Positive Behavioural Support:
Singing from the same hymn sheet
Dr Peter Baker
Transforming care: A national response to
Winterbourne View Hospital Department of Health Review: Final
Report
‘The CQC inspections revealed widespread uncertainty on the use of
restraint, with some providers over-reliant on physical restraint
rather than positive behaviour support and managing the
environment to remove or contain the triggers which could cause
someone to behave in a way which could be seen as challenging. In
Winterbourne View, bullying, punishment and humiliation were
disguised as restraint.’ (para 7.28)
‘With external partners, the Department of Health will publish by
the end of 2013 guidance on best practice on positive behaviour
support so that physical restraint is only ever used as a last resort
where the safety of individuals would otherwise be at risk and never
to punish or humiliate.’ (p.44)
‘Providers should have... a whole organisation approach to Positive
Behaviour Support training....recruit for values and ensure that staff
have training for skills - mandatory training which can include
training on value bases when working with people with learning
disabilities, positive behaviour support....etc.’ (p.54)
Positive Response Training & Consultancy
2013©
UK Support for PBS
Ensuring quality
services
Core principles for the
commissioning of
services for children,
young people, adults
and older people with
learning disabilities
and/or autism who
display or are at risk
of displaying
behaviour that
challenges
Positive &
Proactive
Care: reducing
the need for
restrictive
interventions
A positive and
proactive
workforce. A guide
to workforce
development for
commissioners and
employers seeking to
minimise the use of
restrictive practices
in social care and
health.
Opportunities
• Clarification
• Development of PBS
• Clarification
• Involvement
• Unity
A framework for understanding why challenging behaviours occur
Vulnerabilities
Maintaining
processes
Challenging
behaviour
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Impact
Exclusion, harm to
self, harm to others
A framework for understanding why challenging behaviours occur
Vulnerabilities
Maintaining
processes
Impact
Biological
•Sensory/physical health
problem
•Genetic vulnerability
Psycho-Social
Negative life events
Challenging
behaviour
Communication deficits
Adaptive skills
Impoverished social networks
Lack of meaningful activity
Mental health problems
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Exclusion, harm to
self, harm to others
A framework for understanding why challenging behaviours occur
Maintaining
processes
Impact
Pain reduction
Challenging
behaviour
Other people’s
behaviour
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Exclusion, harm to
self, harm to others
Influences on other people’s behaviour
Beliefs and attitudes
Other people’s
behaviour
Emotions
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
Influences on other people’s behaviour
Beliefs and attitudes
Other people’s
behaviour
Emotions
Hastings, Allen, Baker, Gore, Hughes, McGill, Noone & Toogood (2013)
UK Definition
Positive behavioural support is a multi-component
framework for
(a) developing an understanding of the challenging
behaviour displayed by an individual, based on an
assessment of the social and physical environment
and broader context within which it occurs;
(b) with the inclusion of stakeholder perspectives
and involvement;
(c) using this understanding to develop, implement
and evaluate the effectiveness of a personalised
and enduring system of support; and
(d) that enhances quality of life outcomes for the
focal person and other stakeholders.
Gore, McGill, Toogood, Allen, Baker, Hastings, Noone & Denne (2013)
Scope for PBS
PBS may be implemented in at least three main ways:
• On a case-by-case basis by a single practitioner
coordinating all elements of the framework and leading
each stage of the process, (e.g. Emerson et al, 1987;
Toogood et al, 1994; Blunden and Allen, 1987).
• By professional teams where different professionals
contribute to different elements of the PBS framework or
process (e.g. Allen et al, 2005; Hassiotis et al, 2009).
• Through system-wide approaches whereby the PBS
framework is implemented at varying levels of intensity
via a tiered-model of prevention that covers an entire
organisation or geographical area (Allen et al, 2005;
Sugai and Horner, 2009; Allen et al, 2012).
Gore, McGill, Toogood, Allen, Baker, Hastings, Noone & Denne (2013)
PBS emerged from several key
concepts:
Applied
Behavioural
Analysis
Social Role
Valorisation
(Normalisation)
Person Centred
Approaches
Positive Response Training & Consultancy
2013©
Defining Positive Behavioural
Support
(Gore, McGill, Toogood, Allen, Hughes, Baker, Hastings, Noone & Denne
l,2013)
PBS VALUES
•Prevention and reduction of
challenging behaviour occurs within
the context of increased quality of
life, inclusion, participation, and the
defence and support of valued social
roles
•Constructional approaches to
intervention design build
stakeholder skills and opportunities
and reject use of aversive and
restrictive practices
•Stakeholder participation informs,
implements and validates
assessment and intervention
practices
Positive Response Training & Consultancy
2013©
Theory & Evidence Base
• An understanding that
challenging behaviour
develops to serve
important functions for
people
• The primary use of
applied behaviour
analysis to assess and
support behaviour
change
• The secondary use of
other evidence-based
approaches to support
behaviour change
PBS PROCESS
•A data-driven approach to
decision making at every
stage
•Functional assessment to
inform function-based
intervention
•Multicomponent
interventions to change
behaviour (proactively) and
manage behaviour
(reactively)
•Implementation support,
monitoring and evaluation of
interventions over the long
term
Positive Response Training & Consultancy
2013©