Positive Behaviour Support (PBS) is a framework used to gain a detailed understanding of a person – their behaviour, skills, needs and health – to support planning and service design around an individual and their care provision. It delivers enhanced quality of life, both as intervention and as an outcome, for individuals with learning disabilities and challenging behaviour. Care Management Group have developed a PBS strategy that is decreasing behaviours that pose challenges.
Our main aim, within the PBS team at Care Management Group, is to deliver high-quality behavioural support, informed by a PBS framework and guided by national standards and policy. As a team, we are also driven by a passion to achieve a better life for the people we support and we are determined to inspire, share and learn from everyone we work with. This leads us to create opportunities through additional projects, research and events that promote and further the technologies and transformative outcomes of PBS.
"I kick off by practising different behavioural strategies with my team, including how to distract, what reinforcement looks like, and how to follow, implement and track a skills plan."
A PBS framework can be utilised by a number of different people and in varying scenarios. Typically, CMG’s organisation-wide Pass & Port PBS framework follows a standard process. It begins when the PBS team receives an internal referral for behavioural support. A behavioural specialist is then assigned to an individual, and conducts a functional assessment of their behavioural needs. The specialist then works with the individual, their family and others supporting them, to devise strategies and support planning, with the aim of enhancing quality of life and decreasing behaviours that pose challenges.
A PBS Action Plan is also developed to enhance the staff’s score skills in Total Communication, Active Support, Person Centred Planning and Meaningful Activity Planning. To ensure the plan is well understood and practical, the staff are given up to 36 hours of face-to-face training on PBS at the service, putting the plan into action.
The final stage of the journey is to enhance the practice leadership around PBS within the service, and to embed the strategies and planning in working practice. This is achieved by coaching specific team members in the service, supporting the service to achieve the quality standards in PBS and using positive monitoring to engage staff in utilising the plan fully and monitoring its outcomes.
A typical week for a PBS professional may not actually exist. There is nothing typical or routine about it, as every week brings new challenges, opportunities and ideas. Of course, as with most social care professionals, it is also a role with long hours, responsibility and pressure, but also, like most social care work, it is incredibly rewarding. Here is a quick run-through of my last week at work, which epitomises the life of a PBS practitioner and the varying ways that strategies can enhance the quality of life of the individuals we serve.
Monday: Kicking off the week with a day of training with a great team, practising different behavioural strategies, including how to distract an individual, what reinforcement looks like and how to follow, implement and track a skills plan in order to teach an individual at the service new strategies to relax and cope with her busy lifestyle. On the way home, I stopped in to see a family member of an individual I have worked with for several years, who had been having a tough time with recent changes in his health. We identified some ideas for approaches that might reassure him, and they were added to the to-do list for the next day.
Tuesday: I spent the day in the small regional office near where I live. By the end of the day, mood charts for an older lady with personality disorder and mild learning disabilities had been analysed, graphs generated, and some tweaks on her strategy plans agreed with the service manager, to enhance her everyday life.
Wednesday: Heading to another service, I completed an assessment and met with a gentleman who had recently been referred. We had a lovely time talking about his favourite topics. I met with his support team and completed an interview based assessment, collated behaviour recording charts and set up some new recording methods. I then headed to another service to attend a strategy planning meeting for another young man with some very complex, ritualised behaviours. We discussed the issues and devised ways of evidencing ideas on what he may be experiencing and how we can make the right changes for him.
Thursday: Back in London, I spent the day in a new service supporting the transition planning for two people on the autistic spectrum and coached staff to use the visual communication aids. Myself, the service users and staff put together a Scalextric set, which promoted the importance of meaningful activity and engagement. Boredom is one of the most common influencing factors in challenging behaviour.
Friday: I started the day catching up on the progress of a PBS plan for an older lady with schizophrenia. We have managed to reduce her use of pro re nata (PRN) medication completely now, changed her living environment and introduced a new skills plan around communication. We are tracking the staff who are following the plan through the use of a Periodic Service Review, which I go through monthly with the individual’s keyworker. The PBS strategy is achieving positive outcomes for this individual and I believe we can start looking at reducing her regular medications further shortly. Finally, I caught up with the planning around the Surrey PBS network, which I am currently co-chairing. CMG really champions raising awareness of PBS across the sector and we are planning a quality tool, so arranged the next steering group meeting and assigned some actions to everyone involved in designing the tool.
PBS is a framework. It is tools, approaches, skills and a structure within which a professional can work. For me, though, it is also a foundation, a place to begin and return to through the week. Social care never sits still, staff teams change, placements change, needs and wants of individuals change, so to work with PBS you need to be both still enough to have an oversight of what is happening, and fast enough to be one step ahead or, at the very least, right on the heels of that changing landscape.
Lynsey Way is the PBS Strategic Lead at Care Management Group (CMG), a national provider of residential and supported living services for children and adults with profound learning disabilities, autism, mental health and associated complex health needs.