Why do services need specialist support?
Overview
Understanding why a behaviour of concern occurs is fundamental to developing an effective and ethical behaviour support plan. However, understanding the impact between organisational culture and the behaviour, and accurately identifying the function of the behaviour under those conditions, are not always straightforward. It can have significant consequences when we don’t have appropriate specialist oversight to ensure the safe, effective and accurate implementation of trauma-informed care.
Sometimes I hear care professionals say:
“I can figure out why the behaviour is happening. What do I need a specialist for?”
Or
“I have experience implementing trauma-informed care, so we don’t need specialist input”.
Professional experience and training are undoubtedly valuable. However, there are situations where specialist assessment and oversight are essential, particularly when the behaviours of concern are complex, persistent, or present significant risks.
What happens when we get behavioural assessments wrong?: A case study
I previously worked with a special school where the staff had experience with implementing Positive Behaviour Support (PBS). The team were confident in applying the fundamental principles of PBS, and were capable of implementing behavioural strategies effectively.
However, in this particular case, they were unable to establish what was maintaining a child’s behaviour during a difficult transition.
The child was experiencing significant difficulties when transitioning from the classroom to school transport at the end of the day. The school had observed that the child was getting on and off the bus repeatedly, completed a Functional Behavioural Assessment (FBA) and concluded that the behaviour was maintained by attention/interaction.
Based on this assessment, the team introduced a strategy in which staff would turn away and withdraw their interaction when the child hesitated in getting into the vehicle. The intention was to avoid reinforcing the behaviour with attention.
However, there were two significant concerns with this approach.
Selecting the right intervention
The strategy being used was ‘planned ignoring’, which is based on the idea that when we stop attending to a behaviour that is maintained by interaction, it will no longer continue to occur.
There are important ethical and practical considerations when using these types of extinction-based approaches. Completely withdrawing social interaction is inappropriate in most situations, as it doesn’t recognise that the behaviour is the person’s best way of achieving a sense of connection with other people, or teach them alternative ways of obtaining this connection.
Alongside ethical concerns, extinction can also result in an ‘extinction burst’ - a temporary increase in the frequency, intensity or type of a behaviour when reinforcement is withdrawn.
In this situation, the behaviour of concern was intense and disruptive. And an extinction burst would have presented greater levels of risk to the child and those around them. This highlights an important principle: we cannot just withdraw reinforcement as a way of changing behaviour. The risks, ethics and suitability of interventions must be carefully considered.
2. Identifying the correct function of the behaviour
There was also another important question to consider: was attention actually maintaining the behaviour?
Interestingly, despite it not being my recommended intervention, it theoretically should have reduced the behaviour if attention had indeed been the reason why the behaviour was occurring - assuming that it was being implemented consistently by all staff.
However, it did not.
Noticing this, I reflected with the team that the behaviour could not be maintained by attention. And when I conducted further assessment of the behaviour, I realised that it was actually maintained by escape.
The child was struggling to process the end of the school day, and move from the classroom to the school transport. Despite the child’s best intentions, it was just too tricky for them, and too overwhelming - so the child hovered between getting on and getting off. Not because they wanted the interaction, but because it was too much for them to cope with.
After realising this, we changed the intervention. And rather than withdrawing interaction, we did the exact opposite - we increased it. We played the child’s favourite music from the car stereo and had a dance party. We made the transition fun, rather than overwhelming. We provided lots of praise for sitting in the car, and made the transition as enjoyable as possible.
The result was a significant improvement: the child begun getting into the vehicle and going home much more successfully.
3. Understanding the culture
In this example, the school were fantastic. They recognised that the behaviour is symptomatic of an unmet need. They did everything they could to offer support. However, many services are not as informed.
It would be easy, in an example like this, to start blaming the child. “They’re just attention-seeking”. “They’re choosing to be difficult”. “The behaviour is happening for no reason”.
But when we start to understand behaviour, we start to be able to develop compassion towards the person engaging in it. When we understand that behaviours of concern occur because a child is coping in the only way they know how - we realise that they’re not trying to be difficult, upset us, or be rude and selfish. We realise that they’re actually doing the best that they can - and we just need to create the environment that supports them to do that.
This is incredibly important in trauma-informed care, where the children we support have experienced some of the most difficult past experiences. When we lean into a culture of care that blames the child, we are unable to remain curious about the behaviour and the context in which it occurs.
Specialist support helps the staff team to position themselves in a place of curiosity, compassion and empathy. And from these values, we can understand the child better, and respond to them in the way that they need us to.
So why does specialist support matter?
This example demonstrates why behavioural assessment should be about more than simply identifying a behaviour and making an assumption about why it occurs.
A high-quality functional behavioural assessment should consider:
What happens immediately before the behaviour?
What happens immediately after the behaviour?
What are the wider contextual factors: the child’s sensory needs, medical diagnoses and communication differences.
Is the proposed intervention appropriate, ethical and aligned with the UK-SBA’s Code of Ethical and Professional Conduct?
What are the risks associated with the behaviour, and any suggested intervention?
Can the team supporting the child actually implement the intervention in the way that we need them to?
Is there evidence that the intervention is addressing the correct function of the behaviour?
Summary
Many professionals can develop and implement effective everyday strategies, and their experience is extremely valuable. However, when a behaviour is complex, presents significant risk, or does not respond to intervention in the way that we would expect it to, specialist assessment and support can provide an important additional level of expertise.
The goal is not simply to stop a behaviour. The goal is to understand why it is happening, and to develop ethical, appropriate and person-centred interventions which improve the person’s quality of life.