West Midlands Positive Behaviour Support Organisational and ...

West Midlands Positive Behaviour Support Organisational and Workforce Development Framework

Contents The PBS Organisational and Workforce Development Framework Scope of proposed framework and guide to its use .................................................................................................. 3 Positive Behaviour Support Workforce Development Framework ................................................................... 6 Level 0 Awareness table ........................................................................................................................................ 12 Level 1 Foundation ............................................................................................................................................... 13 Level 1 table .......................................................................................................................................................... 14 Skills and Knowledge for Level 1 Foundation ........................................................................................................... 15 Level 2 Practitioners .......................................................................................................................................... 20 Level 2 table ........................................................................................................................................................ 21 Skills and Knowledge for Level 2 PBS Foundation for Practitioners ..................................................................... 22 Level 3 PBS Lead Practitioners .......................................................................................................................... 28 Level 3 table .......................................................................................................................................................... 29 Skills and Knowledge for Level 3 PBS Lead Practitioners ..................................................................................... 30 Level 4 Higher Level Specialist / Consultant / Organisational Lead ................................................................ 43 Higher Level table .................................................................................................................................................. 44 Skills and Knowledge for Higher Level Specialist / Consultant / Organisational Lead ............................................. 45 References ............................................................................................................................................................ 60

CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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Scope of proposed framework and guide to its use This framework is intended for all services in the West Midlands that provide support across the life span for people with intellectual disabilities and /or autism that may sometimes show behaviours of concern. It supports the embedding of Positive Behaviour Support (PBS) approaches across the six West Midlands Learning Disability NHS Trusts. It can be viewed as a framework for organisational development as well as the standardisation of PBS practice. Positive Behaviour Support is a multicomponent framework (Gore et al 2013) that has a set of rights based values, theory evidence base and defined processes. PBS challenges the view that behaviours of concern are owned by the person – it is more likely that the person is challenged by the environment and has learned that behaving in certain ways can be an effective way of getting some of their needs met. A range of biological and psycho-social vulnerabilities are likely to be risk factors (Hastings et al 2013 ). PBS is an integrated approach that recognises other complimentary evidence based assessments and approaches will be needed to meet all of people’s health and wellbeing needs. This would include consideration of the impact of each individuals unique history which may include trauma and loss, mental health vulnerabilities and neurodiverse needs such as autism and ADHD. PBS supports a multidisciplinary solution focused approach and this may sometimes take the form of a shared formulation at specialist level. At times a more intensive focus may be needed and a more formal assessment and support strategy or plan is required to ascertain the function of the presenting behaviours of concern and identify better ways of the need being met. A functional assessment will take into account individual differences and diagnoses, psychological and physical health needs and will usually be part of a wider range of assessment of need and complimentary interventions. Direct support workers will need the skills to support assessments and implement plans and strategies. A small percentage of people may sometimes need intensive support and a specialist team. For many people receiving services a general PBS approach is preventative and provides stability. A good preventative PBS service would provide a person centred, supportive and capable environment that promotes the health and wellbeing of the person. The PBS Competence Framework describes ‘the shared knowledge and associated actions’ necessary to perform each of the competencies defined as best practice (http://pbsacademy.org.uk/pbs-competence-framework/). This framework shows a clear pathway for development of these competences within the workforce at different levels.


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Underpinning all PBS is a commitment to taking the least restrictive approach to intervention and active engagement at all levels of the system to reduce unnecessary restrictions so that children, young people and adults who may sometimes show behaviours of concern can live ordinary and meaningful lives. The diagram opposite demonstrates the key skills that are needed to provide good Positive Behaviour Support. Some element of all of these skills is needed at all levels. The framework recognises that there are different pathways to successful learning and that a combination of methods is best, particularly where those competences apply to direct support within services. We recommend a multi-stage model is used - verbal instruction, demonstration and role play and then coaching and assessment in situ - similar to that described by LaVigna and Willis (1994) in the Periodic Service ReviewThe framework is flexible enough to be used in a range of settings and recognises the delivery of PBS may be different and sometimes unique to reflect the range of individualised support.

Associated Training Active Support Active Support is a set of tools and guidance for supporting anyone with a learning disability to participate more in everyday activities. This framework should be considered as part of wider plan for training staff to enable people with intellectual disabilities to have good lives. Research shows that an environment that supports enablement and provides plenty of opportunity for meaningful engagement will reduce the likelihood of behaviours of concern occurring within services. (Jones E, Lowe, K, Brown, S, Albert, L, Saunders, C, Hake, N Leigh, H. 2013) For this reason we also recommend that all direct contact staff are trained in Active Support as it is integral to a successful PBS model. Active Support is a proactive preventative strategy for both.


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Functional assessment skills Functional assessment is a process for identifying the events that reliably predict and maintain behaviour. Complimented by other types of assessment a functional assessment underpins PBS approaches and provides the evidence base for a behaviour support plan. Anderson and Horner, R (2007) suggest these 4 levels which we have used in this framework:    

Informal – everyday problem solving Level 1 Basic – needs some training (brief observation and interview) Level 2 Complex – needs a higher level of training (observations and interviews) Level 3 Functional analysis – Specialist or behaviour analyst (direct observations, interviews and testing hypotheses by manipulation of environment)

These levels are incorporated into this workforce development framework.

Mindfulness training There is some evidence to indicate that mindfulness training for staff can be helpful in reducing rates of restraint and PRN medication (Singh et al 2009). Concomitantly, attention has also been a focused on the role of positive emotion in supporting physical and emotional well being, and there is also interest in CMT, Compassionate Mind Training, for staff (Gilbert 2009), and ACT, Acceptance and Commitment Therapy (Jackson Brown 2013) for both staff and people with learning disabilities.

Physical intervention training Staff may have had training in using physical interventions which may or may not have covered some elements of a PBS approach. It could not necessarily be assumed that training offered by a commercial physical intervention training provider would be enough to enable staff to meet the full range of PBS competences. PBS has a much wider context , reactive strategies may be part of a plan but the majority of PBS work is proactive. Physical intervention and other restrictive practices whether planned or unplanned should only ever be a last resort and the least restrictive option available that is needed to prevent harm to someone or to other people.


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Positive Behaviour Support Workforce Development Framework Tiered Approach The proposed framework is tiered, outlining the skills and knowledge required at each of the different levels to support the active implementation of good Positive Behaviour Support., see graphic, below.

The table below has more information about each of the tiers outlined above.


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Level

Who

What

Level 0 Awareness

PBS for Partners

We recommend that you provide some Awareness and orientation sessions for everyone who comes into contact with services that use PBS approaches. This would be important for the people that use the services provided by the Trusts - for example people with learning disabilities and their families and commissioners and also for a range of people that work together with the services like social workers or GPs. General awareness raising supports the notion of the development of common language and conceptual understanding of PBS. There are a variety of ways that awareness about PBS can be raised and the most appropriate method can be chosen for each group.

Level 1 Foundation and Level 2 Practitioner

The skills and knowledge needed at both Foundation and Practitioner level are grouped into modules - this gives flexibility for both delivery and coverage and further continuous professional development signposting. It also supports best practice models of workplace assessment for direct support workers who could be set practical and relevant tasks to complete in the workplace. The PBS Support Workers Competence checklist can be used as an assessment tool for these modules This training could be delivered by external providers but a best practice model would support lead practitioners/ coaches developing and delivering training and monitoring competence in the workplace.


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Level 1 Foundation

For everyone who is part of the delivery of PBS at any level direct or otherwise. Usually delivered universally at Induction.

We would suggest that a basic understanding of the key components so PBS should be part of everyone’s induction process. This level supports the idea of creating a supportive environment and using general PBS approaches. The successful implementation of PBS relies on a whole organisational approach - it is therefore important that everyone in the organisation has some knowledge about PBS and has a shared understanding that behaviours of concern are serving important functions for people. Some of this basic awareness can be gained using an online PBS Awareness course if understanding is followed up within service and within supervision. Direct contact workers who provide direct support and implement PBS plans will need further competences, which are outlined in the next tiers, which can be competence checked within the workplace

Level 2 Practitioner

For direct contact workers and carers who provide direct support and implement behaviour support plans.

This level builds on knowledge and skills gained at induction and is for direct contact workers who need to implement behaviour support plans and need an understanding of the assessment, intervention and monitoring process so they are able to support them effectively. The level focuses on practical application of knowledge into the workplace. Please note practitioners will still require coaching in the implementation of individual behaviour support plans. The multi-stage model verbal instruction, demonstration and role play and then coaching and assessment in situ - similar to that described by LaVigna and Willis (1994) in the Periodic Service Review seems to be the most effective way of ensuring people are competent and confident to teach new skills and follow agreed behaviour support strategies.


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People who have completed Foundation and Practitioner level training would be using functional assessment at an informal level (see Anderson and Horner 2007). Dependent on service need it may be useful to train a number of staff to do basic functional assessment - they could be overseen by a PBS Lead Practitioner or a Specialist.

Level 3 PBS Lead Practitioners

For experienced practitioners with a good understanding of behavioural support and knowledge of practice leadership (including mentoring and coaching to facilitate on the job feedback) to support the direct implementation of PBS to the workforce in services

PBS Lead Practitioners are significant in the maintenance of positive culture and competence within teams (Deveau R and Mc Gill P 2014, Denne et al 2015). PBS Lead Practitioners are an important link between the Specialist’s knowledge and the implementation of the support by direct carers. PBS Lead Practitioners need to spend time on the floor providing formal and informal coaching sessions and role modelling good support. Research supports the notion that without practice led from the floor, PBS practices are not likely to embed and the fidelity of BSP delivery will be compromised. Modelling and competence checking in the workplace are essential to support and maintain good service delivery (Deveau, R and McGill, P, 2014). PBS Lead Practitioners and Coaches provide the crucial link between Specialists - those who carry out assessment, develop interventions and the people that actually deliver the PBS. They are also the link between the concept of PBS and the actual practice. Due to the wide range of service models and different job roles, the competences needed by PBS Lead Practitioners are described as functions. These functions may be carried out by different people or they may be the same person. They have been grouped into the three areas


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needed to support service implementation – Coaching, practice leadership, behavioural expertise and management. The functions in all three areas are interdependent, and a focus on purely behavioural expertise or management function will leave a gap in implementation. For example behavioural expertise without practice leadership will not be effective. Some of the behavioural expertise could be external to the service but the coaching and management functions must be in situ. The PBS Lead Practitioners should be linked to an external body for peer support, CPD and external QA purposes. Dependent on service need PBS Lead Practitioners could develop the skills to undertake descriptive/ complex functional assessment and develop intervention plans though a range of accredited programmes. A higher level of skills at this level would decrease the external support needed for the service.

Level 4 Higher level Specialist / Consultant / Organisational lead

These are professionally qualified experts who can manage complex cases or complex systems. They may be part of an Intensive Support Team

Due to the range of service models and different job roles the competencies needed at this level are also described as functions. These functions may be carried out by different people or they may be the same person. They have been grouped into the two areas needed to support complex case management or complex systems management i.e. Higher level Behaviour Management or Strategic. The functions in both areas are interdependent, both are needed. The skills and knowledge checklist from the PBS competence framework is designed to help services and organisations decide which qualifications are the most appropriate. Higher level specialist / consultants will have a clear professional and CPD pathways facilitated externally. Consultants at this level may be able


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to undertake the most complex functional assessments and functional analysis which is the highest level subject to appropriate behavioural qualification.


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Table 1: Awareness and orientation for everyone who comes into contact with services providing PBS


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Level 1 Foundation For everyone who is part of the delivery of PBS at any level, direct or otherwise CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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Table 2: Level 1 Foundation – for everyone who is part of the delivery of PBS at any level, direct or otherwise


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Level 1 Foundation - knowledge and skills

Modules

1. Values base and human rights

Knowledge and understanding

Ability to

What the following principles mean in practice:

Show dignity, respect, warmth, empathy, and compassion in all your interactions

Respect, choice, competence, relationships and community presence

Support choice and community presence and advocate for the rights of people you support

Current legislative framework including the Human Rights Act

Enable the inclusion of people in daily choices Ability and willingness to work in partnership with the person, their carers and families Apply the key points from legislation in all the care and support you provide Question appropriately if you believe the person’s rights may be being transgressed

2.Person centred

The importance of knowing the individual

Treat every person as an individual and support individual needs


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working - planning and action

and understanding their needs in the following areas:

Ensuring people get the right support

       

Physical and emotional health and wellbeing Communication Need to have meaningful activities Need for predictability Need for positive relationships Environmental needs Sensory needs Preferences and dislikes

Be aware of where this information might be found The difference between what is important to a person and what is important for a person

Communicate with the person and build rapport Be able to give examples of how the person shows enjoyment and displeasure in activities Support behaviour and daily interactions that make the person look and feel good. Describe a person’s preferences and likes and dislikes for a range of different activities Demonstrate that you support people to take part in everyday activities and be part of their community – do things with the person - not for them Support the person to actively maintain positive contact with friends and family Provide opportunities for learning and development in everyday activities Show effective communication using a range of methods, (e.g. nonverbal, verbal, gestures, pictures) Demonstrate respect for a person’s choices even if they are not consistent with your own Identify and interpret a person’s physical and emotional state from nonverbal behaviours (i.e. facial expression, body movements, other behaviour) Support individuals to maintain physical/mental health and wellbeing (e.g. cleaning teeth, checking testicles, healthy eating, exercise, mindfulness etc.)


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Use individual health care plans (including competent administration of medication) and record/report appropriately Support the use of health care, e.g. visiting GP Seek support/advice from senior manager or clinician when needed Talk about your thoughts and feelings in relation to the management of a person’s health Actively monitor health of the person and report any changes that may require assessment Recognise and report any signs of distress in the person that may indicate a health problem

3. Providing supportive and capable environments

How personal attitudes and values can impact on your responses to people When you need to seek personal and or professional support Why team working is important and the different roles of people that are involved with the person’s life

Identify attitudes and values that may hinder the provision of good support Reflect on your relationship with the person Attend to your own physical and emotional well-being and seek support to manage your work Reflect on your own actions and feelings and awareness of their impact on others

What is meant by the least restrictive approach

  

The factors that make people with intellectual disabilities vulnerable to showing



seek support from others when required actively participate in training actively participate in teamwork including meetings, supervision, and supporting colleagues. communicate with colleagues, families, and other professionals in


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behaviours of concern Why safe, secure and predictable environments are important Basic understanding of ‘goodness of fit’



an appropriate way describe your role in the team and that of others

Support people in a range of activities and situations and minimise unnecessary restrictions Show how you include people in planning their daily activities give them opportunities to engage in ordinary things Actively use strategies to help the person predict, understand and control their environment (e.g. visual timetable, social stories) Identify likely factors that make people with intellectual disabilities likely to show behaviours of concern Identify where environments might not feel safe, secure or predictable for people

4. Understanding behaviour

The 4 term contingency model of how behaviour is learned and maintained

The basic principles of behaviour

Behaviour has a function or purpose The difference between the form and function of a behaviour Behaviours are communications and each individual will have a unique way of communicating

Describe a real life example of 4 term contingency Identify the things in the environment which make behaviours of concern more likely for the person Describe a behaviour accurately after you have observed it Articulate possible communicative functions of the behaviour Generate the possible functions of the behaviour

What is meant by ‘behaviour’ and the phrases ‘behaviours perceived as


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challenging’ or ‘behaviours of concern’? Identify a range of factors that may impact on behaviour The link that there could be a relationship between behaviours that are perceived as challenging or concerning with the physical and mental health of the person


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Level 2 Practitioner Anyone who provides direct PBS support and has completed the induction programme for practitioners


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Table 3: Level 2 Practitioners


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Level 2 Practitioners - knowledge and skills

Modules

Knowledge and understanding of

Ability to:

1. Value base of PBS and personal values

The history of people with learning disabilities and the principles of social role valorisation, normalisation, inclusion, person centred planning and action.

Actively promote peoples development and ensure that support is based on the principles of respect, choice, competence, relationships and community presence. Identify areas where this may be improved for individuals.

The relationship between PBS and Applied Behaviour Analysis

Identify some behaviour analysis tools to support the collection for evidence for assessment ABC charts , frequency charts etc

The Human Rights Act as underpinning rights and how it interacts with the MCA and the MHA

Use supervision and professional forums to reflect on your practice.

What reflective practice means and how personal values and attributions can affect responses

2. Person centred working planning and action

The range of needs a person may have:    

Physical and emotional health and wellbeing Communication Need to have meaningful activities Need for predictability

Actively attend appropriate training and CPD activities Seek support from colleagues

Describe the person and their needs and explain how their needs are currently being met when asked Understand what aspects of an environment may be stressful for a person and make attempt to mediate this Contribute to the identification and use of strategies that support the person to have a good quality of life and reduce the likelihood of behaviour which challenges from occurring.


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   

Need for positive relationships Environmental needs Sensory needs Preferences and dislikes

These may include:      

a physical environment that matches a person’s needs use of preferred communication increase engagement in activity for a person increase choice and independence for a person support to ensure physical and mental well being development of social relationships

Support the person through any medical assessment needed Participate in assessing mental capacity of the person in all aspects of everyday care Monitor health of the person and report any changes that may require assessment Recognise and report any signs of distress in the person that may indicate a health problem

3. Providing supportive and capable environments

The difference between an enabling model of support and a hotel model of care.

Find out about different activities a person likes and create opportunities for these every day Make sure there is at least one activity available at all times with necessary support available Help the person do things they do not like, but that are essential. Offer extra motivation and reward for these things Introduce new activities so that a person has more activities to choose from


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Support the person to develop skills in order to do things as independently as possible Break down complex activities into smaller steps and adapt support so the person can do as much as possible Keep track of what people do to make sure there is a good balance of activities which offer variety, occur often enough and are of good quality Record information required for assessments objectively, e.g. level of independence in tasks

4. Supporting a functional assessment

What a functional assessment and what functional analysis is and what contribution you can make to the process

Identify and clearly describe behaviour and environmental factors in observable and measureable terms (clear descriptions and not judgements)

The purpose of data collection

Identify and report other things that might affect the person (e.g. illness, relocation, medication)

Why it is important to describe and record behaviour accurately

Recognise the effect of your own behaviour on the person and try to adapt this Record information according to the agreed procedures, e.g. ABC forms, behaviour recording forms Record a range of information to develop an understanding of the person’s skills and needs Identify what is important for the person, their likes and dislikes and contribute this information to the BSP


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5. Implementing behaviour support plans

The purpose of a BSP, who needs one and what should be in it A developmental approach is an essential part of a plan Importance of teaching new skills and communication and the range of ways this can be done

Understand a person’s BSP/PBS plan Describe the goals of the BSP/PBS plan and collect data (information) related to them as requested Identify the possible outcomes of failing to follow the BSP/PBS plan, e.g. increase in challenging behaviour, things that prevent the person learning skills, not helping the person to have a better quality of life etc. Reflect on your own practice, and that of other team members and try to ensure that everyone follows the plan Monitor progress and report changes in challenging behaviour, development of skills and participation in activities and other quality of life indicators Complete records and other documents that help monitor the use of the BSP/PBS plan Regularly attend and participate in supervision and review meetings Communicate any changes made to a BSP/PBS plan and ensure new strategies are used consistently. Demonstrate the ability to carry out strategies correctly Participate in training, supervision and feedback on the correct use of BSP/PBS plan


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6. Teaching new skills

The range of techniques used to teach new skills The use of reinforcement in skill teaching

Teach and support the development of new skills/communication either as an alternative to behaviour of concern or as part of developing independence. Use strategies derived from behaviour analysis to teach complex new skills including: be able to complete a task analysis, and use chaining, prompting and prompt fading, modelling and imitation and shaping behaviour. Be able to use reinforcement appropriately

7. Using reactive strategies

The arousal cycle

Identify early warning signs that indicates a behaviours of concern may occur.

What a reactive strategy is and when to use them The difference between using a planned or an unplanned reactive strategy

Identify where on the cycle of arousal a person is at and respond accordingly Use a range of de-escalation techniques and match the technique to the individual person Change strategies (e.g. lower demands, modify physical environment; clarify routines at different stages of cycle) Prompt the person to use an alternative behaviour/new skill, e.g. Using a card to indicate a break is required if appropriate Check you understand crisis management strategies in the BSP/PBS plan Remain calm and use the crisis plan quickly, ensuring safety of everyone


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Use ethical reactive strategies Record and report accurately (e.g. strategies used, details of the incident, injuries sustained). Use knowledge from training when unplanned strategies are needed Seek help when necessary and recognise your own signs of stress and anxiety Reflect on your experience of delivering reactive strategies Record accurately any use of restrictive strategies


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Level 3 PBS Lead Practitioners For workers that support the direct implementation of PBS in services


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Table 4: Level 3 PBS Lead Practitioners


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Level 3 PBS Lead Practitioners - knowledge and skills Due to the wide range of service models and different job roles, the competences needed by PBS Lead Practitioners are described as functions. These functions may be carried out by different people or they may be the same person. They have been grouped into the three areas needed to support service implementation – PBS behavioural expertise, practice leadership/Coaching, and management. The functions in all three areas are interdependent, and a focus on purely behavioural expertise, or management functions will leave a gap in implementation. For example behavioural expertise without practice leadership will not be effective. Some of the behavioural expertise could be external to the service and but the practice leadership/Coaching and management functions must be in situ. Practice Examples:   

One person could have responsibility for all the practice leadership/Coaching and management functions in a service and some of the behavioural expertise functions but could be supervised by someone with the appropriate qualifications external to the service Another organisation may have a behaviour specialist in each service that covers all functions Another service may have a manager who is an active support coach and a practice leader who can also cover some of the management functions and all of the behavioural expertise functions

This level is flexible so it can be adapted to all service types. The skills and knowledge checklist below is designed to help services and organisations decide which competences are needed and into which job role they are best assimilated.


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Function


Have the ability to

PBS knowledge

The essential components of PBS

Ability to explain what PBS approaches are, how PBS developed and how PBS works to different audiences

The evidence base for PBS

Who

The history of PBS development The UK definition The applications of PBS

PBS practice development

Where external and internal resources and support are available

Access and use resources and support to help implementation

the needs of the audience for the resources

Develop accessible resources if needed

The importance of peer support and review

Translate technical information for practical use Develop training materials to coach people at awareness and level one and two To be able to identify when good PBS is or isn’t happening To access peer support and CPD as well as practice sharing opportunities through the UK network of Coaches Drive continuous improvement in PBS practice

Support organisational approaches to implementation

That PBS is a whole organisational approach and which strategies are necessary for implementation

Participate in action planning and implementation of organisational strategies that support the PBS including developing baseline measures within services


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Practice leadership

The difference between training and coaching techniques

Provide regular and frequent individual supervision for all staff (detailed in supervision contract)

The role of supervision in terms of supporting the skills, training and personal wellbeing needs of others within the team such that they can fulfil their roles adequately

Observe staff working practices and provide verbal and written feedback – practice supervision – and systematically check procedural fidelity3 in delivering agreed support plans

The importance of practice leadership1 The impact of one’s own role; the roles of team members and other key stakeholders The need for consistent approach amongst team members The relevance of positive monitoring2, including Periodic Service Review (PSR) Responsibilities outlined within BSPs of own role and the role of supervisees That key stakeholders, as well as staff, need to know and understand the BSP

Demonstrate good supervision skills in training and developing skills around: understanding behaviour; work relationship dynamics; maintaining personal boundaries; work-life balance Monitor staff wellbeing and mentor staff in this area Conduct appraisals, monitor staff performance, and identify and meet training needs of direct care staff Monitor staff awareness of their own behaviour and provide feedback, guidance and supervision as needed Lead and model the implementation of PBS in practice (i.e. practice leadership) Clarify staff roles in practice, and promote team work Organise regular Periodic Service Review (PSR) and ensure assessments are valid and that the results are readily apparent to staff. Facilitate regular team meetings to review and update support plans, gain staff feedback, and involve staff in decision making.

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A model of leadership in which managers prioritise spending time in the care environment and routinely role play and model desired standards of practice to their staff. A system for monitoring, giving feedback on and improving staff performance first described by Porterfield. 3 A measure of how accurately and reliably a behaviour support plan is implemented. 2


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Set clear goals and vision with team involvement Provide frequent and regular feedback to individuals and the team as whole on everyday performance and progress toward goals Know the plans in detail and communicate key strategies and reasons why they are needed. Describe the short, medium and long term goals of the plan Check individual team members’ understanding of their respective roles and responsibilities within the BSP and address any misunderstandings Organise resources (e.g. rotas) to ensure that a plan can be followed within the appropriate timeframes Record any variance (e.g. if teaching strategy has not been introduced at point in time), and establish response to rectify the issue If necessary, seek further support from senior managers for resource issues or performance management

Active support coaching

What is needed to implement active support effectively

Use appropriate teaching methods to enable staff to actively support people

Leadership

The concept of leadership

Help shape and change, when appropriate, the values of the organisation or service

The importance and knowledge of signs of stress and anxiety within the team Why it may be beneficial to change staff rotas -

Support other staff to describe and deliver the values and core aims of the organisation, orally, in writing and in actions


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for example to alleviate staff stress and the potential negative impact of this The importance of aftercare for staff and people being supported

Provide positive feedback on staff performance related to their support of the person’s community presence, relationships, choice, behavioural skills and image Recruit team members with appropriate values and attitudes Review and discuss team members’ attitudes regularly and support team members to demonstrate positive attitude to the person. Respond when positive attitudes are not present Role model dignity, respect, warmth, empathy, compassion in interactions at all times, and monitor this in the team Facilitate feedback from the person and their family and friends on how values are expressed in actions, and use this to shape and change the organisation Actively manage staff and the environment to build a positive environment

Monitoring staff performance

The importance of ensuring the BSP is implemented as intended, including the implications of poor adherence The importance of an integrated performance monitoring and quality assurance system What ‘positive monitoring’ means

Teach direct carers why adhering to the BSP is important Explain possible long terms implications, such as how failing to ensure high levels of procedural integrity can result in behaviours of concern occurring , poor quality of life and repeated, unnecessary revisions to the BSP (i.e. people mistakenly think the BPS is the problem)

How to summarise and analyse delivery monitoring data

Check records are completed accurately

How to present delivery monitoring data in a visual format

Undertake regular and frequent positive monitoring observations

How to operate and design customised

Summarise and analyse monitoring data and use this to regularly discuss and feedback to the team e.g. presenting it


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Periodic Service Review schedules

visually as graphs etc. on the effectiveness of the BSP Use computer software to analyse and present delivery monitoring data in a visual formats Provide feedback to supervisees and stakeholders on what worked well and what could have worked better Incorporate the above monitoring, feedback and review systems into whatever overarching performance management quality assurance systems is in use (e.g. PSR)

Oversee person centred planning and action

Understand the person’s individual history, health needs, communication preferences, preferred activities / items, likes / dislikes, skills and abilities Why this is important The importance of person-centred planning How to implement a person-centred approach

Proactively support other staff to develop and maintain positive relationship with the person, for instance, by suggesting/supporting joint activities relevant to person’s interests and interactional style, communication skills and abilities Organise person’s personal documentation and collect, arrange or change this information as required by different agencies and systems Support the team to reflect on their relationships with a client, both the positives and the negatives. Organise a person’s support to include circle of support4 meetings, key worker5 meetings and activities with keyworker Offer support and guidance if direct contact staff are finding rapport building difficult, e.g. organises staff training in interaction techniques

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A circle of support is a network of friends, family members and supportive workers who come together to help promote and support the goals of a person with learning disability. 5 A key worker is someone who plays a lead role in planning and co-ordinating the delivery of services to a person. CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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Liaise with circle of support Organise and lead on collecting information about a person’s strengths, needs, preferences, hopes, dreams and desires Schedule the implementation of and measure progress towards personally important goals Check that implementation balances across areas of life, type of outcome and preferences Incorporate the above monitoring, feedback and review systems into whatever overarching performance management quality assurance systems is in use (e.g. PSR) Ensure that the most up to date version of the BSP is available and used by staff Oversee the creation and maintenance of a supportive environment

What meaningful engagement means for each service user

Ensure that staff supporting the person develop good links with the local community

How careful presentation of activities can avoid evoking behaviour maintained by escape from aversive demands, and can instead lead to engagement that will often create the feeling of control, and contact attention from others and contact with tangibles

Support staff to identify and develop meaningful activity for each person throughout each day, using core activities as ‘anchors’

What each service user has as their next goal, e.g. to go on holiday, to go for a trip out, to do a course, to work Local community organisations and what they offer An understanding of the impact of intellectual

Coach staff to break down complex activities into steps (carry out task analysis) and vary the help they provide at each step Coach staff to provide just the right amount of help Monitors that each service user has meaningful activity in their lives, and things they are looking forward to goals they want to achieve Participate in a skills assessment as required Support the person in a skills assessment as required


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disability (e.g. that learning is different, can take a long time and needs specific supports) An understanding that developing a person’s strengths is the most effective way to build skills repertoires A range of tools that may be used to assess a person’s skills The relevant assessment tools to determine skill and ability levels

Objectively record levels of independence in tasks Select and conduct appropriate skills assessments Detail a communication profile in assessment reports Advocate for person and staff team when resources are needed Ensure the physical environment is an appropriate match for the person and recommend changes in line with their needs

The importance of including communication skills as part of this assessment Ethical and legal framework around responding to someone in crisis Competence required of staff team to deliver crisis response Ensure compliance with legal framework for PBS

When legislation (Mental Capacity Act; Deprivation of Liberties Safeguards (DOLs); Mental Health Act, Human Rights Act and other legal issues relating to restrictive practices including physical intervention) comes into practice Who should be involved in capacity assessments and best interests decisions based on the nature of the decision Ethical and legal framework around

Ensure relevant legislation is understood by staff and is implemented appropriately Ensure that court of protection has approved any restrictions agreed by multi-disciplinary team in the case of DoLS standards Monitor and review use of restrictive practices on a regular basis. Monitor Quality of life indicators Contact appropriate people to involve them in capacity assessments and/or best interests decisions and arrange


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responding to someone in crisis

assessments

Competence required of staff team to deliver crisis

Check the team’s understanding of the crisis management strategies included in the BSP and address anything that is not fully understood Ensure that all staff have been trained appropriately by a suitably qualified trainer with opportunity to practice procedures through modelling, practice and feedback

Descriptive functional assessment and intervention plan

The process of functional assessment and the development of an intervention plan A range of functional assessment tools and their strengths and limitations

Produce a descriptive functional assessment report Conduct a functional assessment interview Conduct direct and indirect observation (data included in above)

The limitations of own knowledge, and the need for other professional input

Use rating scales (data included in above)

That importance of considering health needs within assessment

Verify analysis and formulation

That the quality of life and physical and mental health are interrelated Specific syndromes and conditions that may indicate behavioural profiles

The triangulation6 of data from a number of sources Validation – goodness of fit Design a multi-component intervention plan across settings with stakeholder involvement Facilitate implementation intervention plan Provide training, guidance and emotional support Assess fidelity of intervention

6

The process of bringing together data from different types of behavioural assessment in order to enhance the accuracy of our understanding of why a behaviour is occurring. CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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Evaluate intervention effect, adjust intervention procedures and evaluate changes. Fade additional support for intervention Plan for generalisation and maintenance Reflection Arrange full health assessments as part of any initial assessment and routine medical health check-ups as a follow up Arrange medical assessment following any significant change in behaviour Liaise with medical team to facilitate the physical and mental health assessment of the person (e.g. preparation for invasive investigations) Specialist Behavioural knowledge

Have an in depth understanding of principles, processes and concepts of Behaviour The conceptual framework of challenging behaviour About contingency diagrams and how they are constructed

Support the team in developing an understanding of why behaviour occurs for every person supported recognising that those reasons will be specific to that person Support the team in understanding the effect of their own behaviour on others including the person supported and help them adapt accordingly Achieve relevant qualification to demonstrate high level of knowledge Participate in regular clinical supervision


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The implementation and monitoring of behaviour support plans including skill teaching

Understand: The strengths and weaknesses of various data collection methods and the appropriate method for the behaviour(s) in question The application of data collection procedures to evaluate goals in the BSP; and the need for functional graphical and tabula representation of data All of the elements that constitute a good BST: 



the contextual nature of challenging behaviour and how it serves a function for the individual support strategies that are evidence based, multi-element and use preventative antecedent interventions but also seek to offer the individual a functional alternative behaviour. When appropriate, there should be clearly defined reinforcement strategies



a robust crisis management strategy based on least restrictive options



a plan to ensure effective team coordination and communication

The theory behind the application of antecedent strategies; a range of antecedentbased support strategies and how these are implemented Teaching strategies (skills teaching and

Put in place data collection procedure appropriate for the behaviour, the dimensions of that behaviour (frequency, intensity, duration etc.) and the context in which it occurs Train and supports staff in data collection procedures Analyse and produce graphical and tabular representation of data Ensure that all members of the support team understand and are able to accurately implement each BSP, for every person being supported Demonstrate to members of the team the strategies described within the BSP Direct anyone new to the team to the BSP and offer supervision to ensure they can demonstrate required standards Maintain quality by offering direct coaching to others in implementation of strategies and provide regular performance feedback Model antecedent strategies to staff and support them in their implementation Support staff in the promotion of choice and independence

Support staff to increase engagement levels for the person via strategies outline in implementation plan Relate skills teaching and increasing the communication repertoire to the support plan and short, medium and long term aims/goals, ultimately leading to improvements in quality of life that are measurable and appropriate


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functional communication skills teaching) and procedures’ including task analysis, chaining, shaping, modelling, prompting, discrete trial teaching7, natural environment teaching8, establishing stimulus control9 The principles of reinforcement, maintenance and generalisation. Appreciation of how other evidence based interventions may be used as an element of the PBS plan where indicted (e.g Cognitive Behaviour Therapy

Appreciation of and ability to apply principles of organisational change management The importance of evaluating effectiveness The different ways in which outcomes variables can be measured How to summarise and analyses outcome data How to present outcome data in various

Empathise with and support other staff to empathise with person’s communication needs Review potential antecedent strategies during BSP development and raise concerns if impractical Ensure that antecedent strategies are shared and understood by the team and that necessary resources are in place Contribute to the development of teaching strategies and protocols

Check each member of the team understands the teaching strategies and protocols within the BSP, through supervision and observation of practice Ensure that resources are available for teaching opportunities Identify wide range of options to be used to reinforce appropriate behaviour for each person Explain the rationale for evaluating a given outcome variable and link this to the PBS model

7

A structured instructional teaching method based on the four-term contingency (see below) in which the person teaching sequentially presents an instruction and provides a consequence for the response for a number of trials. 8 (Also sometimes called Incidental Teaching) is an instructional method similar to that of Discrete Trial Teaching and also based on the four-term term contingency. The difference is that in NET the teaching opportunity is learner rather than instructor initiated; i.e. the learning opportunity arises as a result of the learner’s motivation to do or to want something at that point. It is often initiated by requests for preferred items which are likely to serve as reinforcing consequences for any correct responses. It is also less structured and takes place in the context of other activities. 9 Stimulus control is a situation in which some dimension of behaviour is altered by the presence or absence of a specific antecedent stimulus (e.g., Stimulus = green man shows at a pelican crossing; response = cross road) Establishing stimulus control is an important aspect of behaviour change, is widely used in teaching, and plays a critical role in most forms of learning. CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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formats including visually (e.g. using graphs) The cycle of assessment, intervention, monitoring and evaluation, with particular emphasis on the outcome variables relevant to the PBS model The BSP is a live document, and the need to translate on-going data into actions aimed at achieving the existing goals of the BSP, or how on-going data can be incorporated into adapting the goals of the BSP

Select or design appropriate measures that evaluate outcome variables (e.g. individualised frequency charts, record of physical interventions used) Train direct carers in the use of the data gathering methods Ensure the continued competence of direct carers in the use of the data gathering methods. Summarise and analyse outcome data and present in visual format, (e.g. using computer software such as Excel) Provide data on the effectiveness of the BSP in visual format (graphs)

How to make, and facilitate the making of, data-based decisions How to effectively chair review meetings

Address any inconsistencies in the delivery of the BSP and ensure that all members of the team understand the measures taken Change or adjust elements of the BSP based on the evaluation data gathered and ensure that all members of the team understand the measures taken Make clear the link between the data collected and the decision making process and ensure that the team understand this relationship Ensure, when chairing a review meeting, that all stakeholders have their say, that timings are observed, that appropriate data are used to inform all decisions, and that all necessary areas are covered, such as:    

What has been tried (description of BSP) What worked (includes visual feedback) What did not work (includes visual feedback) What do we do next (action setting)


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Level 4 Higher level Specialist / Consultant / Organisational lead Professionally qualified experts who can manage complex cases or complex systems


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Table 5: Level 4 Higher level Specialist / Consultant / Organisational lead


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Level 4 Higher level Specialist / Consultant / Organisational lead knowledge and skills Due to the wide range of service models and different job roles the competencies needed at this level are also described as functions . These functions may be carried out by different people or they may be the same person. They have been grouped into the two areas needed to support complex case management or complex systems management .i.e. Higher level specialist /organisational / consultant. The functions in both areas are interdependent, both are needed. The skills and knowledge checklist from the PBS competence framework below is designed to help services and organisations decide which qualifications are the most appropriate. * Competencies that require specialist behavioural knowledge and abilities are shown in italics Higher level Specialists or Consultants who are responsible for supporting complex case management will need to have a range of skills and knowledge to inform a person centred Positive Behaviour Support plan that supports a bio/psycho/social understanding of the person’s strengths and needs. This includes the ability to integrate other evidence based interventions and approaches to meet individual needs in a holistic way. They may need to use data from multiple sources and coordinate work from other clinical specialists. Complex cases could include people who have a diverse range of cognitive differences and/or vulnerabilities including autism, ADHD, current and historic experiences of trauma, and attachment difficulties as well as psychological and physical health needs. The specialist will need a good understanding of how these different factors or vulnerabilities interact with the overall environment to create and maintain behaviours of concern, how those conditions can be altered to reduce the likelihood of them occurring.


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Function


Have the ability to

Creating high quality care and support environments

The policies and procedures that enshrine legislation and best practice and reflect the service philosophy base

Develop a values led strategic vision and philosophy for the organisation

The principles of change management and the process of establishing an organisation-wide culture

Create the necessary infrastructure to support a values-led culture and documents that clearly communicate principles, values, guidelines Commission or develop training that will ensure that the service can provide the support required by the individuals that it supports

The evidence base behind the reasons why everyone who has direct contact with an individual needs to have a detailed knowledge of that individual

Develop partnerships with commissioners to ensure that they are able to be actively involved in the initial provision of service and its ongoing development

Multiple systems for person-centred planning

Ensures that anyone having direct contact with a person either knows them or knows where and from whom to get pertinent information

The strategic importance of effective team leadership The importance of robust human resource management in the support of a positive environment

Who

Interacts positively and respectfully all persons within the service Implement personalised systems for goal-based person-centred outcome planning, implementing

The importance of effective staff recruitment


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and on-going staff retention in a market in which there is often high turnover The strategic importance of effective team leadership The importance of supporting the supervisors Functional communication training and the relevance of this to challenging behaviour A comprehensive range of augmentative and alternative communication10 methods What health and social care systems and resources are available to support complex cases The complexities involved in co-morbidity Ways of collecting and analysing data on health and wellbeing Medication, including as required medication protocols

plans, and monitoring their impact Establish a human resource infrastructure and policies that facilitate effective team working and encourage staff involvement Implement good human resource and personnel management and supervision procedures Establish an effective staff recruitment process Monitor reasons for high staff turnover and empower the management team to address this issue Establish system wide structures that comply with the regulatory framework11 Support communication development of staff (i.e.computer literacy training) Support staff in the understanding of more complex systemic communication needs Support assessment and intervention components that address alternate functional communication Establish and maintains good working

10

Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas, including facial expressions or gestures, the use of symbols or pictures, or written words. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help those with difficulties communicating. 11 The legislative and policy frameworks within which support services are delivered. CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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Intervention strategies from behaviour analysis that enable a person to access mainstream or specialist health services*

relationships with all health and care services to ensure multi-disciplinary team work is effective Collect and analyse data on physical and mental health and wellbeing Provide clinical expertise in complex cases involving co-morbidity

The importance of community involvement in the lives of persons at risk of engaging in challenging behaviour and the strategic importance of engaging with the family and wider community Systems and procedures necessary to maintain safe, consistent and predictable environments Available resources, including sources of funding that might be used to provide meaningful activities within services The model of causality of challenging behaviour and the relationship between meaningful engagement and challenging behaviour Current legislative framework Where to find relevant case law and/or seek specialist advice

Develop a clear strategy for ensuring that the amount of medication used is never more than is therapeutically necessary; establishes monitoring and data collection process; ensures that data collected is fed back into prescribing and administering process Promote mental and physical wellbeing activities for person’s supported as well as staff Facilitate joint working with other disciplines, e.g. psychiatry colleagues Design and support the implementation of a programme to enable a client to visit their GP or local hospital Establish the networks necessary to ensure family and community participation Design policies and procedures to establish safe,


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consistent and predictable environments Monitor the safety, consistency and predictability of environments that define the service Influence and change the system of support if it does not produce a safe, consistent and predictable environment Secures the resources necessary to ensure that all persons supported are able to engage in meaningful activities Provides a clear expectation that participating in everyday activity is a key outcome Supplies operational and procedural guidance for supporting activity engagement – active support training and practice leadership Measures participation and community involvement as outcomes and reports to stakeholders along with data on the occurrence of challenging behaviour Ensure that all staff have access to updates to legislation as necessary. Ensure that policies and procedures meet current legislation and are up to date. Ensure that policies and procedures feed into


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service philosophy Lead strategic process, safeguarding, training as required Develop a culture in which it is safe to report

A comprehensive and up to date knowledge of communication and skills teaching

Discuss with staff their understanding of the person’s communication needs Conduct training audits, identify gaps in staff knowledge and deliver training support as required

Functional, contextual and skills based assessment

The critical importance of stakeholder involvement The challenges of facilitating stakeholder involvement and know how to overcome them The wider systemic factors that influence behaviour, including the societal, cultural and policy context The resources/infrastructure necessary to support a PBS framework in terms of model of

Enable/establish necessary infrastructure/policies to establish links and sustain stakeholder involvement Outline strategies for stakeholder engagement Assess the resources at macro organisational level Develop strategic plans which secure the resources necessary to support a PBS framework Develop strategic plan for whole team training and


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care and assessment pathways

continued professional development

The importance of contextual fit12 and how the needs of the population might be assessed and resources made available

Prior to other assessments ensure an appropriate professional conducts a full health assessment

The importance of physical and mental health and supports others in the organisation in that understanding The infrastructure available to be able to assess health/access to medical assessment Who to go to for information on rare genetic syndromes and /or complex health issues/mental health issues

In-depth understanding of Principles, Processes and Concepts of Behaviour The contingencies within the organisational system, and teams and how these can translate into effective intervention of barriers to implementation

Include in reports that syndromes and conditions have been considered Assessment demonstrates the relationship between health and quality of life Communicate assessed relations to stakeholders the interrelatedness of quality of life and physical and mental health and ensure these factors are included in assessments Ensure the organisation has access to primary health care; care pathways, establish links with local hospitals and specialist services,

Make referrals, liaises/coordinates at senior level with specialists in specific syndromes/complex health issues

Achieves relevant qualification to demonstrate high Data collection procedures (e.g frequency, 12

Contextual fit is the extent to which the elements of a behavior support plan are consistent with the values, skills, resources, infrastructure and support available to those responsible for implementing the plan. CAPBS, Health Education England - Working in Partnership with Black Country Foundation Partnership Trust: PBS Development Framework

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duration, partial & whole interval, momentary time sampling) The importance of having specialist behaviour analytic services to assess the function of behaviour

How to select the most effective assessment procedures and the ethics of completing functional assessment

Situations when hypothesis testing is indicated

level of knowledge

Participates in regular clinical supervision by experienced peers

Establish an infrastructure that supports data driven decision making Design and implement the most effective data collection procedures (e.g., frequency, duration, partial & whole interval, momentary time sampling) Design assessment procedures to evaluate effectiveness of interventions, to inform evidence

The safe design and conducting of hypothesis testing through experimental functional analysis The outputs of the BSP should emphasise a person’s strengths and building skills The need to select the most appropriate skills required to encourage independence That the outputs of the BSP should make use of the information arising from a preference assessment; both for addressing behaviours of concern and skills development

Complete functional assessment incorporating all variables of the person, environment, staff team and organization Conduct and support experimental functional analysis where this is indicated to derive functional hypotheses Demonstrate triangulation and synthesising of assessment outcomes to develop a clear hypothesis Produce and communicate assessment results in


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an accessible form that enables supervisory and direct support staff to integrate findings into support plans Use and interpret appropriate assessment tools to determine current skill levels and appropriate next steps in skill building Use and interpret appropriate assessment tools to determine a person’s preferences and incorporate this into the BSP

Developing and implementing a Behaviour Support Plan; Evaluating intervention effects and monitoring outcomes

That in the UK, BSPs are recommended for all people whose behaviour challenges and that the quality of a BSP may have an impact on outcomes The need for specialist behaviour support in the development of BSPs

Establish service quality standards that every person, being supported, will have an active, meaningful BSP implemented with integrity Ensure that BSPs are audited regularly and that an action plan to address deficits is developed and implemented Coordinate access to further specialist behavioural training and consultation when required Establish the necessary infrastructure to facilitate the synthesis of data Synthesise data from relevant skills and functional assessments to create an overview of a person’s


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Behavioural specialists overseeing BSP will have a detailed understanding of the science of behaviour within the overall context of the PBS model; the processes involved in synthesising data from multiple sources; and the application of that information in order to create an overview of a person’s skills and needs. Will be able to integrate other evidence based interventions by co-ordinating work of other clinical specialists

Those responsible for organisation resources will have knowledge of the infrastructure and available resources that contribute to the development of an effective BSP Organisational managers will know how to access expertise from Behavioural Specialists who will have a detailed knowledge of the conceptual model of challenging behaviour; the factors that maintain it and the relationships between those factors

skills and needs Work collaboratively with stakeholders in the reporting results of assessment Construct a formulation that explains the functions of a person’s challenging behaviour and how it is maintained. Describe and explain each formulation to the teams involved in supporting each person with challenging behaviour.

Offer staff training, at all levels, to help them understand the formulation.

Describe how the important variables surrounding an individual and their care team, interact to produce challenging behaviour within a contingency diagrams

A comprehensive and up-to-date knowledge of implementation procedures in respect of


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behaviour analysis How antecedent interventions can reduce the likelihood of challenging behaviour occurring. How teaching strategies can offer a replacement and appropriate behaviour to serve the same function as the challenging behaviour and therefore rendering it redundant. How teaching strategies can foster skills development Current developments and training opportunities of national standing to maintain and enhance quality services. That interventions are often system wide and need active management/support

How system change can be difficult for staff and the need to support them The importance of using least restrictive crisis management procedures The ethical and practical implications of using reactive strategies

Ensure service has access to required expertise to advise on best practice.

Ensure general organisational systems support individual antecedent intervention (e.g. consistent workforce, maintaining routines, minimal disruption).

Ensure that antecedent strategies are understood by everyone within the system and necessary resources are in place to maintain fidelity

Ensure the highest levels of consistency are maintained for most complex individuals

Maintain standards for all teaching protocols

The importance of investigating unplanned


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restrictive incidents

The current legal and ethical framework and how to implement nationally agreed standards of best practice within organisation

Ensure on-going, continuing professional development activities around clinical practice

Speak with wider staff team to understand the system needs Design and support staff in the implementation of system wide interventions Support staff reflection Clear policy on the use of restrictive practices Ensure the delivery of accredited, effective theoretical and practical training in line with this policy

Importance of multi-disciplinary working and the need to include everyone who is supporting a person in the BSP; to know their respective roles and responsibilities and to understand the timeframes involved

Establish an infrastructure and allocate the resources needed to support a least restrictive management strategy

The evidence base behind the reasons why everyone who has direct contact with an individual needs to have a detailed knowledge of that person’s BSP

Ensure a least restrictive crisis management strategy is in place for each person that is appropriate and congruent with accredited training; address concerns for any proposed strategies that might not be practical; ensures that least restrictive strategies are understood by all members of the team

Data driven procedural integrity reflects a more

Encourage discussion around ethical and practical


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scientific or effective approach to assessing the effectiveness of an intervention; and is the only way to be sure that the strategies outlined in the BSP are implemented or not How to design and implement delivery monitoring systems The importance of practice being evidencebased at the an Individual, group of individuals , and organisational level , and that the only way to assess effectiveness is through systematic monitoring and evaluation at each level The different outcomes variables that can be measured at an Individual, group of individuals, and organisational level How to analyse outcome data at an individual/ group of individuals and organisational level The importance of the periodic auditing of systems and procedures across the organisation The infrastructure and processes that need to be in place in order to support the cycle of assessment, intervention, monitoring and evaluation, with particular emphasis on the outcomes variables relevant to the PBS model

implications of reactive strategies; support staff at all levels to understand these issues Routinely monitor restrictive practices (e.g. for an individual and across the organisation) for trends and variances Investigate unplanned restrictive interventions and maintains paperwork trail to ensure it was legally and ethically appropriate; redesign systems and programmes accordingly Establish mechanisms and skilled workers to ensure debriefing occurs and staff support in place Review debriefing data regularly and devises and ensures action plan is implemented to address recommendations including need for further training, change to processes and procedures etc. Ensure that restrictive interventions are delivered within an overall organisational framework that actively seeks to reduce their use to a minimum

Ensure staff are trained in or have access to, specialist behavioural skills, in order to write high quality plans based on accurate assessment data Ensure an agreed format is used and mechanisms


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are in place to review BSP regularly Ensure, that within a multi-disciplinary approach, all stakeholders understand their respective roles and responsibilities within the BSP and address anything that is not fully understood Ensure that there are organisation wide systems for monitoring the delivery of BSPs in place and are utilised within the organisations performance management and quality assurance systems. Select or design delivery monitoring systems and train direct carers in their use Explain why, in addition to being evidence-based in terms of using empirically supported methods, we must also evaluate what works for the person and what works at a group and organisational levels and how to monitor outcomes organisationwide Select or design appropriate measures that evaluate outcome variables at an Individual, group of individuals , and organisational level (e.g. physical aggression and self-injury, along with use of physical interventions) Ensure that there are organisation wide systems for evaluating outcome data at an individual, group and organisational level in place and are utilised


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within the organisations performance management and quality assurance systems Implement periodic audits of systems in place across the organisation Ensure that the resources and infrastructure are in place so that the cycle of assessment, intervention, monitoring and evaluation occurs


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References Anderson, C and Horner, R (2007). Developing Feasible and Effective Interventions based on Functional Behavioral Assessment. PPT presentation. Available at: http://bit.ly/1Qtfe7N Jones E, Lowe, K, Brown, S, Albert, L, Saunders, C, Hake, N Leigh, H. (2013). Active Support as a primary prevention strategy for challenging behaviour. BILD, International Journal of Positive Behavioural Support 3 (1)16- 30 Deveau R and Mc Gill P (2014 ). Leadership at the front line: Impact of practice leadership management style on staff experience in services for people with intellectual disability and challenging behaviour Journal of Intellectual and Developmental Disability, Volume 39, Issue 1, 0 LaVigna , Willis TJ., Shaull J., Abedi.M, Sweitzer M. ( 1994 ) The Periodic Service Review A Total Quality Assurance System for Human Services and Education Pitonyak , D ( 2005 ) Ten Things You Can Do to Support A Person With Difficult Behaviors Version 1 November 2005 http://www.dimagine.com/ Hastings , R,P. Allen, D. Baker, P. Gore , N. Hughes, C. McGill, P. Noone ,S. Toogood, S . ( 2013) A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities. Special issue International Journal of Positive Behavioural Support Volume 3 number 2 Autumn 2013 BILD Denne L, Jones, E. Lowe, K. Jackson Brown, F. Hughes ,C. ( 2015) Putting positive behavioural support into practice : the challenges of workforce training and development. International Journal of Positive Behavioural Support Volume 5 number 2 Autumn 2015. Gilbert P, The Compassionate Mind ( 2009 ) A new approach to life's challenges. Constable and Robinson. Jackson - Brown F, ( 2013 ) Get the life you want. Finding meaning and purpose through Acceptance and Commitment Therapy. AbeBooks. Singh NN, Lacioni ,GE Winton ASW,Singh AS, Askins AD, and Singh J( 2009) Mindful staff can reduce the use of physical restraints when providing care to individuals with intellectual disabilities. Journal of Applied Research in intellectual Disabilities ,22,194-202


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