CHC08 Disability Behaviour Support Skill Set
Learner Resource Suite
Learner Workbook 3
Community Services and Health Industry Skills Council Ltd
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Published by Community Services and Health Industry Skills Council Ltd
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PO Box 49
Strawberry Hills, NSW 2012
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Page 1 of 75
Workbook 3: Plan and Provide Advanced Behaviour
Support
Person Centred Practice .................................................................................................... 2
Supporting Person Centred Practice ................................................................................. 2
Behaviour ............................................................................................................................ 4
Identifying the Communicative Function of the Behaviour ................................................. 4
Behaviour of Concern ........................................................................................................ 5
What causes influences behaviour of concern? ................................................................. 6
Socially Inappropriate Behaviour ..................................................................................... 11
Positive Behaviour Support ............................................................................................. 12
Developing Strategies for Behaviour Support ................................................................ 15
Proactive Strategies ........................................................................................................ 16
Immediate Response Strategies ...................................................................................... 21
Crisis Response Strategies ............................................................................................. 25
Restrictive Practices ........................................................................................................ 29
Prevention ....................................................................................................................... 39
Reducing or Changing Triggers ....................................................................................... 45
Personal Choice .............................................................................................................. 51
Assessing Behaviour of Concern .................................................................................... 54
Functional and/or Cognitive Assessment of Individuals ................................................... 56
Collecting and Analysing Data ......................................................................................... 60
Positive Behaviour Support Plans ................................................................................... 68
Collaboration with others ................................................................................................. 69
Review and Monitoring .................................................................................................... 71
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
Person Centred Practice
The first principle of the UN Convention on the Rights of Persons with Disabilities states:
“The respect for inherent dignity, individual autonomy including the
freedom to make one’s own choices, and independence of persons.
This means service providers will closely consult with and actively
involve persons with disabilities, including children with disabilities,
through their representative organisations.”
In Australia we refer to this as person centred practice, which means treating clients as they
want to be treated. This includes considering concepts such as dignity and respect. A person
centred approach finds strategies that are based on who the person is and enables a more
positive approach to risk that does not use risk as an excuse to trap people in boring and
unproductive lives. This is achieved through involving the client, their family and other
significant people in the development of their goals and planning their direction in the future.
In the disability industry, person centred practice ensures services for people with a disability
remain focused and responsive to the needs and choices of individuals. It considers
individualised funding packages and the organisational capacity to design and deliver
services for individuals. It may also includes recruitment, staff training, business planning
and management.
Person centred practice utilises a number of techniques that are reflective of the client’s
personal communication ability and assists them to meet their needs, wishes and goals. The
practice was first explored by Carl Rogers, a psychologist who focused on client centred
therapy using empathy, genuineness and unconditional positive regard.
Some techniques which are used in the development of a person centred plan are:
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Person centred thinking skills. Consider how a person tells us what they want and
how they are feeling.
Total communication techniques. Communicating by any means possible, not just
in words, but adding pointing, gestures, signing, objects, pictures and body
movements.
Graphic facilitation of meetings. A power facilitation tool which uses both words
and pictures to record and facilitate meetings.
Problem-solving skills. To help the client navigate through the system to overcome
hurdles and problems.
PATH. Planning Alternative Tomorrows with Help is a creative, visual process which
helps everyone involved to think creatively to find solutions and positive outcomes.
Circles of support. At the centre of the circle is the client and the circle moves
outwards in a concentric pattern to include those they love, their best friends and
others who help them.
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
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MAPS. Making Action Plans for Me focuses on the actions which create what the
client wants.
Person futures planning. A dynamic and empowering approach to focus on the
other person’s goals, abilities, dreams and needs. Supported by a team composed of
parents, family, educators, friends and professionals, the client is the central figure
and the prime mover in charting the future.
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ACTIVITY 1.1: What techniques does your workplace use for providing a person centred
approach to assist clients with meeting their wishes, needs and goals?
ACTIVITY 1.2: How can you support person-centred practice in your workplace?
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
Behaviour
All behaviour is a form of communication. For example, the behaviour may emerge as a
response to their own life stories, a reaction to experiences of abuse, isolation, rejection,
frustration, or a lack of support at earlier stages of development. For some people the
behaviour can be attributed to their experience with social support or housing.
Identifying the Communicative Function of the Behaviour
To support and appreciate a client’s behaviour and the message it is communicating, you
must understand the message from the client’s point of view. You can then provide a more
adaptive means of communicating this message in the future.
For example, a person engages in behaviour that others find challenging to:
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Obtain something positive.
Avoid something negative.
Meet a physical or emotional need.
Express or communicate a need.
To gain control over their life.
Reduce arousal or anxiety.
The client may do this because:
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No one has shown them another way.
This way has been effective in achieving what they want.
They have tried a different way and no one has responded to meet their needs.
They are driven by biochemical or neurological factors currently beyond their
conscious control such as mental illness, drug use, unrecognised pain or discomfort,
or a medical issue.i
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ACTIVITY 2.1: Think about the clients you work with. Fill in the table below with the
behaviours you might you recognise in clients trying to convey the following messages?
Message
Behaviour
Client wants something positive, for
example, to see their family.
Client wants to avoid something negative, for
example, avoid feeling worthless.
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
Client wants to express or communicate a
need, for example, express that they are
angry or frustrated.
Client wants to reduce their feelings of
arousal or anxiety, for example, they don’t
want to feel nervous or shy.
Behaviour of Concern
Behaviour of concern is defined by Eric Emerson, Professor of Disability and Health
Research UK, 1995, as:
“Behaviour of such intensity, frequency and duration that the physical
safety of the person or others is placed or is likely to be placed in serious
jeopardy, or behaviour which is likely to seriously limit use of, or result in
the person being denied access to ordinary community facilities, services
and experiences.”
People using behaviours of concern are sometimes described as having high support needs
or complex needs. They may be perceived as people with unmet needs. People with
intellectual disabilities have a much higher prevalence of behaviours of concern (in the order
of 40%) compared to the general population because communication and cognitive
difficulties may compound the presentationii. Common types of behaviours of concern
include:
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Self-injurious behaviours (such as hitting, head butting, biting).
Aggressive behaviour (such as hitting others, screaming, spitting, kicking).
Inappropriate sexualised behaviour (such as public masturbation or groping).
Behaviour directed at property (such as throwing objects and stealing).
Stereotyped behaviours (such as repetitive rocking or echolalia).
These behaviours can be challenging for a service provider. Such behaviours are likely to
limit the person’s ability to participate in daily life and to enjoy potentially life-enriching
experiences. The behaviour of some people may be so disruptive and harmful that families
and services have extreme difficulty in meeting the person’s needs, or even understanding
what their needs are. Behaviours of concern can be viewed as occurring in a cycle of:
1.
2.
3.
4.
5.
6.
Trigger
Escalation
Build Up
Climax
Wind Down
Recovery
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
Analysis of this cycle provides a foundation for strategies to minimise the triggers, encourage
more appropriate behaviours in response and encourage a more appropriate response.
The behaviours set a challenge to services to improve the way they operate. The term was
first used to encourage service providers and the community to develop better services,
supports and attitudes to address the behavioural difficulties demonstrated by some people
with a disabilityiii.
What causes influences behaviour of concern?
Behaviours of concern are often exhibited as a consequence of a person’s experience of:
1. Impairment. The loss of their body structure or of a physiological or psychological
function.
2. Limitations on their daily activities. The range of frequency, variety, duration
and/or degree of independence or self-determination.
3. Limitations to their participation in society. Including their opportunities for social
interaction and relationships i.e. the form, frequency, duration and perceived quality
of their interaction with significant others.
These three factors need to be considered when developing strategies which address a
client’s behaviours of concern.
It is extremely rare that the behaviour of any person can be explained by a single factor or
cause. All behaviours have underlying causes which may be biological, psychological,
sociological or environmental. This is referred to as the biopsychosocial model. All these
factors combine to effect the person’s development, including their cognitive, emotional and
social functioning.
Frequently behaviour will occur for a number of interrelated reasons and so in order to
understand the behaviour we need to understand the reasons or contributing factors
underlying that behaviour.
•
What their needs, wishes and personal preferences are.
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
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Where they are at the time.
Who they are with or not withat the time.
What others are doing to and for them.
What pressures and demands they are experiencing.
How well they understand what is happening or expected of them.
How responsive people are to them.
What skills they have to meet their needs independently of others.
What alternative behaviours they have to express their needs.
Their family, cultural or religious background and subsequent beliefs and values.
Their individual biochemistry and genetic makeup.
© Community Services and Health Industries Skills Council Ltd www.cshisc.com.au
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
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ACTIVITY 2.2: Think of a client you work with. Fill in the below table taking into consideration
the context and how it can influence the behaviour.
Behaviour
Message
Purpose
Context and
Frequency
(Environmental,
Emotional, Health or
Medication factors)
As with people in the general population; fatigue, confusion, disappointment, excessive
demands and interpersonal conflict can all give rise to behaviours of concern. These
stresses that confront most people occaisionally are continually present in the everyday
experience of people with an intellectual disability. Your clients with an intellectual disability
may nothave the coping skills or resources to deal effectively with these events or situations.
Subsequently even events which may seem like minor everyday inconveniences to you can
cause your client to quickly become emotionally distressed and reactiveiv.
Following is a diagram of the social model of disability which shows all of the factors which
can precede behaviours of concern in a client with a developmental disability:
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
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ACTIVITY 2.3: Explain the concept of the social model of disability, and relate it to the clients
you work with.
a) What is the impact of social devaluation on the clients you work with?
b) How can you address this devaluation?
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CHC08 Disability Behaviour Support Skill Set
Learner Guide Book 3: Plan and Provide Advanced Behaviour Support
Social Model of Disability
Developmental
Delayed brain development
Arrested cognitive, emotional and/or social development
Biological
Psychological
Genetics
Cognitive strengths and weaknesses
Cerebral dysfunction
Social and communication impairments
Susceptibility to mental illness
Reinforcement of maladaptive behaviours
Severe and complex epilepsy
Impact of adverse life events
Sensory and physical impairments
Perceived lack of emotional support
Low self-esteem
Social
Psychological, sexual, and physical abuse
Negative life experiences
Lack of meaningful opportunities
High Risk
Atmosphere of blame
High level of stress
Individual’s needs not recognised
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Socially Inappropriate Behaviour
While not all actions are behaviours of concern, all behaviour is communicating a message.
However, when your clients use socially inappropriate behaviour it is not always easy to
understand the message that behaviour is communicating.
The behaviour may be a way of telling us they are annoyed, want to leave or want to avoid
non-preferred events. The environment may be disagreeable for the client, aggravating
them in some way and they want to escape. They may begin inappropriate social behaviour
like fondling their private parts, singing loudly when others are being quiet, or using
inappropriate language, gestures or sounds.
One third to half of studies show that it is possible to teach your client how to say ‘stop’ or
‘no’ in an appropriate way, for others to understand. They can learn to use gestures, manual
signs, a PECS card or an electronic board which has a message that says ‘stop’. All these
methods teach your client how to communicate their objection without using socially
inappropriate behaviours.
Understanding the cause of a behaviour is vital to help the client change behaviours, as the
answer can be as simple as changing their environment.
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ACTIVITY 2.4: Think of other behaviours of concern you’ve seen your clients use. What
message can be interpreted from the behaviour?
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Positive Behaviour Support
The origin of positive behaviour support is the philosophy of inclusion, applied behavioural
analysis and person centred practices. The goal is to enhance the quality of life of a person
with a disability. Positive behaviour support is based on the assumption that people with a
disability require different levels of support as they learn to self-regulate their feelings and
behaviour as they understand themselves through the support of others. The Positive
Behaviour Support Plan must give priority to adapting the environment to better meet the
needs of the person and support them to develop skills and behaviours they need to live
independent and interdependent lives.
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ACTIVITY 2.5: What policies and procedures does your organisation have in place relating
to behaviour management?
ACTIVITY 2.6: Describe some examples of strategies you have seen in your workplace?
Positive behaviour support is not a simple answer to the complex reasons why people
engage in behaviours of concern. The approach includes the systematic gathering of
relevant information, conducting a functional behaviour assessment, designing support
plans, implementation and ongoing evaluation. Immediate response strategies for the
management of serious episodes of the behaviour are also addressed. There is a strong
emphasis on proactive strategies as there is a belief that the best behaviour support occurs
when the behaviour is not happening.
Positive behaviour support is based on the aim of decreasing behaviours of concern and
improving the person’s quality of life. It tells us the best way to work with an individual who
engages in behaviours of concern, providing ways to improve the quality of life for the
person and addressing more than just their behaviour.
This approach places an emphasis on the need for responsiveness to a person’s feelings
and needs and has the following defining features:
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Valuing the person, deliberately building a sense of self-worth, and acknowledging all
attempts.
A positive interaction.
Creating situations where the person is placed at their best advantage.
Acknowledging and trying to interpret what the person is communicating via their
behaviour.
Analysing the functions of the behaviour.
Teaching the person other ways to meet their needs or communicate their feelings.
Gently supporting and leading the person to a calmer state.
Providing encouragement and feedback about personal successes along with
aspects of difficult situations the person may have handled well.
The overall aim of the positive behaviour support is to reduce and, wherever possible,
eliminate the use of restrictive practices and improve the quality of life for the adult. The
importance of a Positive Behaviour Support Plan is that it provides a planned and multielemental approach to supporting the individual.
To respond to people’s individual circumstances, the focus is on the following features of
positive behaviour support:
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Analysing the functions of behaviour.
Acknowledging and trying to interpret what the person is communicating via the
behaviour.
Gently supporting and leading the person to a calmer state.
Teaching the person other ways to meet their need or communicate their feelings.
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ACTVITY 2.7: What does positive support mean for clients?
Principles and Practices
There are a set of principles which are commonly used in the disability sector when working
with a client who engages in behaviours of concern. These are known as The Five
Accomplishmentsv and state that the client should:
1.
2.
3.
4.
5.
Be present in their community, not isolated or segregated
Actively participate in mainstream services, not be restricted to specialist settings.
Experience choice and autonomy in their daily life.
Develop competence and have opportunities to demonstrate that competence.
Have their rights and dignity respected as citizens of the wider community.
These principles need to be considered at each stage of planning and implementing support
strategies.
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ACTIVITY 2.8: What principles does your workplace use to develop their policies and
procedures for behaviours of concern?
Positive Practices
All behaviour support strategies and work practices must emphasise positive practices
above all others. Positive practices aim to maintain the dignity of the client and achieve
behavioural change. This is a distinct evidence-based clinical approach with established
procedures and replicated positive outcomes.
Consistent with this approach, legislative requirements, and organisational policies and
guidelines, the broad principles upon which positive behaviour support services are
delivered must be:
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Holistic.
Person centred.
Skill-based.
Solution/outcome focused.
Non-aversive.
Socially, culturally and age-appropriate.
Reflective of current methods of best practice.
Consented to or approved by the person with legal authority to do so as appropriate.
Subject to regular monitoring and review.
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ACTIVITY 2.9: Who are the behaviour support workers or clinicians you use to assist in
developing strategies for your clients?
ACTIVITY 2.10: Give an example of how you implemented positive behaviour support.
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Developing Strategies for Behaviour Support
All behaviour support activities and interventions will be respectful of the individual needs
and goals of the client, as identified through an Individual Plan, and based on a current and
comprehensive assessment.
Behaviour support strategies fall into the following categories:
1. Proactive strategies. Proactive practices are aimed at preserving the dignity of the
client to achieve positive and lasting behaviour change. Proactive practices are
founded on the principles of a positive approach to behaviour support and are part of
a client’s Individual Plan and include individual response.
2. Immediate response strategies. Strategies aimed at deescalating or managing a
behaviour of concern such as redirection, talking about the issue, responding to early
signs of the behaviour and anger management.
3. Crisis response strategies. A response in situations where the client begins to
engage in a behaviour of concern and risk intervention is necessary.
4. Last resort. An emergency response following failure of the crisis response
strategies, including self-protection strategies. May also include restrictive practices
which can only be implemented with informed consent as they control a person’s
freedom or intrude on their rights or dignity. For consistency across Australia and the
range of different disability services organisations, this an Individual Restrictive
Practice Plan (IRPP). They must be legally consented to and have authorisation.
All these strategies need to be evidence based; the process of merging experience, personal
beliefs, literature, reviews, and clinical trials with findings of current research. Therefore
continuous reading and learning is important in your work role.
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ACTIVITY 3.1: Think about the clients you work with and fill in a possible message and
strategy for each of the below items:
Reason for Behaviour
Possible Message
Positive Behaviour
Support Strategies
Obtain something positive
Avoid something negative
Meet physical or emotional
need
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Express or communicate a
need
To gain control over their life
Reduce arousal and anxiety
Proactive Strategies
An analysis of the client’s STAR chart and/or ABC chart will have identified possible factors
that are contributing to the behaviours of concern. It is now possible to develop positive
intervention strategies that build on the client’s strengths and are proactive. Proactive
strategies empower the person to want to change because they focus on what the client
does well, what they want and why they want the change. These strategies support
behaviour changes, and include changes in the environment, positive intervention and
reinforcement strategies.
The strategies consider the client’s communication needs, social and cultural background,
and understand their goals and aspirations for the future. They use their strengths to assist
in overcoming barriers or blockages. It is important to consider the following areas when
developing positive strategies:
1. Personal factors. To gather relevant information about the person and use the
information to identify what impacts on their behaviour – both positive behaviours and
behaviours of concern, including:
• Medical conditions
• Medication and side effects
• Patterns of eating and energy levels
• Sensory sensitivities
• Communication needs
• Goals and aspirations
• Likes and dislikes
2. Changes to the environment. The environment plays an important role in
developing a person’s desire and ability to communicate such as:
• Setting – concentration and distractions, space, variety, settings that are not
personalised and comfortable, equipment, noise, crowding
• Human environment – positive interactions with others, others’ expectations
about the person, respect received from others, others recognising their
strengths, level of acceptance and people equating the person with their problem
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•
Opportunities to communicate – encouragement to interact, say what they are
thinking and not being judged, asking for what they want, others being interested
in what they want, feeling in control of decisions.
3. Positive skills. Selecting and implementing skill development strategies, supporting
the client to learn new behaviours instead of engaging in the behaviour of concern.
Skill development strategies need to be linked to the reason why the person is
engaging in the behaviour of concern. The skills taught need to have as an effective
outcome as if the person was engaging in the behaviour of concern.
It is important to consider:
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The person’s strengths
General skills development (e.g. teaching person to do more things for
themselves)
Useful communication strategies that promote effective communication (e.g.
teaching the person to sign)
Coping skills (e.g. teach the person what to do when feeling angry).
4. Reinforcement strategies. These may be required for a short period of time to
produce a rapid change in behaviour. These strategies are used to facilitate a more
immediate change to the behaviour and may need to consider:
• Reinforcing specific behaviour
• Avoiding events you know upsets the person
• Dos and don’ts list for trigger control
• Strategies to increase engagement
5. Immediate response strategies. These strategies are used to minimise risk to the
person and others by planning responses aimed at de-escalating or managing a
serious episode of the behaviour. These strategies provide all involved with a plan for
immediately responding to the behaviour as it occurs. They include strategies such
as:
• Redirection (e.g. distract the person by offering another activity)
• Talk to the person and find out what the problem is
• Respond to early signs of the behaviour
• Respond to serious episodes of the behaviour
Teaching Replacement Skills
Once we know the function that the behaviour serves for the person we need to discover
how they can achieve the same result through using an alternative skill.
In considering replacement skills it is important to think about the following factors:
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Effort involved. The replacement skill being taught must require less effort than the
behaviour. Asking for a break takes less time than breaking a chair, however, making
a full meal when you are hungry is more effort than stealing food.
Impact on the client’s environment. The replacement skills need to impact on the
environment in the desired way more often than the behaviour.
Time for a result. The replacement skill should lead to a desired result more often
than the behaviour. Telling staff that the client has lost something will probably lead
to finding it quicker than the client crying and withdrawing to their room. Asking ‘can
you please talk to me?’ will be an easier way for a client to get interaction than
pinching staff who may perceive the behaviour as a form of aggression.
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Response match. The replacement skill must match the function of the behaviour it
is meant to replace.
Response mastery. The replacement skill must be based on a person’s skill base
and they must be able to successfully achieve the behaviour requested effectively
and efficiently.
Response acceptability. The replacement skill is something that is socially
acceptable and in accordance with social conventions.
There are three types of replacement skills you can teach your clients:
1. Communication skills It is important to choose a way of communicating that builds on
the person’s current communication strengths and will be relatively easy for the person to
learn.
2. Coping skillsSometimes people engage in behaviours of concern because they are
frustrated, disappointed, angry or scared and the behaviour provides them with some
relief. It could be that the behaviour helps the person cope because they are comforted,
given them something else to do or they gain access to something they have been
denied.
3. Independence skills. Some people will engage in behaviours of concern as a means of
getting an object, activity or sensory experience. When this is the case, we can teach the
person to independently, but appropriately get these things.
Reinforcement Strategies
Changing the environment and teaching skills can take some time to have an impact on the
behaviour displayed by the person. It is often useful to take some practical steps to promote
short-term change that will give you, the client and others some respite from the person’s
behaviour and build some positive feelings for the future.
Incentive Programs
An incentive program provides your client with some very strong incentives to stop engaging
in the behaviours of concern.
Consider the example of Matthew, whose behaviour of concern had been monitored by staff,
and their data collection revealed that on average, Matthew engaged in the behaviour once
every 12 hours. This means the staff should reward Matthew if he can go for six hours
without engaging in the behaviour.
To conveniently track Matthew’s progress throughout, his day is divided into three intervals:
1. From the time he wakes up until lunch time.
2. From lunch time until tea time.
3. From tea time until bed time.
A simple chart was developed with each of these intervals clearly marked. After each interval
passes without Matthew engaging in the target behaviour staff sign their initials on his chart.
Staff members involve Matthew in this and praise him. When Matthew is not successful, staff
do not spend time telling him off. Instead they leave the chart blank and encourage him to try
again in the next time interval.
Because the program has not been going for very long Matthew needs to earn two
consecutive initials to get an incentive from his incentive menu. The rewards chosen for
Matthew’s incentive menu were all things that he did not get before the program started.
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The incentives used included:
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Using the iPhone that staff bought him specifically for this program.
Shooting hoops with a disability services worker one-on-one for 15 minutes.
Watching a fishing DVD.
Getting to choose the channel on the TV while watching Home & Away, while his cotenants control the TV remote during their favourite programs.
Having a cappuccino with a staff member.
Getting breakfast in bed.
Having sections of the newspaper read to him.
As the program progresses the length of time Matthew is expected to go without engaging in
the behaviour will be gradually increased. When Matthew reaches his program objective the
rewards from his incentive menu will be available to him unconditionally on an informal basis
General Risk Minimising Strategies
When you are prepared to respond to behaviours of concern before you even arrive at work,
you are less likely to injure yourself or be injured during a serious episode of a client’s
behaviour of concern. When you are fully prepared you have a good understanding of the
person, you are appropriately dressed and have adequate mobility, well-practised
observational skills and an organised plan for self-control.
Protective behaviours are actions which can assist you to remove yourself from situations of
potential harm or at least minimise the impact of an aggressive act on the person and others
involved. The following key points should be followed when using protective strategies in
your work environment:
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Adopt a neutral posture – be careful not to appear aggressive, move slowly and
calmly, keep your arms by your side, don’t try and stare down the person, don’t raise
your voice.
Create personal space for the person.
Withdraw from the situation, if possible.
Call for assistance.
If cornered adopt a defensive posture until help arrives.
If attacked, use minimal restraint if necessary. Do not arm yourself or attempt to use
anything which will inflict pain or injure the person.
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ACTIVITY 3.2: Fill out the following Proactive Strategies for Behaviour Support form based
on your workplace.
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Proactive Strategies for Behaviour Support
Name:
DOB:
Behaviour of concern:
Goal:
Proactive strategies – what to do to prevent the behaviour:
Change the environment – areas to improve:
Offer choices:
Positive interactions:
Predictability:
Positive learning – skills to support person to learn new behaviour
Reinforcement strategies – to reinforce changed behaviours and recognise achievements
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Immediate Response Strategies
Rather than waiting for incidents to occur involving your client’s behaviours of concern, it’s
much wiser to be prepared. This is where immediate response strategies come in. Before
these strategies can be planned, it is imperative that the warning signs (precursors) to
behaviours of concern are identified. The warning signs are the behaviours that the person
engages in during the lead up to the actual behaviour (as opposed to triggers that are the
setting events that occur immediately before the behaviour).
Immediate strategies should be planned in a hierarchical manner. There should be a series
of steps incorporated into the plan, which match the level of escalation that the person is
displaying at any particular time. Steps should always reflect the principles of the least
restrictive alternative ranging from the least to the most restrictive strategies.

ACTIVITY 3.3: As a group, discuss and record strategies that you could implement to
change or manage the behaviours of concern in your client.
Immediate Response Strategy
How could you use it?
Using space
Instructional control
Encouraging communication
Active listening
Encourage relaxation
Inter-positioning
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
ACTIVITY 3.4: What are some active and reactive strategies you have used?
Anger Management
Anger is often identified as the reason for aggression and violent outbursts, yet anger is
often a symptom of other aspects of a person’s life they find frustrating, annoying and
unacceptable. Sources of these frustrations can be:
•
•
•
•
Their current situations; housing, job, relationships
Grief and loss; the death of someone special or a pet, departure of someone who is
significant
Threats to their self-esteem or self-worth; not feeling good enough, clever enough,
strong enough
Lack of personal control over day-to-day situations and life events; not having
choices, being told what to do, feeling confined, lack of freedom to be themselves
As with all behaviours intervention needs to take place on two levels:
1.
2.
Address the source of the anger.
Tteach the person coping skills to better manage their anger. This is a
specialised area and the person can be referred to a psychologist. It is critical to
the success of the strategies that family members, carers and staff work with the
person between their formal sessions to practice and implement what they have
learnt.
The basic steps to anger management are:
1.
2.
3.
4.
5.
6.
7.
Recognising anger – physical and emotional changes.
Cooling down – things to do and say in the short-term.
Indentifying causes – what has led to this feeling.
Emptying the anger tank bank – things to say and do in the medium term
Developing strategies for the future – ways to avoid or delay anger provoking
situations.
Learning and rehearsing strategies.
Monitoring and reinforcing progress. vi

ACTIVITY 3.5: What strategies could you use to remove or avoid situations leading to
aggression or violence?
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Social Stories to Develop Strategies to Minimise Stress and Manage
Anger
An effective way of helping someone make sense of their world is to use social stories –
short stories written or tailored to help a person understand and behave appropriately in
social situations.
Social Stories are a concept devised by Carol Gray in 1991 to improve the social skills of
people with autism spectrum disorders (ASD). They describe a situation in terms of relevant
social cues, the perspective of others, and often suggest an appropriate response.
The story describes:
•
•
•
What a person does.
Why they do it.
What the common responses are.
Social stories are structured and provide a script to use with the client providing consistent
information, reassurance and clarity to know what to do in certain situations. Social Stories
are used:
•
•
•
•
To develop self-care skills (how to clean teeth, wash hands or get dressed), social
skills (sharing, asking for help, saying thank you, interrupting) and academic abilities.
To assist a person to cope with changes to routine and unexpected or distressing
events (absence of teacher, moving house, thunderstorms).
To provide positive feedback to a person regarding an area of strength or
achievement in order to develop self-esteem.
As a behavioural strategy (what to do when angry, how to cope with obsessions).
The stories generally use a set of three types of sentences:
•
•
•
Descriptive sentences give accurate information about the setting, providing the
basic facts about what can be seen.
Perspective sentences provide simple information about why things happen, letting
the person into the hearts and heads of those featured in the story.
Directive sentences present in positive terms, a response or choice of responses to a
situation or concept, the appropriate behaviour (common responses) and what is the
expected behaviour. They can be illustrated using a person’s photos or magazines.

ACTIVITY 3.6: Write a social story for a client to help develop a positive behaviour strategy.
How would you work with your client to create their social story focusing on how the
character can manage their anger or stress?
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Evidence-based behavioural practice
Evidence-based behavioural practice entails promoting healthy behaviours by integrating the
best available evidence with practitioner expertise and other resources. The characteristics,
state, needs, values and preferences of those who will be affected are considered.
This is done in a manner that is compatible within the environmental and organisational
context. The evidence is made up of research findings from the systematic collection of data
through observation and experimenting with the formulation of questions and testing of
hypotheses. Practitioner expertise and resources pertain to the skills and infrastructure
support that are needed to offer behavioural interventions. Resources include physical,
technological and financial assets needed to deliver behavioural treatments, for example,
space, time or technological support.

ACTIVITY 3.7: How do you go about developing evidence based behavioural intervention in
your workplace?
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Crisis Response Strategies
It is important to have in place a set of strategies to respond to emergency situations and
ensure those who implement the strategies are well trained and confident in their use. Crisis
response strategies should not to be used as the first and only means of providing support.
When planning crisis response strategies it is important to think about:
•
•
•
•
•
What can be done in response to early warning signs?
What can be done to minimise the behaviour escalating?
What steps can be taken at the climax of the behaviour?
What needs to be done to calm the situation down as soon as possible?
What needs to be done following the incident for the client and others involved?
When planning crisis response strategies those involved need to think about:
•
•
•
•
Personal risk factors. Baggy clothing, loose jewellery, long hair that can be
grabbed, inappropriate footwear that makes it difficult to run or in which you can be
easily knocked over.
Environmental factors. Locked doors, plate glass doors, readily accessible knives
can all pose a risk.
Medication risk factors. Side effects like disorientation or agitation.
Person centred risk factors. Things not to say or do as they are known to agitate
the person.

ACTIVITY 3.8: Provide an example of your workplace critical response plan.
ACTIVITY 3.9: What are your workplace requirements for reporting a critical incident?
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Here are some suggestions to de-escalate an incident and respond to the situation rather
than reacting to it.
Staying calm:
•
•
•
•
•
•
Make a conscious effort to view the person – focus on them and be aware of any
dangerous behaviour.
Affirm your capacity to provide them support. Telling yourself, ‘Megan is worried or
upset and I am here to support her.’
Avoid taking their emotion personally and reflecting their emotion back to them. This
will usually escalate the situation.
Control your breathing, lower your voice.
Call the person by name; distract them to think of something else.
Feel and look in control of yourself.
Neutralise the situation:
•
•
•
•
•
•
•
This is not the time to teach someone a new way of responding.
Assess the risks to the person, yourself and others.
If necessary you may need to leave the scene.
Focus on the people not property. If safe to do so remove any potential weapons
from the immediate area
Stop all distractions, for example; turn off the TV, turn off the stove, or stop the car if
driving.
Call for assistance.
If you were there when the incident began it may help to have another person to
support the client.
Meet the person’s immediate need or attempt to refocus their attention:
•
•
•
Do or give them something positive – don’t be concerned about ‘rewarding’ the
person’s behaviour by giving them what they want – at this time the priority is to calm
the situation and keep everyone safe. Talk to them, distract them, even use social
stories to remind them of who they want to be, suggest going outside for a walk.
Reassure them to stay safe and believe in their ability to move through this climax to
a wind down.
Avoid attempting to dominate or win as the situation may escalate in placing the
person and others in danger.
A crisis response may require the use of a restricted practice in order to prevent serious selfinjury or harm to another person or property. The crisis response should:
1.
2.
3.
Involve the minimum amount of restriction or force necessary
Involve the least intrusion
Be applied only for as long as is necessary to manage the risk.
A crisis response should never be used as a routine behaviour support strategy. As soon as
practicle after the critical incident has been managed, steps should be taken to have a
Positive Behaviour Support Plan or Incident Prevention and Individual Response Plan
created.

ACTIVITY 3.10: Fill in the following Critical Incident Form.
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Critical Incident Record
Client’s name:
Date of incident:
Time incident began:
Time incident ended:
Name of support worker:
Who supported you during the incident:
Area
Target Behaviour
Insert a description of behaviour that can
occur and its different levels
Severity
5 =The outburst behaviours resulted in
serious physical injury to the adult or others
requiring medical treatment.
Description
Behaviour incident (record the behaviour
observed):
Rate the severity of the behaviour and
describe the effects or impact:
4 =The outburst behaviours resulted in
physical injury to the adult or others requiring
first aid but not immediate medical treatment.
3 = The outburst behaviours resulted in
bruising, scratching and redness but did not
require medical attention or first aid.
2 = The outburst behaviours resulted in
damage to property that will require
replacement or repair.
1 = The outburst behaviours were observed
but did not result in physical injury or
damage to property
Where was the adult when the incident
occurred?
What was happening immediately prior to
the incident?
Antecedents/possible triggers:
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Who was in the environment at the time
of the incident?
Describe what was happening in the
environment.
e.g. is the person unwell, or did they have an
issue with the venue, noise, weather, mood
of others etc.
What happened immediately after the
behaviour?
Consequences/possible reinforcers:
i.e. what resulted from the adult’s actions?
How did you or others respond to the
person’s behaviour at the time of the
incident? What strategies were
implemented?
including restrictive practices
Were there any other contributing
factors?
e.g. personal or environmental
Signature:
Date:
Office Use Only
Date received:
Date responded:
Response:
Feedback to the team/worker:
Manager’s name:
Signature:
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Restrictive Practices
Behaviours that are high risk and high intensity are the behaviours of concern that may, but
not necessarily, require restrictive practice. High risk behaviours that can be observed with
people with multiple and complex needs can include:
•
•
•
•
•
•
•
•
•
•
Aggressive behaviours. Verbally abusive and threatening behaviour toward staff
and members of the community that can be observed when the individual was afraid,
confused and/or withdrawing from substances
Inappropriate sexualised behaviour. Sexual assault, prostitution, rape, unsafe and
indiscriminate sexual behaviour and charges of paedophilia.
Socially inappropriate behaviour. Urinating, defecating and masturbating in public.
A limited ability to understand consequences, being given a warning and not being
charged and then continuing to re-offend
Deliberate self-harming. Chewing glass and opening wounds, self-mutilation such
as lacerating wrists, jugular vein and abdomen, stabbing self with used syringes and
inserting foreign objects into open wounds
Suicide attempts. Setting themselves alight, ingesting chemicals and razor blades,
attempted hangings, attempting to shoot or stab self, electrocuting self, walking in
front of traffic, lying on train tracks, attempting to jump off bridges and other
multistorey buildings (resulting in paraplegia), overdosing and carbon monoxide
poisoning.
Risk-taking. Train surfing, playing ‘chicken’ with traffic and unsafe drug taking
practices. These behaviours are often associated with the individual being affected
by substances, culminating in activities such as promiscuity, prostitution, reckless
and dangerous driving and theft.
Violent crime. Unlawful imprisonment, hostage taking, armed robbery, aggravated
assault, armed in public (guns, knives and syringes), bomb threats, manslaughter
and murder.
Assaultive behaviour. Charges of stalking, threats with a weapon, assaulting
members of the community, staff and other clients, using knives, syringes, broken
bottles and rocks and attempted strangulation.
Arson. Setting fire to other clients, houses, schools, cars, supported accommodation
facilities and furniture
Under-age prostitution. Sexual favours in return for money or cigarettes and in
particular exchanging sex for drugs.
Some individuals displaying these behaviours will have been formally involved with the
police and/or courts around these behaviours, while others will not have had any formal
contact with the police and/or courts.

ACTIVITY 3.11: Research the restrictive practice guidelines for your state/territotory.
ACTIVITY 3.12: Who has the authority in your workplace to request restrictive practice?
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ACTIVITY 3.13: What forms of restrictive practice does your organisation have permission to
use?
In relation to an adult with an intellectual or cognitive disability the least intrusive restrictive
practice:
•
•
Ensures the safety of the client or others.
Imposes the minimum limits on the freedom of the client, as is practical in the
circumstances.
Principles of Restrictive Practices
Consideration of the following principles with regards to clients within your disability services
organisation who engage in behaviours of concern:
•
•
•
•
Human rights principle. Managers and support staff must have regard for the
human rights principle, that people with a disability have the same human rights as
other peoplevii.
Service delivery principles. Your organisation must consider all service delivery
principles in the Disability Services Act relevant to your state or territory.
Assessment of individual. Behaviour that causes harm occurs for a reason.
Gaining an understanding of the adult and the purpose or function of their behaviour
is an essential component in the development of appropriate support strategies.
Positive and proactive approach. A positive and proactive approach to behaviour
support involves the development of multi-element support plans. These encourage
the adult to live a full and active life and with a focus on the links between
antecedents to the behaviour and occurrences of the behaviour.
If your disability services organisation considers it necessary to use a restrictive practice in
response to the adult’s behaviour that causes harm, your managers will need to consider:
•
•
•
•
•
•
•
Least restrictive way. Use of the restrictive practice ensures the safety of the client
or others and, having regard to this, imposes the minimum limits on the freedom of
the adult as is practical in the circumstances.
Implementing positive strategies. A restrictive practice must only be used as a
time-limited measure for the purpose of preventing harm to the client or others, while
positive strategies are developed and implemented to address the behaviour that
causes harm.
Reduction or elimination of restrictive practices. A Positive Behaviour Support
Plan must support the reduction or elimination of restrictive practices in the longterm.
Consultation with significant others. In the development of a Positive Behaviour
Support Plan, the client, their guardian and significant others (family members) must
be consulted.
Review and monitoring of the restrictive practice. To safeguard against abuse,
neglect or exploitation.
Skills and knowledge of the individual implementing the plan. Individuals who
use the restrictive practice must have sufficient knowledge and skills.
Evidence-based research. Any action taken should be based on evidence-based
research and practice.
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•
•
Preventative strategies. Any action taken should reinforce best practice in
behaviour support through preventative strategies and early intervention to respond
to emerging behaviour that causes harm.
Transparency. Transparent and accountable processes should be in place in
relation to decision making and the use of restrictive practices.
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
ACTIVITY 3.14: In the table below, tick which principles your workplace uses and give
examples of how they are practiced in your workplace:
Used
Principle
Example
Least restrictive way
Implementing positive
strategies
Reduction or elimination of
restrictive practices
Consultation with significant
others
Review and monitoring of the
restrictive practice
Skills and knowledge of the
individual implementing the
plan
Evidence-based research
Preventative strategies
Transparency
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Medication
The use of medication in the support of people with an intellectual disability who engage in
behaviours of concern that are high risk and high intensity is controversial.
Medication is important when
behaviour frequently places the person
or others in immediate danger and the
behaviours are resistant to the
environmental and teaching skills that
have been set in place. Neurological or
biological factors could be significantly
influencing the behaviour and
intervention at a chemical level can
assist in these cases.
Medication can provide a person with
short-term relief from their clinical
symptoms such as depression, anxiety and disorientation and so they are able to better
respond to the environmental and educational interventions. A medical practitioner provides
advice on these matters and in some cases a psychiatrist may need to be consulted.
Where medication, particularly PRN (pro re nata – as and when needed), is used in support
of behaviour management, instances of administration should be clearly defined.
It does not include feelings which are subjective such as the client is upset, feeling anxious,
is agitated or aggressive. Using definable stages ensures information is objective when
administering medication. Clear guidelines concerning who is to be notified before and after
giving the medication also need to be in place.
It is also part of your role to have a working knowledge of what medications your client uses.
MIMs Annual with medication charts can be useful for those with minimal or no medical
training.

ACTIVITY 3.15: Where can you access working knowledge of the medication the clients you
work with are taking?
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ACTIVITY 3.16: Consider the example of John. John paces up the hall way and gets
agitated, his sweating increases, his engagement with others becomes less and he wants to
go outside. The medical practitioner has provided a prescription sedative to be taken after 15
minutes of observing this behaviour. Your manager needs to be notified before medication
is administered and 30 minutes after medication has been given.
a) What are John’s identifiable stages?
b) What notes would you write in John’s communication book?
Side Effects
When providing support it is important you are aware of possible side effects of medication
so that you can monitor change in your client. As a general rule if the person is not behaving
in their usual manner and is not as responsive as you would normally expect them to be,
seek medical advice quickly.

ACTIVITY 3.17: What is your workplace’s policy on monitoring side effects of medication?
While waiting for a person's mood to stabilise after administering medication, environmental
changes should be made which will help the person to recover, for example neutralise any
noises you can, and create opportunities for privacy. Once the client’s mood and behaviour
is stabilised you can then engage them in activities which are familiar and stabilising.
Reasonable Force
If confronted with an aggressive person an individual can only use enough force to defend
themselves. To do otherwise may be viewed as assault, and a prohibited practice. As with
duty of care, reasonable force is not defined in legislation but is determined by a court
reflecting on specific events that have happened. Just as with duty of care, when considering
use of reasonable force a court will look at:
•
•
•
•
Relevant imbalance in the power of the person involved
The environment in which the incident occurred
Availability of additional resources
Alternative courses of action
If it is at all possible it is best to withdraw from the situation and escape. If this is not possible
place a sort of barrier between yourself and another person. For example move under a
table or behind the lounge and minimise risk.
If you are hit, the preferred option is to take a defensive stance such as curling into a ball.
Hitting back or taking up a weapon like a stick, broom or wooden spoon, would be totally
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inappropriate in almost every situation and could give rise to charges of assault, regardless
of what the client did in the first instance.
Restraint and Seclusion
The use of restraint in any behaviour intervention process requires careful consideration of
legal, ethical and practical issues. Restraint may include physical, mechanical or chemical
restraint and for this reason disability services organisations will usually have a policy
governing the use of restraint. These policies are dictated by state and territory legislation.

ACTIVITY 3.18: Look at the restraint and seclusion policy for your state or territory. How do
they impact on your role in the disability services sector?
There are a number of methods of restraint and an even greater number of working
definitions about what constitutes restraint. In some states and territories of Australia,
definitions are provided in legislation, regulations, or policy documents.
People with a disability who engage in behaviours of concern and are subject to restrictive
intervention must have a Positive Behaviour Support Plan in place, which is reviewed and
submitted to the senior practitioner at set regular intervals. Restrictive practices are not set
up to promote long-term behaviour change. Long-term change is achieved through changing
background factors and positive intervention

ACTIVITY 3.19: Research what constitutes restraint in your state/territory as provided in
legislation, regulations, or policy documents.
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ACTIVITY 3.20: If you were to consider the chemical restraint of an adult with an intellectual
or cognitive disability, which one of these would be considered a restraint as it controls a
person’s behaviour?
a) The use of medication for the primary purpose of controlling the adult’s aggressive
behaviour towards others.
b) Using medication for the proper treatment of a diagnosed mental illness or physical
condition.
Any form of restraint can only be used as an emergency response, as a last resort. It is
important that:
•
•
•
•
•
•
A team of health care professionals, including those with training in behaviour
support are consulted
Advice is received from the office of public guardian, the guardianship board, or
external ethics committee
Staff should be provided with extra training of its appropriate use
Circumstances must be documented
Provisions should be made for regular practice of the procedure at staff meetings for
example, and induction of new standards
Documentation of when restraint is used
Consent to Restrictive Practices Authorisation
Seeking consent to proceed with an RPA involves meeting with the client involved and, if
possible, with one or two others the person knows well. In the past it has generally been
accepted that it was sufficient to gain implied consent where the client’s participation in the
process and their lack of any objection was interpreted as consenting to the process.
However, now that there is increasing recognition of the rights and respect that should be
extended to people with a disability, there is greater emphasis being placed on the
importance of gaining explicit consent.
Therefore to gain consent it is important to explain to the client:
•
•
•
•
•
•
•
Why the restricted practice application is being proposed
Who is involved and the process
Possible likely outcomes
How the information is stored
The alternatives
Their rights with respect to approval or disapproval
The likely outcome if they choose not to proceed
Once the strategies have been developed, further consent should be sought prior to
proceeding with the implementation of the intervention program. This would include
discussion of:
•
•
•
Personal benefits
Potential risks or adverse consequences
Alternatives
Generally if the client gives verbal consent this will be sufficient. Staff must ensure that each
client has a Consent to Gain or Release Information form in their file. Consent forms need to
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be specific about the matter, act or purpose that it is intended, with regards to the client’s
personal information.
When seeking consent, staff must ensure that they inform the client or the client’s guardian
and decision-maker, of their right to withdraw consent for release of personal information at
any time.
The steps for the process vary between the states and territories. To find out the steps and
further understand the data collection that is necessary for the Restrictive Practice
Authorisations, research the process in your state or territory.
Consultation
The Specialist Response Service conducting an assessment for containment or seclusion, or
the disability services organisation conducting an assessment for other restrictive practices,
should at a minimum, consult with, and consider the views of:
•
•
•
•
The client.
Each relevant service provider supporting the client.
Any guardian or informal decision-maker for the client.
The authorised psychiatrist responsible for treatment of the client (where the
Specialist Response Service or disability service organisation is aware the client is
subject to a forensic order or involuntary treatment order made under the state or
territory Mental Health Act)

ACTIVITY 3.21: Consider the legislation and guidelines in relation to restrictive practice in
your area of work. Is it possible for a person to receive an anti-psychotic medication to
control their behaviour without any other behaviour management strategy or the care of a
psychiatrist?
Prohibited Practices
Prohibited practices interfere with an adult’s basic human rights and are demeaning or
constitute a form of abuse or neglect. Due to their illegal or unethical nature, the practices
are unacceptable and therefore prohibited from use as positive behaviour support strategies
It is against the law to use these practices, if they are used the worker and the workplace
can have their contract terminated. In a family home the continued use of such practices
might warrant intervention by the state department of social services or community welfare
(in the case of children) or the office of public guardian (in the case of adults with a
disability).
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
ACTIVITY 3.22: Managing a person’s behaviour through a formal strategy could be open to
abuse of human rights. How do you ensure this doesn’t happen?
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Prevention
The provision of behaviour support services should focus on strategies which aim to prevent
the occurrence of behaviours which challenge the support system and are damaging to the
client and their goals. It should be clearly understood by service providers that there is a
fundamental distinction between:
a. Assessment and management of risk.
b. Assessment of behaviour and provision of behaviour support.
Service providers have a duty of care towards the people who receive their service to ensure
all reasonable measures have been taken to prevent harm which may be reasonably
foreseen. Risk management strategies should be in place to minimise or remove the risk of
harm arising from activities or events for the client such as swallowing, mobility or
transitioning.
Employers must also show reasonable care for the safety of workers. Risk management
strategies are required in all designated workplaces. There is no statute law that defines
precisely what constitutes a duty of care. Duty of care is usually scrutinised from a legal
perspective after an event. The law then needs to consider what would have been
reasonable to expect another person with the same skills and experience to have done in a
similar situation.
A worker must always ensure that their duty of care to a person they support is not used
automatically to override the rights of the person with a disability, including the client’s rights
to take reasonable risks; this is known as dignity of risk. When working with a person who is
engaging in behaviours of concern, disability services workers must balance their duty of
care with the person’s dignity of risk. Workers need to minimise harm without eliminating all
possibilities of choice and freedom for the person with a disability.
A disability services worker must also take into consideration the least restrictive alternative
when exercising their duty of care, i.e. the minimal coercion or force necessary to support a
person to participate safely in an environment or activity.
An assessment of a client’s behaviour needs to include the range of variables in their life and
include the following factors:
Quality of Life
Often behaviours of concern are a way for the client to express their poor quality of life.
Behaviour interventions must therefore include strategies to enhance the client’s quality of
life which will positively affect their wellbeing, happiness, health and behaviour.
One approach to promoting quality of life is active support, which involves:
•
•
•
•
Indentifying meaningful activities.
Documenting necessary supports.
Ensuring skilful and effective assistance is available when required.
Monitoring and evaluating the effectiveness of the support provided.
Active support includes:
•
Activity plans. What the client does to be included in work and home activities.
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•
•
•
Long-term and short-term goals. What the client would like to do in the future.
Positive skills. What the client needs to learn.
Reinforcement strategies. What the client needs support in to create the quality of
life they want.
Incidental learning, the learning and rehearsing of skills as part of a daily routine, is an
important dimension of active support.
Relevant Genetic, Developmental and Cognitive Factors
Intellectual disability impacts on the processing, analysing and retention of information. In
addition, social and communication skills, emotional development and expression are
affected. Gross and/or fine motor skills are also affected.
A behaviour assessment must gather information sufficient to consider how the level of
intellectual disability impacts the client, and how it affects their experience of the world
around them. According to McVillyviii, it would be reasonable to expect that a person with an
intellectual disability will experience difficulty in varying degrees with:
•
•
•
•
•
•
•
•
•
Orientating or attending to people and events.
Concentrating on activities.
Learning or remembering new information.
Recalling existing knowledge.
Imagining an alternative.
Developing meaning related to a particular experience – understanding why.
Generate a response or action based on new and existing knowledge.
Evaluating effectiveness and appropriateness of actions.
Modifying or changing their actions in response to new circumstances.
While it is important not to label a person with a disability or use terms such as ‘a disabled
person’ it is important to acknowledge that some types of disabilities have common
characteristics. The information here should be used as a guide only, with the understanding
that every person is different and therefore may behave or interact in different ways.
Remember the person always comes first.
Particular types of syndromes have common characteristics. Although some links exist
between certain syndromes and behaviours of concern, often the behaviours occur as a
result of people not having been supported to learn skills in particular areas, such as
appropriate social interaction.
Understanding particular syndromes and the associated characteristics can be useful when
trying to learn more about a person with a disability especially if they engage in behaviours
of concern or socially inappropriate behaviour.

ACTIVITY 3.23: What relevant genetic, developmental or cognitive factors affect your clients
behaviour?
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As a result, support strategies are designed to take into account that people will need to:
•
•
•
•
•
•
Gradually increase the amount of time they can spend on one task or in a particular
situation – increase their attention span.
Be shown what to do through demonstration, how to do it by modelling and
systematic instruction by clearly defining the steps.
Have repeated opportunities to practice to remember what to do
Have prompts to assist with recall:
o Verbal – your words
o Pictorial or signs using pictures, symbols, photos
o Physical tap on the shoulder, holding hand, guiding the client to move away
o Social stories
To have reinforcements and recognition of achievements and success to help
encourage the meaning and purpose of the activity
To work collaboratively with others and interpret the responses of others to develop
the ability to improve their own skills to adapt.

ACTIVITY 3.24: Which of the following supports will be important for your client to use in
learning new tasks? Make notes on the ways in which you could implement these supports
for your client.
Supports

Comment
To use their senses – look, listen,
touch, smell and taste. Access to
glasses and hearing aids will be a
benefit.
Be shown what to do through
demonstration, how to do it by
modelling and systematic
instruction by clearly defining the
steps.
Have repeated opportunities to
practice to remember what to do
Have prompts to assist with
recall:
o
o
o
Verbal – words
Pictorial or signs using
pictures, symbols, photos
Physical tap on the shoulder,
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o
holding hand, guiding the
person to move away
Social stories
To have reinforcements and
recognition of achievements and
success to help encourage the
meaning and purpose of the
activity
To work collaboratively with
others and interpret the responses
of others to develop the ability to
improve their own skills to adapt.
Medical and Dental Factors
Even when a client’s behaviours are due to chemical imbalances in the body and require
specific medical treatment, the behaviours still send a message ‘I am not well’. Before
seeking medical intervention it is useful to have documented information about any
variations in key aspects of a person’s health over the past month or two. Consulting with the
client’s carers and keeping factual notes for monitoring the data will create a data resource
to help understand the medical needs and significant aspects of the client’s life.
Key health factors to consider include:
•
•
•
•
•
•
•
•
•
Sleep patterns, time of going to bed, getting up, sleep disturbances.
Changes in appetite, weight, body temperature and pulse.
Charting of fluid intake, urination and bowel movements.
Unrecognised pain such as a toothache, fluctuating blood pressure, constipation,
infected ears.
Undiagnosed neurological problems such as epilepsy or the onset of dementia.
Undiagnosed psychiatric problems, for example, depression, bipolar, anxiety
disorders.
Hormonal imbalances, for example menopause, depression.
Deteriorating sensory functions such as failing eyesight or poor hearing.
Common diseases and infections.
An awareness of the side effects of medications and observing and documenting changes in
behaviours after being given medication is important data to collect for the client’s treating
medical practitioner (general practitioner, psychiatrist or neurologist).
Some common side effects associated with psychotropic medication include:
•
•
•
•
•
Extreme restlessness in the legs that may result in excessive pacing.
Extreme thirst.
Extreme hunger.
Hand tremors.
Difficulties with eating, drinking and swallowing (dysphagia).
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
ACTIVITY 3.25: What medical or dental factors have your clients experienced in the past
which affected their behaviour?
ACTIVITY 3.26: Have you observed changes in your client’s behaviour with some
medications?
ACTIVITY 3.27: Do you know of allergies, reactions or mood swings that occur with
medications?
ACTIVITY 3.28: How would you know what to look for when observing side effects of
medications?
Behaviour of concern may be associated with physical pain or discomfort, particularly when
your client experiences communication difficulties and they are unable to effectively indicate
the experience of pain or discomfort to workers and carers through any other means. Failure
to detect the presence of pain can lead to you making incorrect decisions and can lead to
serious consequences for your client.
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It is important to consider whether a dental or medical consultation is necessary. Their
assessment should also identify any medication that your client may be prescribed, the
purpose of the medication, possible side effects, symptoms of overdose and complications.
Mobility and Sensory Factors
Mobility factors that impact on fine and/or gross motor skills and abilities of the client need to
be considered. For example, people with cerebral palsy can have impaired control of
voluntary movement of limbs or of the whole body, have disorders of balance, or loss of
control of body posture. They can present in a range of behaviours from apparent inactivity
to violent movements.
Cerebral palsy often also presents the individual with motor planning and hand-eye
coordination difficulties, and vision and hearing impairments. These characteristics should
never be confused with behaviours of concern even though they may present challenges to
supporting the person.
Difficulties with fine motor skills may present as an inability to tie shoelaces or unscrew the
top from a container which can lead to frustration and anger. Again, care must be taken to
consider the individual and these characteristics to develop a realistic and person centred
Positive Behaviour Support Plan.

ACTIVITY 3.29: Does your client have any mobility and sensory impairments?
The Environment
An environmental analysis looks at the environmental factors that impact on the person’s
day-to-day living. An occupational therapist will be helpful as they specialise in equipment
and assistive technology, as well as how to promote people’s physical and social access to
their environment. In an environmental assessment it is useful to consider both:
•
•
Background triggers. Settings or events observed to be associated with a higher
likelihood the behaviour will or will not occur.
Immediate triggers. Factors observed to have occurred prior to the behaviour.
After completing the general assessment of a client’s environment, it is now important to
consider the following triggers:
•
•
•
Physical environment. Noise temperature, space, people and stimulation, smells.
Activities. The purpose of the activity, being told what to do, too many choices,
when the activities stop and start, pace of the activity.
Interactions. Attention of others, interruptions, complexity of the interactions,
preferred communication, response of others.
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•
•
•
•
What other people are doing. A particular person, staff member, other client, is
present, group setting, certain characteristics excite or annoy them.
Expectations on the person. If they want to do it, would prefer to do something
else, expectations of others, they feel limited.
Person’s routine. Consistency of the routine, too many changes, too much structure
or not enough.
Background factors. What happened at home, disappointed in something that
occurred a couple of hours before, an interaction with a friend, family member or
stranger.
Reducing or Changing Triggers
To reduce or change your client’s exposure to the events or settings which trigger their
behaviours of concern, you need to increase opportunities and events which produce their
desired positive behaviours. For example, you can:
•
•
•
Provide your client with greater access to their preferred activities.
Provide your client with clear instructions.
Allow your client to spend more time with their favourite disability services workers.
As well as increasing opportunities for positive behaviour, you can decrease or eliminate the
events which trigger the behaviour of concern in your client by:
•
•
•
•
•
Reducing the number of demands made.
If assessment reveals that directive instructions act as triggers, give your client
instructions in a way that is not directive, for example, ‘The table is ready to be set
when you’ve got a chance’.
Providing the person with a room of their own.
Slowing down the morning routine if you know the bus will be late and waiting has
been shown to act as a trigger.
Putting together a dos and don’ts lists to ensure staff consistency.

ACTIVITY 3.30 : Use the following Triggers form to identify potential triggers for your client.
ACTIVITY 3.31: What strategies could you use to reduce or change the triggers.
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Triggers Form
Use the following formix to identify your client’s background and triggers and onsider if the
behaviour is more likely to occur when:
Triggers
Comments
Physical environment
Noise – too quiet, too noisy
Temperature – too hot or too
cold
Space – too small, or enclosed,
too large
People – too many, only a few
Interest – not stimulating, too
stimulating
Activities
Being told to do something
Given a choice
Activity starts or stops
Doing the same thing for a long
time
Activity is too fast or slow
Activity is liked or disliked
Activity is too hard or too easy
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Purpose is not understood or
outcome is not clear, not
relevant
Interactions
Attention – too much attention,
not enough, being given to
someone else
Way the interaction is
conducted – told yes, no, wait,
they were touched, corrected,
ordered
Interruptions or stopped
Interaction is too complex, too
fast, long sentences, difficult
words
Preferred communication is not
used
Response to a request is
delayed or not addressed
What are other people
Particular person is present or
absent
Around people with particular
characteristics eg loud, active,
quiet
Group setting or on their own
Other people enter their space
or touch their possessions
Other people are the focus
Expectations on the person
If repeatedly asked to do
something
If repeatedly asked to stop
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doing something
Would prefer to do something
else
Particular chores or tasks
Expectations or rules – eg not
to swear, eat at the table, take
turns putting out garbage,
spotless bedrooms
Person’s routine
Does not have a routine
Routine is too structured or not
flexible
Person does not know their
routine
Changes occur in routine
Routine does not suit their
needs or preferences
Recent events
The person is upset or
disappointed with someone
they live with, work with, friend,
stranger
Several events have occurred
close together
Family Context
Knowing the expectations that family and carers of your clients have of your disability
services organisation will help guide the development of the client’s Individual Plan.
Identifying these will promote the engagement of the family as valued stakeholders in the
positive behaviour support process. This also allows for an understanding of the family
context and the roles of various family members within your client’s support system. It may
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also reveal additional issues such as risks of support breakdown, or other areas of concern,
which can be addressed in the Individual Plan.
Sibling relationships are usually more long-lasting than any other within families, and siblings
often play a crucial role in the long-term support of the client. To understand the family
context you should include not only parents and siblings, but the extended family as well.

ACTIVITY 3.32: Who are the members of your client’s family and how does your client relate
to each of them?
ACTIVITY 3.33: What are the expectations of your client’s family of the service your
workplace is offering the client?
Information on the client’s social network, peers and how others outside the family system
interact with the client will assist in understanding the other influences on the client.
Established friendships can be linked to self-esteem and self-identity, opportunities for
intimacy, help and advice. Being in supportive relationships contributes to enhanced quality
of life and improved physical and mental health. It may also help to identify important
stakeholders for inclusion in the collaborative approach for positive behaviour support.
Cultural and Linguistic Factors
It is essential that disability services workers understand the broader cultural group with
which the client and their family identifies themselves. These factors include social
differences, beliefs and values that stem from nationality, ethnicity, race, religion, gender,
generation or socio-economic status. This applies to clients from culturally and linguistically
diverse (CALD) communities and to clients from Aboriginal and Torres Strait Islander
communities that are significant to the client, and extends beyond the use of interpreters or
translators of community languages. Awareness of key cultural values helps you identify
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factors which might impact on the client’s behaviour but also helps you to acknowledge gaps
in your own understanding.

ACTIVITY 3.34: What cultural and language group does your client identify with? How does
this impact on their behaviour?
Life Skills, Experiences and Preferences
A person’s life experiences can include their history of involvement with multiple services,
across agencies, and over time. Knowing the additional life experiences of your client, such
as grief, loss, adolescence, ageing and other life changes can help you identify triggers in
their behaviour – both positive and negative. Knowledge of your client’s activities, pastimes
and what they like to do helps in developing strategies to support the client in a way which
works for them.

ACTIVITY 3.35: How would you access information about your client’s significant life
experiences?
Previous Experiences of Support System and Service Providers
Clients can be in contact with multiple services which may be crisis-driven and not effectively
coordinated. In some situations the capacity of the support system to cope is placed under
severe stress.
In family settings stressors tend to accumulate as individuals try to adapt, and parents and
siblings are at greater risk of negative outcomes such as depression, social isolation and
relationship problems. These factors need to be identified in the assessment in order to
inform development of the Individual Plan and its successful implementation.
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
ACTIVITY 3.36: What other services has your client accessed in the past that have resulted
in a negative experience and could be affecting their present behaviours?
Personal Choice
Choice has been established as one of the core
components and indicators of best practice when
supporting people with an intellectual disabilityx.
The lack of choice in a wide range of significant
areas of their lives can be a major contributor to
the experience of stress in the everyday life of a
person with an intellectual disability. Constraints in
their choices include, which clothes to buy and
wear, what food to select and eat, leisure activities
to participate in, where they are going to live and
whom they live with, how they will forge personal
and intimate relationships or manage their
finances and health.
Studies by Wehmeyer & Mitzlerxi show people with
an intellectual disability have themselves identified
a lack of opportunity to make choices or even the
ability to express personal preferences, as areas
of major concern in their life.
Activity plans ensure the Positive Behaviour Support Plans respect the rights of the client to
personal choices and preferences in achieving their goals. They detail key or preferred
activities that the person or those who know them well have nominated for inclusion in the
weekly schedule.
They have few goals and minimal instructions to ensure the person:
•
•
•
Gets a chance to do the things they enjoy doing.
Can try to do things they have indicated they would like to try.
Provides opportunity to do things independently and achieve a sense of self worth.
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•
•
•
Provides opportunity to practice to do things on a regular basis to increase their
confidence, their independence and their interdependence.
Has some control over the events in their life.
Has support resources directed towards enabling people to do the things that are
important to them.

ACTIVITY 3.37: Fill out the following Activity Plan for one of the clients you support.
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Activity Plan
Weekly Activity Plan
Name:
Opportunity Goal
Date:
Min.
Offered
per
Week
Mon.
Tue.
Wed. Thur.
Fri.
Sat.
Sun.
Key:
 = complete
? = partially complete
X = not offered (staff to initial)
General Notes:
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Assessing Behaviour of Concern
Behaviour assessment is the process of systematically gathering information which clearly
defines the behaviours or issues identified in the whole-of-life context of your client.
Without conducting a functional behaviour assessment it is very easy to jump to inaccurate
conclusions about why a person is behaving in a certain way and this can result in the
selection of inappropriate strategies that will not address the person’s needs or have positive
effects on the behaviour. Inappropriate strategies can often make the behaviour worse, lead
to an increase in the frequency, intensity and duration of the behaviour. This may give rise
to new behaviours creating more problems and risking harm to the person and others
involved.
Behaviour assessment and analysis is therefore:
•
•
•
•
Seeking to understand and define the behaviour to be changed and the importance
of it being changed.
Evidence based, involving collecting data and summarising the patterns and history
of the identified behaviour.
Seeking to understand the complexities of the support needs of the client across
environmental contexts.
Seeking to understand the function of the behaviour for the client across
environmental contexts.

ACTIVITY 4.1: Think of a client you know who engages in a behaviour of concern that is
impacting on the quality of their life and relationships.
Define their behaviour with the help of the following diagram, and describe the behaviour
and the frequency of its occurrence:
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Factors to Consider for a Behavioural Assessment
Define the Behaviour
Understand the behaviour
How does the behaviour give them a
quality of life?
Long-term goals
Positive skills
Reinforcement strategies
Genetic,
developmental
and cognitive
factors
Previous
contact with
services
Dental and
medical factors
Life skills,
experiences
and networks
Mobility and
sensory factors
Wider social
network
Family context
and
expectations
Environments
and triggers
Cultural and
linguistic
factors
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Functional and/or Cognitive Assessment of Individuals
Consistent with policy, the process followed in behaviour assessment and analysis usually
consists of a combination of:
1. An interview with the client to gain their permission to start the investigation of their
behaviours of concern.
2. Interviews with key parties, including:
o .
o The people they live with.
o Colleagues.
o Family members and advocates.
o Friends and acquaintances.
o Support staff.
o Other professionals who are involved with provision of care and/or support
with the client (e.g. therapist, teacher, neurologist, paediatrician, psychiatrist).
o Practitioners from other disciplines who are involved in providing a service to
the client or to others within their support system (e.g. mental health worker,
probation and parole officer).
3. File review of relevant documentation.
4. Observations of the client across environments.
5. Data collection.
6. Research.
Once these steps have been completed, the information collected can be analysed and used
to formulate hypotheses. A behaviour support worker is a skilled or experienced professional
who assesses, develops, implements, monitors and reviews Positive Behaviour Support
Plans using the collated information. Where issues of safety or risk of injury are present, the
behaviour support worker will strike a balance between professional rigor and timely
intervention.

ACTIVITY 4.2: Provide an example of a functional cognitive assessment form used in your
workplace.
ACTIVITY 4.3: Who would be involved in a functional and cognitive assessment in your
workplace?
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Assessment and analysis should lead to the development of actions, recommendations and
strategies aimed at improving the quality of life of the client, enhancing their skills, reducing
the severity of issues associated with the identified behaviour/s, and improving the quality
and effectiveness of the behaviour support system. Positive behaviour support may be
provided with varying degrees of intensity and intrusion. In general, the least intrusion
required in order to achieve the best outcome for the client and their family is preferred.
It is important that workers are absolutely objective and ensure:
•
•
•
•
•
Accurate data collection.
Data collection is incorporated into their day-to-day tasks.
Several months of data collection is used to assess one behaviour at a time.
Data is reviewed and understood to identify a trend.
Workers need to see collection as a project. xii
As you record information about your client’s behaviours of concern, you need to write about
the behaviour in a way that the actual behaviour of concern can be easily understood by
others. Your data collection can then be used to form reliable documentation on when and
where the behaviour does and does not occur.
This is often referred to as an operational definition of the behaviour; having a clear and
concise definition of the behaviour is essential when conducting a functional assessment. As
a functional assessment may consider observations, records or ideas from more than one
person, it is important that everyone has exactly the same behaviour in mind. A good
operational definition may also serve as a helpful reference for others involved in providing
support to the person, such as the client’s family, carers, friends or other health
professionals.
Behaviours should not be written about in a way that is vague, subjective or broad. The
definition needs to be specific. A good operational definition of the behaviour is one that is
written in a way that:
•
•
•
Can be visualised.
The frequency can be counted.
Is agreed on by different observers regarding its occurrence and absence.
Understanding the cause of the behaviour is vital to help the client change behaviours, as
the answer can be as simple as changing their environment.

ACTIVITY 4.4: Fill in the following Behaviour Assessment Form based on a client you work
with.
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Behaviour Assessment Form
Define the behaviour:
Consider the following factors which impact on the behaviour:
1. How does the behaviour link to the meaningful activities they like to do – home/work
life?
2. How does the behaviour add to their long-term and short-term goals?
3. What relevant genetic, development and cognitive factors are important to consider
for their learning to change the behaviour?
Genetic
Developmental
Cognitive
4. What important supports will they need to assist with learning new behaviours?
Senses
Demonstrations
Opportunities
Prompts
Reinforcers
Collaboration
5. What medical and dental needs do they have that will impact on behaviour?
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6. What mental health factors need to be considered that impact on the behaviour?
7. What augmentative and alternative communication strategies do they need to assist
with understanding their behaviour?
8. What mobility and sensory factors need to be considered that impacts on the
behaviour?
Fine Motor Skills
Gross Motor Skills
9. What family context and family expectations are expected of the service provider?
10. What cultural and linguistic factors are impacting on the behaviour?
11. What life experiences, experiences with support systems need to be considered?
12. How is previous contact with support services – history and outcomes impacting on
the behaviour?
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Collecting and Analysing Data
Your role as a disability services worker requires you to take a holistic approach to
assessing the needs of your clients. While purpose designed tools can assist you, you also
need to remember that formal tools may not always be relevant because symptoms can
often present in hugely varied ways.
Therefore, your knowledge and skills provide informal assessments through:
•
•
•
•
•
Looking at reports from carers and the client’s history and reputation.
Observing changes.
Being able to exclude physical problems by organising a comprehensive health
assessment.
Recognising if there is a stigma attached to a certain diagnosis.
Seeking a diagnosis from qualified professionals from a range of disciplines to
determine a prognosis and treatment.
The data you need to identify the complex needs of your client can be collected in the
following three ways:
Interviews
These can be planned interviews using a questionnaire or forms that methodically gather
information on specific areas. These forms allow you to look at different perspectives of a
person’s situation. Remember to avoid your biases, as you may already know your client
very well, so try to come to your interviews without preconceptions. Listen and look from a
new perspective, this stops you from trying to prove your previous thoughts and opinions are
correct and allows you to discover what’s really there.
Observation
Observation of your client means really looking at what they are doing to understand the
client. Notice the different ways they communicate, hand movements, eye movements and
breathing, which you know and which others may not see. If you know your client well you
can especially focus on looking for something different in what they do to give you more
understanding of them.
Taking time
As many of the tasks you help your client with are mechanical, like researching, filling out
forms, driving, showering, dressing or cleaning, you don’t have to think in great depth. This
gives you an opportunity to think more about the client whilst you are doing these tasks, to
notice the little things they do to send you messages, and this makes the tasks more
stimulating.
Taking time to record those incidental observations helps in developing the client’s skills and
will help with understanding their behaviours of concern which demand a lot of your time and
energy. Avoiding the energy-draining behaviours of concern by understanding your client
and noting the little things that make a difference, will enable more valuable and effective
communications.
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Types of Assessment Tools
There are a number of assessment tools which assess, refer and identify broader needs.
One of the most common is a Functional Assessment Tool. Assessment tools look at all
areas of a person’s life, including:
•
•
•
•
•
•
•
•
•
•
•
Daily living
Medical history
Mobility
Health conditions
Orientation
Leisure activities
Perception of time
Behaviours of concern
Memory/recall
Eating and sleep patterns
Interaction with others

ACTIVITY 4.5: What data collection methods do you use in your workplace? Provide an
example
Monitoring the behaviours of concern by recording them each time they happen is necessary
to help you see what the function of the behaviour is, and whether there is a better way to
overcome the frustrations before they happen. Some of the ways you could record this
information is to use the following forms:
ABC chart [Antecedent (trigger), Behaviour, Consequence]
This type of form can help you identify the events which occurred around the incident, where
you record what happened immediately before the behaviour and may have been a trigger,
the behaviour itself and the immediate consequences after the behaviour.
STAR chart [Setting, Trigger, Action, Response]
Allows you to consider the environment in which the behaviour takes place, then the trigger,
the behaviour of concern and your response, remembering that the way you respond to a
behaviour can determine whether the client sees this as an effective or appropriate way to
communicate.
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Questionnaires
These can focus on one very specific behaviour at a time and asks questions to gather
information about all possible events which may trigger that behaviour.

ACTIVITY 4.6: Fill in the following data collection tools based on the clients you work with
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Quality of Life Record
Record for (client’s name):
Completed by (your name):
Date: .................................................................. Shift:
Sleeping pattern: time they went to bed, out of bed, woke during the night, drowsy during
the day
Diet: what did they eat and drink, what quantities, how often
Activities: what did they do, where did they go, who was there, what was their response –
client and other people
Health: general status, changes to health and medication, medication refusal
Support needs: anything they need
Behaviour and communication: what, where, when, how long
General comments:
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Activity Log
Activity log for (client’s name):
Completed by (your name):
Time
Venue/Activity
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Comment
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STAR Chart
Behaviour of (client’s name): .............................................................................................................................................................................
Behaviour being monitored: ............................................................. Behaviour Monitored For: ........................................................................
Duration of Incident: ..........................................................................................................................................................................................
Reported by: .....................................................................................................................................................................................................
Setting
Triggers
Action
Response
Where?
Who was there?
What happened immediately
before the incident?
What happened up to two
hours before the incident?
Anything else significant that
day?
What did the client do?
Describe the incident.
What happened then?
What did you do?
Day
Date
Time
Possible Messages
Communicated Through
the Behaviour
To Get Something
(tick)
To Avoid Non-preferred Situations
(tick)
Gain attention from others
Demands, responsibilities, failure, independence
Gain access to preferred activities or objects
Being uncomfortable with sadness, anger, pain,
embarrassment, sharing their space
Reduce arousal and anxiety, disappointment or
frustration at not being able to do something
Being dependent on others or being alone
Sensory stimulation, eg, hand flapping, face
picking
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ABC Chart for Monitoring Behaviours
Client:
Worker:
Remember to report facts, what actually happened, avoid assumptions and judgements.
Date/Time
Antecedent
Behaviour
Behaviour
(what lead to the
behaviour,
environmentally and
personally)
Assessment of Risk
Consequences of the
Management of Risk (strategies used)
Client
Others
Environment
Provision of Behaviour Support (suggestions for what can be done to maximise the
quality of life for the client and avoid this in the future)
Trigger
Escalation
Crisis
Recovery
Suggestions
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CHCICS404A Plan and provide advanced behaviour support
Facilitator Guide

ACTIVITY 4.7: How do these forms assist you in developing positive behaviour support
strategies?
From information collated via these forms it is possible to supply an informed idea
(hypothesis) why the behaviour is occurring; the purpose or function the behaviour appears
to be serving for the person.
Hypotheses regarding the function or relationship between the behaviour and the individual’s
environment can identify positive behaviour support strategies. Be aware however that a
single behaviour of concern may serve more than one function.
The function that a behaviour serves has direct implications for how disability services
workers respond to the behaviour. For example it could be decided to redirect a person who
is engaging in the behaviour of head banging. In the long-term this may lessen the behaviour
in a person who head bangs exclusively to gain social interaction. However, the exact same
strategy to redirect the person could worsen the behaviour if the person who head bangs
does so because they prefer to be alone; in this case this response may reinforce the
behaviour that “I bang my head and people leave me alone”.

ACTIVITY 4.8: Who else could you consult in the development of positive behaviour support
strategies?
What is your workplace referral process?
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Positive Behaviour Support Plans
A Positive Behaviour Support Plan can begin to be developed using a planned approach to
providing the client with interesting and enjoyable activities that foster personal growth and
community participation. This can be done by:
•
•
•
•
•
•
•
•
•
Improving the client’s living environment.
Providing predictability and consistency in their life.
Increasing their ability to make choices about their life.
Stakeholder participation.
Social validity for the client.
Emphasis on prevention of the situation which triggers the behaviour.
Valuing the person, deliberately building a sense of self-worth, and acknowledging all
attempts at positive interaction.
Assisting the client to develop the skills that allow them to participate in everyday
tasks and activities.
Providing encouragement and feedback about personal successes along with
aspects of difficult situations the person may have handled well.
For positive behaviour support to be successful it requires:
•
•
•
•
•
Team work.
Identifying the person’s strengths and being committed to the person.
Seeing the person and seeing the behaviour.
An appreciation that all behaviours have a purpose.
Being positive.
Positive Behaviour Support Plans:
•
•
•
Are developed based on the individual’s needs.
Are used to guide workers in providing direct support to the client to manage any
behaviours of concern.
Provide consistency for all workers to utilise the most appropriate and effective
strategies when supporting a person with behaviours of concern.
It is not a one size fits all approach.
The development of a Positive Behaviour Support Plan should involve the person with a
disability and those who know the person well. Of equal importance is ensuring that the plan
is based on recent functional behaviour assessments. Other highly relevant assessments
include:
•
•
•
•
Assessments of communication skills.
Risk assessments.
Sensory assessments.
Neuropsychological assessments.
The Positive Behaviour Support Plan must describe the use of the restrictive intervention.
The inclusion of the restrictive intervention must be explained to the person with a disability
by an independent person.
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
ACTIVITY 5.1: Provide an example a Positive Behaviour Support Plan from your workplace.
Who was involved in the implementation? Who is involved in the monitoring?
ACTIVITY 5.2: What is strengths-based support?
Collaboration with others
Your client’s support system is made up of the range of services, teams and stakeholders
who support the client. This includes families, staff, unpaid carers as implementers,
behaviour support workers, staff supervisors, case coordinators, key workers, managers,
and other professionals such as therapists, medical practitioners and educators. Positive
behaviour support services should aim to promote, establish and maintain environments and
interactions which ensure resilience of the support system and deliver positive and
sustainable outcomes for the client.
Those within the support system should be responsible for identifying any additional training
and support needs relevant to their role within the support system.

ACTIVITY 5.3: In your workplace how do you consult with stakeholders in the development
of support plans?
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As part of the team who is working with and supporting the client to develop positive
behaviour strategies, it is important you not only understand your own responsibilities, but
also those of the other team members.
Families and Implementers
Implementer is a term given to those whose role it is to implement particular behaviour
strategies. They will require training and support in order to implement strategies effectively
and consistently.
In family settings, there is often a greater need for support of implementers (parents,
siblings, extended family members) in order to maintain the capacity of the family to manage
behaviour and monitor outcomes under complex and/or difficult circumstances. Every care
must be taken in the provision of positive behaviour support services to identify any aspects
of the support system which might lead to a breakdown of support for the client, and to
address these constructively.
Behaviour Support Workers
Ideally, staff conducting assessments, planning and consulting on positive behaviour support
should be behaviour support workers, and be receiving regular practice supervision from an
appropriately qualified and skilled supervisor.
Supervisors
It is the role of the supervisor to monitor implementation of positive behaviour support
strategies, promote consistency in their implementation and address performance issues.
Case Coordinators/Key Workers
Where multiple services are involved in the support of the client, the case coordinator or key
worker plays a pivotal role in coordinating effective lines of communication between
services. This ensures the wellbeing of the client and provides a central contact point for
other services.
Management
It is the role of management of the disability services organisation to promote environments
in which positive behaviour support outcomes for the client and their families can realistically
be achieved.
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Review and Monitoring
Monitoring should take into consideration any contextual difficulties, practical constraints,
resource limitations and other significant factors that impact on implementation. It may
involve procedural reliability checks on disability services workers but should also promote
sharing of information and feedback through regular forums such as family or team
meetings.
Ensuring workers understand the crisis response and how to implement it is important for the
success of the strategies. A behaviour support worker can support disability services
workers in ensuring they implement and monitor the strategies to the benefit of the client.
The following table presents methods to ensure workers and other support people are
implementing strategies effectively:
Measure
Description
Verbal reliability
A worker verbally demonstrates their knowledge of a support
plan in order to identify those areas where further training or
development may be required.
Procedural reliability
A worker is observed performing components of a Positive
Behaviour Support Plan in order to identify those areas where
further training or development may be required.
Role-play
Disability services workers and behaviour support workers
role-play particular strategies and receive constructive
feedback and encouragement.
Supervision
Supervision of work practices and implement strategies, in
relation to the Positive Behaviour Support Plan, by line
management

ACTIVITY 5.6: What reports and documentation have you used in the workplace to maintain
behaviour support plans?
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When reviewing a Positive Behaviour Support Plan the following questions are important to
ask:
•
•
•
•
•
•
•
•
•
•
•
Have the person’s circumstances changed significantly and positively during the
program?
Has their behaviour changed significantly?
Does everyone involved in the plan know what they are supposed to be doing?
Has anyone new become involved since starting the plan?
Have the strategies been implemented consistently?
Do the strategies remain relevant to the person’s needs?
Are the resources – human, financial and equipment – still necessary or do they
need to change?
Does the plan need to continue?
Can we do it a better way?
Do we need further advice?
What does the client think about the strategies?
The purpose of the positive behaviour support strategies is to promote an improved quality
of life for the client, it is therefore important to reflect whether this has occurred since the
plan was implemented.

ACTIVITY 5.4: In groups, discuss your workplace practices for reviewing and monitoring the
effectiveness of response plans.
a) How often are plans reviewed in your workplace?
b) What is the process for implementing changes when they are needed?
The twin processes of work practice supervision and peer review seek to maintain a culture
of good practice in behaviour support services.
Peer Review
Peer review is a process through which relevant information and hypotheses are shared with
other behaviour support workers with a view to obtaining informed and constructive feedback
prior to implementation of a strategy.
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
ACTIVITY 5.5:Discuss the following based on your role as a support worker:
a) How can you ensure ongoing positive and adaptive responses?
b) How can you reduce risk of harm to the person and others?
c) How can you ensure a minimum level of intrusion on the client’s dignity and self esteem?
Supervision
Work practice supervision should be regularly provided by behaviour support practitioners.
Elements that might be addressed in work practice supervision include:
•
•
•
•
Work practice issues such as interpretation, analysis or reasoning.
Adherence to work practice standards.
Professional development and support for example availability of and access to
internal and external training courses, seminars and conferences.
Difficult or complex issues can be explored jointly by the behaviour support worker
and their supervisor in a supportive environment.
Work practice supervision should be provided to a behaviour support practitioner as part of,
or in addition to, any other discipline specific supervision (for example, psychological or
speech pathology). It is important that advice and assistance from relevant health
professionals is sought when the person’s goals are not being reached; people such as
doctors, psychologists, medical specialists, pain specialists and social workers.

ACTIVITY 5.7: What professional development and support opportunities can you access?
© Community Services and Health Industries Skills Council Ltd www.cshisc.com.au
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McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association
i
ii
McVilly, K.R., Physical restraint in disability services
iii
Toogood, S., Bell, A., Jacques, H., Lewis, S., Sinclair, C. & Wright, L. 1994, Meeting the
Challenge in Clwyd: The Intensive Support Team, Article first published online, 26 Aug.
2009.
McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association
iv
v
O’Brien, 1992 & Murray & Lakhani, 1998
vi
McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association – cited from Riches, 2000 Anger management training
conference paper, University of Sydney
vii
Section 123C of the Disability Services Act 2006
McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association
viii
McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association
ix
x
McVilly, K.R. 2002, The classification of intellectual disability – based on American
Association on Mental Retardation (AAMR) classification system and World Health
Organisation(WHO,2002) international classification of Impairment , Disability and Health,
American Psychiatrist Association
xi
xii
Wehmeyer& Mitzler, 1995
Jack Dikian, Senior Clinical Consultant, Statewide Behaviour Intervention Service
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