Positive Behaviour Support (PBS)

Positive behaviour support (PBS) is a person-centred approach to supporting people with learning disabilities and/or autism to reduce behaviours of distress and improve their quality of life.

Dimensions use PBS to create personalised positive behaviour support plans for individuals with a range of different needs, to help people like Isabelle, Gillian, Paul and Richard improve their quality of life, reduce distressed behaviour, and eliminate restraint as a management strategy.

Research and long experience tell us that most behaviours described as challenging result from a failure to understand a person’s distress. With a PBS plan in place, we work to overcome that lack of understanding and provide the support needed to minimise distressed behaviour.

What is positive behaviour support?

The first PBS services were developed in the 1980s in response to worries about applied behaviour analysis (ABA). While some theories underpinning ABA were carried forward into PBS, the PBS model is more compassionate and person-centred.

So, what is PBS? At its heart, a PBS assessment aims to describe the individual’s distressed behaviour and understand the function that behaviour serves. In doing so, PBS therapists acknowledge that such behaviour can represent a way to communicate an emotion or a need learned in a previous environment.

Our Behaviour Support team focuses on developing person-centred strategies that help people to lead full lives in the community and avoid more costly interventions.

What is ABA & what is the difference to PBS?

We mentioned applied behaviour analysis above – so what is ABA, and how is it different from PBS?

In the past, applied behaviour analysis autism therapy often lacked compassion and was largely ineffective. The roots of ABA go back to the start of the last century when the technique was about measuring behaviour and attempting to change it.

Modern ABA autism therapy avoids these unnecessary interventions and is based on strong ethics, as you would expect from any modern-day therapy. However, the long-term reputation of ABA continues to cause controversy.

You can read more about this controversy in our blog post, Applied Behaviour Analysis vs Positive Behaviour Support.

Why we choose PBS

At Dimensions, we are aware of the ABA controversy and aim to clarify our position as a person-centred PBS services provider. First and foremost, we believe in providing support that improves the individual’s quality of life.

This means that we give equal footing to questions of respect, dignity and individual choice alongside other concerns like promoting good health, protecting safety and offering positive support in place of reactive care.

We see continued evidence supporting the use of PBS care services to reduce the chance of distressed behaviour. This is achieved by understanding the individual, interacting with them accordingly, and changing the environment where necessary.

Our approach

Our approach is built on years of experience and research into best practices in the field. We adhere to the PBS Competence Framework and NICE guidelines.

You can read more about Dimensions’ approach to PBS in our downloadable Behaviours of Distress manual.

 

We combine the expertise of three specialist Dimensions teams to create PBS plans that deliver safe support to individuals in need of behaviour support:

• Behaviour Support Team: A team of experienced professionals with expertise in assessment, planning and training.
• Operational Team: With a broad knowledge of the support individuals need in their local community.
• Circle of Support: Our third and final team, which includes friends, family, and the NHS, will create a group of people who are interested in the person and who we can work with on an ongoing basis to safeguard the individual.

Crisis management

We believe in a proactive approach to crisis management. This means we work to protect the individuals we support while also taking steps to keep our staff safe at all times.

Personalised support

Involving Dimensions from the early outset of an individual’s service design allows us to create personalised PBS plans, including identified behaviour triggers and compassionate ways to understand and address those behaviours.

We encourage independence where possible. That means our PBS services are tailored to meet individual needs without over-supporting individuals. The outcomes of this include cost savings for local authorities while delivering improved quality of life for the individual.

Working together

We implemented several critical processes to ensure that we could deliver consistent, sustainable, long-term placements for individuals.

Some of these strategies include:

• Our Autism Strategy
• Our Complex Needs Protocol
• Services at Risk of Breakdown Review Panel

We are happy to discuss any of these in more detail. If you would like more information or you have any questions, please contact us.

PBS Assessments

Through the functional assessment process, we formulate an understanding of why an individual may be engaging in behaviour. Understanding behaviour underpins the effectiveness of everything else, so assessments are comprehensive and thorough.

We gather information on the factors that influence the behaviours, including through:

• Spending time with and observing the person
• Interviewing key stakeholders (e.g. parents, carers, professionals)
• Document review and incident analysis
• Ecological analysis and service development

The Behaviour Support Team is trained to use a variety of nationally recognised and specialist assessments.

The assessment identifies needs and required outcomes for the individual, forming the basis of a detailed behaviour support plan. The team will use this to ensure that the person gets the very best support.

PBS Planning

Each individual will have a PBS plan written by a behaviour specialist in line with the PBS competency framework. The plan aims to increase the quality of life and minimise or eliminate challenging behaviours by modifying the person’s social, programmatic, and physical environments and teaching them new skills. We write plans with the agreement of all the key people in the person’s life.

Our behaviour support plans include:

• Possible reasons for behaviours of distress
• Proactive strategies – to support positively on a day-to-day basis to ensure needs are being met
• Potential triggers to behaviours and how to minimise their impact
• Active strategies – strategies designed to prevent behaviours from escalating, focusing on de-escalation, redirection, and distraction
• Description of behaviours of distress
• Reactive strategies – strategies designed in response to situations of risk. They involve managing a challenging situation in order to minimise the immediate risk and keep everyone safe.
• Recovery – strategies to support recovery following an incident

We then review and monitor behaviour support plans for:

• Levels of behaviour
• Quality of life, including learning new skills
• The use of psychotropic medication (medication that changes behaviour or mood)
• Use of physical intervention
• How accurately the plan is being used

Goals identified as part of the behaviour support programme are set as outcomes with the person we support and support colleagues, which are in line with their overarching person-centred support plan.

Referrals and funding

Following an initial screening, we will provide a bespoke assessment of planned support and cost.

We expect the cost to fall over time as the person becomes more independent, leading to a complete withdrawal from behaviour support.

Partners and frameworks

Our commissioners include Local Authorities and the NHS. Much of our work is jointly commissioned.

We work through multi-disciplinary teams and in the context of legislation, including:

• Mental Health Code of Practice (2015)
• Health and Social Care Act (2012)
• Equality Act (2010)
• Mental Health Act (2007)
• Mental Capacity Act (2005)
• Health and Safety at Work Act (1974)

These are just some examples—there are many other codes, guidelines, and acts that guide our service provision.

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