Functional behaviour assessment and provision of positive behaviour support is recommended in guidance out in November 2017, from NHS England. The guidance is clear that for a young person with a learning disability and/or autism, whose behaviour presents a challenge, their EHCP should refer to a completed functional behaviour assessment and there should be provision which covers positive behaviour support (PBS). However, its possible that not everyone involved in the EHCP process will have a clear understanding of what a functional behaviour assessment or what a good one may look like. So we thought we would provide a bit of information on this. A link to the full NHS England report is included at the end of this article.
What is a Functional Behaviour Assessment?
A functional behaviour assessment is a process which seeks to gain a thorough understanding of the person, the people around the person and behaviours which occur in the context in which they happen. The approach is primarily behavioural in that observable behaviours and contexts form the main part of the assessment. The aim is to identify the ‘function’ or reason behind the behaviour. There are four main functions of all behaviour – 1) social attention, 2) tangible objects or activities, 3) escape or avoiding tasks, situations or people and 4) sensory seeking or avoiding. See short video here. We all aim to avoid what we find difficult or aversive and gain what we like such as social attention, objects, activities or foods. We also avoid sensations that are uncomfortable and seek ones which give us pleasure.
A detailed functional behaviour assessment should take a minimum of 30 hours to complete and should be an in-depth process which gathers information from a number of different sources. The assessment should include meeting and talking with the person themselves if this is possible, completing a structured interview with people around the person who spend the most time with them, structured questionnaires and observations within the context where the behaviours occur and where the person spends time. It’s not essential that the behaviours are seen first-hand as this is sometimes not possible when behaviours are very intense but infrequent.
The professional completing the functional behaviour assessment uses the information gained from the different sources to propose a potential explanation of the function(s) of the behaviour or behaviours. They then share this with everyone to check that this fits with their experience. Sometimes the same behaviour may have different functions in different contexts and different behaviours can have the same functions. This is why there is a focus on the function rather than just what the behaviour looks like. When the person themselves can take an active role in the process this should always be encouraged and supported. For young people who have the ability to tell others what they find difficult, a slightly different process should be used which involves the young person being supported to lead the process.
The assessment should include the following:
- Collation of Historical Information – Background information of how situations have become difficult and how behaviours have escalated are essential for understanding both what the young person has experienced and what has also been difficult for the family. While the FBA takes a primarily behavioural approach, difficult life events for the person and their family are of great significance.
- Collation of Relevant Health and Biological Factors – Research evidence is clear that on-going and undiagnosed physical health issues have a significant impact on the presence and maintenance of behaviours that challenge. Ruling out and making sure that physical and biological factors have been treated is an essential element of assessment and intervention before a behavioural approach is taken to behaviours that challenge.
- Current Behaviours that Challenge – All presenting behaviours that occur frequently or are of a significant intensity or duration should be assessed in detail to identify their co-occurrence, whether they occur in any type of hierarchy and whether they are have the same or different functions.
- Assessment of Likes, Dislikes, Communication and other Functional Skills- This is to identify the young person’s likes and dislikes in everyday life, how the young person communicates and how they can take control their environment. In addition, questions regarding activities the young person is engaged in and their ability to make choices are also assessed with the aim of identifying potential skills deficits which can increase the likelihood of behaviours that challenge.
- Environmental Context – The characteristics of the environmental settings the young person spends time in are assessed. This includes the physical environment such as types of building and how it is furnished, along with the social environment and the approach to supporting the young person. The aim is to identify potential areas of training or support for those within the environment where the person will be living and is educated. Assessment of the people within the environment who will be having direct contact with the person are of fundamental importance to the successful implementation of the positive behaviour support interventions.
If you are a parent or a professional commissioning a functional assessment here are some points which you may want to check off and ask about
- Has everyone who knows the young person well inputted into the assessment?
- Does the assessment report include a clear statement about the functions of the behaviour(s)?
- Have parents and teachers both been actively involved at the point where the assessment results are discussed?
- Are the results of the assessment clearly explained to you?
A few other key pointers about Positive Behaviour Support interventions are included below, but we also recommend that parents or those commissioning a functional behaviour assessment, and looking to get positive behaviour support in place for a young person, review the very helpful information on the PBS Academy website, this is all free information created by a group of experienced professionals, see the link at the end of the document.
- Are parents and teachers (and the young person where possible) actively involved in agreeing the specific PBS interventions?
- At least two thirds of the strategies in a PBS plan should be ones which are implemented when the person is not presenting with any behaviours that challenge, with a third or less about what to do when the behaviours occur.
- A written PBS plan alone will not result in good outcomes for a person. Often there is a need for more support to implement changes for the person than can be achieved from a written plan alone.
- Restrictive practices such as time outs and seclusions are not part of the PBS approach and should not be labelled as such.
- The use of physical interventions should be time limited and used only to manage risk of harm. If physical intervention is in regular use, then there should be a plan to reduce this based on the functional assessment. If there is a plan in place and physical interventions are still in regular use, then it is not effective and should be reviewed.
- PBS interventions should increase skills, quality of life and opportunities. If they do not achieve this then they are not PBS interventions, or they are ineffective.
- Appropriate, effective PBS interventions do not create restrictions in a person’s life, if this is happening then they are not PBS interventions, even if they have been labelled as such.
© Redstone PBS 2017
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Kate Strutt – Director of Redstone PBS and Clinical Psychologist. Kate has over 19 years’ experience of working in intellectual disability and autism services, both within statutory services and the independent sector. Kate is registered with the Health and Care Professions Council. Bsc Psychology, D.Clin Psyc, PG Certificate Applied Behaviour Analysis.