Function function function

image

This week has seen the launch of the guides for families for PBS by the PBS Academy.  I was one of the original contributore of the PBS Competency Framework so I support what they are trying to do. However, I would like to raise some supportive questions in order to improve the services people with learning disabilities receive.

A rough scan of the documents here and I estimate 80% of the content is good person centred planning and not PBS. A key aim when developing the competency framework was to clarify what PBS is and stop the increase in practice that says it is PBS when it is not. Are the PBS Academy achieving this and helping to define the difference of blanket improvements to quality of life compared to quality of life improvements that are related to the functions of challenging behaviour? Do these guides help families differentiate from services that use PBS and services that use person centred approaches alone?

The documents describe functional assessment but don’t provide a lot of detail on what the markers of a high quality functional assessment should be and who is qualified to undertake this. When PBS is being promoted as the answer to the post Winterbourne agenda is the PBS that these documents describe going to be enough to support people with learning disabilities and complex challenging behaviours to live in their own homes safely? Will it prevent the heartbreak families face when homes and placements break down and admission or arrest occurs?

We do a functional assessment to design function based, instead of behaviour based, interventions. This cognitive shift is central to the success of PBS. However, the guides for families only discuss primary responses to behaviour (green), secondary responses to behaviour (Amber), reactive responses to behaviour (red) and post incident responses to behaviour (blue). Where are the plans to meet function? There is no discussion about how we support people to learn functionally equivalent behaviours (positive programming), how we ensure these new behaviours are more reinforcing (focussed strategies), or how we change the ecological factors to support the new behaviours to happen more (ecological strategies).

The core underpinnings of PBS is to make challenging behaviour redundant by understanding the function and giving people the “disruptive technologies” that make the challenges redundant by increasing skills.

Is this a missed opportunity by the PBS Academy by not fully representing what quality PBS is about? Does this support the acceptance that people with learning disabilities cannot develop further? Instead of a constructive approach to PBS, supporting people to continuously develop, the guides seem to support the assumption that all we have to do is manage what we are presented with (in a proactive way) instead of having aspirations for people to develop and continuously grow.