It’s not just quality of life

You will no doubt have heard someone say Positive Behaviour Support is all about improving quality of life. “We just listened to what he wanted…” or “We did things his way and now we don’t need to restrain him” are some of the common themes you will hear in this perspective.

I agree without a doubt that doing things the way that person wants and improving quality of life are core components of PBS. But I disagree this on its own is not enough to be Positive Behaviour Support. Here’s why.

If you aren’t doing this then what are you doing!

Are there really approaches out there that don’t listen to people, try to do things their way, and try to improve quality of life? How is this any different to any other approach that is out there? If you are in the health or social care profession and these are not your goals you are in the wrong career. It is also something that is very easy to say you are doing but difficult to prove.

When we are saying we are improving people’s lives are we doing it to our beliefs of what is good or theirs? How do we know it is what they consider good if they cannot tell us?

lack of respect for people who are experiencing challenges. 

If the notion is that when people are listened to and their quality of life is good they are not challenging, then the assumption is that if someone is challenging us we obviously aren’t listening and are not trying to improve quality of life.

I have worked with many families and teams who have been challenged. Usually, they are doing their very best in a very difficult situation. If you are a parent who is challenged by your child’s behaviour and you know if you ask for help they will come in and tell you that you are obviously not listening to him enough or you should just try to make his life a bit better would you ask for help?

PBS is more than that

I see PBS as being on a spectrum of interventions. Person Centred Support is a values based approach to supporting people with learning disabilities that focuses on listening to people and improving their quality of life. I would estimate that for around 80% of people whose behaviour challenges others Person Centred Support will address this.

There are some people for whom person centred approaches alone would lead to people rocking in the corner in the name of “choice”. Some people need additional support and encouragement to sensitively try new things, to experience success, and increase occupation. For many of these people Active Support alongside Person Centred Support is needed.

And finally there are a small number of people whose behaviour is challenging their supports to a level that engaging in activities is not easy. In this instance PBS and Active Support and Person Centred Approaches are needed. You cannot do PBS without Person Centred Approaches.

Multi Elimental

PBS needs to be based on the science of behaviour and must be multi elemental.

Firstly we need to understand the function. Sometimes this is simple but other times a detailed functional behaviour assessment is required to properly understand the function of a behaviour. When we understand that function we can then plan how we can support the person to meet that function in a better way.

There is nothing prescriptive about what should or shouldn’t be in a multi elemental approach. However, they are commonly arranged with the following headings:

  • Teaching new skills – giving people better ways of getting what they want
  • Environmental interventions – changes to the physical environment and people in it (approaches by support) to make the new behaviours more likely and the environment more supportive
  • Focussed strategies – reinforcement is key to learning for all of us. People with learning disabilities sometimes need support in understanding reinforcements are connected to actions so we make plans to ensure reinforcement is effective
  • Proactive Strategies – how we avoid the behaviours that challenge us from occurring
  • Active Strategies – how do we respond to early warning signs that behaviours that challenge us may occur, or how do we manage risks in high risk situations that we know are likely to lead to these behaviours
  • Reactive strategies – how do we respond when the behaviours that challenge us are occurring to end the situation as quickly and safely as possible.

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A moral decision

Positive Behaviour Support is using the word “Positive” to mean “adding”. People with learning disabilities have learnt fewer behaviours than us to meet their needs. What right do we have to reduce or stop behaviours when behaviours that are effective for them are challenging us? In PBS we are choosing to “add” behaviours instead of reducing them.

Understanding the function of behaviour, changing our focus away from reducing the behaviour to meeting the function instead, and choosing to add behaviours instead of take behaviours away is central to what PBS is about. You can improve quality of life without doing this, but you are not delivering PBS if Quality of life is your only focus.

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