It can be confusing to understand what Active Support is and how it fits with PBS. The name doesn’t give a lot away, and when described, I’ve often heard managers within organisations say, “well we’ve always done that, support people to be busy and active!”; but this essentially misses the point about what Active Support is. It’s not purely advocating of an active life for people, which of course is a good thing, it’s a way of training staff so that they have the skills to support people to maximise participation in activities.
A Way to Increase Quality of Life
When staff are supporting or educating someone with a significant intellectual disability, they need to have the skills to engage the person in the activity. So this means that the person is not just near those doing the task, or passively holding activity materials. The reality is that some adults and children are not easy to engage in activities, due to their intellectual disability. This doesn’t mean they can’t engage; it just means that we need to find the right way to support them so that they can.
The aim of Positive Behaviour Support is to improve the quality of life of people who are supported, their families and carers. What it means to have a good quality of life will be different for everyone. However there are some common elements, that if we get right for the person, will help enrich their day to day experiences. These include having new opportunities, good health and relationships, but also learning skills and participating in meaningful activity; this is where Active Support comes in.
Why Active Support is part of PBS
Active Support is an intervention for training staff to increase activity, engagement and participation for people with intellectual disabilities. It is based on behavioural principles, is evidence-based and is a key part of the PBS framework.
Although people who have an intellectual disability are more at risk of engaging in behaviours that challenge, when they are more meaningfully engaged, such behaviours are less likely to happen. When someone presents with a behavioural challenge we often hear how the person needs to calm, how they are stressed; this may be the case in many situations. However, it’s also the case that the more severe an intellectual disability someone has, the less able they are to independently engage in activities that they may find interesting. This results in the person having lots of unoccupied time, which essentially leads to high levels of boredom and lack of opportunity to engage with others. So, unless those people around the person have the right skills, it’s likely that a behaviour issue may result from this boredom. As human beings we prefer not to be bored and in such situations will seek out something to do, to provide us with stimulation and to fill our time. Activity is good for us. It keeps us mentally alert and provides a sense of self-worth and achievement. It enables us to develop our skills and to communicate with others. If a person has an intellectual disability and limited skills in being able to engage in activities, then this will not happen naturally, and so carers will need to plan for this to happen. Active Support provides a framework and training approach for doing this.
Three Key Elements
So, what does Active Support involve? In a nutshell it’s a way of training and coaching staff to provide the right level of support for people to participate in a variety of different activities. This could be a leisure activity, being able to play a game with a sibling, or play an instrument; or it might be a household activity, such as being able to make a sandwich or make your bed. It is always about encouraging participation and independence; for the person to be able to do as much of the task as possible, even if that is with help, rather than having others do everything for them.
Activities may be done in a ‘little and often’ way with lots of breaks, or completed jointly, with the person doing some parts and the carer doing others. It is about learning what works best in getting the support right. Activities are carefully planned to take into account people’s preferences, strengths and abilities.
There are three key elements to Active Support
Breaking the Task Down
This is done by looking at the steps in a task and breaking them down. This process is called task analysis. Activities are often more complex than we realise and have a lot of steps. Take making a cup of tea for example. Do we start by putting the teabag in the cup and then the water or vice versa? Oh, and did we remember to fill and turn the kettle on? Agreeing on the steps and the order of the steps is important as there is often a team of people involved in providing support and it is important that everyone is consistent in their approach. Whilst the goal is participation, task analysis, when used effectively alongside other procedures can lead to the person mastering new skills, as long as everyone supports them to do the task in the same order. To help with this a written plan of the steps can be out in place, this details the steps and how to support the person.
Right Level of Support
This is how we provide the right level of support for the person to be successful. Active Support uses the following levels of support as a prompt to participate:
- Ask: We set up the activity, let the person know that it is available and ask if they would like to take part. ‘Shall we make a cup of tea?’
- Instruct: We provide specific instructions to complete parts of the activity. ‘Put the teabag in the cup’.
- Prompt: We use a gesture or point towards the activity to indicate what we are wanting the person to do. We point to the cup.
- Show: We show the person by doing the activity ourselves. We put a tea bag in a cup.
- Guide: We gently provide a physical prompt. We gently nudge the person’s arm in the direction of the cup.
Active Support doesn’t force participation and it is important to honour when the person is indicating no, in whatever form that may take. We begin with ‘ask’, the least intrusive prompt and only when the person appears happy to participate do we provide further prompting if needed. Ask is the least intrusive prompt through to guide which is the most intrusive and includes physically prompting the person. We increase the level and frequency of prompts to ensure success, and then as soon as possible, we fade the prompts out again.
This is essential. In Active Support we take the view that regardless of behavioural ability or challenge, everyone can participate in activity in some way. Verbal praise and encouragement is used, in a way that is appropriate for the person. In this way the activity is a pleasant and positive experience.
Active Support Training Model
To understand the principles of Active Support and to put it into practice, it is important for carers to have the necessary training and support. The approach to Active Support training recognises that people do not learn best in a training room. Key individuals are identified as coaches, who then work alongside staff to coach them whilst supporting the person directly. A method called behavioural skills training is used which comprises the following four elements;
- Instructions: We give clear guidance on what to do and how to do it.
- Modelling: We show people what to do by doing it ourselves.
- Rehearsal: We practice the skills.
- Feedback: We give feedback which includes positive praise and corrective feedback.
Activity Planning for People Supported
Alongside training and coaching, another key part of Active Support is activity planning. This is vital for Active Support to be put into practice and there are some tools we can use to help us plan. A good way to begin is by putting together a weekly activity schedule for the person. A weekly activity schedule shows planned events for the week, for example, going out to attend clubs or engage in hobbies, appointments, going to college or a job and to visit people. Once the weekly schedule is in place, the next step is to create daily activity plans. First we transfer events from the weekly schedule for that day, then we enter daily routines such as mealtimes. Once this is done, what is left is termed ‘white space’. ‘White space’ is unstructured periods in a person’s day when there is no planned activity. Active Support aims to fill these spaces with activities, some of which will be tasks that need to happen that day, such as putting out the rubbish bins, and others will be activities that would be nice to do such as going for a walk. The idea is to have a range of activities including leisure, household, vocational, educational, and to reduce prolonged periods of unoccupied time.
Active Support Meeting Needs
Getting Active Support in place can address some of the factors that c
ontribute to behavioural challenges without having to complete a detailed assessment called a functional behaviour assessment. There are four main functions of behaviour and engaging in activity can meet each of these in the following ways:
- Sensory: The person gains a range of sensory experiences from activity.
- Escape: With the right level of support and encouragement, and planned breaks the person is motivated to engage with activity.
- Attention: The person interacts with others and gains social attention during the activity.
- Tangible: The person is able to access a range of activities and associated items.
Practices to Establish and Maintain Active Support
For Active Support to be successful, the practices described need to be fully embedded into the support provided and not viewed as an optional add-on. Coaching needs to be scheduled to happen on a regular on-going basis. Activity planning needs to occur every day. It is also important to have a regular forum (e.g., team meeting) in which to discuss how things are going. Teams should regularly review the recordings, set targets and troubleshoot any difficulties as they arise. It is important that plans do not become static and continually evolve to build on what works. Within staff teams, managerial support is crucial, to help drive things forward. With these practices in place, Active Support leads to significant improvements in people’s quality of life, the key aim of Positive Behaviour Support.
Start by looking at whether the person engages in frequent and varied activities across the week and aim to fill the ‘white space’ as much as possible.
Look at breaking activities down into small steps and being consistent in how you help people to engage.
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© Redstone PBS 2020
Emma has worked in the field of applied behaviour analysis and positive behaviour support with people with intellectual disability and/those who are autistic for over 20 years. Emma has an MSc in Applied Behaviour Analysis from Bangor University. She became a Board Certified assistant Behaviour Analyst in 2005 and a Board Certified Behaviour Analyst in 2010. Emma has worked with both children and adults in a variety of settings.
Kate Strutt – Director of Redstone PBS and Clinical Psychologist.
Kate has over 20 years’ experience of working with adults and children with intellectual disabilities and those who are autistic, both within statutory services and the independent sector. Kate is registered with the Health and Care Professions Council. Bsc Psychology, D.Clin Psyc, MSc Applied Behaviour Analysis.