Fast Triggers & Slow Triggers??? My concerns re the future of PBS in the UK

I was in the pub the other day, chatting to a friend about the use of the terms “fast triggers” and “slow triggers” (Yep, I am a riot to go to the pub with!). These terms are sometimes used to simplify antecedents that affect behaviour. I personally don’t like these terms as I feel they misrepresent the science of how behaviour works. My friend thought I was getting hung up on semantics, and I didn’t fully explain why it was more than that, so I thought I would blog it out here. I will try and explain the things I talk about in as plain English as I can, but I may at times accidentally slip into geek speak! If I do this, please feel free to contact me to explain anything clearer.

So lets start with “fast triggers”. This term is used to present what a ‘discriminative stimulus’ is, in simple terms. These are things that tend to happen immediately before a behaviour. The problem is a discriminative stimulus doesn’t trigger anything! It doesn’t produce a behaviour, it lets you know a reinforcement is available.

I will try and explain it here with a real situation. A discriminative stimulus for me is seeing a pack of Rolo’s. When I see them I know that Rolo’s are available. The behaviours I select to use will largely depend on environment on the environment I am in.

– If I see a pack of Rolo’s at home I will just pick them up and eat them.

– If I am in a shop I take them to the lady behind the counter, give her some shiny coins and walk out the shop with them

– If the Rolo’s are with a friend I might ask them for a Rolo if I am feeling cheeky, or I might pass comment, such as “oh I see you’ve got Rolo’s, what you going to do with your last one?” (hoping they say its for me!).

Seeing the Rolo’s lets me know they are available. It doesnt “trigger” a behaviour. When I know Rolo’s are available I select from the behaviours I have learnt what I think will most likely result in me getting them. I know that if I see them at home I don’t have to give coins to my wife. I don’t walk into a shop and see them, and walk up to the lady behind the counter and say “I see you’ve got Rolo’s, what are you going to do with your last one?”!

But what if I hadn’t learnt these behaviours? What if I had learnt if I see Rolo’s at home and I take them someone will stop me and tell me that it is bad to take them? How would I respond when I saw them then? I guess seeing Rolo’s may make me display behaviours that challenge you.

This is what we need to consider for people with disabilities in learning. If you focus on what are the fast triggers for this behaviour you would conclude that when I see Rolo’s I am challenging. Your intervention would be to never show me the “fast trigger” of the pack of Rolo’s ever again. So I would be denied from seeing or eating Rolo’s ever and never enjoy a pack of Rolo’s because you are focussing on the “trigger” for the behaviour, and not what reinforcement the discriminative stimulus is indicating, or why I have selected this behaviour to achieve this function. But if you did focus on the function you might consider teaching me appropriate ways to get Rolo’s instead. 

I fully appreciate that the term “discriminative stimulus” doesn’t slip off the tongue and isn’t everyday language. But by choosing to simplify this with the term “fast triggers” is inaccurate. “Fast triggers” puts the focus straight on the behaviour and not the function. It misses that behaviours are learnt and selected depending on their successfulness in different environments. And it misses that they may not necessarily be fast.

So discriminative stimuluses let me know that Rolo’s are available. I can then consider what behaviours have worked in that environment before. But then there will be a whole lot of other things going on too, like motivating operants – things that affect how much I want the Rolo’s. If I have just eaten a 200g bar of Galaxy I won’t care there is a pack of Rolo’s there. The “trigger” isn’t working. The term “fast triggers” misses things like this and provokes the assumptions that a trigger always equals a behaviour.

So lets look at “slow triggers”. I will use headaches and violence to illustrate this, but if I have a headache and you are near me I promise I am not usually violent. Slow triggers are generally used to describe “setting events”. If a headache is a slow trigger you might think that if I have a headache I might punch you in the next hour. The trigger has been pulled and it is just a matter of time! That’s not how setting events work.

Setting events make discriminative stimuli more potent. So most the time I can handle it when someone comes in and I am eating my Rolo’s and they help themselves to one of my sweets, I might even be generous and share them myself without prompting! But if I have a headache and you come in and take one of my Rolo’s, the headache has made you taking my sweets more potent/powerful, so I might punch you. Nothing slow about it!

But when I have a headache it will have a bigger effect than just when you take my Rolo’s. It might affect the value of things I usually find reinforcing (like sitting in the pub discussing behaviours) or might make things I don’t usually do more appealing, like having a long bath. So is this still a “slow trigger” for me, has this triggered slowly me avoiding things I normally like, or slowly do things that I don’t normally do? Again, the term “slow trigger” over-simplifies things in my view.

If you were told headaches were a slow trigger for me punching you, when I get a headache you would be extremely worried about when I am going to definitely punch you, as that’s what it says I will do. If you understand that headaches will affect my behaviour, that they may make things that irritate me more potent, and that it changes things I find reinforcing you would have a whole different plan.

So again, a very understandable attempt to simplify the language, but the science behind it is lost. The focus of where the intervention needs to be is skewed and behaviours that could have been understood with the application of the science is missed in a defensive – “avoid my challenging behaviour” – approach rather than understanding function and supporting the learning of successful strategies.

I hope I have clearly explained my frustration here. It is more than semantics, it is science. If you dont understand what an elephant is you dont just call it a monkey! And even if it is just about words, words are really powerful – as we all know in the learning disability field some words used are very disrespectful and disempowering. Here the use of words instantly puts the focus on the behaviour by looking at what triggers it, instead of understanding the science and the function and how we can help people with disabilities in learning to learn alternatives.

So, some of you will not have heard “fast triggers” and “slow triggers” before and be wondering where these are used. Well you can find it in the BTEC course on PBS. It was announced in the “Transforming Care (post Winterbourne): One year on” that this is the course that the British Psychology Society will be sending 15 Psychologists on to prepare them to be the lead agency in taking forward Positive Behaviour Support in the UK.

I have had concerns for some time, and I have not been alone, in relation to whether Psychologists have the competencies required to undertake and take forward Positive Behaviour Support. Psychology training has focussed very little on behavioural sciences, focussing on cognitive models of psychology, for a long time now. This has lead to a huge skills gap in the profession. There are some exceptions to this, but many psychologists will agree that this competency gap exists.

So why has the Winterbourne View Joint Improvement Programme (I really wish they would change their name!) chosen the British Psychology Society to lead on this? Well I guess to the uninformed this would be the logical choice, but again if theProgramme  leads are uninformed is this not also a concern?

So who does know all this stuff about behaviour you may be asking? If its not the BPS who should lead on it then? Well I know this stuff because I have just finished a 3 years masters that is accredited by the Behavior Analysis Certification Board so as I can apply to become a Board Certified Behaviour Analyst (BCBA). BCBA’s have studied behavioural science in depth, and had extensive practice and supervision experience before the Behavior Analyst Certification Board will certify them as a practitioner who can work to behavioural sciences and to their code of conduct.

BCBAs are represented by the UK Society for Behaviour Analysis in the UK. Perhaps the UK Society for Behaviour Analysis would be in a better position to lead on this? Or what about the British Institute for Learning Disabilities (BILD)? BILD have been the leading authority on Positive Behaviour Support in the UK for some time. They provide training and have more publications on Positive Behaviour Support than anyone else. They are just about to launch the Center for the Advancement of Positive Behaviour Support, and BILD have the impartiality of not having any professional body’s best intentions at heart, and they are solely there for people with learning disabilities.

To the informed the current direction of Positive Behaviour Support in the UK is concerning. It will be led by psychologists talking about “fast triggers” and “slow triggers” without fully understanding or promoting the science. The leadership of the Winterbourne View Joint Improvement Programme has just changed. Maybe this is an opportunity for some U-turns on what has been agreed so far? Positive Behaviour Support has so much potential if implemented correctly, but the current direction will lead to little more than old school Behaviour Modification being relabelled. Someone should address this, but who?

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