Positive Behaviour Support is an evidence-based approach which is primarily aimed at improving a person’s quality of life. It is intended to reduce behaviours identified by the person and/or their support network that have caused or have the potential to cause harm and reduce the need for any practices that may be restrictive or infringing on their human rights.
Typically, it involves the development of a Positive Behaviour Support Plan via a comprehensive assessment of a person’s behaviour, lifestyle, environment, and a support system. We use empirical methods to determine WTF… What is The Function of the behaviour? A detailed report is documented describing the persons history, current circumstances, and recommended strategies for support. This includes potential environmental changes, skill development for the person and response plans for supporters to follow.
In training sessions I hear viewpoints that are generally coming from a good place, but based on assumptions that can be harmful. Here are some of the most common themes.
The Tester
I regularly hear comments to the effect that a person is “testing” a new staff member to see what they can get away with. It may be a comment like “he only acts up with new staff because they haven’t put in firm boundaries.”
You may want to consider, that it’s far more likely the conditions have not been positive in the past when new staff are introduced, and mistakes are likely to be made as the new member learns about the person they are supporting. This results in increased anxiety, which is caused for based on history, and this is likely to be communicated through behaviours of concern. A longer hand over period and getting to know the person better and their unique communication style is likely to result in a smoother transition.
The Alpha
This is the ugly cousin to the “tester.” It is the assumption that we have to exert ourselves as dominant over people with disabilities. Many times, its based on good intentions, as some people believe that in order for someone to feel safe that we need to be in control as supporters.
Rarely a day goes by that I do not hear “they are being manipulative” or “they like to have control.” A carer once suggested that a person with severe physical, visual and intellectual impairments was leaving a scooter in front of the door to block the exit and exert his control. Would it not be far more likely that closest to the door was the most practical place to leave it, for the least amount of effort to get inside?
I can state without any question from looking at hundreds of data points, that the supporters that use an overly directive or authoritarian approach are far more likely to put the person and themselves at risk. If you want to make someone feel safe, being regulated and calm within yourself, non-threatening and friendly is far more effective.
The Necessary Consequence
I regularly hear comments that suggest punishment-based strategies are needed to change unwanted behaviours. Most people don’t like to use the term “punishment” but it’s a common belief that we should take something away or limit an enjoyable activity (negative punishment), or give a lecture (positive punishment) so that person has a consequence for their behaviour. In Operant Conditioning, these are all punishment-based tactics.
Punishment can result in behaviour change; however it has some pretty nasty side-effects. It can create resentment and damage the relationship of the punisher and punishee. Over a period it can cause mental health issues and a sense of learned helplessness. It focuses on the behaviour and not the cause and when there is no threat of punishment, the behaviour is likely to still occur. How many times have you seen cars speed up when they are out of range of a speeding camera?
We are paid supports for adults with disabilities, we aren’t their bosses, parents or teachers. Consider a time that you acted out, maybe someone pushed your buttons and you became agitated. You would expect friends or family to side with you, take you out for a coffee, help you calm down. Do we feel like we need to be punished for every outburst, so we don’t do it again? Positive Behaviour support only uses reinforcement based strategies as they are much more effective and without the negative consequences.
The Challenger
There is an assumption that when we give someone what they want we will reinforce unwanted behaviours. Behaviours of concern are almost always because someone is trying to communicate an unmet need and not being heard. Maslow’s hierarch of needs is a framework for understanding what needs we have as humans and what motivates us, including physiological, safety, love and belonging, esteem, and self-actualisation.
Consider if someone was “hangry” and you provided them with food, would the behaviours more likely increase or decrease? When you meet someone’s needs the behaviours are likely to stop, as they are unnecessary. It’s more effective to learn to communicate with the person so you can understand and meet their needs, without having to resort to using behaviours of concern.
Further to this, I commonly hear judgements about staff members that do not experience any behaviours of concern. It may be a comment like “its because they give them what they want all the time.” Well, why not? When I’m paying for a service, I expect to get what I want, I don’t expect to be “challenged.”
In addition, I find that the staff members that have good relationships with the person they are supporting are MORE likely to successfully encourage and inspire them to try something new, choose a healthy option etc. It’s about meeting the need in an effective and respectful way. There’s a very big difference between inspiring and supporting someone to eat healthy, build capacity, learn skills vs. challenging or dictating what they need to do.
The High-standards
Do we wash our dishes right away, always eat healthy, jump out of bed in the morning, take medications that make us feel sick, shower on time, live with others without conflict, go to bed at 9pm etc? Often, I hear of exceedingly high expectations placed on people with disabilities that we would never place on ourselves. I regularly hit the snooze button when the alarm goes off in the morning. When someone with a disability chooses not to do something its many times defined as “refusal.” If I do not feel like going to a party, I think of it as my human right to say no.
I also engage in behaviour sometimes that I know that is not the best for me, such as eating that extra piece of cake or staying up late, as we all do. Yes, we have a duty of care, however we need to allow the person we support to have the dignity of risk. This is the idea that self-determination and the right to take reasonable risks is essential for dignity and self-esteem and so should not be impeded by excessively-cautious caregivers.
The Know-it-all
I was once asked if I did social skills training with a person that I had just had my first session with. I made me reflect on all the times over the years that I did make assumptions based on a disability diagnosis and jumped straight to intervention. In Psychology we learn to do an intake, build an a therapeutic alliance and trust by using micro-skills, asking open-ended questions, summarising and paraphrasing, finding out what the persons treatment goals and expectations are, developing an appropriate formulation and THEN deciding on an intervention.
Maybe the person wants to talk about grief from a loved one they lost, or trauma from their past. What do we expect from therapy? A chance to unload? An opportunity to talk about whatever we want with someone we can trust and will not judge us? To feel better about ourselves? People with disabilities have the same right and intervention will be far more effective when you have built trust and really taken some time to understand the person.
Most of us who work in disability have a strong desire to care for others. We are all trying the best we can and to do this we need to take some time to listen and observe to the people we are supporting, and to find out how they want to be supported. Everyday I learn something new, and I have to reflect on my own assumptions and attitudes. I hope this article has been useful for you in understanding some common misconceptions and supporting the people you serve better. I have seen time and again that just the process of reflecting on our own behaviours can create a much more positive and safer environment for all.
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