What actually is Positive Behaviour Support (PBS)?

Overview

I see a lot of confusion about PBS – what it means, and the difference between behaviour support and behaviour management. This article will outline the difference between PBS and behaviour management training, and will give an overview of the primary aims of PBS.

The key goals of PBS

The primary aim of PBS is to improve service users’ quality of life. It operates on the assumption that all behaviour is functional – it meets an underlying unmet need. Behaviour is like an iceberg, in that we see that the behaviour as we see the tip of an iceberg emerging from the water. However, we don’t always see the bit that’s below the surface, in the same way that we don’t always see the underlying need that drives behaviours of concern.

PBS is built upon the scientific understanding of behaviour that stems from Applied Behaviour Analysis (ABA). It couples behavioural science with a strong values base, and a clear set of guiding principles.

There are two primary ways that we achieve behaviour change within PBS. Firstly, we look at preventing behaviours of concern by proactively meeting the underlying need. In recognising that behaviours of concern occur in order to meet an underlying unmet need, proactively meeting that need will mean the behaviour has no reason to occur in the first place. And secondly, we look at building people’s skills in meeting their own needs. If people are less reliant on the staff around them to meet their needs – if they’re able to meet their needs themselves – the likelihood of them needing to communicate this unmet need to someone else reduces. This is called Active Support.

1 PBS is a framework – not just an approach

PBS is not just another word for ethical behaviour change, or for a reinforcement-based approach. It’s not just a set of principles to be used as part of other therapeutic frameworks. It’s a framework in its own right. It has its own values, its own literature and its own methodology for change.

On an organisational level, PBS is about creating capable environments – the identification and commitment to 12 key facets of quality of life improvement, and to the development of an organisational context that gets the most out of the frontline staff implementing it.

It’s about not just saying you’re doing PBS, but actually showing it. It’s about recording and measuring quality  of life data, and using this data to inform our decision-making process for the people we support.

2 PBS isn’t about addressing behaviour, it’s about improving quality of life

PBS isn’t about behaviours of concern directly, it’s about improving quality of life. Of course, there’s a really helpful phrase that I use in training which is that ‘happy people don’t hit people’, so behaviours of concern do reduce in environments where PBS is being implemented correctly. However, reducing behaviours of concern should be a secondary goal, with quality of life being the primary outcome. Our main focus should be on building people’s skills, and identifying and creating environments that are right for them.

3 PBS isn’t about managing behaviour or de-escalation

PBS isn’t just about managing behaviour reactively, or de-escalating a situation that is already tense. It’s about preventing the escalation from even occurring in the first place.

Often, people will confuse PBS with behaviour management training. They’ll say “we don’t need training in PBS, because we have training in how to manage behaviour already. But PBS is actually about not needing to manage the behaviour in the first place.

If we are needing to de-escalate a situation where there is risk of a behaviour of concern occurring, we’ve already missed the biggest part of PBS – preventing that escalation from happening. PBS does recognise that prevention is not always possible, and PBS Plans do outline what to do when the person has become distressed – but this is only a very small section of the plan, and it always from the perspective of reducing the need for restrictive approaches.

4 PBS is not just a plan – it’s a culture

Often, I’ll hear services say that they’re “doing PBS” because the people in their care have a PBS Plan. But the framework of PBS should extend to our culture of care across the organisation, not just a plan that is implemented with one or two individuals.

In order to improve people’s quality of life, we have to have a keen focus on reducing restrictive practices and positive risk-taking. We have to start from the belief that behaviour can change, and that giving people new opportunities is a protective factor against the likelihood of behaviours of concern occurring.

However, if the management staff within the organisation are unnecessarily risk-averse, positive risk-taking cannot occur. Instead, we get into this cycle:

Behaviours of concern occur → We deem it too risky to go out on meaningful activities → The person’s world gets smaller, and their quality of life reduces → Behaviours of concern are more likely to occur due to poorer quality of life

Rather than finding reasons not to do something, we need to take positive risks. We need to be creative in the way we try new things, and put the appropriate safeguards in place to make sure that it can go ahead safely rather than it not going ahead at all.

Want to know more about how to implement PBS within your organisation? Reach out to us via our Contact Page to learn more.