Positive behaviour support and supported
decision-making:
People with behaviours of concern and
forensic disability
Supported Decision-Making Conference,
Office of the Public Advocate, 18th October 2013,
Victoria University
Jeffrey Chan, PhD
Chief Practitioner, Yooralla and
Adjunct Professor, University of Queensland
Aims of the presentation
1. What is positive behaviour support?
2. What is “mediator analysis” in positive behaviour support?
3. Why supported decision-making is important to people
with behaviours of concern and forensic disability?
4. What are some of the practical applications of supported
decision-making in clinical practice in relation to behaviour
support?
What is positive behaviour support (PBS) ?
 Evidence-based therapeutic approach = applied science
 Value-based
 Preventative and drives change in the person’s context
 Collaborates with a range of partners (“agents of change”) to deliver the
systemic change and behavioural change
 Consistent with the CRPD
 Evolving with new technologies and research
What is mediator analysis?
 Traditionally the model is PBS practitioner as consultant, mediators as
“anyone with the reinforcers” and the target as “anyone with the problem”
(note terminology)
 Simply defined as an analysis of the people (partners) and factors that
influence or impact on the delivery and implementation of PBS
 Supported decision-making presents a new context in PBS
 Range of partners – key to successful implementation and delivery of PBS
 Collaborative relationship throughout the process of assessment,
implementation, monitoring and review process, rather than as “experts”
Why supported decision-making is important to
people with behaviours of concern and
forensic disability?
Behaviours of concern can result in –
 Restrictive interventions - physical, mechanical, chemical and seclusion
but also “other” restrictive practices such as access to the refrigerator,
larder, free access to front door etc
 Compulsory treatment - detention orders
 Contact with the criminal justice system - Incarceration
 Limitation of their rights re dignity of risk
 Abuse
What are some key qualities required in this area in
relation to supported decision-making?
 Know the person very well - a positive relationship with the person ,
such as a high level of mutual trust and confidence
 Other partners to know you well and have confidence in the “plan”
 Know the “subject matter” very well
 Advocacy – “don’t give up”
 Tiered approach
What are some of the practical applications of
supported decision-making in clinical practice in
relation to behaviour support?
Preventative approach
•
Saul is a young man with autism and who presents with a long history
of elopement. There have been some occasions where there had been
minor accidents with motorists and cyclists. Given this history and advice
from the local police, Saul is often secluded and the front door is locked.
He lives with three other men.
• Miriam had lived in an institution for most of her childhood and early adult
years. She recently moved into supported community living. She
presents with self-injurious behaviour of skin picking left side of her head
and hitting her left side of her head with left palm or wrist. She also
presents with a history of physical aggression against staff. She is
mechanically restrained. She will request for her restraint.
What are some of the practical applications of
supported decision-making in clinical practice in relation
to behaviour support?
Advance planning
• Gina is a young woman mild intellectual disability and a history of trauma
re severe sexual assault over several years. She presents with a
extensive history of self-harm such a cutting arms, inserting objects into
her wounds, swallowing small objects etc. She is subject to medication
and seclusion often, and often requests to be secluded.
• Tobias is a 40-year old man who had lived for most of his life in an
institution, there is no record of family history. He has been diagnosed
with bipolar disorder and mild-low moderate intellectual disability. He
presents with high level physical aggression and subject to a range of
psychotropic medications.
Supported decision-making – what next?
 Lack of research in this area – exciting field and a particular relevance to
people with behaviours of concern
 To date – people with mild to moderate level of intellectual disability and
some functional level of expressive language and comprehension
 Can benefit from drawing on other paradigms re cross-disciplinary
approach
 Fundamental – a person exercising his/her rights and responsibilities
Readings
Allen, D. (1999). Mediator analysis: annoverviewof recentresearch oncarers supporting peoplewith intellectual disability andchallenging
behaviour.. Journalof Intellectual Disability Research, 43(4), 325-339.
Chan, J., French, P., &Webber,L. (2011). Positive behaviouralsupport andthe UNCRPD. International Journal of Positive Behavioural Support,
1(1), 7-13.
Chan, J., French, P., Hudson, C., &Webber,L. (2012).Applying the CRPD to safeguardthe rights of peoplewith adisability in contact with the
criminal justice system. Psychiatry, Psychology andLaw, 19(4), 558-565.
French, P., Chan, J., & Carracher, R. (2010). Realising humanrights in clinical practice andservice delivery to persons with acognitive impairment
who engage in behaviours of concern. Psychiatry, Psychology & Law, 17(2), 245-272.
Gooding, P. (2012). Supported decision-making: arights-bseddisability concept and its implications formentalhealthlaw. Psychiatry, Psychology &
Law, DOI:10.1080/13218719.2012.711683.
Pathare, S., & Shields, L.S. (2012). Supported decision-making forpersons with mental ilness: a review. Public Health Reviews, 34(2), 1-40.
Hogren, K.A., & Broussard, R. (2011). Exploring theperceptions of self-determination of individuals with intellectual disability. Intellectual and
Developmental Disabilities, 49(2), 80-102.
Webber,L., McVily, K., Fester, T., & Chan,J. (2011). Factors influencingthe quality of behaviour support plans andtheimpact of quality of BSPs on
the useof restrictive interventions in disability services inAustralia. International Journal of Positive Behavioural Support,1(1), 24-31.
Wils,S., Shephard, J., & Baker, P. (2013). Evaluating theimpact of positive behaviloursupport training onstaff knowledge, attributions, emotional
responsesandhelpingbehaviour: capturing hearts andminds. International Journalof Positive Behavioural Support, 3(1), 31-39.
Woolls,S.,Allen, D., & Jenkins, R. (2013). Implementingpositive behaviouralsupport ing practice: the views of mediators andconsultants.
International Journalof Positive Behavioural Support, 2(2), 42-54.
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People with behaviours of concern and forensic disability