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GUEST COLUMN: How Positive Behaviour Support reduces restraint and enhances peoples’ quality of life

Jo Lourmpa cropped

By Jo Lourmpa, Lifeways’ Specialist Support Manager for Positive Behaviour Support

We know how difficult it can be to work with individuals who may display behaviours that challenge, which create risks for themselves and people around them. And of course, behaviours that challenge don’t happen in a vacuum – they happen for a reason.

Yet simply reacting to behaviours that challenge isn’t enough, and at best, it’s a short-term fix.

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As support professionals, the bigger part of our job is to understand why a person is behaving in a certain way, and what they are trying to get across. For example, an individual may struggle to communicate – so will display behaviours that challenge as a way to ‘get through’ to people.

But what if we focused not on what challenges – but instead looked to understand why these behaviours occur?

How Positive Behaviour Support works

Here’s how our framework, which we call Positive Behaviour Support, or PBS, works.

As the name suggests, PBS starts by taking a positive point of view. This means working to reframe the way our Support Teams see behaviours that challenge. Through focused, individualised training, we help Support Teams fully understand that there are non-aversive – and non-restrictive – ways to respond to an event.

Then, once we understand why an individual we support relies on showing behaviours that challenge, rather than other ways to communicate, we support the person to build communication skills in different, positive ways – and to maintain them.

What Positive Behaviour Support looks like

Here’s an example of how Positive Behaviour Support works in practice.

One individual we support, called Ashley, used to come across as loud and threatening – and would at times get into trouble, like when he’d break into the cars of his Support Team. But by working with Ashley, and by utilising the person-centered approaches learning from Positive Behaviour Support training, his Support Team began to understand what was important to him.

For example, Ashley’s Support Team knew he was inquisitive, and loves cars. So they decided to channel his energy into something he’d enjoy and take him Go Karting (before the pandemic). Unsurprisingly, Ashley loved it!

To help him relieve frustrations, Ashley’s Support Team introduced him to golf, and before the pandemic hit, Ashley had started to go to his local driving range where, in his words, he’d get ‘whacking a few balls.’

In this situation, Ashley’s been supported to get into golf as a self-coping skill technique to manage his feelings.

How Positive Behaviour Support effects people’s quality of life

For us at Lifeways, it’s key that we get our Positive Behaviour Support right – and implement it for everyone who needs this mode of support.

Utilising Positive Behaviour Support heavily reduces occasions where there’s a need to restrain an individual. And reducing the need for restraint is very important for the health, dignity, and independence of the individual. If we don’t reduce the amount of times we need to restrain an individual, we see the negative impact that behaviours that challenge have on peoples’ lives.

When a person can’t take part in an activity they used to like due to the risk to themselves or others, the individual’s quality of life starts to decrease, and incidents of behaviours that challenge tend to increase. When activities the person enjoys become off-limits, the individual experiences more repetition in their life, and fewer meaningful relationships as a result of not being able to take part in the activity.

Our role is to break this negative cycle – while also keeping the people we support and their Support Teams safe.

As a rule, Positive Behaviour Support always focuses on options which are the least restrictive for the individual. We regularly complete a thorough investigation of our records that helps us understand if any restrictive interventions are necessary – and make sure we go back 12 months later to assess if the need is still there.

Tailored approach

A large, important part of Positive Behaviour Support looks at multiple aspects of an individual’s quality of life – such as their social inclusion, physical and emotional wellbeing, personal development and interpersonal relationships. And as each individual is so different, there’s really no blanket, one-size-fits-all approach to Positive Behaviour Support.

When we’re getting to know individuals while training their Support Teams, we look at the person’s history, likes, dislikes, and strengths – as well as their own life’s journey, including where things went wrong, and opportunities that were missed.

Another factor to keep in mind is that some individuals live with past traumas, which can also heavily impact the way they communicate and behave.

Understanding past traumas the individual may have experienced is particularly important when supporting individuals who have transitioned out of hospital or a secure setting, where they may have experienced seclusion, segregation and physical restraint.

Better outcomes

Using Positive Behaviour Support, we are able to replace an individuals’ behaviours that challenge with what we call functionally equivalent skills, or in simple terms, behaviours that can achieve the same outcome but do not put the person – or others – at risk.

Here’s what a functionally equivalent skill looks like: an individual often pinches members of their Support Team repeatedly as a way to show they no longer wish to take part in an activity. In response, the Support Team teaches the individual to communicate that they want a break in a different way, such as using a hand gesture or word.

Our Specialist Leads, Practitioners and Trainers work closely together to achieve this.

Ultimately, taking the time to understand the person and figure out the environment that works best for them is key to supporting individuals to live happier, healthier and more independent lives.

And for us as support professionals, it’s wonderful to see an individual’s life transform when they find positive, constructive ways of communicating that’s right for them.

Tags : Guest ColumnLifeways
Sarah Clarke

The author Sarah Clarke