Positive Behaviour Support: our PBS approach

Improving quality of life and reducing behaviours of distress

Research and long experience tell us that most behaviours described as challenging result from a failure to understand a person’s distress.

At Dimensions we use Positive Behaviour Support to help people like Isabelle, Gillian, Paul and Richard improve their quality of life, reduce distressed behaviour, and eliminate restraint as a management strategy.

Juanita and Lynsey hugging
Our team develop person-centred strategies that help people to lead full lives in the community

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.

Who we support

It is estimated that 10-15% of people with learning disabilities display behaviours of distress, such as self-injury and aggression. This can result in excess use of medication and lead to physical injury and social exclusion.

By teaching people new skills, improving the support they receive and redesigning their living environments, Positive Behaviour Support (PBS) is proven to be an effective way of improving quality of life and reducing distressed behaviour in people with autism and learning disabilities.

We are passionate about supporting people using our Activate support model.

A values-driven, evidence-based approach.

We aim to understand the reason behind the behaviour, and reduce it through non-aversive strategies that focus on skills teaching, lifestyle change and changing the way the person is supported. If an individual’s needs are met, then quality of life will improve and behaviours that are challenging to support will be reduced or eliminated.

Proactive strategies become part of the day-to-day way we support a particular person. This is how we improve quality of life and decrease behaviours of distress. In behaviour support, the emphasis is always on proactive strategies. (For more information please ask us for our behaviours of distress manual.)

In addition to standard trigger reduction strategies, we have worked hard to develop more technical strategies aimed at teaching people new skills.

We work closely with relatives and support teams, providing hands on training to ensure they have the skills they need to implement a person’s behaviour support programme.

Teaching people the skills they need to live the life they want

Our Behaviour Support Team is trained in sophisticated behavioural skills-teaching techniques. We teach the person what to do when they encounter a trigger for their challenging behaviour.

This approach adds to a person’s skills set and increases their independence. It is the best way to bring about long-term positive changes in behaviour. And it frequently leads to cost savings through reduced need for high staffing levels.

We know that people can learn positive alternatives to challenging behaviour, communicating more effectively and leading happier and less distressed lives.

How we work

behaviour support team structureOur approach combines years of experience with best practice in the field, including NICE guidance and the PBS Competence Framework.

Three distinct Dimensions teams work together to deliver safe support for people who receive behaviour support:

  1. Behaviour support team; which has a depth of professional expertise and experience in specialist assessment, planning and training.
  2. Operational team; with broad expertise at supporting people within their local community.
  3. Circle of support; The final team includes family, friends, NHS, etc. who have an interest in the person and with whom we work continuously in the best interests of the individual.

Crisis management

We take a proactive approach to managing crisis situations, ensuring the people we support and our staff are kept safe.

Personalised support

Our team can be involved from the outset of a person’s service design. Our personalised approach helps to identify behaviour triggers and ways of addressing the behaviour.

Positive Behaviour Support goes a long way to help make sure people are not over-supported and are enabled to lead more independent lives tailored to their needs. This not only improves quality of life for the individual but can also mean considerable savings for local authorities.

Working together

Several critical processes exist to help us consistently deliver long term sustainable placements for people. These include our autism strategy, our complex needs protocol, and our ‘services at risk of breakdown review panel.’ Contact us for more information about any of these – we are happy to share.

Assessment

We formulate an understanding of why an individual may be engaging in behaviour through the functional assessment process. 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:

  1. Spending time with and observing the person
  2. Interviewing key stakeholders (e.g., parents, carers, professionals)
  3. Document review and incident analysis
  4. 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, which will form the basis of a detailed behaviour support plan. The team will use this to ensure that the person gets the very best support.

Planning

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

Our behaviour support plans include:

  1. Possible reasons for behaviours that challenge
  2. Proactive strategies – to support positively on a day to day basis to ensure needs are being met.
  3. Potential triggers to behaviours and how to minimise their impact
  4. Active strategies – strategies designed to prevent behaviours from escalating focussing on de-escalation, redirection and distraction.
  5. Description of behaviours that challenge
  6. 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.
  7. Recovery – strategies to support recovery following an incident.

We then review and monitor behaviour support plans for:

  1. levels of behaviour
  2. quality of life, including learning new skills
  3. the use of psychotropic medication (medication that changes behaviour or mood)
  4. use of physical intervention
  5. 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, in line with their overarching person-centred support plan.

Referrals and funding

Following 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 complete fade out of 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 the Mental Health Act (2007), Mental Health Code of Practice (2015 Mental Capacity Act (2005), Health and Social Care Act (2012), Care Act, Human Rights Act (2010), Equality Act (2010), and the Health and Safety at Work Act (1974), among others.

To find out more about our services for people with challenging behaviour in your area, click the button below: