Positive Behavioural Support (PBS)
for People with Autistic Spectrum
Conditions (ASC)
Dr Lesley Steptoe
Chartered Clinical Forensic Psychologist
Forensic Learning Disability Service and
Behavioural Support and Intervention Unit
Dr Amy Kilbane
Highly Specialist Clinical Psychologist
Autistic Spectrum Condition Service
Aims
• To provide an overview of the PBS model.
• To provide an overview of where PBS fits with
current policy direction and evidence base for
individuals with ASC.
• To illustrate the use of the PBS approach with
an individual with ASC and offending needs.
Positive Behavioural Support (PBS)
• Person centred approach which conceptualises challenging
behaviour (CB) as having a function and a meaning to an
individual.
• Seeks to understand that function and meaning from the
perspective of the individual using functional analysis.
• Values based system of interventions which uses
behavioural strategies to promote personal competence,
respect and community participation, rather than simply
achieving behavioural change.
• Proactive and constructive approach, with a combination of
preventative and planned reactive strategies.
• Quality of life as an intervention and an outcome.
PBS- A Multielement Model (La Vigna & Willis, 1995)
Process
Assessment
Content
Materials
PROACTIVE STRATEGIES
ECOLOGICAL CHANGES
POSITIVE
PROGRAMMING
REACTIVE
FOCUSED SUPPORT
SITUATIONAL MANAGEMENT
SERVICE DESIGN
TRAINING
SOCIAL
CHANGE
AGENTS
OUTCOMES
SPEED & DEGREE
OF EFFECTS
DURABILITY OF
EFFECTS
GENERALISATION
OF EFFECTS
SIDE EFFECTS
SOCIAL
VALIDITY
CLINICAL/
EDUCATIONAL
VALIDITY
Outcomes
SPEED & DEGREE
OF EFFECTS
DURABILITY OF
EFFECTS
GENERALISATION
OF EFFECTS
SIDE EFFECTS
SOCIAL
VALIDITY
CLINICAL/
EDUCATIONAL
VALIDITY
• Outcomes represent the value base and
foundation of the model.
• Complex combination of outcomes requires a
multi-element plan.
• Need individualised and systemic intervention
in relation to all outcomes for each case.
Assessment
• Components of PBS plan based on the outcome requirements.
• Need to gather the information relevant to design these components.
• Assessment methods, information and materials are considered useful if
they contribute to beneficial outcomes.
• Comprehensive behavioural assessment and functional analysis including
direct observations, file reviews, semi-structured interviews,
implementation of recording frameworks and carrying out structured
assessments of impact, contextual control, mediators, motivators and
environment.
• Develop understanding of the meaning and function of the behaviour.
Basis for design of multi-element plan.
Proactive – Ecological Changes
• Make changes to an individual’s environment
to reduce or eliminate environmental triggers
and setting events.
• Try to reduce the mismatch between the
individual’s environment and their needs.
• Some ecological changes can occur
immediately, but many take place over time.
Therefore, must be balanced with other parts
of the PBS plan.
Examples of Ecological Strategies
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Expanding choice in structured way
Improving the communication environment
Routine and structure
Non-contingent access to preferred activities
Matching environment to individual’s sensory profile
Changing the number and quality of interactions
Matching task demands to arousal levels
Proactive – Positive Programming
• Interventions to promote skill development
for the individual.
• Aim to improve the match between the
individual’s skills and the environments within
which they exist.
• Teaching alternative and more appropriate
behaviours.
• Skills may be general, functionally equivalent,
functionally related or coping/tolerance
focused.
Examples of Positive Programming
• Personal care or domestic skills
• Learning a new sport or hobby
• Methods for communicating needs (e.g. I need to
leave, I want you to spend time with me, I need
reassurance)
• How to make choices
• How to cope with feelings
• How to cope with waiting
• How to cope with tolerate non-preferred tasks
Proactive – Focused Support
• Situations which cannot be
prevented/controlled and for which the
individual does not have the skills to cope.
• Provide more rapid effects than ecological
changes or positive programming.
• Aim to produce rapid effects, reduce risk and
minimise the need for reactive strategies.
Examples of Focused Support
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Differential schedules of reinforcement
Antecedent control
Individualised support protocols or guidelines
Medication
Stimulus satiation
Reactive Strategies
• Planned ways of responding in order to stop a crisis once a
behaviour occurs.
• Seek to bring an episode of behaviour under control as quickly
and effectively as possible, with dignity, and minimising risk to
individual and others.
• Good reactive strategies have a gradient approach.
• Does not seek to create changes to behaviour in future, but to
ensure safety in the ‘here and now’.
• Goal is resolution, with dignity and safety.
Examples of Reactive Strategies
• Communication guidelines
• De-escalation and breakaway
• Immediate creation of low arousal
environment
• Redirection
• Stimulus control/change
• Medication
• Physical intervention
Mediators
Training
• General PBS implementation training and
specific, person-focused workshops.
• Useful referencesCarr et al (1999)
McClean and Grey (2012)
Dunlap et al (2000)
Kincaid et al (2006)
McClean et al (2005)
Mediators
Social Change Agents
• Natural, professional or specialised?
• Factors that can facilitate change?
• Barriers to acceptance or implementation?
Where’s the Evidence?
• La Vigna, G.W., and Willis, T.J., (2012), The efficacy of positive
behavioural support with the most challenging behaviour,
Journal of Intellectual and Developmental Disability, 37 (3),
185-195. Systematic review.
• National Institute for Health Research and Health Technology
Assessment Programme – Clinical and cost effectiveness of
staff training in PBS for treating CB in people with Intellectual
Disability: A cluster randomised controlled trial (commenced
Nov 2013).
• NICE guidelines: Autism- Recognition, referral, diagnosis and
management of adults on the autism spectrum (June 2012)
• NES Psychological Therapies Matrix
Practice and Experience to Theory
References and Resources
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NHS Education for Scotland e-learning resource on Positive Behavioural Support http://www.nes.scot.nhs.uk
Institute for Applied Behaviour Analysis (IABA) http://www.iaba.com/
Association for Behavioural Support website: http://www.apbs.org/index.html
Allen, D., James, W., Evans, J., Hawkins, S., and Jenkins, R., (2005), ‘Positive
Behavioural Support: definition, current status and future directions’, Tizard
Learning Disability Review, Vol. 10, 2, 6-8.
LaVigna, G.W., and Willis, T.J., (1995), Challenging Behaviour: A model for breaking
the barriers to social and community integration, Positive Practices, 1, 1.
La Vigna, G.W., and Willis, T.J., (2012), The efficacy of positive behavioural support
with the most challenging behaviour, Journal of Intellectual and Developmental
Disability, 37 (3), 185-195.
McClean, B., and Grey, I., (2012), A component analysis of positive behaviour
support plans, Journal of Intellectual and Developmental Disability, 37 (3), 221-231.
References and Resources
Carr et al (1999), Positive behaviour support for people with developmental disabilities:
A research synthesis, Washington, DC: American Association on Mental
Retardation.
Dunlap et al (2000), Essential elements of inservice training in positive behaviour
support, Journal of Positive Behavioural Intervention, 2, 22-32.
Kincaid et al (2006), Review of the PBS Training Curriculum: Supervisory and Direct
Support Editions, Journal of Positive Behaviour Interventions, 8, 183-188.
McClean et al (2005), Person focused training: A model for delivering positive
behavioural supports to people with challenging behaviours, Journal of Intellectual
Disability Research, 49, 340-352.