Positive Behaviour Support (PBS) is a transformative approach that aims to enhance the quality of life while minimising behaviours that could result in harm to the person or others. At its core, PBS seeks to shed light on the meaning and purpose behind an individual's behaviour, rather than merely eliminating it. In this article, we'll delve into the key principles and components of PBS and explore its applications, including the differences with Applied Behaviour Analysis (ABA).
The Goals of Positive Behaviour
PBS has two primary goals: to maximise the individual's quality of life (primary) and to minimise behaviours of concern (secondary). Instead of focusing solely on eradicating problematic behaviours, PBS strives to understand these behaviours from the individual's perspective. It shifts the question from, "What's wrong with this person?" to "What can go right in this person's life?"
At the heart of PBS are specific values, strategies, and procedures that guide its implementation:
Values
Person-Centred Planning: PBS prioritises the individual's perspective, specific needs, and goals over staff values.
Self-Determination: It empowers individuals to make informed choices and decisions with the support of those who know and care for them.
Wrap-Around Processes: PBS plans are needs-driven and strengths-based, focusing on the person's strengths rather than deficits.
Strategies
Self-Directed Approaches : These strategies place the individual at the centre of service design and decision-making, offering personalised support to achieve their wishes and aspirations.
Capable Environments: Those that support a person effectively and provide the optimal setting to support positive interactions and opportunities.
Skill building and therapy: These assist the person to have the skills to meet their needs and increase independence and participation.
Planning Procedures
Helping Individuals Identify Their Goals: PBS assists individuals in determining what they want in their lives.
Clarifying Support Needs: It ensures a clear understanding of the support required to pursue aspirations.
Involving Supportive Parties: PBS brings together people who play a role in supporting joint problem-solving.
Motivating and Energising: It motivates individuals and shapes contributions from service agencies based on their perspective.
PBS emphasises flexibility, greater control, and improved outcomes for individuals with disabilities, enhancing their overall quality of life.
Applied Behaviour Analysis (ABA) vs. PBS
Positive behaviour support is a blend of values about the rights of people with disability and the practical science of learning and behaviour change. Both PBS and ABA involve behaviour analysis; they use technology to evaluate antecedents and consequences associated with behaviour.
There is a risk of PBS becoming exclusively values-driven to the detriment of technology. Behaviour support practitioners need to have a thorough grounding in both the philosophical and technological aspects of positive behaviour support so that ethical value and empiricism can be merged to avoid ‘services adopting the lexicon of positive behaviour support but not its core practices.
ABA is a behavioural therapy approach aimed at understanding and modifying behaviour, primarily used to assist autistic children and those with developmental disabilities. ABA encompasses various strategies and techniques that help individuals acquire new skills and manage their behaviour effectively. ABA focuses on improving social, communication, academic, and daily living skills while reducing problematic behaviours such as aggression or inattention. The approach is rooted in behavioural psychology and is based on the principles of environmental stimuli influencing behaviour and the reinforcement of positive outcomes. ABA programs involve assessing a child's current abilities, setting goals, designing personalised teaching programs, and continuous evaluation.
These programs can be delivered one-on-one or in small groups, with an emphasis on creating opportunities for children to learn through everyday interactions. ABA is highly structured, often requiring over 20 hours of therapy per week for young autistic children. It emphasises positive reinforcement and historically has involved punishment. While research supports its effectiveness in behavioural change, there are concerns within the autistic community about ABA potentially not respecting neurodiversity, suppressing natural behaviours like stimming, and sometimes causing stress due to its intensive nature. ABA practitioners vary in qualifications, and it's essential to assess the credentials and experience of practitioners. Ultimately, ABA is one of several therapeutic approaches available for autistic children, and its suitability should be evaluated on an individual basis.
PBS establishes a direct link between functional behaviour analysis results and the development of a support plan. This ensures that individuals with disabilities have their needs met safely while improving their quality of life. PBS does not ever use punishment based strategies, and is in directly opposed to treatments that are coercive, demeaning, restrictive or abusive. PBS practitioners are specialists with tertiary qualifications in disciplines like nursing, psychology, special education, speech pathology, occupational therapy, or social work. They use empirical approaches rooted in scientific principles to assess, develop, and implement evidence-based behaviour support programs. In Australia, PBS practitioners who work in the NDIS, require registration with the NDIS Quality and Safeguard Commission.
Behaviours of Concern
"Behaviours of concern are those of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in serious jeopardy, or behaviour which is likely to seriously limit the use of, or result in, the person being denied access to ordinary community facilities." (NDIS commission)
Behaviours of concern are socially constructed and result from the interaction between the individual and their environment. They may be reactions to an inappropriate environment, communication of unmet needs, or responses to overstimulation. PBS focuses on changing disabling environments rather than labelling individuals as problematic.
Restrictive Interventions
In Australia, there are laws and regulations around restrictive practices and at times, PBS practitioners are required to include a protocol for an authorised restrictive practice in the Positive Behaviour Support Plans. Restrictive practices are used as a stopgap measure while more proactive measures are being implemented, and should always be assessed ongoing and faded out as soon as is practicable.
Under the disability service act these restrictive practices need to meet the following:
The least restrictive option to keep the person, their supporters and wider community safe
Used as a last resort when all other non-restrictive strategies have been attempted.
Be necessary to reduce harm
Proportionate to the risk associated with the behaviours of concern
Used for the shortest period of time possible
The restrictive intervention needs to be included in an authorised Behaviour Support plan with a very clear protocol (Outlining the above). The PBS plan primary focus, is always in relation to increasing the person's quality of life.
For instance, a physical restraint may look like a gentle blocking during meal time assistance, if a person with disability is at risk of pulling their PEG out, which could result in them having to undergo life threatening surgery. The protocol would clearly outline the exact procedure, time, context, and recording of the intervention. The person using the restrictive practice, is obligated to report monthly on any use of authorised restrictive practices, and within 5 days in relation to any unauthorised use.
Behavioural Assessment
Behavioural assessment is a critical aspect of PBS, aiming to understand why problematic behaviours occur. It involves systematically gathering information about the individual, their environment, and the behaviours of concern. A hypothesis-driven approach is used to generate preliminary explanations for these behaviours. This process includes direct observation and an analysis of the intervention's system or environment. Every Behaviour support plan requires to be based on a Functional Behavioural Assessment.
PBS is defined as a multifaceted approach building from functional behavioural assessment of behaviours of concern, resulting in a comprehensive and educative support plan. Its foundational components include functional behaviour analysis, antecedent manipulations based on assessment, teaching strategies, and altering contingent reinforcement to emphasise the positive and reduce or remove aversive elements.
PBS's Applicability
PBS is applicable to people of all ages and abilities, with or without disabilities, across various settings. It recognises that every individual, regardless of their behaviour, possesses basic human rights, and any assessment or intervention should respect and support these rights. Understanding the purpose of existing behaviours, aspirations, and the environment in which they occur is essential for developing effective behaviour change strategies.
Conclusion
In conclusion, Positive Behaviour Support is a holistic approach that prioritises the individual's well-being and focuses on understanding the meaning behind their behaviour. It is applicable to individuals of all abilities and aims to create supportive environments that enhance their quality of life. PBS practitioners, well-versed in both values and technology, play a pivotal role in implementing this approach successfully. By addressing behaviours of concern in a person-centred manner, PBS seeks to promote a more inclusive and supportive society.
Reference: https://www.daru.org.au/wp/wp-content/uploads/2018/04/Positive-Practice-Framework-April-2018-.pdf
An Introduction to PBS
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