Positive Behaviour Support learning program –DAS staff
Learner’s guide
Version 1

Page 1Positive Behaviour Support learning program – DAS staff v.1


Positive Behaviour Support learning program – DAS staff
Learner’s guide
Version 1
To receive this publication in an accessible format phone 03 9096 2023, using the National Relay Service 13 36 77 if required, or email centreforl&
Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, Department of Health and Human Services January 2016
Except where otherwise indicated, the images in this publication show models and illustrative settings only, and do not necessarily depict actual services, facilities or recipients of services.

Contents

Acknowledgements

Overview

DAY 1 – Overview and Background Factors

Value, Rights and Responsibilities

Telling the Story – Getting to know the Individual

What is PCAS?

What is a PCP?

Quality of Life

Getting to know the individual

1. Personality

2. Strengths and Abilities

3. Family of Origin and Cultural Implications

4. Diagnoses: Impact of the Disability/Mental Health/Medical Conditions/Medications

5. Sensory Processing Considerations

6. Emotional Considerations

7. Historic Experiences

8. Communication

DAY 2 – Functional Behaviour Assessment

What is a behaviour

Behaviours of concern

Functional Behaviour Assessment (FBA)

The Behaviour Assessment Process

Functions of Behaviour

Behaviour Recording

DAY 3 – Developing a Plan

Positive Behaviour Support Framework

Change the Environment

Teach New Skills

Focused Supports

Response Strategies

References

Application Activities

Resources – Positive Behaviour Support

Page 1Positive Behaviour Support learning program – DAS staff v.1

Acknowledgements

This publication has been produced by Lancaster Consulting Australia Pty. Ltd. on behalf of the Centre for Learning and Organisational Development, Department of Health and Human Services.

We would also like to acknowledge the contributions from the following department staff:

Brent Hayward – Senior Practitioner, Office of Professional Practice.

Andy Moore – Senior Practice Advisor, North Division.

Shanker Pragnaratne – Senior Practice Advisor, South Division.


Overview

Welcome to Positive Behaviour Support (PBS) learning program. This course aimed at Disability Accommodation Services (DAS) staff will provide you with a solid understanding of positive behaviour support along with the tools and techniques necessary to implement the culture and practices of PBS in your workplace.

The first two days of this course are focused on understanding the principles, philosophy and systems underlying a positive behaviour support approach. Using a person-centred framework, participants will develop the skills necessary to undertake a functional behaviour assessment.

During the final portion of the course we will explore how this assessment leads to the development of an individualised, multi-pronged positive behaviour support plan.

PBS is a team-based approach and in this course, you will work with your staffing team to:

  • Work through the steps for gathering information about the individual.
  • Describe a behaviour operationally.
  • Measure/record a behaviour accurately.
  • Identifythe function of a behaviour and be able to clearly explain the underlying message.
  • Articulate the components of the positive behaviour support framework.
  • Plan and use a range of immediate response strategies.
  • Explainto all members of an individual’s circle of support including: family, support teams, managers, Community Visitors, and others your rationale for strategies/decisions.
  • Work together, consistently as a team to implement the plan your develop.

The learner’s guide is designed to assist with your learning throughout the three day program, and provide a resource to utilise in your ongoing implementation of Positive Behaviour Support strategies throughout your everyday work practice.

DAY 1 – Overview and Background Factors

Proactive Strategies
What to do BEFORE an issue arises / Response Strategies
What to do when an issue is occurring
Change the Environment / Teach New Skills / Focused Supports

Value, Rights and Responsibilities

The Oxford dictionary defines a value as “principles or standards of behaviour; one’s judgment of what is important in life.” We all use values everyday as a guide to how to behave. They consciously and unconsciously influence our decisions, attitudes and behaviour choices. Governments and organisations have taken steps to ensure that these are underpinned by law and policy. In Victoria our rights and responsibilities are enshrined in the:

1. Victorian Charter of Human Rights and Responsibilities 2006

The Charter sets out the basic rights, freedoms and responsibilities of all people in Victoria. It requires that governments and other public authorities, including the Department of Health and Human Services, consider human rights when they make laws, develop policies or provide services.

The Charter gives legal protection to 20 fundamental human rights, such as freedom of movement, right to life, equal recognition before the law and protection of privacy.

For more information see

2. The United Nations Convention on the Rights of Persons with Disabilities 2007

The Convention is an international agreement to protect and uphold the rights of persons with disabilities. Parties to the Convention are required to ensure persons with disabilities are treated as equal under the law and that their human rights are promoted, protected and ensured.

For more information see

3. The Disability Act 2006

The Disability Act outlines a whole-of-government, whole-of-community response to the rights and needs of people with a disability, and provides a framework and principles for providing quality services to people with a disability. The Act also sets boundaries for the limitation of the rights of people with disabilities through the use of restrictive interventions and compulsory treatment.

For more information see

Our Group Value is: ______

  1. What does the value mean?
  2. Give examples of when you have seen this value in practice at work?
  3. Give examples of when you have seen this value infringed upon at work?

Telling the Story – Getting to know the Individual

Everybody has a story. It is how we have come to be who we are, why we react the way we do, why we prioritise the way we do. The elements of an individual’s story and our interpretation of them colours how we perceive them – positively and negatively.

“Person-centred planning begins when people decide to listen carefully and in ways that can strengthen the voice of people who have been or are at risk of being silenced.” ~ John O’Brien

The basis for PBS is a solid understanding of the individual. The backbone is your Person Centred Plan (PCP) and related Person Centred Active Support (PCAS).

What is PCAS?

“Support workers who use PCAS see that every moment has potential for a person to be engaged. They provide little amounts of assistance often. They provide just enough assistance of the right kind, to enable a person to succeed in doing all, or part of a task. They provide opportunities for people to exercise choice and control over many aspects of their lives”

What is a PCP?

Person-centred planning is about listening to and learning from what people want from their lives. A person centred plan captures the whole of life and focuses on identifying the goals and aspirations of the person and the supports needed to achieve them. Though the tools of person-centred planning are applicable for all, it is most often used to support those with a disability or others with support needs such as mental health, significant illness or for children/young people. Person centred planning facilitates the inclusion and participation of individuals in the community. The Person Centred Plan (PCP) is referred to as the ‘Support Plan’ in section 54 of the Disability Act 2006 and must be completed by a disability service when it provides an ongoing disability service.

Note: this is different from the Behaviour Support Plan in Part 7 of the Act.

How does all of this relate to Positive Behaviour Support?

When PCAS is in place, individuals are engaged in meaningful activity, with exactly the right amount of the right type of support to experience success. They have choices; they have control over their own lives and they make decisions for themselves. Individuals develop and learn new skills and they are a part of their community. When PCPs are in place, individuals have dreams and aspirations that have been heard; they have goals that are important and meaningful to them, and they are provided the support they need to work towards achieving these goals. When all of this is in place, individuals literally have fewer reasons to engage in behaviour of concern as their needs have been met and they are enjoying a good quality of life!

Where behaviours of concern exist, it is because an individual has an underlying need that they are attempting to meet in the best way they know how. InPBS we use scientifically validated methods to try to understand what that unmet need is, and to have that need met so that there is literally no need for the individual to resort to behaviours of concern. Meeting the unmet need may involve changing the individual’s environment, teaching the individual new skills and/or changing the supports provided to the individual. The end result is that the person’s quality of life has improved, the behaviour of concern is eliminated and therefore the need to use restrictive interventions (such as chemical restraint or seclusion) is also eliminated.

Person-centred active support, person-centred plans and positive behaviour support all have the same aim – to increase individuals’ quality of life.

Quality of Life

There are lots of different opinions about what constitutes a good quality of life, however there is general consensus that it includes feeling happy and satisfied, having a general sense of well-being and having the chance to achieve potential. Quality of life applies to all humans equally, so people with disabilities should, and are entitled to enjoy the same quality of life as others in the community.


1. Personality

This is getting to the core of an individual. Are they introverted or extroverted? Optimistic or cynical? Logical or creative? As well as giving indications of who they are and how they might choose to engage with the world around them, understanding these traits is essential for the development of effective support systems.

2. Strengths and Abilities

We all have strengths and abilities. Some strengths are overt such as extreme music or sporting abilities, while others are more subtle or relative to the persons other ability levels.

3. Family of Origin and Cultural Implications

Each of us has been shaped by our early family experiences. How our family home operates (highly routine/organised versus free-flowing/spontaneous), how we were parented (such as use of punishment and rewards, expectations), how events and activities were approached and discussed shapes our expectations and perceptions. Similarly, we all bring a cultural and/or religious heritage which provides a lens through which we see ourselves and others.

4. Diagnoses: Impact of the Disability/Mental Health/Medical Conditions/Medications

As discussed earlier, the Victorian Charter of Human Rights and Responsibilities 2006 was an important step towards ensuring all individuals are afforded freedom, respect, equality and dignity. One of the practical outcomes of this was the renewed focus by DHHS and other bodies to “see the person and not the disability”.

At face value there are not many of us who would openly disagree with that focus. However, while we are right to be wary of “labelling” and making judgements based solely on a diagnosis, we, as professionals, have a responsibility to understand disabilities and other health conditions that impact on those we support on a daily basis. It is a part of their personal journey to who they are.

In furthering our understanding we need to look at issues which are on-going, current or were a significant element in the past, for example, an individual may not be depressed now, but it is essential we know if depression is something they’ve dealt with so we know what signs to look out for.

The Australian Bureau of Statistics (2007) estimates the prevalence of individuals with an Intellectual Disability at between 1-3% of the population. Of these between 30-40% are likely to experience a mental illness at some time in their lives (Senior Practitioner, 2010). There is also a higher prevalence of medical conditions, such as epilepsy, in this population with studies indicating 20% of those with an Intellectual Disability have epilepsy (Calvert, 2011).

What are things we look for or think about when supporting someone with:

  • Intellectual Disability.
  • Autism Spectrum Disorder.
  • Medical Conditions such as epilepsy, coeliac disease, diabetes.
  • Mental Health such as depression, psychosis.

For each of the above areas, it is important to understand:

  • What impact does the condition have on the person?
  • Are there any symptoms to be aware of?
  • Are there warning signs to monitor for changes in the condition?

Influence of Medications

The use of medication within the population of individuals with an intellectual disability is now almost commonplace. A report by the Senior Practitionerin 2010 details that the population of people with intellectual disability is one of the highest medicated groups in society. Some of this is related to diagnosed mental health disorders within this population,however, a growing percentage of psychotropic prescriptions are used to address behaviours of concern. Of those who present with behaviours of concern, as high as 80% may be treated with these medications without adequate reviews in place (Senior Practitioner, 2010). It is important, we understand that medication used in this manner is a restrictive practice and constitutes chemical restraint. Regardless of the reason for use, it is important support staff understand:

  • What medications the person has been prescribed?
  • Why is each medication prescribed?
  • What benefit the medication is meant to be having?
  • What side effects the medication might result in and what are the warning signs which require monitoring?

It is important to remember, it is not your job to make decisions about medications, but it is your responsibility to be well informed about the medications those you support are taking and the positive and negative implications of such medications.

More information and resources can be obtained in the Residential Services Practice Manual (RSPM).

  • What diagnoses are part of their story? Remember these may be on-going, current or in their past.
  • What implications do these present for this individual?
  • Are there appropriate systems in place to monitor conditions that may have a fluctuating impact?
  • Are there ways in which these elements could be better catered for in their current care plan?
  • In relation to medication:
  • What medications has the person has been prescribed?
  • Why has each medication prescribed?
  • What are the benefits the medication is meant to be having?
  • What are the side effects of the medication might result in and what are the warning signs that need to be monitored?

5. Sensory Processing Considerations

Sensory Processing involves taking in information from our body and the environment through our senses and then being able to organise and process that information to produce purposeful goal directed responses. It is important to consider the role sensory processing has on the way in which an individual engages in their world, as differences or impairments in processing can affect participation in daily life. Sensory processing impairments are known to coexist with a number of other conditions, such as Autism Spectrum Disorders, fragile X syndrome, attention deficit hyperactivity disorder, developmental disability, childhood trauma, and some mental health disorders (Watling, Koenig, Davies, & Schaaf, 2011).

What are our senses???

Touch (Tactile):

Four elements:

  • Texture (smooth, rough, bumpy, slimy, etc.).
  • Pressure.
  • Temperature.
  • Pain.

Touch processing includes:

  • Identifying when we are touching something.
  • Identifying where on our body is being touched.
  • Identifying the attributes (weight, texture, etc.) of what is being touched.
  • Identifying whether touch is light or deep.
Hear (Auditory):

Auditory processing includes:

  • The ability to hear sounds and sensitivity to noise levels.
  • The ability to determine what sounds are important (discriminate –hear directions in a busy room, etc).
See (Visual):

Visual processing includes:

  • The ability to take in visual information (what I see).
  • Sensitivity to light.
  • The ability to see what is important (discriminate – find something in a closet, recognise facial expressions).
Taste (Gustatory):

Gustatory processing includes

  • Recognising the primary tastes: sweet, sour, salty, bitter and savoury (umami).
  • Determining whether what is in our mouth is appropriate.
Smell (Olfactory):

Olfactory processing includes:

  • Recognising smells (average human can detect 20,00 distinct smells).
Movement (Vestibular):

Vestibular processing includes

  • Knowing whether we are moving or standing still.
  • Determining in which direction we are moving and how fast.
  • Recognising if we are upright and where we are in relation to the ground.
  • Whether the objects around us are moving or motionless.
Body Awareness (Proprioception):

Proprioception includes:

  • Knowing where our body is in relation to itself and the environment.
  • Understanding how to orient our body to perform particular movements.
  • Knowing how to time the movements of our body.
  • Regulating the amount of force we use.
  • Its engaged through all push, pull, lift and carry activities.

Our Sensory Fingerprint:

For each of us, the way we experience the world is as unique to us as our fingerprint. We have no way of knowing for sure how those around us are experiencing their own sensory world. Some people require more information to register, or process, particular sensory information. They have a high threshold. Others require less information to register particular sensory information. They have a low threshold. Most of us have some differences in our sensory processing, but individuals with neurological conditions such as Autism Spectrum Disorders or Dementia often show much greater variation in one or more sensory areas.