Understanding positive behaviour support & restrictive practices

Positive Behaviour Support (PBS) is a person-centred approach to understanding and addressing challenging behaviours. The team at Insight PBS & Bridging Psychology explain further….

WHAT IS POSITIVE BEHAVIOUR SUPPORT?

Positive Behaviour Support aims to understand the reasons behind an individual’s challenging behaviour and develop proactive strategies to prevent these behaviours from occurring in the first place. This approach focuses on building the individual’s skills and strengths, rather than simply trying to reduce or eliminate problematic behaviours.

It involves several key components:

• Person-centred planning: this involves working closely with the individual and having them and their views as the centre of the service.
• Functional behaviours assessment: to identify the underlying reasons for challenging behaviours, such as environmental factors or unmet needs.
• Positive/preventative strategies: using and teaching strategies that will help the person to have their needs met in a prosocial way and develop the needed skills that will assist in achieving a higher level of quality of life.
• Data-driven decision making: PBS emphasises the importance of collecting data on an individual’s behaviours to identify potential triggers (and antecedents), track progress and make informed decisions about interventions.

The goals of PBS are to promote the well- being and quality of life of individuals and to reduce and eliminate restrictive practices. The practice uses positive reinforcement to encourage positive behaviours, such as praise, rewards, and privileges. This approach is designed to encourage positive behaviours rather than punishing or eliminating problematic behaviours (behaviours of concern).

BEHAVIOURS OF CONCERN

PBS comes from the perspective that all behaviour is a means of communication and there is a reason for everything we do. People will try and communicate in the most efficient, effective and easiest way they know, but this may not be the most acceptable way.

“Behaviours of concern”are behaviours of such intensity, frequency or duration that the physical safety of the person or others is placed in serious jeopardy, or behaviours which are likely to seriously limit or deny access to the use of ordinary community facilities.

Examples of behaviours of concern can include physical aggression, verbal aggression, self-injury, property destruction, and elopement (leaving a
safe area without permission). These behaviours can be distressing for the individual and those around them and can interfere with their ability to participate in daily activities and social interactions.

RESTRICTIVE PRACTICES

A restrictive practice is defined as any practice or intervention that has the effect of restricting the rights or freedom of movement of a person with a disability.

You can see the official definition and full outline of Restrictive Practices in Section 9 of the NDIS Act 2013.

There are five categories of regulated restrictive practices that are monitored by the NDIS Commission. These are the following:

1. Seclusion

Sole confinement of a person with disability in a room or a physical space at any hour of the day or night where voluntary exit is prevented, or not facilitated, or it is implied that voluntary exit is not permitted.

Seclusion is strictly prohibited in most states for individuals under 18.

2. Environmental restraints / restricted access

Environmental restraint, which restricts aperson’s free access to all parts of their environment, including items or activities.

Includes practices that are beyond ordinary community standards for the purposes of addressing behaviours of concern that can cause harm to the individual and others (normal practice – locking the door for safety).

3. Mechanical restraint

The use of a device to prevent, restrict, or subdue a person’s movement for the primary purpose of influencing a person’s behaviour but does not include the use of devices for therapeutic or non-behavioural purpose.

4. Physical restraint

The use or action of physical force to prevent, restrict or subdue movement of a person’s body, or part of their body, for the primary purpose of influencing their behaviour. Physical restraint does not include the use of a hands-on technique in a reflexive way to guide or redirect a person away from potential harm/injury, consistent with what could reasonably be considered the exercise of care towards a person.

5. Chemical restraint

The use of medication or chemical substances for the primary purpose of influencing a person’s behaviour. It does not include the use of medication prescribed by a medical practitioner for the treatment of, or to enable treatment of, a diagnosed mental disorder, a physical illness or a physical condition.

All of the above should only be used as a last resort, be the least restrictive response possible in the circumstances, reduce the risk of harm to the person with disability or others, be in proportion to the potential negative consequence or risk of harm, and be used for the shortest possible time to ensure the safety of the person with disability or others.

BEHAVIOUR SUPPORT PLANS – WHAT ARE THEY, AND WHAT GOES IN THEM?

A Behaviour Support Plan (BSP) is a detailed document designed to understand the person, the reason behind the behaviours, and support the person and carers to address challenging behaviours through Positive Behaviour Support (PBS) strategies.

Here’s what typically goes into a BSP:

• Information about who the participant is
• Information and overview of disability/ies
• Goals and objectives of the person
• Any identified Behaviours of Concern
• Individualised proactive and reactive strategies to prevent and respond to challenging behaviours
• Methods for collecting data to track progress and adjust strategies as needed
• Scheduled evaluations to review data, assess progress, and make necessary adjustments
• Information about the restrictive practices that might be either recommended or are currently being used.

Any behaviour support plans containing regulated restrictive practices must be lodged by specialist behaviour support providers with the NDIS Commission.

Information in the Positive Behaviour Support plan will be based on the findings from a Functional Behaviour Assessment (FBA) process.

Once a Functional Behaviour Assessment (FBA) has identified the potential triggers (and antecedent) and reasons of a behaviour/behaviours,
and information has been analysed; the information will then be used to develop person specific interventions to be recommended.

Some of these interventions could be:

• Environmental modifications:
• Adjustments in the physical and structural settings (e.g. routine) to reduce stressors and triggers
• Skill development, this can include, but not limited to social, communication, coping skills
• Positive reinforcement with meaningful rewards
• Proactive strategies: Uses preventive measures like visual schedules and breathing techniques
• Introduction of purposeful activities
• Collaboration and training: Train staff and caregivers in PBS strategies and foster teamwork.

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Insight PBS is an NDIS-registered provider of Positive Behaviour Support operating in VIC, NSW, SA and WA. More information on their services is available at www.insightpbs.com.au. Bridging Psychology, a sister company of Insight PBS, is committed to making psychological services accessible to individuals with disability – bridgingpsychology.com.au.