Positive behaviour support (PBS)
Positive behaviour support (PBS) is an evidence-based approach that is person-centred and proactive. Positive behaviour support focuses on improving wellbeing, preventing behaviours that may challenge and reducing the use of restrictive practices.
Once assessments are completed, the clinician will plan strategies and changes with parents or carers. The strategies will be written into a PBS plan.
The positive behaviour support intervention uses a variety of tools which may include:
- Risk management plan: This is completed for all children and young people seen within the children and young people’s mental health service. It is a tool to help us identify and work with you to manage and reduce any risks.
- Behaviour assessment tool (BAT) helps to identify the young person’s preferred communication method and helps us get to know about them and their behaviours.
- Annual health check helps rule out physical health issues as a cause for presenting behaviour.
- ABC charts: An observational monitoring tool to record presenting behaviour, what happened before the behaviour, a description of the behaviour, and what was the outcome of the behaviour. These take 5 to 10 minutes to complete after each incident of the behaviour presentation.
- Scatter plot monitoring: This is a tick box exercise that takes less than a minute to complete per behaviour presentation. This helps to identify patterns in behaviour.
- Outcome measures: These help us evaluate the care we provide and identify areas for improvement.
The positive behaviour support plan will be handed over to parents or carers and other services caring for the young person. Guidance will be provided on how to implement the plan. The clinician does not implement the plan.
After 4 to 6 weeks, we would expect to see a reduction in behavioural presentation, with the behaviour being more manageable.
At discharge, behaviour may still be present, however those caring for the young person will be aware of their next steps.
Useful information
Positive behaviour support (PBS) is an evidence-based approach. It is person-centred and proactive, focusing on improvements in wellbeing, prevention of challenging behaviour, and reduction in the use of restrictive practices.
PBS is accepted internationally as current best practice for supporting people with learning disabilities and is increasingly considered to be the indicated approach for supporting many vulnerable client groups, including people with learning disabilities, those with mental health problems, dementia, brain injury and looked after children.
As part of the PBS intervention, we may feel a risk plan needs implementing. This will be discussed as part of the assessment process and implemented where required. Please be aware a risk assessment is completed regarding all young people.
Within a 3 to 6 month time frame, a clinician from the Learning Disability (LD) team will complete the following assessments with you.
Challenging behaviour interview (CBI)
What are the behaviours?
What these behaviours look like, including type of behaviour, intensity, frequency, severity, duration. This will take approximately 1.5hours.
Once we have identified behaviours of concern, we will ask you to identify which behaviours are the most difficult for you to manage. Up to 3 behaviours will be selected and the function of these the behaviours will then be assessed to plan how to meet your child’s needs.
Functional analysis
Assesses the function of behaviours. Functions include, sensory, initiating social contact, escape or avoidance, obtaining objects, expressed emotion and reduction of stress.
We aim to establish: Why the child or young person is engaging in this behaviour and what purpose does it serve for the child/young person. Each function is scored in a percentage (%). This information can inform new ways of managing behaviour.
Behaviour assessment tool (BAT)
A written assessment supports which supports:
- establishing the young person’s preferred communication method
- knowing their preferences, likes and dislikes
- identifying daily activities and routines
- understanding when behaviours are most likely to happen.
- finding out how often behaviours may happen.
- helping to determine if there are any underlying physical health or mental health functions.
- further clarification around functions of behaviour.
This assessment can help to determine if there are any underlying physical health or mental health functions to the presenting behaviour. This information further clarifies the function of the behaviour and how this can be best managed to promote a good quality of life for the young person.
This will be completed over 2 to 3 visits (each approximately 1 hour long).
If indicated, a positive behaviour support plan can be written form the information received from the assessments. Any PBS advice or plans need to be implemented by those people who support the young person daily. Once this advice or plan has been implemented for around four weeks, the CBI will be repeated.
Repeat CBI (1.5 hrs): Repeating this measure helps to determine if the behaviour intensity, frequency and severity have reduced. If they have, a reduced discharge will be planned. If they have not reduced, a review of the plan will take place and further advice will be given before discharge.
ABC charts
An observational monitoring tool to record presenting behaviour, what happened before the behaviour, a description of the behaviour, and what was the outcome of the behaviour. These take 5 to 10 mins to complete after each incident of the behaviour presentation.
Scatter plot monitoring
This is a tick box exercise that takes less than a minute to complete per behaviour presentation. This helps to identify patterns in behaviour.
Outcome measures
The clinician will send outcome measures (questionnaires regarding our service) to parents or carers to complete on least at 2 occasions during the intervention.
After the assessment phase, the clinician will plan strategies and changes with parents or carers. The clinician may write a positive behaviour support (PBS) plan. The plan will be handed over to parents or carers and other services that care for the child or young person.
Parents and carers will be given guidance on how to implement the plan. The clinician from the LD team does not implement the plan. Parents and carers implement the PBS plan.
After parents and carers have implemented the plan for 4 to 6 weeks, we would expect to see a reduction in behavioural presentation and (or) the behaviour to be more manageable.
At discharge, the behaviour may still be present, however the system caring for the child will be aware of their next steps.
Young people with a learning disability, aged 14+ years, should automatically receive an invite for an annual health check from their GP.
We will ask for physical health to be ruled out as a cause for presenting behaviour.
- Environmental factors that are impacting behavioural presentation. Environmental triggers would need addressing before intervention takes place.
- Physical Health issues that may be the cause, or trigger, for behaviours that challenge. These would need addressing before intervention takes place.
- 3 times cancellations: We understand that cancellations need to happen at times. Unless there are exceptional circumstances for several cancelations, the Learning Disability team would stop intervention and close your child’s episode of care.
The Learning Disability team are not care co-ordinators. We are an intervention-based team and provide an episode of care before discharging or closing. An episode of care will last up to 6 months.
The LD team or clinician may request from school that a speech and language or an occupational therapy assessment are completed (if this is a highlighted need from PBS assessments).
If you agree to start with the positive behaviour service pathway, you will need to sign the consent and contract which confirms the commitment from you as well as the Learning Disability team.
You will agree to planned visits from a clinician from the Learning Disability team to complete assessments as described above and to complete monitoring charts if requested. If there is any element you are not happy with, please discuss this before signing. The clinician will arrange visits as agreed with you between the hours of 9am to 5pm from Monday to Friday. There may be additional visits to pick up monitoring charts.
As part of the consent and contract you will need to consent to the clinician contacting other professions and carers that are part of the child or young person’s care (including social care, education, carer organisations, GP, other health professionals and advocacy agencies).
Please speak to your clinician if you have any questions or concerns about the consent and contract.
