Positive Behaviour Support for Adults and Children with Challenging Behaviour

This is a evidence informed resource collated for the VSO Task group on Psycho Social Skills and Emotional Learning.. This focuses on positive behaviour support (PBS)for those whose behaviour we find challenging. “The overall aim of Positive Behaviour Support (PBS) is to improve the quality of a person’s life and that of the people around them. This includes children, young people adults as well as older people.” . PBS is a values based approach based on human rights and inclusion, working in partnership with the person and their family to eliminate unnecessary restrictions.. It uses a range of methods to find out what a person’s behaviour means in order to use support to help people to meet realise their  potential. “PBS aims to  provide the right support for a person, their family and friends to help people lead a meaningful life and learn new skills without unnecessary restrictions. It is not simply about getting rid of problematic behaviour”
from Key Messages on Positive Behavioural Support

 

Introduction
Summary of PBS Short introduction Evidence for School Use
Miniature of poster PBS Intro Video Screengrab Partial detail of poster
This is a BILD  poster that summarises the PBS approach. This 6 minute video uses info graphic techniques to cover the key concepts of PBS in a visual way. It was produced by the BPS Alliance with
the British Institute of Leaning Difficulties.  
Further videos from the BPS Alliance..
This BILD poster quickly summarises why PBS can benefit schools who have to support learners whose behaviour can challenge others.

 

Key Messages of Positive Behavioural Support

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges

Behavioural and cognitive-behavioural interventions for outwardly directed aggressive behaviour in people with intellectual disabilities (Review)

First Page of document
Key Messages of Positive Behaviour Support
Front Cover Front Cover ehavioural and cognitive-behavioural interventions for outwardlydirected aggressive behaviour in people with intellectual disabilities (Review)
The overall aim of Positive Behaviour Support (PBS) is to improve the quality of a person’s life and that of the people around them. This includes children, young people adults as well as older people.PBS provides the right support for a person, their family and friends to help people lead a meaningful life and learn new skills without unnecessary restrictions. It is not simply about getting rid of problematic behaviour” The UK NICE  guidance (2015) relating to individuals with learning disabilities and challenging behaviour, highlights the evidence base for core components of PBS. These are as follows:
●● Functional assessment of behaviour;
●● Personalised intervention, based in behavioural principles;
●● Psychological interventions indicated before antipsychotic medication;

●● Restrictive interventions are used as the last resort;
●● Training for staff providing direct support in proactive interventions, in addition to high quality on-going supervision; and
●● The use of routine outcome measures and periodic monitoring.
National Institute for Care and Health Excellence 
Aim:To evaluate the efficacy of behavioural and cognitive-behavioural interventions on outwardly-directed aggressive behaviour in people with intellectual disabilities when compared to standard intervention or wait-list controls. We were unable to include any studies using behavioural interventions. There were no studies of children.

The existing evidence on the effectiveness of behavioural and cognitive-behavioural interventions on outwardly-directed aggression in children and adults with intellectual disabilities is limited. There is a paucity of methodologically sound clinical trials and a lack of long-term follow-up data. Given the impact of such behaviours on the individual and his or her support workers, effective interventions are essential.

This review is the update on two previous reviews in the same area.

Transforming care: A national response to
Winterbourne View Hospital Department of Health Review: Final Report
Stopping Over-Medication of People with a Learning Disability, Autism or Both (stomp) An evaluation of positive behavioural support for people with severe challenging behaviours in community-based settings
Cover of Transforming Care Front Page 1st Pages of article
The report sets out the UK government’s final response to the events at Winterbourne View ‘hospital’. It sets out a programme of action to transform services for people with learning disabilities or autism and mental health conditions or behaviours described as challenging. “We all need to make It a priority to reduce
and stop the use of inappropriate drugs, to reduce adverse side effects and potential drug interactions. This is vita to the person’s safety and their quality of care The goal is to improve the quality of life of people with a learning disability, autism or both by reducing the potential harm of inappropriate psychotropic drugs this includes   being used wholly inappropriately, as a “chemical restraint” to control challenging behaviour, or in place of other  more appropriate treatment options”.
This study employs a multiple baseline across individual design to describe positive behaviour support for five people in community settings. The individuals represent all people with intellectual disability residing in one county with long-standing challenging behaviour resulting in serious physical injury. Five types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology, quality of life and revenue costs. The systems of support required to maintain outcomes and develop real lifestyles include behaviour support planning, mental health review, on-call intensive support and emergency respite care. Behaviours reduced to near-zero levels following implementation of positive behaviour support and improvements were sustained over 24 months. The use of psychotropic medications reduced by 66 percent over the same period. Quality of Life Questionnaire scores improved significantly for three of the five participants. The results are discussed in the context of a framework for supporting people with severe challenging behaviours in the community.

https://www.ncbi.nlm.nih.gov/pubmed/17846050

Guidance on practice

Five signs of good Positive Behaviour
Support
Helpful Communication in “Enabling Environments” during COVID19 webinar Positive Behaviour Support Principles for Practice
during COVID-19
First Page Titles Screen Front Page
“The overall aim of Positive Behaviour Support (PBS) is to improve the quality of the person’s
life and the quality of life for those around them.
PBS is not a quick fix. PBS means that people receive the right support at the right time. The
right conditions need to be created and maintained so people can achieve the quality of life that they want and deserve to have. Successful implementation needs a whole organisational approach and ongoing commitment.”British Institute of Learning Difficulties; Centre for the Advancement of Learning Support 
A recording of a webinar on the use of visual approaches to support communication and understanding during COVID 19 .by Jane Johnson (Bild Consultant and Speech and Language Therapist)

British Institute of Learning Difficulties; Centre for the Advancement of Learning Support 

“People with learning disabilities and autistic people will be confused and may find altered routines and changes difficult to cope with. It is important that the core principles of Positive Behaviour Support person-centred support are maintained and human rights are respected, even when everyday lives are affected by national restrictions. Below are some straightforward principles we should all try to follow.”

British Institute of Learning Difficulties; Centre for the Advancement of Learning Support 

Positive Behaviour Support  : British Psychological Society (2018) PBS Working Together to Make Things Better

NICE Quality Standard: Learning disability: behaviour that challenges

Front Covere of the report Front Cover of Leaflet Front Cover of Guidance

Aim:To map out the role of Clinical Psychologists in Relation to the practice of Positive Behavioural support

It provides a definition and rational for PBS and makes a claim for the centrality of psychology within this approach.

This is an ‘Easy Read’ version of the information about PBS for people with learning difficulties that explains why PBS is needed and how it can help.

British Institute of Learning Difficulties; Centre for the Advancement of Learning Support 

 

The quality framework for the evaluation of provision in the UK for adults and children whose complex needs can lead to challenging behaviour.

National Institute for Care and Health Excellence

 

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