Positive Behaviour Support What good looks like Emma

Positive Behaviour Support What good looks like? Emma Agar emma. agar@unitedresponse. org. uk Lyn Armstrong lyn. armstrong@unitedresponse. org. uk United Response | www. unitedresponse. org. uk

At United Response, we believe that all behaviour is a form of communication that can tell us important things about the quality of a person’s life. We use Positive behaviour support and Active Support alongside person centred planning to underpin the way we work. United Response | www. unitedresponse. org. uk

United Response | www. unitedresponse. org. uk

United Response use specialist approaches, where necessary, to assist the people we support to live a meaningful and enjoyable life of their choosing. These are used alongside our core approaches, which aim to deliver innovative and flexible support that suits each individual. United Response | www. unitedresponse. org. uk

Active support and PBS go hand in hand. United Response | www. unitedresponse. org. uk

Training of staff. All staff who work at United Response receive training on Positive Behaviour Support. Managers training requires practical application of skills to carry out functional analysis of behaviours that will inform the writing of a PBS plan. Support staff receive training on the principles of PBS. United Response | www. unitedresponse. org. uk

Training of staff. Staff also receive the following training. Active Support training, Person Centred Support, Person Centred Thinking. United Response | www. unitedresponse. org. uk

Where the person used to live - ATU United Response | www. unitedresponse. org. uk

Before § Special support unit where doors were locked § 2 people lived with C. He said he didn’t like them / didn’t get on with them § Territorial on spaces – C spent majority of time in bedroom with 2 staff members watching him § Valuable items – had to request – eg i. Pad as if he kept them he would just break them § In the 7 months support at the Assessment and Treatment Centre United Response staff member supported C to make a meal twice – had to take out to DDG area office to do (Skills assessment) § Occasional home visits if there was sufficient staffing levels § Staff did everything for C de-skilling him § Limited access to the community – quite a walk to get to local village § Wasn’t allowed to be supported by women United Response | www. unitedresponse. org. uk

Concerns highlighted Prior to Discharge § Overstimulation – C would find it difficult to manage his behaviour in busy environments within his local community. Activities on a 1: 1 would be beneficial § C needs to be supported by males only, due to his very challenging behaviour. A firm approach was needed at all times. § C will destroy his belongings - he will need support to replace things he breaks as they are important to him § Psychologist had concerns that someone so challenging may not manage in a supported living setting § Environment needed to be as risk free as possible United Response | www. unitedresponse. org. uk

Living in own house § External doors still locked but free to move within the house - he knows where keys are and will get to answer the door § Lives on own and will often just go to his room for time alone. § Work on one staff supporting C and another staff in building in case needed § X Box and all items are just left out. Access to i. Pad – 5 -7 pm as functional analysis identified as ‘difficult times’ for C § Regular visits to family and family come and see C § We support and enable, not ‘do’ § Supported to cook; C makes own meals and drinks when he wants them. § Women are supporting C with male support United Response | www. unitedresponse. org. uk

How this was achieved § By talking to C listening to what he hoped to achieve, setting short and long term goals § I attended activities & was able to observe staff support, and step in to divert behaviours before they heightened and model good support § Was able to coach staff, teach them that they were focusing too much upon what may happen, rather than what C was doing. Stressing the importance of observation and body language. § Working together to gather information about activities tried, what worked, what didn’t. Ask C what he liked/disliked about the activity § Staff debrief after incidents what could they have done differently § Amending the PBS plan as required § Gave control back to C gradually at a level he could cope with § Worked closely with the MDT asked for support when needed or just to keep everyone informed around what was working; what was not United Response | www. unitedresponse. org. uk

The difference this made to C § § People supporting C have a more proactive rather than reactive approach § Increase in a positive way of looking at how C is a ‘skilled’ person and we are supporting his skills. Adapting our approach to best suit C needs § C is gaining reasoning and life skills – e. g selling games for play station and DVD to get a new game – recognising that he has to save for large purchases. People supporting C followed an MDT revised joint PRN protocol written by health and social care that meet C’s needs § The joint protocol gives clear roles and responsibilities. For example if staff have administered PRN x 3 in one week we seek support from the community nurse whose role it is to then support the team. This took away a lot of the teams anxieties, and in 14 month this happened only once Reduction in severity and episodes of behaviours § I am continually working with MDT & psychology department to look at and revise PBS plan. The plan is currently in it’s 3 rd edit and working very well. There have been no instances of C breaking or destroying any of his belongings C has positive community presence and participation experiences § C goes to the local shops, pubs, gym, library, opticians – all call him by name § C never had a ‘friend’ – yet made friends with S from another service – lots in common. . Just came naturally playing a ‘game’ with support from positive reinforcement from staff. United Response | www. unitedresponse. org. uk

Other factors we feel important to recognise for C service that has contributed to the project § Support from Local Authority involved in setting up a contingency plan when first came out. The support is still ongoing and we are currently looking for more suitable accommodation for C § Being able to demonstrate on a day to day basis that the PBS plan worked. And a staff team who were willing to learn and reflect upon their own working practices and make changes to their support to better suit C needs, as well as being prepared to take acceptable risks § Family were and still are fully supportive of the team § Recognising when C makes a small ‘on the spot’ decision eg to change route on way home to go through Mc. Donalds Drive through – that is big for him and never been able to do before. He now does this regularly. § C being involved in all aspects of his support this includes his hopes for the future and things that are very important to him. Being present when I am changing plans, discussing why I am changing them, and encouraging him to be part of that process. United Response | www. unitedresponse. org. uk

So how is life now § C is enrolled on an IT course which is classroom based § He attends a weekly session at a local recording studio. It is hoped this will lead to paid employment, setting up the studio for sessions § C has been going to an allotment where he has been learning how to build fences and look after livestock. He loves animals § He meets his friend S they go out and do things together § C has been invited to 2 parties and these were both very positive experiences even with ladies present § C anxiety levels have reduced massively § C has more self awareness, so when he is in danger of loosing control he will get his guitar and try to calm himself by playing it § C will request PRN should he feel he needs it § Physical interventions are still required however these have been reduced to 1 or 2 per month § C attended Sunderland Air show without incident United Response | www. unitedresponse. org. uk

Dad “. . you don’t appreciate how nice it is leaving C to go home when you know he is living somewhere he is happy. . . ” Staff team member “. . I supported C in hospital so I can see what C had, to what he has now. I know how important the PBS plan and structure is to C. It’s reduced the number of physical interventions, and his levels of anxiety. C has come a long way and I believe this is just the beginning” United Response | www. unitedresponse. org. uk

Useful links: https: //www. unitedresponse. org. uk/forprofessionals United Response | www. unitedresponse. org. uk