Including positive behaviour support in the core service ...

Specifying positive behaviour support, creating capable environments Peter McGill Overview Tools for The use of PBS with individuals The organisational context within which PBS is used Identifying and designing capable environments Other tools include PBS competency

framework and other resources developed by PBS Academy What we know about challenging behaviour Importance of understanding the immediate context But broader context also important Genetics Health Personal capacities Components of PBS

Personalised Systematic (functional) assessment Identification of broader influences Proactive supports Reactive supports

Reduce challenging behaviour and improve quality of life Avoid punishment and minimise restrictions Why we should use PBS Best evidenced approach (case studies, metaanalyses, RCTs) Best supported approach (NICE, DH, Mansell report, BPS, RCPsych, RCSLT) Internationally endorsed (Australia, USA) What should the service specification say? For individuals (Tool 1)

Written PBS plan Based on assessment Specifying why challenging behaviour displayed Identifying how to prevent it Identifying how to replace it Identifying how to respond to it With monitoring/review arrangements But PBS cannot be implemented in a vacuum or a challenging organisational environment So important to also specify those elements

that need to be in place to support this kind of focussed, individualised approach What should the service specification say? For organisations (Tool 2) Leadership/ownership User/carer/family involvement Person-centred culture Acceptable physical environments Active support of alternatives to challenging behaviour Trained, well-deployed staff Data-driven practice

Learning organisation Challenging behaviour doesnt belong to the individual Rather it occurs in contexts of Immediate support and interactions Classroom/group home/workplace setting, practices and culture Organisational policies and procedures These are all components of the environment that may be challenging or capable

A whole-system understanding and approach are necessary What is a capable environment? A social/physical context which supports capable behaviour and discourages challenging behaviour (Tool 3) Based on A sound understanding of the causes of challenging behaviour Recognising challenging behaviour as a problem of the system not (just) the individual The ability and opportunity to intervene across the system

With a focus on improving the quality of support, care and treatment In practicedeveloping more capable social care environments Structured model of social care (see next

slide) Agreeing goals or standards for the setting to achieve (cf. LaVigna et al, 1994) Support, training, monitoring and feedback with staff = Setting wide positive behaviour support Health Communication/ Social Interaction Activities and skill

development Relationships / Family and Others Physical Environment Service Management Service Staff Wider

Organisation Aberrant Behaviour Checklist scores 60 50 40 Experimental Control 30 20 10

0 Time 1 Time 2 Time 3 Additional information More on the research project at https:// www.kent.ac.uk/tizard/research/research_projects/new _research-pages/preventingcb.html More on capable environments at https://

www.kcl.ac.uk/sspp/policy-institute/scwru/news/2014/n ewsfolder/McGill-et-al-Capable-environments.pdf Mark Dornan has developed a visual representation of some of these ideas https:// my.visme.co/projects/n067jyy7-capable-environments-2 Contact me at [email protected]