Jonathan Beebee




“The Department of Health with external partners will publish guidance
on best practice around 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.”
Transforming Care, DH 2012
“The core principles for commissioning and specifying services outlined
below stem from PBS.”
Ensuring Quality Services, LGA 2014
“Evidence has shown that PBS-based approaches can enhance quality of
life and also reduce behaviours that challenge which in turn can lead to a
reduction in the use of restrictive interventions.”
Positive & Proactive Care, DH 2014
“Positive behaviour support is widely accepted as good evidence-based
practice when supporting people with learning disabilities and/or autism
who display or are at risk of displaying behaviour that is challenging.”
Positive & Proactive Workforce, Skills4Care 2014


Not clearly defined in the UK.
This leads to:
“PBS practitioners” with no qualifications
 Providers claiming to do PBS as it is what everyone wants
 Lack of clarity when it comes to evaluating how “PBS” a
“PBS plan” is
 Inconsistencies in practice, leading to inconsistencies in
what our customers receive

This all leads to a big risk that PBS will be the same old
practices rehashed, or an intervention that has potential
being written off because not correctly applied


Positive Behaviour Support is Supporting Positive
Behaviours. Not Positive behavioural approaches, not
positively BS.
“An approach that blends values about the rights of
people with disabilities with a practical science about
how learning and behaviour change occur” Horner,
2000.
 Science of learning (ABA) ideal for people with a disability in
learning.
 We teach replacement skills to make challenging behaviours
irrelevant, they reduce as a natural side effect



“We explicitly & unashamedly use the practices of
ABA to achieve culturally valued goals” Lavigna, 2012.
Needs technology of ABA + values
Who is competent in ABA?







Competence in ABA required, at least in
supervision
Interviews
Rating scales
Review recordings
Direct observations
Triangulation
Frequently there is not enough focus on direct
observations, leading to assessments being largely
based on other peoples reports.




PBS aims to understand functions of challenging behaviour,
then define plans to teach and promote functional
alternatives.
Consider a plan based upon “Ben hits himself when he
wants to avoid demands. We are going to consider our
primary responses to reduce this behaviour, secondary
responses when there are warning signs, and reactive plans
when it all goes wrong”
Now consider a plan based upon “Ben hits himself in the
head when he wants to avoid demands. We are going to
plan to teach Ben another way to avoid demands, we will
consider the environmental needs, and how he knows this
new way is more effective.”
One is PBS, the other is risk management. One is focussed
on function, the other is focussed on behaviour.



Too often the focus is solely on environments
We create Disneyland’s in peoples homes that
they cannot safely leave
Need a larger focus on teaching skills


Consider if someone has a fear of dogs. The
environment control is to never go out so you don’t
see a dog.
https://www.youtube.com/watch?v=32yNVG
CrUSk




Punishment in behavioural terms ONLY refers to
reduction of behaviour in the future. Not abuse,
not harsh consequences – we should oppose these
anyway. But punishment is not abuse - hugs can
punish!
Aim is to avoid aiming to provide learning
through negative consequences and to avoid doing
things that people don’t like
Medication, physical intervention, reprimands,
time out, ignoring, etc do not belong on a PBS
plan.
Beware of “hidden punishments”.







Function based assessments
Function based plans
Constructive plans
Enabling environments
Enabling development of skills for
independence
Ensuring rich access to positive reinforcement
If Reactive strategies are included totally nonaversive