Common PBS Questions
Positive Behaviour Support (PBS) is a growing theory of practice that improves the quality of life of people with a disability and those around them. PBS is used to reduce presenting behaviours of concern and restrictive practices. PBS is a way of supporting people that respect their human rights and improve their quality of life by
- Identifying NDIS goals
- Collaborating with all of those around them
- Assessment and intervention
- Developing a Behaviour Support Plan (BSP)
- Reducing Restrictive Practices
- Skill building
- Staff Development
- Environment changes
Behaviours are deemed to be “challenging” or “of concern” (BoC) when they are perceived to be of an intensive, frequent or duration that will put others around the individual at risk. Behaviours are also of concern when they negatively influence relationships or community participation.
Some examples of these include:
- Hurting themselves or others
- Breaking things
- Refusing to do things
- Doing the same thing again and again
- Hiding away from people
- Doing things that others don’t like
Every behaviour is a form of communication. Every behaviour has a purpose. Many participants cannot express openly their inner thoughts and feelings due to physical or mental limitations.
Behaviours of concern occur for a variety of reasons. These reasons could be neurological, environmental or reactional. Some behaviours are even learned behaviour from past experiences. In most cases, there is a combination of different forces contributing to each behaviour.
Positive Behaviour Support aims to bridge the communication gap between the participant and their support system. By gaining an understanding of the real reason behind each behaviour, we will be able to improve quality of life for everyone involved.
Restrictive Practices (RP) refer to any action, approach or intervention that has the effect of limiting the rights or freedom of movement of a person.
Restrictive practices are used as a last resort, to prevent or protect people from harm. This includes a perceived risk of harm. Restrictive practices are usually in place to prevent or protect an individual or others from Behaviours of Concern.
There are 5 types of regulated Restrictive Practices. These include:
Environmental (eg. locked doors & cupboards)
Mechanical (eg. restrictive clothing & bedrails)
Physical (eg. physically holding someone down)
Seclusion (eg. secluding in one’s room)
Chemical (eg. seduction through drugs)
Behaviour Support is about creating individualised strategies for people with disabilities that are responsive to the person’s needs, in a way that reduces the occurrence and impact of behaviours of concern and minimises the use of restrictive practices.
The key roles of a Behaviour Support Practitioner include:
- Assess the behaviours of concern presented by a participant
- Develop background information associated with the behaviour of concern along with prior history and current situation of the Participant
- Conduct relevant behaviour assessments to help determine the function of the behaviour
- Decipher the function of the behaviour of concern based upon the outcomes of results provided from assessments and from prior and current Participant circumstances
- Develop a behaviour support plan that outlines functional replacement strategies and behaviour goals within a specific timeframe
- Review the behaviour plan with key stakeholders and make the necessary changes that need to be implemented.
- Monitor and review the behaviour support plan on a six-monthly basis, or when necessary
It is important to note that the role of a Behaviour Support Specialist is not to be a psychologist or therapist. While all of our Behaviour Support Specialists are provisional/registered psychologists, their role is to decipher the function of behaviour and report on it.
In short, no they are not.
While all of our Behaviour Support Specialists are provisional/registered psychologists, their role is to decipher the function of behaviour and report on it.
The main goal for a Behaviour Support Specialist is to create a Behaviour Support Plan (BSP), and to help other allied health professionals act on the recommendations.
We create the map for other allied health practitioners. We outline the strategies for them to implement. Our specialists do not take crisis calls.
We encourage all participants and their families to continue seeing/start seeing a psychologist or therapist alongside a Behaviour Support Specialist.
A Behaviour Support Plan (BSP) is a 30+ page document created by a Behaviour Support Specialist
It takes between 10-20 hours to write a full BSP.
A Behaviour Support Plan is developed to:
- Strengthen the positive behaviours and personal interests of the participant
- Understand the causes and underlying functions of the presenting behaviour, including the effects of trauma
- Equip all relevant stakeholders with appropriate strategies and skills to address or prevent challenging behaviours.
- Clearly identify the circumstances under which any restricted practices can be used within the context of behaviour management, and to include the appropriate authorisation of those.
My Behaviour Support Specialist is writing an ‘interim’ BSP?
Whenever we find restrictive practices in use, we need to stop our current work an begin writing an Interim BSP.
We complete an interim BSP because we need to inform the NDIS of restrictive practices within 30 days from our first knowledge.
An Interim BSP is a shortened form of a full BSP, and is usually around 20 pages.
Positive behaviour support is an important step in trying to gain an understanding of specific behaviours of concern. PBS aims to bridge the communication gap between the participant and their key carers/family members so that everyone can be understood.
The history of dealing with challenging behaviours was aversive, now there is a collective shift to focus on learning to communicate effectively with the participant so we can understand how they are feeling and why.
There are three main goals when it comes to Positive Behaviour Support:
- Improve the participants’ quality of life by
- Reducing their Behaviours of Concern which will
- Reduce any Restrictive Practices
Our PBS Service
National PBS offers two main services:
Positive Behaviour Support
Most of our participants are presenting with behaviours of concern and require Positive Behaviour Support.
In this instance, we go in and create a map for all other supports to alleviate the behaviours of concern + reducing restrictive practices.
We talk with all stakeholders, interact with the participant and undertake various assessments to gather a holistic understanding of the situation. We then create a FBA + BSP to advise how best to move forward and improve the quality of life for participant and all stakeholders.
Sometimes we are referred participants that do not need Positive Behaviour Support. In this instance, we can also provide Psychology service.
This role is the more traditional Psychologist role we see in the field. A common plan for a Psych participant would be fortnightly sessions including counselling & therapy sessions. For our psych participants, we conduct the therapy ourselves instead of writing plans for interventions.
A provisional psychologist is someone who has completed their tertiary qualifications and is eligible to undertake a program of supervision (internship) as they develop their applied skills “on the job”.
Typically this involves a minimum of two years of weekly supervision with an AHPRA board approved supervisor. The provisional psychologist is required to complete a number of hours including psychological practice (supervised direct client contact and client related activities), supervision and professional development.
When working with participants, provisional psychologists are still doing exactly the same things a fully registered psychologist would be doing, however the only difference is that they need their reports to be checked & signed by a fully registered psychologist before sending to the NDIS.
The Behaviour Support Therapist’s role is to gather as much information as possible and to then create a report that highlights recommendations.
The varying level of support received from National PBS will depend on how much funding from the NDIS is allocated to our services.
Once referred to, here is how the process works:
- We allocate each participant to one of our Behaviour Support Specialists (approx 4-5 week wait time)
- Once allocated, the Specialist will reach out to the Key Carer to communicate that their work is beginning.
- The Specialist will then gather as much information as possible from all possible stakeholders
- Depending on risk factors, the Specialist will then conduct an observation (in person or via zoom)
- Over the next few visits, the Specialist will conduct numerous assessments that will help them gain a broader understanding of the situation and how they can help.
- Once they have gathered as much information as possible, the Specialist will then begin writing the Behaviour Support Plan (BSP).
- Once the BSP has been written, the Specialist will work with other stakeholders to start implementing the recommendations.
We understand that many of our participant’s families and Support Coodinators are under a lot of stress and are hoping to find a solution that brings Behaviour Change very soon, if not immediately.
The truth is however, behaviour change does not happen immediately.
Research shows that It can take anywhere from 18 to 254 days for a person to form a new habit and an average of 67 days for a new behavior to become automatic.
This average time can be longer for individuals presenting with intellectual or psychosocial diagnoses.
For Behaviour Change to occur, there needs to be a consistent effort from all stakeholders. If there is inconsistency in how each stakeholder interacts with the participant, then behaviour change is going to take much longer.
This is why Positive Behaviour Support takes a holistic approach and brings together all possible stakeholders from the participant’s life. By having everyone on the same page, behaviour change can happen earlier.
Our wait times vary depending on how many current participants we are working with, and how many of our Behaviour Support Specialists have capacity.
We are constantly working hard to reduce the wait time for new referrals. Currently, the wait time is approximately 12 weeks. We will communicate with you on a fortnightly basis while you’re waiting to update you on how we are progressing.
The NDIS stands for the
National Disability Insurance Scheme.
It provides support to eligible people with permanent or significant intellectual, physical, sensory, cognitive and psychosocial disabilities. (NDIS, 2021)
Supports include assistance and services of products that can help the individual in their daily life and help them participate in the community and reach their goals.
Our participants have already been granted funding from the NDIS for their behaviours of concern. Therefore, when we get a referral, we are able to start our support for the participant immediately.
The funding from the NDIS continues if we can help the participant achieve their NDIS goals – so they must be central to our support. We write all of our reports to the NDIS to give guidance as to if the participant needs: more hours/funding, more support or if their goals have been reached.
Not all types of support required by a person living with a disability fall under the responsibility of the NDIS. Some supports are funded by other areas of government (e.g. state health systems) or existing public/community services. In general, the NDIS will fund reasonable and necessary supports that help a person living with a disability enjoy an ordinary life.
National PBS can be allocated funding from the two broad categories of:
Improved Relationships: Support that will help you develop positive behaviours and interact with others.
Improved Daily Living: Assessment, training or therapy to help increase your skills, independence and community participation