What is positive behaviour support, and how does it work?
At Yarrow we use positive behaviour support (PBS), specifically the PROACT-SCIPr-UK approach.
PROACT-SCIPr-UK is all about prevention rather than intervention: having the right tools and a carefully thought out plan to support each individual. PROACT stands for Positive Range of Options to Avoid Crisis and use Therapy, and SCIPr stands for Strategies for Crisis Intervention and Prevention.
Positive behaviour support is person-centred and proactive: the aim is to work out how to reduce challenging behaviour in advance, rather than react to it. If all behaviour is communication, how we can better understand what is being communicated?
The first element of a successful PBS plan is to really get to know a person well. We learn from them and work closely with their clinical team and circle of support to identify the signs that show that they are becoming unhappy. Are there certain situations that often cause frustration, anger or fear – or perhaps over-stimulation? How can we better support a person so that this doesn’t happen as often? And if it does happen, how can we support that person better in the moment, to avoid the behaviour escalating.
Another important part of the PROACT-SCIPr-UK approach is to look for ways to raise self-esteem. By improving quality of life and empowering the people we support to take more control, we can help to reduce feelings of boredom, frustration and anger that are often a factor in challenging behaviour. We support each individual to truly flourish by expressing themselves, doing more of the things they enjoy and trying out new things.
With all this in mind, we make a detailed positive behaviour support plan for each individual. Having a consistent approach is really important, and every member of the support team will follow the plan carefully.
The plan includes green, amber and red sections. Green is what we are aiming for: the person is happy, doing things that they like, and showing no challenging behaviour. The amber section outlines behaviours that might indicate frustration, for example a particular facial expression, pacing up and down or actions such as hand biting. Paying close attention here is key: we want to nip this in the bud. This section includes ideas for the support team to avoid the behaviour escalating. It could be for example moving to a different room or listening to a certain song. It may be that an individual needs a short break. The red section shows strategies for when these approaches haven’t worked.
The PROACT-SCIPr-UK approach has been very effective, and we have seen real changes in the people we support. We would like to tell you about one person in particular who has really flourished.
Royston is 30 years old and came to live in his own flat at one of our supported living services two years ago. Royston is autistic and does not use speech, but he does use some Makaton signs. Transition to a new home can be a difficult time for many people. A new routine and unfamiliar setting can be unsettling and confusing. As we were getting to know Royston he was also getting to know us, and to start with he showed challenging behaviours. But gradually he began to trust us more and feel more at home.
We used the PROACT-SCIPr-UK approach from the first day that Royston joined us, drawing up a detailed plan for how we could best support him. Royston’s mother was very involved and visited regularly, and really helped us to get to know him better. Quite soon we discovered that one of the things that Royston loves to do is jumping. Royston has a lot of energy and we realised that supporting him to be active would be a really important part of his happiness. We started a new activity with him: trampolining at a local trampoline centre. We were mindful that Royston may find the noise and crowded areas challenging, but he has taken it all in his stride and he is wonderful at waiting for his turn and being careful around the other visitors. This is real progress for Royston and has really boosted his self-esteem.
As time has gone on, we’ve discovered more things that Royston enjoys, such as gardening, having meals out with his fellow neighbours, swimming, collecting leaves, cycling and walking at the park. He also likes spending time in our sensory hut and often chooses to use the keyboard. He loves a trip in the car and always likes to be in his favourite clothes when he goes out!
Making sure that Royston can do all of these activities regularly, and where possible when he wants to, has really helped. Giving him more control over his day has grown his self-confidence, and the activities have also helped him to learn new skills such as holding a watering can or a garden hose. His concentration and attention span have improved, and he now attends our residents’ meetings, something which was not possible before.
Over time, his medication has reduced and some of his challenging behaviours have stopped completely. Royston’s clinical team have commented that they have not seen him so happy before and are amazed when he attends his meetings and sits for the whole time. He also attended a 30th birthday party at Yarrow last year where there were more than 200 people in the room, and he appeared to enjoy being amongst everyone. It has been wonderful to see his progress and his team are so proud of him and their own input into encouraging him to develop into the young man they see today.
The involvement of Royston’s clinical team in Ealing has been instrumental in Royston’s progress. We work closely with the Community Team for People with Learning Disabilities, including Psychiatrist Dr Shuwa, Advanced Nurse Practitioner Tribute Nyoni and Social Worker Sibu Bilankulu. Royston also benefitted from a transition worker, Sarah Layram, who knew Royston well prior to him moving in, and who was able to guide the transition into his new home, making it as smooth as possible. The team are always available and see Royston regularly to discuss his well-being.
Royston’s mother has also played a vital role in helping the team to support Royston in the best way possible by sharing her experiences and knowledge with the team. It is fabulous that she lives nearby and is able to pop round at any time. Royston also regularly visits home to have quality time with his mum. She also joins his team on practice workshops where we celebrate Royston’s achievements and also look at the PROACT-SCIPr-UK theories and Positive Support Plans which are used to support her son. This gives everyone a chance to view Royston’s progress and recognise the important roles everyone is playing in his well-being.
His mother has seen real changes in Royston’s behaviour, which continue when he goes home for the weekend:
“He goes out more now. The staff understand him better. In the beginning it was more difficult but now, as time goes by, Royston makes signs and they understand him. It makes me feel really positive. Now he knows that he can go to his room, have a jump and a scream, then lie down and listen to music. He is like a different boy. Totally different. Now we can sit together and watch TV, laugh. He does this at home too. I can go home and sleep at night knowing that he is safe and happy. They [Royston’s support team] are doing a great job. I feel happy for the future that Royston will carry on being happy and positive and using more signs.”
We’re so proud of everything that Royston has achieved, and of the commitment, patience, and kindness shown by the whole team in working to support him to truly flourish.