Positive behavioral support for people with brain injury: the Virginia experience

Abstract

The effects of an acquired brain injury may impede an individual's ability to achieve meaningful employment and live independently. Unfortunately, existing community-based services are often inadequate or inappropriate to meet the needs of people with brain injury. As the number of people with brain injury increases due to advances in emergency medical and surgical care, survivors, family members, and service providers seek ways to meet the needs of people with brain injury beyond the acute recovery stage. The need for effective brain injury rehabilitation services is especially critical for individuals with challenging behaviors. In Virginia, a non-aversive, community-based support team approach known as Positive Behavioral Support (PBS) is being used with persons with brain injury. This approach, initially used with individuals with developmental and other severe disabilities, appears to have potential as an effective approach to working with people with acquired brain injury who have difficult behaviors. The first time that the Positive Behavioral Support model was utilized specifically with persons with brain injury was in 1992 when the Virginia Department of Rehabilitative Services, in collaboration with the Virginia Institute for Developmental Disabilities, a University Affiliated Program, implemented a one-year federally-funded project called PITON ('Positive Intervention and Training Outcomes Network'). At the time of the PITON project, eighteen states including Virginia had implemented this innovative behavioral approach, mostly with people with developmental disabilities. This article provides a brief overview of the Positive Behavioral Supports approach, as well as two case studies describing the use of PBS with persons with brain injury in Virginia.