By Jonathan Beebee
I have a reputation for challenging everything. I am split as to whether this is a good thing or a bad thing.
How I see this is people are finding me “challenging”. My professional stance on challenging behaviour is that it is behaviour that challenges others. Sometimes my behaviour challenges others. I accept this. In general the people my behaviour challenges are people who specialise in working with challenging behaviour, so surely my challenging behaviour will be something that they will celebrate, right?
Suggesting I challenge everything is a little inaccurate. I have some core beliefs and values about Positive Behaviour Support and I aim to maintain integrity to my viewpoint. I won’t change my viewpoint to be accepted by the gang. I won’t accept things that don’t agree with my beliefs just because they are said by someone who is in a position of high esteem.
Those who know me will know I find one of the biggest challenges out there at the moment the wealth of the P.B.S that is Positively Bull Sh*t. Here are my key values and beliefs that I view things against using my Positively BS (versus genuine PBS) detector:
– Positive Behaviour Support is underpinned by the science of Applied Behaviour Analysis
Understanding behaviour is complex. Understanding the behaviour of people with learning disabilities can be even more complex. There is a genuine science that can help us understand behaviour. This science can help people learn new skills (fantastic news for people with a disability in learning) and it can help people to change behaviours that are problematic for them. If PBS isn’t underpinned by Applied Behaviour Analysis then what is it underpinned by? what is the scientific evidence base it follows?
– Positive doesn’t mean “good”, it means “adding”
Some people take the stance Positive Behaviour Support means supporting behaviours that are “positive”. Who are we to say which behaviours are “positive” for others and which are not? If the only behaviour a person knows to get the attention they need is to throw poo at others, then for them this behaviour is extremely “positive” (i.e. good). We have absolutely no right to say this is not a “positive” behaviour.
Saying Positive Behaviour Support means “we are doing good” or “this is when we are using behavioural approaches in a good way” is again a judgement we are making that isn’t ours to make. (This is often when people try to add “al” and call it Positive Behavioural Support).
The key difference I see in Positive Behaviour Support is its about recognising people with learning disabilities have fewer behaviours than those without learning disabilities to get their needs met. So when there is a behaviour that challenges us, preventing or reducing these behaviours is completely unethical. Positive Behaviour Support should seek to “add” (aka “positive”) behaviours, so as we give people more, better, more efficient ways of getting their needs met. If we give people better behaviours the “challenging” ones become redundant (a bit like how CDs made cassettes redundant) and we don’t have to take anything away from people with learning disabilities. So genuine PBS is about taking the ethical standpoint of we want to increase behaviours, not reduce them.
Any approach that calls itself PBS whilst focussing solely on preventing and reducing challenging behaviour sets the Positively BS detector into overdrive. This is no different from behaviour modification that has been done for decades. It need some the additional element of giving people something better.
– PBS is not just about improving quality of life.
Every single approach out there seeks to improve quality of life. So what makes PBS different? Person centred approaches are out there already that by themselves aren’t PBS. So when people describe PBS as being about being person centred and improving quality of life I have to ask myself so what is different to PBS compared to approaches that are not PBS?
For me the answer is that we are focussing on meeting the function of behaviours. The behaviours we are looking at the person are leading to restrictions on the persons life.
The focus of any PBS plan should be about understanding the function of behaviour and supporting people to meet this in a better way. This should lead to skills that stick with the person for a lifetime. It should lead to a reduction of behaviours that challenge as a naturally occurring, good side effect. This should mean more “doors are open” for people and they have more opportunities open in their lives.
– PBS cannot be done by anyone
Please don’t misunderstand this as me saying that not everyone can be part of PBS and wider understanding of PBS will benefit everyone. A wide understanding of PBS is clearly a great step.
As mentioned earlier, PBS is underpinned by Applied Behaviour Analysis. Why should people with learning disabilities not expect to receive this intervention from people who have been trained to a recognised professional standard, who are accountable to their registration/certification, and who are bound to work to a duty of conduct? Saying that support staff can do this unaided and unsupervised after attending a days course is ridiculous. It needs professional/clinical leadership.
We wouldn’t accept heart surgery from a support worker with a NVQ level 2 in heart surgery. We wouldn’t accept CBT for depression from a support worker with a BTEC in CBT. Why is it acceptable for people with learning disabilities to receive a half baked intervention from half trained staff? And we wonder why problem behaviour exists.
I recently saw a man who was putting his finger to his cheek and twisting it. The support said “ah he is asking for bonjella” and promptly went to get the bonjella and applied it. He was using the Makaton sign for sweets. What he was asking for was not understood. He was learning that a behaviour he had learnt now had a new reinforcement. He was now also unable to ask for sweets as they didn’t get it. And we wonder why people with learning disabilities have challenging behaviour.
In summary, I am arguing for high quality PBS for people with learning disabilities. Why should we not accept the best. If something passes my Positively BS detector I wouldn’t challenge it, but sadly I haven’t found anything yet. And this may mean I appear to challenge everything. I am willing to accept that my behaviour may challenge others and the label that I have “challenging behaviour”, and I embrace it. Maybe one day something will start meeting the function of my behaviour.
I became fed up of sitting on the side lines with a critical eye saying what everyone is doing wrong from afar a long time ago. I established PBS4 with the aim of rolling my sleeves up and showing how it should be done. Gosh, do I now know how difficult it is to get things delivered how you plan! But we are on a journey and we will get there. I am trying to stick true to the reality that 20 years ago I was nearly in a position where I would have been dependent on support for the rest of my life and could have been that person who was classed as “challenging”, so is the PBS out there now good enough for me? Sadly no. So I will continue to maintain my integrity. We still have so far to go.
Nothing should be beyond challenge. Myself included. Challenge everything? Well why not!