People who are able to develop and maintain positive behaviour patterns are more likely to lead happy and fulfilling lives and maintain positive relationships to be active participants in the community

What is positive behavioural support (PBS)? Over the last three decades, PBS has increasingly become the model of choice in supporting people whose behaviour poses challenges to services. While there are several existing descriptions of PBS available (Allen et al., 2005; Carr et al., 2002; Horner et al., 1990, 2000; LaVigna and Willis, 2005), a recent definition by Gore et al., (2013) sought to bring together the fundamental elements of PBS in a way that could usefully inform future service, policy and research developments in the UK.

This policy sets out instructions and guidelines employed by our organisation to promote behaviour that enhances people’s quality of life and that the person is at the centre of all aspects and decisions related to their behaviour management.

Human behaviour is a complex and often fascinating subject. Some people display challenging behaviour as a response to certain triggers or events that occur and a person’s learning difficulties causes them distress resulting in behaviour that challenges.

In attempting to modify behaviour, it is important to examine the motives for the behaviour and identify the need for which the behaviour is meeting. To achieve this there needs to be a thorough functional analysis so that avoidance strategies can be implemented to avoid future episodes
Effective strategies include:

It is vital to create a positive environment where people feel safe and supported. People need to feel good about themselves through actions, words and attitudes and staff will be trained to ensure this philosophy is adopted at all times. Staff should follow the following principles:

The influence of the environment must not be underestimated in terms of its effect on a person’s behaviour. Therefore, the environment needs to be calm but supportive but also functional in meeting people’s needs. A positive environment will include:

Rewards are important in the encouragement of good behaviour and success no matter how small should be celebrated to allow the person to recognise that positive behaviour results in positive feelings from others. However, there needs to be an understanding of the consequences to register disapproval for poor or challenging behaviour. It is also important that the person understands why consequences have been used through:

The skill and experience of the staff is an essential element of maintaining a positive environment. It requires a great deal of patience and dedication and so staff will be supported to carry out their role in this highly demanding and sometimes challenging environment. Sphere Specilalist Healthcare will ensure that staff:

Staff who are expected to employ restrictive physical techniques must receive specialist training. Our specialist training is provided by Allyson McLeod Learning for Excellence and covers the least intrusive methods up to more restrictive techniques. Any use of force must be reasonable and proportionate and last for the minimal amount of time possible.

All interventions must be carried out under the supervision of an identified member of staff who has undertaken the appropriate accredited training.
In an emergency, it may be necessary for staff to apply restrictive physical techniques who will not have received training. However, in these cases, the use of force must only ever be employed if it is the only way to prevent injury or a criminal offence from occurring.

Staff should normally only use physical restraint once they have received training. Specific techniques should be closely matched to the characteristics of each individual and there should be a record of permitted techniques to be employed and these must be followed at all times
Training will be updated at least every 12 months and individual training needs will be identified as part of the ongoing continued professional development.

A behaviour support plan is a document created to help understand and manage behaviour in children and adults who have learning disabilities who display behaviour that others find challenging. A behaviour support plan provides carers with a step by step guide to making sure the person not only has a great quality of life but also enables carers to identify when they need to intervene to prevent an episode of challenging behaviour.

A good behaviour support plan is based on the results of a functional assessment and uses PBS approaches. The plan contains a range of strategies that not only focus on the challenging behaviour(s) but also include ways to ensure the person has access to things that are important to them. The strategies used are referred to as proactive strategies and reactive strategies.

Proactive strategies are intended to make sure the person has got what they need and want on a day to day basis and also includes ways to teach the person appropriate communication and life skills.

Reactive strategies are designed to keep the person and those around them safe from harm. They provide a way to react quickly in a situation where the person is distressed or anxious and more likely to display challenging behaviour. A good behaviour support plan has more proactive strategies than reactive ones. This helps to ensure that the focus of the plan is not just on the challenging behaviour but provides ways to support the person to have a good life, enabling the person to learn better and have more effective ways of getting what they need.

A behaviour support plan is for individuals who regularly display challenging behaviour

A format that is particularly useful in helping carers to understand the different stages of behaviour is based on a ‘traffic light’ system: colour coding a behaviour support plan using this format can be a very useful way of clarifying the different stages of the behaviour. Using the traffic signal analogy, an individual’s behaviour moves from typical behaviour (green) to a level that indicates that problems are about to occur (amber) and the occurrence of the behaviour itself (red). After the behaviour (blue), care must be taken to ensure that the person returns to the green phase. This format enables carers to more easily identify when they could intervene to prevent behaviour escalating into an episode of challenging behaviour.

Plans will be regularly reviewed and updated every six months or as necessary as, once risks have been identified and behaviour strategies agreed to help minimise those risks, it is important to get feedback on how effective the strategies are and to reflect on their impact on the person and those caring for them.

In certain situations, the use of medication may be indicated as a method of
managing extreme behaviour. Medication must only be administered upon medical
advice and must only be used as a routine method of managing difficult behaviour
where it is included within an individual’s care plan and agreed by a qualified
medical practitioner. The use of medication should comply with all prevailing regulations or national minimum standards and will be managed as part of the organisation’s medication management protocols

The management of behaviour carries an element of risk. If strategies are not appropriately applied it can result in pain, physical injury and emotional distress to all concerned. Therefore, the behaviour support plan will include a risk assessment which will identify the risk to both client and staff.

Reporting and monitoring of behaviour are of paramount importance for several reasons:

Documentation used:

Following an incident, both staff and clients will be given opportunities to talk about what happened in a calm and safe environment: this is called a debrief session. These sessions should only take place once all involved have regained their composure.
Post-incident reviews are about gathering the facts and must not be an opportunity to apportion blame or punish those involved.
If the client is not capable of using verbal language then other forms of debriefing techniques should be provided. Specific ways and techniques of providing post-crisis support should be detailed in the individual support plan.
Other forms of post-incident support are:

If there is any reason to suspect a service user or member of staff has experienced injury or severe stress following a serious incident, prompt medical attention must be sought. In the case of serious injuries such as a traumatic head injury then immediate medical help must be sought

Following the organisation’s consenting protocols, details of incidents will be communicated to all stakeholders involved in the individual’s care and support.

Complaints will be dealt with by following the procedures in our complaints policy. In the case of an allegation against a member of staff, this will be dealt with under our multi-agency safeguarding procedures.

Adult Safeguarding
Accidents, Incidents and Emergencies Reporting (RIDDOR)
Challenging Behaviour, Violence & aggression
Code of Conduct for Workers
Deprivation of Liberty Safeguards
First Aid
Personal Safety and Lone Working
Professional Boundaries
Record Keeping
Restraint
Risk Assessment

Bild: The Seven Key Questions about Positive Behavioural Support:
https://www.england.nhs.uk/6cs/wp-content/uploads/sites/25/2016/07/bild-key-questions.pdf

Skills for Care Positive Behavioural Support Framework:
https://www.skillsforcare.org.uk/Document-library/Skills/People-whose-behaviour-challenges/Positive-Behavioural-Support-Competence-Framework.pdf

Bild What are the Five Signs of Good Positive Behavioural Support?
http://www.bild.org.uk/capbs/positive-behaviour-support/

The Challenging Behaviour Foundation:
https://www.challengingbehaviour.org.uk/understanding-behaviour/keymessagespbs.html

All staff, during induction, are made aware of the organisation’s policies and procedures, all of which are used for training updates. All policies and procedures are reviewed and amended where necessary, and staff are made aware of any changes. Observations are undertaken to check skills and competencies. Various methods of training are used, including one to one, online, workbook, group meetings, and individual supervisions. External courses are sourced as required.

Date Reviewed: May 2021
Person responsible for updating this policy: Carly Fortune
Next Review Date: May 2022