. During this stage, the support providers will analyse the cause of the behaviour and the purpose of the behaviour. The support providers will also identify the individual’s and family’s strengths and passions.

Manage Stage

The manage model provides guidelines for successfully responding to behaviour that occurs before or after behaviours that challenge. The model stage aims to defuse the situation, redirect the individual, and provide a framework to de-escalate behaviours before they become challenging.

Prevention Stage

The aims of the last model stage, prevention, seeks to stop or minimise behaviours that challenge by preventing potential triggers. It should be an effective strategy customised to the person’s needs, providing them with skills and alternative, healthy behaviours to improve their overall life.

PBS provides a human-centred framework, ensuring those with a learning disability, autism and mental health conditions are supported with empathy and care.

Leaf Complex Care provides PBS services uniquely tailored for children, young people and adults.

What is a Positive Behaviour Support Plan or PBS Plan?

A Positive Behaviour Support plan, or PBS plan, is developed with the person requiring support, their family, support staff and professionals. This process is led by a Positive Behaviour Support practitioner based on understanding why these behaviours are displayed.

The plan will describe the agreed strategies developed with the circle of support and the person. PBS plans should be easy to understand and provide support guidelines. A PBS plan identifies behaviours of concern. It also identifies the impact on the quality of life for the person and those around them. It will clearly explain why the challenging behaviour happens and what needs it meets for the person.

It is important to remember that all behaviours that challenge have a purpose. When the root cause is understood, the individual can receive support and meet their needs through healthy, compassionate methods.

The PBS plan will have multiple elements and be split into proactive and reactive strategies. Success is gained through implementation, and the plan regularly being updated and reviewed to meet individual needs continuously. Progress is measured through accurate data on behaviour patterns, identified goals and quality of life.

Understanding Challenging Behaviour

Challenging behaviours are ways a person has learnt to get their needs met. People with learning disabilities, autism or mental health conditions are more vulnerable to behaviours that challenge. These behaviours can significantly impact the quality of a person’s life.

Both children, young people and adults can exhibit behaviours that challenge, and they all deserve access to the right support to improve their quality of life. The type of behaviour exhibited will differ between children, young people and adults. PBS provides a customised framework so everyone can get the equal and diverse support they deserve.

We are careful when identifying behaviours as challenging to ensure people are not stigmatised for ways of expressing themselves or normal responses to stress and pain.

We recognise that we all have behaviours that challenge and rely on the support, tolerance and compassion of those around us. Some behaviours are more challenging as they significantly impact the quality of life or have a clear risk of harm to the individual or their support system.

The people we support are no different and deserve the same support, tolerance and compassion. PBS provides those in need with a fulfilled life and education to family and friends, teaching them PBS principles to better connect with their loved ones.

Reasons for Challenging Behaviour

PBS implicitly recognises that behaviours that challenge are not a problem within the individual. It is a response learned through interaction with their environment and how the behaviour makes them feel.

It is essential to mention that everyone experiences difficult behaviours. It is not exclusive to those with a learning disability, mental health conditions and autism. The difference is neurotypical individuals are usually equipped with the tools to communicate, express and alter these behaviours.

Antecedents

Every behaviour has an underlying reason linked to something that occurred before the behaviour (antecedents).

Consequences

After behaviours that challenge, there are always consequences. It is not always apparent that these consequences can negatively impact someone or that they are not effectively supporting them.

Common examples of consequences are:

Positive Behaviour Support analyses the unique behaviours of individuals to gain insight into why they exhibit challenging behaviours and the causes of the behaviours and offers PBS-friendly alternatives through an easy-to-understand framework.

We can see broader solutions by removing the blame from the individual and recognising their needs. Under a PBS approach, we do not reduce behaviours that challenge because it is difficult. We reduce behaviours that challenge because we want to enhance the person’s quality of life and enable them to live fully.

Positive Behaviour Support Planning

Positive Behaviour Support is split into pro-active and reactive strategies to understand the root cause of a behaviour and improve a person’s quality of life.

Proactive strategies improve the quality of a person’s life in the long term, requiring time, compassion and patience from support teams. Proactive strategies address the person’s need to display the behaviour and impact on quality of life. Strategies here may include:

Reactive strategies end the episode of challenging behaviour as quickly and safely as possible.

Offering preferred activities or items, distracting or just ending a difficult activity are reactive strategies. Where possible restrictive practices are avoided, and their use minimised. Reactive and pro-active PBS strategies need to be combined to improve the quality of a person’s life and provide the right support for an individual.

What are the Values of PBS?

Positive Behaviour Support is a person-centred approach based on inclusion, participation and choice, designed to improve the quality of a person’s life.

The four core aims of PBS are:

Leaf Complex Care Applies PBS within Tailored Person Centred Care

At Leaf Complex Care, we aim to support and serve those needing quality care. Our mission is to provide expert, compassionate service dedicated to serving those in need. We understand the value of Positive Behaviour Support and witness the difference that PBS has on people’s lives daily.

Our clinicians are trained in PRO-ACT SCIPr, a ‘whole approach’ to supporting individuals with or at risk of displaying behaviours that challenge. This individualised approach emphasises proactive approaches to minimise the need for reactive strategies.

Our positive behaviour support team can provide a range of services to people we support, their families and support staff. These include:

Functional assessment of challenging behaviours
Development of evidence-based support strategies
Personalised training for teams supporting individuals
Development of positive behaviour support plans
Multi-disciplinary working in complex situations
Debriefing and emotional support for our clinicians
Ongoing monitoring and reduction in the use of restrictive and institutional practice

Whether you want to learn more about Positive Behaviour Support or discover how we can help you, please get in touch with our team at Leaf Complex Care, who are ready to guide you, or your loved one, to your next healing journey.