Those who know Robert well describe him as someone with a good sense of humour, who likes to have a joke and a laugh; and that he loves having a regular cup of tea. Robert also has a significant learning disability and is autistic and the work that we did with him and his support service really illustrates one of the key principle of positive behaviour support.
This is ….
If you focus ONLY on reducing behaviours that challenge, this will not lead you to the best solution and is unlikely to achieve that aim. Increasing skills and opportunities will improve quality of life and behaviours that challenge will reduce as a consequence.
Robert had experienced institutionalised care in a large hospital from being a young child. Over the years, since moving into the community, at times he had presented with some behaviours that others had found challenging and despite living in the community for over a decade at one point he was admitted again to an assessment and treatment hospital based service.
When Robert was discharged again I was asked by the service supporting him in the community to help as Robert was ripping his clothes multiple times a day. This was leading to him running out of clothes regularly as well as impacting on his personal dignity. Due to time constraints and other demands I suggested a quick strategy which I thought might manage the situation until I could do a full assessment. I suggested that Robert was given access to fabric that he could rip instead of his clothes. Whilst I wasn’t sure that this would resolve the issue, it was a potential way of managing the situation in the short term. However, it had caused Robert much confusion, he couldn’t understand why he was being given this fabric to rip and he became unsettled when presented with the ‘ripping fabric’.
I then completed a functional behaviour assessment and identified that the behaviour occurrences showed no significant pattern but were occurring across most time periods and contexts. When this occurs, either we have missed something or what the person is gaining from the behaviour is linked with internal events. Robert did not appear unhappy or very agitated when he engaged in the ripping. What the assessment also told me, however, was that Robert was spending significant periods of time unoccupied, especially when he was at home and that he had very few independent skills. Robert did have a number of activities in the community that he was supported to access such as swimming, country walks and other leisure activities but these only occupied a proportion of week.
We needed to reduce the ripping behaviour to improve things for Robert, the people he shared his home with and the staff team supporting him. This is where positive behaviour support differs from other behavioural approaches. Through the wider assessment of Robert’s behaviour, and the context in which it occurred, we were able to put into place an intervention which increased skills and opportunities for Robert. This included household chores and some increased independence. Once the intervention was established, clothes ripping gradually reduced from 2-3 times a day to 2-3 a month over a few months. Roberts quality of life had improved significantly as more of his time was occupied with purposeful activity and his level of independence had increased. Staff reported that Robert appeared much happier, he was smiling more, his co-tenants were happier, and the staff team were really pleased with this new level of independence for Robert.
Sounds easy right? We had to work closely with the staff team to ensure that they were on board with the results of the assessment, and that they helped us to formulate the intervention plan. Some staff were adamant that Robert would not willingly participate in the activities and skills development that we had planned and that there would be an increase in behaviours that challenged. However, with coaching support on how to break each task down, provide Robert with the appropriate level of prompts and the right level of encouragement not only did the staff team implement the plans, they also added in new skills and opportunities for Robert. By the end of this initiative with Robert and the team he was completing a number of household tasks with a small amount of staff support and regularly making himself a cup of tea, independently, using a hot water machine; he was also well dressed.
If you’d like to gain more information about how staff teams can give the right level of support in terms of breaking a task down, giving the right level of prompts and encouragement, email us at firstname.lastname@example.org and ask us to send you our top tips on supporting skills development.
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© Redstone PBS 2017
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.