Practice Perfect
A guide to good practice in disability services
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What is Positive Behaviour Support?
(a summary)
Background
The best way to support a person who uses challenging behaviour is with Positive
Behaviour Support. Positive Behaviour Support is an evidenced based approach. This
means it has been proven to be successful. It is not a fad or new ‘buzz word’ and is based
on research.
Positive Behaviour Support aims to improve the Quality of Life of the person with a
disability and reduces the impact of their challenging behaviour. When you improve a
persons quality of life, they often don’t need to use challenging behaviour anymore. Quality
of Life can be improved by actively assisting a person to live the life they want to lead. This
can be done by assisting the person to develop personal relationships, improve their health,
being more active in the community, or developing personally.
When people are happily engaged in doing the things they like, with the people they like,
they tend not to use challenging behaviour. It’s the same for all of us. Quality of life is also
improved by understanding why a person needs to use challenging behaviour. When this
need is addressed, the person doesn’t need to use challenging behaviour anymore.
Positive Behaviour Support has four parts:
1.
2.
3.
4.
Ensuring the person is living the best life they possibly can – often this is all you need
to do. If the person is leading a good life and the challenging behaviour continues you
should:
Understand why the person uses challenging behaviour
Find the causes for challenging behaviour and modify them
Teach the person new skills to meet their needs. This is so they can use the new skill
and not the challenging behaviour
Building 28, University of Queensland
11 Salisbury Road
IPSWICH QLD 4305
www.centreofexcellenceforbehavioursupport.com.au
Example:
Simon is young man in his early
twenties. Simon has lots of energy, and
loves being busy. His favourite things
to do are swimming, cooking and
spending time with his family. He also
loves music – especially turning up the
stereo and singing at the top of his
voice.
During the week, Simon goes to a day
service. He works in the lawn mowing
crew three days per week, and does
cooking on the other two.
On Saturday, Simon had been in his
bedroom all morning. Then he came
and asked staff what is for lunch. Staff
told Simon that lunch would not be
ready for another hour.
Simon pushed the microwave off the
kitchen bench, breaking it. He said, “I
hate your lunch anyway”.
Simon then left the house without
telling staff.
Think about the four parts to Positive Behaviour Support
1 - Ensuring the person is living the best life they possibly can
Simon, Simon’s staff, family and friends reviewed his Person Centred Plan. They worked
hard on making sure that Simon was doing the things he liked to do, and that he was
achieving his goals. They also made sure he was spending lots of time being with the people he liked most.
2 - Why did Simon use the challenging behaviour?
Simon loves social interaction and none was happening. When he attempted to initiate
some interaction, he felt rejected.
3 - Find the cause and modify it
From now on, staff have decided to include Simon in morning activities, including preparing
lunch with them.
4 - Teaching the person new skills
Staff are teaching Simon how to start a friendly conversation. They have taught him to ask
“Hi, how is your day going”. Each time Simon asks this question, they make sure they
spend some time chatting to him about their day, and asking him about his.
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What is a Positive Behaviour Support Plan?
A Positive Behaviour Support Plan describes the four parts outlined above. The plan uses
these parts to describe how the person will be supported.
A Positive Behaviour Support Plan should describe;
•
Why the person uses challenging behaviour
•
How things must be changed to make this behaviour unnecessary
•
Specific ways of teaching the person new skills. This is so they do not have to rely on
challenging behaviour to have their needs met
•
What the goals of the plan are
•
How all the people in the person’s life will use the plan
An additional part describes ‘emergency plans’ to safely deal with challenging behaviour if
and when it occurs. For some people, these emergency plans will include reference to the
use of a restrictive practice. Any use of a restrictive practice must be undertaken in
accordance with the Disability Services Act (2006)
Who should have a Positive Behaviour Support Plan?
All people who use challenging behaviour should have a Positive Behaviour Support plan.
This is to improve their Quality of Life and to reduce the impact of their challenging
behaviour. A Positive Behaviour Support Plan must contain the parts listed above.
Sometimes the law requires a Positive Behaviour Support Plan be developed for a person.
This is because it has been identified that the person requires the use of a restrictive
practice for the safety of themselves or others. The Positive Behaviour Support Plan helps
to make sure the restrictive practice can be reduced. Most people who use challenging
behaviour don’t need a restrictive practice. What to do
•
•
•
•
•
•
•
Use positive behaviour support for all people who use challenging behaviour
Write this in a plan
Make sure the plan describes why the person uses challenging behaviour
Make sure the plan describes how the environment must be changed
Make sure the plan details the new skills that will be taught to the person. These skills
should help them meet their needs without using challenging behaviour
Make the objectives of the plan clear
Make it clear how all the people in a person’s life will use the plan
For more information
The content of this guide has been kept very simple. It has been based on the technical
aspects of Positive Behaviour Support and Applied Behaviour Analysis. If you would like
more detailed information on these topics please see the more detailed report in the next
section of this guide or consider the professional development opportunities detailed at
www.centreofexcellenceforbehavioursupport.com.au
For more information on the Centre of Excellence for
Behaviour Support’s research projects and learning and
development opportunities please contact us.
Ph: 07 3381 1284
1800 600 722
To join our email distribution list and receive information
about upcoming events and news please email us at
[email protected]
Research undertaken at the Centre forms the basis for innovative approaches to training
for those responsible for providing support to people with intellectual disabilities. The
Centre’s training agenda considers the learning needs of all areas of disability service
provision, from frontline staff member, to clinician, to executive officer. This sees Positive
Behaviour Support embedded as a system of support, not simply an approach employed by
individual professionals.
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What is Positive Behaviour Support?
(a detailed introduction)
Background
The significance of challenging behaviour in the lives of people with an intellectual disability
and those who support them has been well documented. The prevalence of challenging
behaviour is relatively high (Emerson, 2001) and negative outcomes are all too frequently
experienced by both the person and those who provide them with support (Vassos &
Nankervis, 2012). Despite this, the intervention approach required to decrease challenging
behaviour has been well researched and evidenced for many years. Positive Behaviour
Support is almost universally accepted as the most effective approach to improving the
quality of life of the person with an intellectual disability and reducing the impact of their
challenging behaviour.
Positive Behaviour Support is the term used to describe the integration of the
contemporary ideology of disability service provision with the clinical framework of
applied behaviour analysis (e.g., Carr et al, 2002). In the past, this ideology has been loosely
described within the context of “normalization” (Singer & Wang, 2009). More recently
however, the United Nations Convention on the Rights of Persons with Disabilities
(UNCRPD) has shifted the ideological basis of disability service provision from a ‘vision to
a better future’ to an established obligation of legal and administrative protection of
wellbeing and dignity (Chan, French & Weber, 2011). This legal establishment of the human
rights of people with disabilities realises their fundamental human dignity in addition to
their value as fully participating and contributing members of society (French, 2010).
Despite the inarguable obligation to person centred practice, community participation and
Human Rights protections, some people may engage in challenging behaviour despite the
improvement in their social context. In these situations, Positive Behaviour Support
employs applied behaviour analysis, as the technical framework for facilitating reductions in
intensity, frequency or duration of challenging behaviour (Carr et al, 2002). Many decades
of rigorous research and clinical work has articulated the justifiable dominance of applied
behaviour analysis as the technology of choice in facilitating positive behaviour change
(Harvey, Boer, Meyer, & Evans, 2009; Kahng, Iwata, & Lewin, 2002; Matson, Benavidiz,
Compton, Paclawskyj, & Baglio, 1996). The central clinical features of applied behaviour
analysis employed by positive behaviour support include (a) the use of functional behaviour
assessment to inform targeted and specific interventions, (b) the remediation of
problematic environments, (c) specific teaching of alternative and desirable behaviour, and
(d) the manipulation of contingencies to both promote positive behaviour and (on
occasion) to inhibit challenging behaviour (Dunlap, Sailor, Horner, & Sugai, 2009). In most
circumstances a Positive Behaviour Support Plan will include specific detail on how crises
should be managed, should they eventuate (Browning-Wright, Mayer, & Saren, 2006)
What is a Positive Behaviour Support Plan?
In Queensland, the term ‘Positive
Behaviour Support Plan’ has both a clinical
and legal definition. Clinically, a Positive
Behaviour Support Plan is a document
which clearly outlines the four elements
listed on Page 1. In addition, it articulates
achievable goals, monitoring processes,
and mechanisms for coordination of the
person centred team (e.g., BrowningWright, Mayer, & Saren, 2006).
In
Queensland, the legal context for a
Positive Behaviour Support Plan is the
regulation of the use restrictive practices
pursuant to the Disability Services Act
2006.
The two definitions are not
mutually exclusive the Disability Services
Act articulates many of the components
expected of a clinically focussed Positive
Behaviour Support Plan.
The origins of the part 10A of the
Disability Services Act 2006 can be traced
to the seminal review Challenging Behaviour
and Disability: A Targeted Response (Carter,
2006). Carter clearly articulated the
intention of the various change initiatives
that followed, including the Disability
Services Act. Carter stated that the
intention of legislative and policy reform
was to improve the personal
circumstances of Queenslanders with an
intellectual disability who engage in
challenging behaviour. The appropriate
context for the development of Positive
Behaviour Support plans pursuant to Part
10A is therefore the clinical aspects of the
plan, as it is these which ensure adherence
to Carter’s intent.
In simple terms,
rigorous application of both clinical and
legal standards is required.
Who should have a Positive Behaviour Support Plan?
It is a requirement of the Queensland Disability Services Act (2006) that all people subject
to restrictive practices have a positive behaviour support plan. Many people with an
intellectual disability who engage in challenging behaviour however, are not subject to such
practices and therefore do not meet the requirements of Part.10A. For example, despite
their challenging behaviour they are not subject to a restrictive practice. These people too
should have a clinically founded Positive Behaviour Support Plan which clearly evidences
the components listed above. This of course is both a minimum practice requirement and
fundamental Human Right (see Chan, French & Webber, 2011).
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What to do?
1.
2.
3.
4.
5.
6.
Ensure the obligations to the person as described in the UNCRPD are being met
Identify the function of the challenging behaviour using a functional behaviour
assessment. ‘Function’ refers specifically to the operant reinforcing properties of the
consequence of the behaviour. The function must be able to be described in terms of
positive or negative reinforcement. To conduct a functional behaviour assessment;
a. Operationally define the challenging behaviour including its ‘onset / offset’ or
regular course (O’Neill et al, 1997),
b. Employ standardised survey and interview instruments. The Contextual
Assessment Inventory (McAtee, Carr, Schulte, & Dunlap, 2004) and Functional
Assessment Interview (O’Neill et al, 1997) are recommended by the Centre of
Excellence for Behaviour Support,
c. Conduct structured direct observations using established tools such as ABC
notecards or Functional Assessment Observation forms (O’Neill et al, 1997),
d. Develop functional hypotheses based on the corroboration of surveys and
direct observations, and
e. Where appropriate conduct a Functional Analysis to confirm hypotheses (see
Cooper, Herron & Heward, 2007; Emerson, 2001)
Identify both proximal and distal antecedents that are bio-socially mediated (Cooper,
Herron & Heward, 2007; Emerson, 2001; O’Neill et al 1997). Articulate the approach
to addressing these.
Identify alternative, pro social behaviours that meet the same function as the
challenging behaviour. List both;
a. The specific teaching strategy required to ensure the person with a disability
develops mastery over these skills, and
b. The specific reinforcement approach to ensure both learning and generalisation
(e.g., Browning-Wright, Mayer, & Saren, 2006).
Incorporate legislative requirements where required.
And finally, review all of the associated assessment and recommendations within the
context of the UNCRPD. Consider;
a. Is the restriction likely to achieve its stated objective;
b. Is it the least restrictive of the available alternatives;
c. Is the use of the intervention demonstrably justifiable in a society that is based
upon the values of human dignity, equality and freedom (French, 2009)?
For more information
For more advanced information, review the references overleaf or consider the professional
development opportunities detailed at www.centreofexcellnceforbehavioursupport.com.au
References
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Browning-Wright, D., Mayer, G.R., & Saren, D. (2006). The Behaviour Support Plan Quality
Evaluation
Guide– Version II. Retrieved 18 August 2011 from http://www.pent.ca.gov
Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R.L., Turnbull, A.P., Sailor, W., et al (2002). Positive
Behavior Support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4(1), 420.
Carter, W.J. (2006). Challenging behaviour and disability: A targeted response. Report to the Honourable
Warren Pitt, Minister for Communities, Disability Services and Seniors.
Chan, J., French, P., & Weber, L. (2011). Positive behavioural support and the UNCRPD. International
Journal of Positive Behaviour Support, 1, 1, 7-13.
Cooper, J.O., Herron, T.E., Heward, W.L. (2007). Applied behavior analysis (2nd ed.). New Jersey: Prentice
Hall.
Dunlap, G., Sailor, W., Horner, R.H., & Sugai, G. (2009). Overview and history of positive behaviour
support. In W. Sailor, G. Dunlap, G. Sugai & R. Horner (Eds.) Handbook of Positive Behaviour
Support (pp.3-16). New York: Springer
Emerson, E. (2001). Challenging behaviour: Analysis and intervention in people with severe intellectual disabilities
(2nd ed). Cambridge: Cambridge University Press.
French, P. (2010). The management of risk: A human rights perspective. Paper presented to the Strength to
Strength 2010 national Disability Services and Disability Professionals Victoria State Conference. 2
March 2010.
Harvey, S.T., Boer, D., Meyer, L.H., & Evans, I.M. (2009). Updating a meta-analysis of intervention
research with challenging behaviour: Treatment validity and standards of practice. Journal of
Intellectual & Developmental Disability, 34(1), 67-80.
Kahng, S., Iwata, B.A., & Lewin, A. (2002). Behavioral Treatment of Self-Injury, 1964 to 2000. American
Journal on Mental Retardation, 107, 212–221.
Matson, J., Benavidiz, D., Compton, L., Paclawskyj, T. & Baglio, C. (1996). Behavioral treatment of autistic
persons: A review of research from 1980 to present. Research in Developmental Disabilities, 17, 433
- 465.
McAtee, M., Carr, E.G., Schulte, C., & Dunlap, G. (2004). A contextual assessment inventory for
problem behaviour: Initial development. Journal of Positive Behavior Interventions, 6, 3, 148-165.
O’Neill, R.E., Horner, R.H., Albin, R.W., Sprague, J.R., Storey, K., & Newton, J.S. (1997). Functional
assessment and program development for problem behaviour: A practical handbook (2nd ed.). California:
Brooks/Cole.
Singer, G.H., & Wang, M. (2009). The intellectual roots of positive behaviour support. In W. Sailor, G.
Dunlap, G. Sugai & R. Horner (Eds.) Handbook of Positive Behaviour Support (pp.17-46). New York:
Springer.
Vassos, M. V., & Nankervis, K.L. (2012). Investigating the importance of various individual,
interpersonal, organisational and demographic variables when predicting job burnout in disability
support workers. Research in Developmental Disabilities, 33, 1780-1791
For more information on the Centre of Excellence for
Behaviour Support’s research projects and learning and
development opportunities please contact us.
Ph: 07 3381 1284
1800 600 722
To join our email distribution list and receive
information about upcoming events and news please
email us at [email protected]
Building 28, University of Queensland
11 Salisbury Road
IPSWICH QLD 4305
www.centreofexcellenceforbehavioursupport.com.au