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Using Positive Behavioural Support in NAS adult services

In this article Louise Albert, Deputy Area Manager of National Autistic Society (NAS) Cymru, explains what Positive Behavioural Support is, how it is used in NAS adult services and how it has been beneficial for people on the autism spectrum.

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Using Positive Behavioural Support in NAS adult services

What is PBS? 

Positive Behavioural Support (PBS) is an evidence based toolkit or set of procedures that supports staff to safely plan their support of a person with ASD and challenging behaviour. It was initially designed for those with learning disabilities but is useful for people with ASD and other developmental conditions. Essentially PBS provides an ethically based technology to translate modern service values into practice. 

PBS isn’t just about reactive behavioural support, which has previously been the case but instead focuses on supporting the individual’s lifestyle in order to reduce the potential for anxiety or confusion. It is a framework that teaches staff clear techniques in supporting a person in what they want to do with their lives. It puts Person Centred Planning at the core with an emphasis on how to communicate more effectively (Inclusive Communication). It also equips staff to teach skills (Active Support) including using graded assistance, task analysis and goal planning. 

PBS also focuses on how to maintain a comfortable lifestyle for a person and teaches staff how to respond should a person become anxious, unhappy or challenge their service. PBS is also designed to develop ‘Practise leaders’ so that staff are guided and managed by example and not left to themselves to make difficult decisions outside of an agreed action. 

Training

Training in PBS is important – it is not a one day course or a simple book you can read; this is an in-depth, competency based and theory based course. Training can result in a BTEC certificate, Advanced Diploma or Advanced Professional Diploma – all of which are mapped against National Occupational Standards and the NHS Knowledge and Skills Framework.

NAS Cymru services have been rolling out PBS for about 8 years. The main management team and behavioural team are qualified in the Advanced Professional Diploma, the house/service managers in the Advanced Diploma, and we are currently rolling out the certificate amongst the support staff. As well as this the service has developed all the support systems and training strategies to run in line with the PBS materials. 

It is important that all the services are offered Continuing Professional Development training and run a PBS focus group and induction course.

It uses the e-learning courses in Positive Behavioural Support that have been developed by The Directorate of Learning Disability Services of Bro Morgannwg NHS Trust (supported by the Welsh Assembly Government). 

These courses cover the key components of high quality service delivery, including:

• the history of services those with learning disabilities

• contemporary service values

• person-centred planning

• understanding challenging behaviour

• mental health issue 

• the three-stage intervention model, including 3 stage competency training, primary prevention involving: 

• active support

• inclusive communication and skill teaching

• secondary prevention and reactive strategies. 

It also addresses the design of Positive Behavioural Support plans and how to manage implementation, monitoring and review.

Is it an autism specific approach? 

The system is designed to support those individuals who need extra support in their lives around managing anxiety and behaviour that may challenge their services, their environment, themselves etc. However, it is ASD specific from the core as it makes all those involved see the person as the centre of support and all their support needs are then built around any planning. 

Can it be used alongside other approaches? 

The PBS system already incorporates other systems within it; such as Active Support, Inclusive Communication etc. It is really easy to use any other system alongside this. NAS Cymru also use TEACCH, PECS, Social Eyes, Social Stories and other such autism specific approaches. However, the system is designed for being used alongside only BILD approved physical management systems due to the core ethical base of ‘non aversive’ approach. 

Is the approach used across various settings such as home, day support, and outreach support? 

Yes this is one of the core messages of the system; that the approach is an agreed response to support for an individual and is designed for teaching all support staff and carers/families who would need to know the response. All support plans have to be developed by getting those who support them together in a group to agree the plan. 

The approach is designed for supporting adults but could be used for children if adapted. If adapted, the child shouldn’t use the system themselves, it is a toolkit of support strategies for support workers, family and professionals. 

Functional analysis

At the core of the PBS system is a really thorough behavioural assessment procedure called ‘Functional Analysis’ and this will give an in depth view of the defining behaviour, analysing things that lead up to it, why it has happened and what makes the person engage in the behaviour repeatedly. There are also other assessment tools in the package that assist in understanding. 

How long might we use this approach with the person? 

If this system is chosen as the most effective way to support a person, then it would be in place for life. The primary preventative systems that can be put in place such as TEACCH and Active Support would be crucial to be maintained and adapted throughout a person’s lifestyle. The only time that the system would no longer be required would be if the person no longer displayed any behaviours that challenge or no longer required the support techniques to keep them at a level of stability. 

How has this approach benefited people with autism we have supported? Have the results been positive? 

We have noticed that it has benefited a variety of people and not just those with ASD. In the first instances, we have much more confidence as a support team in supporting people who present with complex support needs, especially those with challenging behaviour. The staff have noticed that the three stage competency training system (that offers staff training, role playing and in-situ training) has given them the skills and confidence needed to run any support package that is required for an individual. 

Managers’ report that they find the management and support of staff as clearer as they are using technologies such as Positive Monitoring1 and Goodness of Fit2 to measure effectiveness of staff support and the effectiveness of the plans that have been developed. They didn’t have such monitoring systems before the BTEC training. 

Individuals with autism have benefited from a much more consistent approach from their support staff; they have a lifestyle that offers them what they want and need and an approach to supporting them when they are feeling anxious. In our services we have seen at least two case studies of individuals with ASD who were being supported in high support services that were able to transition to much less restrictive living settings where they were able to access more community services than previously as a result of living much more settled lives. 

The local authority’s health teams have found that working alongside staff that are equipped in such technologies, are trained in the PBS model and have a common language require less support from their already stretched resources. 

Further information 

For further information, including how to enroll, please contact: Joanne Wheeler, BTEC Co-coordinator, preferably by e-mail or by phone on 01656 753939. 

References

1 Where managers and key workers check that PBS plans are implemented (an audit system used as observational checklist).

2 Monitors the effectiveness of PBS strategies for the staff and the individual concerned. 

 

Author: Louise Albert

Date added: 15 October 2014