Positive Behaviour Support (PBS)
Positive Behaviour Support (PBS) is an approach to supporting behaviour of concern, predominantly used in schools and care settings, where there are individuals that engage in behaviours of concern. The approach is based in empirical research and the science of behaviour and involves understanding why an individual engages in certain behaviours, and then proactively preventing behaviours of concern, as well as using reinforcement-based behavioural change interventions, to support an individual away from using behaviours of concern and towards appropriate behaviours.
Principles of PBS
There are three primary focuses of Positive Behaviour Support: increasing quality of life, teaching an individual positive skills and alternative behaviours, and replacing or decreasing behaviours of concern.
Increasing Quality of Life
By increasing an individual’s quality of life, we generally see that an individual engages in fewer behaviours of concern. This is often because they don’t feel the need to. By enriching their schedule with lots of activities they enjoy and find meaningful, they are less likely to engage in behaviours of concern due to boredom. By increasing choice, an individual is less likely to engage in behaviours to gain items, activities, or people, as they have a way to make and communicate a choice or desire to obtain that tangible, or to take a break. Ensuring an individual is as healthy as can be decreases behaviours that occur in relation to health issues or pain.
There are many models of quality of life, and it’s generally difficult to define and quantify. Most models tend to focus on the following domains, however:
- Emotional, physical, and mental wellbeing
- Social inclusion
- Consideration of human rights (e.g. freedom of movement and speech)
- Interpersonal Relationships
- Personal Development, self-determination, and personal competence (i.e. ‘independence’)
Considering how we can increase an individual’s quality of life is one of the main facets of PBS.
Increasing Positive Behaviours and Skill Building
In relation to increasing quality of life, and offering individuals an appropriate alternative, it is important to consider an individual’s skills and what skills we can teach an individual to help them to gain reinforcement in a more appropriate way, whether that is via another individual or supporting them to do things for themselves.
This may include teaching functional communication, in that an individual is able to communicate when they want a break or an escape, a chat, an item/activity/person’s presence, or to engage in a sensory activity. It may also include teaching an individual how to make their own tea or coffee, or how to get a snack for themselves so that they are less dependent on staff or family to do this for them.
Replacing and Decreasing Behaviours of Concern
The third and final pillar of PBS is putting in place behavioural change strategies and interventions to decrease behaviours that are not socially acceptable, including physical aggression, and increasing behaviour that is acceptable, such as functional communication. This often includes reinforcing appropriate behaviours through differential reinforcement procedures and placing behaviours of concern on extinction. It may also include antecedent interventions that decrease the motivation for an individual to engage in behaviours of concern, for example by giving these on a regular basis non-contingent on behaviours.
Understanding Why Behaviours Occur – Behavioural Functions and the Functional Behaviour Assessment
The basis of a PBS plan is a Functional Behaviour Assessment. This essentially is a process for finding out why a behaviour occurs in the first place, in other words, what the ‘function’ of the behaviour is.
There are four primary functions of behaviour:
- Sensory – we engage in the behaviour because we like how it makes us feel
- Escape – we engage in the behaviour to get away from something we don’t like, or find aversive
- Attention – we engage in the behaviour to get some kind of response from others, or for others to pay attention to us
- Tangible – we engage in the behaviour to gain some kind of item, activity or person
We discover which is the function of behaviour by gathering data and information from various sources. This includes observing the behaviour, interviewing staff/family/primary caregivers, recording and reviewing behavioural incidents over a period of time (usually weeks or even months), and reviewing other documentation for the individual, including care plans, risk assessments, and health records.
Given all this information, we then tend to see patterns in behaviour, in that there is often a clear primary reason for why the behaviour occurs. Different behaviours may have different behavioural functions, and the same behaviour may even have multiple functions. It’s never simple, but all interventions and strategies we put in place should relate to these functions of behaviour; the ‘why’.
Now we understand why the behaviour occurs, we can now begin to create a plan to support behaviour. This plan typically includes the following information:
This provides a background for the individual. What is their history? Have they experienced any trauma? What are their health needs? Do they have any mental health diagnoses? What are they able to do for themselves? What do they need support with? How do they communicate? Do they have any sensory needs? What are their preferences?
We then want to consider ways in which we can prevent behaviours in the first place. What skills can we teach the individual? Can we teach them to communicate in a more effective and appropriate way, such as with visuals or Makaton signing? What behaviours do we want to reinforce, and how do we do that? What do we use to reinforce those behaviours? How can we change the environment to increase their quality of life? How can we promote choice and social inclusion? How can we increase their engagement in meaningful activity? How can we support them to develop meaningful and supportive relationships?
Triggers and Avoiding Them
What triggers behaviours of concern? Do they not like crowds or noise? Does the presence of certain individuals or animals trigger behaviour? And then, how can we support an individual to avoid these triggers? Or perhaps we can put in a graduated exposure program, to support them to find whatever it is less triggering over time?
Warning Signs and Actively Responding to them
Are there any behaviours that tend to occur before behaviours of concern, that indicate that behaviours of concern are about to occur? Beginning to raise their voice or pacing? Saying certain statements? Is there any way we can respond to these warning signs to prevent further escalation? Can we prompt coping strategies at this time? Or offer a break or a chat?
Behaviours of Concern and Reactively Responding to them
What behaviours of concern does the individual engage in? Do they hit, kick, shout, scream, swear, smear? Be as clear and objective as possible here. You want it so that a stranger can read and can visualise exactly what the individual does. Terms like ‘physical aggression’ isn’t very clear (does that mean hitting, kicking, pinching, scratching, pushing…).
Then, how do we respond at this point? Typically, we want to manage any risk of harm to themselves or others, and this may mean reinforcing the behaviour to prevent dangerous situations. If it’s not dangerous, considering the function of behaviour, could we place the behaviour on extinction (e.g. ignoring the behaviour if it’s maintained by attention)?
Support After The incident
Then, after the incident, what do we do? Do you need to monitor the individual for health and safety reasons? How can we ensure the individual is ok afterward? Do they need a debrief? Can they reflect and learn from the incident? What about staff? Now is also the time to record the incident, so we can continue to monitor the behaviour over time. Is there anyone who needs to be informed?
One of the first things to note is that Positive Behaviour Support is not a tick box. It means nothing if it’s simply a piece of paper that no one reads or implements. It’s an approach to supporting the individual that needs to be consistent across people and settings. Everyone needs to be on board. That includes everyone within the school or care organisation, but also families, and the individual themselves!
PBS plans are also not something to be reviewed once a year and that’s it. It should be an ever-evolving live document. As new information comes to light, the PBS plan should change and adapt. Again, PBS is an approach and ethos, not a bundle of paper.
Lastly, behaviourism is one approach. Consider other approaches, such as Occupational Therapy and Sensory Integration Therapy, or Speech and Language Therapy. Tying everyone together and ensuring everyone is in line with each other is essential. Again, PBS is an approach everyone should be on board with and integrate into every facet of the organisation.
If you would like to discuss how you could implement Positive Behaviour Support in your setting, please contact us to arrange a free 30-minute consultation.