Positive behavior support is a holistic approach to improving a person’s quality of life that can reduce challenging behavior. Grounded in applied behavior analysis, the concept of positive behavior supports emerged in response to deinstitutionalization and the move toward person centered supports and services. This focus on the individual has led positive behavior supports to include features such as:
- Collaboration with other caregivers
- Helping the client move toward lifestyle enhancements
- The use of function-based interventions
In my experience as an IDD specialist, I applied various components of positive behavior supports with a particular client who benefited from this kind of care.
Recognizing the need for positive behavior supports
There are a few people you meet during your career that leave a lasting impact. I was lucky to have met Luis.
The year before coming to our agency, Luis shared an apartment with his wife, and he worked full time at a mechanic shop. He would often ride the bus to the mall to hang out with friends or visit his family. Direct Support Professionals helped with more difficult tasks like grocery shopping and cooking.
He was friendly and charismatic but also had a reputation of being difficult to work with. Luis would frequently get upset over what seemed like the slightest issue, lashing out at his staff, and destroying things in his home. One day, he wanted to go to the store to buy a bag of potato chips, but staff members were not able to take him right away. He became upset, threw several dining chairs, and broke a large window.
We met as a team to discuss the incident. What happened? Why could he not wait to go to the store? Did he have a bad day? On the surface, it seemed clear. Staff members were not able to meet his demands immediately, so he became angry and broke a window. But if we look at it from the perspective of positive behavior support, the incident looks a lot different.
How to provide positive behavior supports
To help Luis, we needed to look at several key areas from a positive behavior support perspective. This meant taking a step back and working through the processes that culminate in positive behavior supports. To help you provide the same type of care to your clients, let’s walk through these steps one-by-one.
Context and behavior function
All behavior serves a purpose. To prevent challenging behavior from occurring, we need to accurately understand why it is occurring. We can then teach alternative skills or replacement behaviors.
Answers to questions such as the ones below can help identify the behavior’s purpose:
- In what context did the behavior occur?
- What was happening before the incident?
- What does Luis gain from the behavior?
Positive behavior supports as prevention
The best method to addressing problem behavior is preventing it from occurring. And learning new skills and/or positive replacement behaviors is key to prevention.
For example, an individual who has limited communication skills may become frustrated when they cannot express their needs. Teaching an alternative method of communication can help prevent this frustration.
Collaboration plays a key role
Developing positive behavior supports requires the close collaboration of the person supported and the people who both care about them and for them. All parties must be committed to open communication and a shared vision of success.
This means that stakeholders participate in all aspects of the support process with the person supported at the center.
Leaders need to provide endorsement and encouragement for a positive behavior supports-based approach. By getting buy-in from the top down, your organization can ensure that resources and training are a priority.
Systems change is only possible if all stakeholders share a common vision. Therefore, make sure that your staff also share this vision and have the proper training to see it through to fruition. Having leadership and staff all working toward the goal of implementing positive behavior supports will make the process easier and lead to providing better care to clients sooner.
The primary intervention in positive behavior supports is improving a person’s lifestyle according to their defined quality of life. Quality of life is a subjective measure of happiness which often includes satisfaction with relationships, participation in valued activities, involvement in the life of the community, and experiencing the best possible health. Helping someone improve their satisfaction with life significantly reduces the function of challenging behavior.
The effect of positive behavior supports
With all of these factors in mind, my team and I dug deeper into the context and the function of Luis’s behavior and how he viewed his life. We found that Luis’s life had changed dramatically over a brief period before receiving services from our agency, and this was reflected in his challenging behavior.
Whereas Luis had at one time had a large amount of autonomy, he had begun to experience severe issues with his balance and ambulation and was diagnosed with a degenerative disease affecting his muscles. The disease progressed quickly, and he was soon unable to do many of the things he used to enjoy.
When we paused and looked at the broken window from a positive behavior supports lens, we were able to develop meaningful supports to help Luis adjust to his new support setting and live a more fulfilling life. As his needs evolved and changed, so did his supports. While he still experienced frustration in his daily life, we were better equipped to provide appropriate and meaningful supports without unnecessary restrictions.
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