Positive Behavior Support Plans Research Articles

학교 차원 긍정적 행동지원의 중요성과 실행 가능성에 대한 유아교사와 유아특수교사의 인식

Purpose: This study purposed to examine the perceptions of early childhood teachers and early childhood special education teachers regarding the importance and feasibility of school-wide positive behavior support at the school level. Method: To achieve this, a survey was developed based on an analysis of previous studies on the perception of school-wide positive behavior support, and it was administered to early childhood teachers and early childhood special education teachers. Results: First, both early childhood teachers and early childhood special education teachers highly recognized the importance of school-wide positive behavior support in all items. However, early childhood teachers preschool teachers rated 'Organized and predictable daily routine' in the universal level, 'Implementing teacher training' and 'Group guidance for teaching social skills' in the targeted level, and 'Establishing and implementing positive behavior support plans based on functional assessment' in the individual level higher than early childhood special education teachers. Second, both early childhood teachers and early childhood special education teachers highly recognized the feasibility of implementing school-wide positive behavior support as above average in all items. However, early childhood teachers perceived a higher feasibility of implementing five items in the universal level and three items in the targeted level than early childhood special education teachers. In the individual level, there was no perceptual difference between the two groups of teachers. Third, both groups perceived the feasibility of the items much lower than their importance, and recognized factors such as time constraints, lack of collaboration, and insufficient administrative and financial support as obstacles to implementation. Conclusion: Based on the findings, recommendations for further discussions and directions for future research on the implementation of school-wide positive behavior support in early childhood education settings were suggested.

Intellectual disability and autism in adults influence psychological treatments for mental health comorbidities

PurposeThe purpose of the study was to examine whether there were differences in the provision of non-pharmacological interventions based on the level of intellectual disability and the presence or absence of autism. Mental health conditions are often underdiagnosed in adults with intellectual disability and do not always receive psychological interventions as recommended by the National Institute for Health and Care Excellent guidelines. To realise the national UK programme’s aim of stopping the overuse of medications in people with intellectual disability, it is important that these individuals have access to appropriate non-pharmacological interventions. The authors examined the relationship between an individual’s level of intellectual disability and the presence or absence of autism with access to relevant non-pharmacological interventions from specialist community intellectual disability services.Design/methodology/approachA cross-sectional study of adults accessing four specialist intellectual disability services in North West England in 2019.FindingsThere was a high prevalence of mental health comorbidity, even higher for autistic adults. However, a relatively small percentage of the study population was receiving psychological interventions. The most frequent non-pharmacological intervention was a positive behaviour support plan, irrespective of comorbid mental illnesses.Research limitations/implicationsNot having access to psychological interventions for the treatment of mental illness could result in poor health outcomes and increasing health inequalities. The study highlights the need for developing psychological interventions, particularly for those with moderate to severe intellectual disability and for those with associated autism.Originality/valueThis large sample study examined the relationship between intellectual disability level and the presence of autism with accessing psychological interventions.

‘Stakeholders are almost always resistant’: Australian behaviour support practitioners’ perceptions of the barriers and enablers to reducing restrictive practices

A restrictive practice (RP) is defined as a practice or intervention that has the effect of restricting the rights or freedom of movement of a person, and includes physical, mechanical, and chemical restraint, and seclusion. If misused or overused, RPs may present serious human rights infringements. In Australia, behaviour support practitioners who deliver behaviour support funded by the National Disability Insurance Scheme are responsible for developing positive behaviour support plans that aim to reduce and eliminate the use of RPs. At present, little is known about the barriers that behaviour support practitioners experience when attempting to reduce and eliminate the use of RPs and, conversely, what helps (or enables) them to reduce and eliminate RPs. To learn more, we conducted an online survey consisting of two open-ended questions with 109 Australian behaviour support practitioners to identify barriers and enablers. We found that fear and reluctance on the part of stakeholders were often barriers to reducing the use of RPs. However, we found that having time, funding, and resources for training, supervision, other implementation activities, care team collaboration, and data-based decision-making helped overcome barriers. We provide specific recommendations for addressing identified barriers for individual behaviour support practitioners, service provider organisations, and government and regulatory agencies.

Trauma-Informed Care on CAMHS ID Unit. Case Study of a Child with Neurodevelopmental Disorder and Self-Injurious Behaviour

AimsCrystal House is a specialist CAMHS ID inpatient 5-bedded unit based in the Kingswood Centre, North West London - for children aged between 13 and 18 years with primary diagnosis of Intellectual Disabilities with or without additional concerns that warrant admission to hospital for purpose of assessment and management. Reporting this case, we wanted to highlight complexities of management of children presenting with neurodevelopmental conditions and history of trauma.MethodsThis is a case of a fourteen-year-old girl with established diagnoses of Moderate Intellectual Disability, Childhood Autism, Foetal Alcohol Syndrome and childhood trauma. She was admitted to our CAMHS ID Assessment and Treatment Unit with a nine- year history of self-injurious behaviour, suicidal ideation and voice-hearing experiences – after failed treatment in the community and in-patient treatment (including under restrictions of long-term segregation) on generic CAMHS unit. Her current treatment includes a person-centred Trauma- Informed Positive Behaviour Support Plan; individual and family therapy psychology sessions based on the principles of trauma-informed care and consultation with staff on trauma-informed care. She also undertook ADHD assessment, and we are in the process of optimising ADHD medication.ResultsTrauma-Informed Positive Behaviour Support Plan was a new concept for the team. Therefore, this was supported by training and consultations with staff. The latter was introduced to create a psychologically oriented environment using trauma-informed care principals and helping the team understand what trauma means and how it affects the individual. ADHD assessment confirmed the diagnosis of ADHD which was followed by optimising ADHD medication.ConclusionSystemic and a person-centred approach is used for this child with concerning presentation and history of neurodevelopmental disorder and childhood trauma.

Addressing Race and Implicit Bias in the Functional Behavior Assessment Process: A Pilot Study of Preservice Teacher Training Modules

ABSTRACT Despite decades of research and reform, exclusionary discipline remains disproportionately used with minoritized students and students with disabilities (SWD). The present study investigates how functional behavior assessment (FBA) and Positive Behavior Support Plan (PBSP) procedures can be taught in conjunction with an explicit focus on achieving equitable outcomes for minoritized SWD. Specifically, researchers created modules for preservice teachers focused on racial and cultural bias within the FBA and PBSP processes. In this manuscript, we will detail the development, delivery, and preservice teachers’ perceptions of modules, directly and explicitly challenge color-evasive FBA and PBSP practices, and consider how PBSPs can be culturally responsive. We present results of social validity surveys and the School Record Analysis (SRA), a tool used to measure preservice teachers’ implicit racial biases. Exploratory results suggest the modules provide a promising and necessary step for using behavior analysis to address disproportionate use of exclusionary discipline for minoritized SWD.

Implementing a program to reduce restraint and seclusion utilization in a public-sector hospital: Clinical innovations, preliminary findings, and lessons learned.

The Alternative to Restraint and Seclusion State Incentive Grant was a national initiative to reduce restraint and seclusion use in psychiatric hospitals and community based mental health settings sponsored by the National Association of State Mental Health Program Directors. This initiative was implemented in a large public sector psychiatric hospital. It involved the use of a restraint and seclusion prevention project team and a Patient-Staff Steering Committee collaborating on violence prevention. It also entailed systematic data collection and case reviews, staff-training on trauma-sensitive care and other relevant topics, employee recognition, as well as the use of specific restraint prevention tools including sensory modulation, positive behavioral support plans, comfort rooms, Wellness Recovery Action Plans, modified restraint orders, and new debriefing protocols. Compared with a 4-year baseline period, a 4-year implementation phase showed a reduction in annual restraints hours by 89%, annual staff injuries by 18%, and annual Workmen's Compensation medical costs by 24%. The findings illustrate the value of implementing systemic evidence-based practices to reduce restraint use, enhance the quality of care in tertiary care settings, and promote a new, patient-centered and recovery-oriented institutional culture. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Including people with intellectual disabilities in the development of their own positive behaviour support plans

Purpose People with intellectual disabilities are not routinely involved in the assessment of their behaviours that challenge, as this is often completed by a proxy respondent and the health-care professional. This is contrary to guidance stating that everyone should be involved in the planning of their care. This paper aims to show how health-care professionals can support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the subsequent development of their own positive behaviour support (PBS) plans. Design/methodology/approach A non-systematic review of the existing literature on improving the engagement of people with learning disabilities in health-care planning, and specifically PBS planning, was undertaken. Appropriate papers were included in this paper. Findings There are several evidence-based methods to improve people’s engagement in the assessment of their own behaviours that challenge and then the development of their PBS plans. These methods are discussed in terms of their application to supporting people to communicate and involving them in the process of developing a valid and meaningful PBS plan. This is a relatively new focus within the literature, and further research should focus on increasing engagement in the process, as well as monitoring how co-production affects PBS outcomes. Originality/value This paper summarises some of the approaches used to support people with intellectual disabilities to engage in the assessment of their behaviours that challenge and the development of their own PBS plans. This should encourage health-care professionals to consider how to use alternative and augmentative communication strategies to facilitate co-production in their own clinical practice.

Commentary on “Including people with intellectual disabilities in the development of their own positive behaviour support plans”

Purpose The purpose of this paper is to broaden the discussion on some of the barriers and solutions for co-production in positive behaviour support (PBS) planning as identified in the paper “Including people with intellectual disabilities in the development of their own Positive Behaviour Support Plans”. Design/methodology/approach Drawing on the literature associated with co-production in PBS planning, this commentary will reflect on the wider systems and culture needed to enable successful implementation of this way of working. Findings Co-production in PBS planning is recommended as part of best practice guidelines. However, there is limited research in the area of co-production with regards to PBS and use of augmentative and alternative communication methods. Collaboration among speech and language therapy and PBS practitioners is an important factor for co-production to achieve the best outcomes for people with learning disabilities who display behaviours of concern. Along with identifying a range of communication tools/strategies needed for PBS assessment/planning, it also requires a whole systems approach and culture shift to ensure the necessary foundations are in place. Originality/value Co-production in PBS planning remains an under practiced way of working. This commentary builds on the barriers and solutions identified for co-production and provides further insight into what might be needed to achieve this in health and social care settings.

Comprehensive Assessment of Triggers for Behaviours of Concern Scale (CATS): Initial Development.

Challenging behaviour displayed by people with intellectual disabilities (ID) can be difficult to manage if caregivers do not understand the reasons for the behaviour. Identifying the contextual variables/triggers for the behaviour is likely to help undertake a functional analysis leading to a person-centred positive behaviour support plan. Currently, a limited number of checklists are available for trigger assessment and none were developed using an interview with the family caregivers. This article describes the development and contents of the comprehensive assessment of triggers for behaviours of concern scale (CATS). CATS was developed in two stages. Stage 1 used a ‘bottom-up’ approach, in which caregivers of adults with ID who show aggressive behaviour were interviewed to identify the triggers for aggression. In stage two, using a ‘top-down’ approach, a comprehensive literature review was conducted to gather items from existing trigger checklists. Trigger items from both stages were combined and the duplicates were removed. The final list in CATS consists of 333 contextual triggers categorised under five main domains and 12 subdomains. CATS can be used by caregivers to identify triggers or antecedents of challenging behaviour. Further work is needed to test its psychometric properties, utility, and acceptability.

Risperidone in non‐epileptic attack disorder and chromosome 15q deletion syndrome

Chromosome 15q11.2 microdeletion is an emerging syndrome identified in individuals with Prader‐Willi syndrome and Angelman syndrome but also found in isolation. Here, the authors present a case of a 19‐year‐old woman with chromosome 15q11.2 microdeletion and her successful treatment with risperidone, a tailored positive behaviour support plan and with staff training around non‐epileptic attack disorder.

Psychotropic prescribing practices in adults with intellectual disability and autism spectrum disorder in Richmond Neurodevelpmental Services

AimsOur aim was to evaluate psychotropic prescribing practices in adults with intellectual disability (ID) and autism spectrum disorder (ASD) across the Richmond Neurodevelopmental Service (NDS).Stopping over-medication of people with a learning disability, autism or both with psychotropics (STOMP) aims to reduce the potential harm of inappropriate use of psychotropic medications. We aimed to evaluate our prescribing practices in keeping with STOMP and the NICE guidelines.MethodWe collected information from our clinical records on patients that met the inclusion criteria (≥18 years + diagnosis of ID and autism) from October-November 2019. We gathered the following: age, sex, severity of ID, psychiatric diagnoses, psychotropic medication, presence of challenging behaviours, involvement of positive behaviour support (PBS) and documentation of a PBS plan.Result32 patients met our criteria (3:1 Male-Female ratio with an age range of 20-74 (Median 33 years old)). All 32 patients showed evidence of challenging behaviours. In the cohort, mild ID represented 18.8% (n = 6), moderate ID 40.6% (n = 13) and severe ID 40.6% (n = 13).17 patients (53%) had a PBS plan in place. For those without a PBS plan (47%, n = 15), a referral to behavioural analysis had been considered/requested in 67% (n = 10).31 patients were on psychotropic medication and 84% (n = 26) had an indication documented in the notes although every patient had had a medication review in the last 6 months. 67.7% (n = 21) of the prescriptions were for challenging behaviours.The average number of medications prescribed was 2 (median 2, mean 2.41) but this was reduced to 1 (median 1, mean 1.76) when additional psychiatric diagnoses and epilepsy were excluded.ConclusionPrescriptions are regularly reviewed in keeping with STOMP guidance but there is more scope for utilising behaviour analysis input as well as the need to improve documentation of the rationale for psychotropic medications.

The characteristics of patients requiring readmission to an Australian forensic psychiatric intensive care unit

IntroductionPsychiatric intensive care units (or PICU’s) emerged to manage high acuity patients outside the justice system. Studies have sought to better understand characteristics of those admitted to forensic or civilian PICU’s. Few, in contrast, have explored the frequency and contributors to readmission. The following study was conducted on Apsley unit, a Forensic PICU based in Melbourne, Australia, and seeks to understand the differences which would allow early identification of patients likely to require readmission and the provision of targeted interventions.ObjectivesExamine rates of and contributors to forensic PICU readmission over a 6-month period.MethodsA retrospective audit was conducted to collect clinical, problem behaviour (and strategies to manage), forensic history and demographic information for consecutively admitted patients to an 8-bed forensic PICU between March-September 2019.ResultsData analysis is ongoing. Interim analysis found that 96 patients were admitted during the 6-month study period: 74 (77.1%) had a single admission; 22 (22.9%) required readmission. Almost all were admitted from prison (96.9%), most had a psychosis diagnosis (80.2%) and substance abuse history (96.9%), and many had a personality disorder (24.0%) and history of adolescent antisocial behaviour (46.5%). Patients requiring readmission were significantly more likely to have been previously under compulsory mental health treatment (95.5% vs 75.3%, p=.039) and have a Positive Behaviour Support Plan developed during admission (85.7% vs 54.8%, p=.010).ConclusionsInterim analysis highlighted the multicomplexity for forensic PICU patients alongside the occurrence of problem behaviour during admission and history of compulsory treatment as indicators of increased risk for re-admission.

Family perspectives on the acceptability and usefulness of the FAB Positive Behaviour Support program: A pilot study

ABSTRACT Purpose: This pilot feasibility study aimed to gain preliminary insight into the acceptability and usefulness of the FAB-PBS program for providing behavior support to families following acquired brain injury (ABI) in community settings. The FAB-PBS program is based on a Positive Behavior Support (PBS) framework and principles of Family-Centered Care and Family-Directed Intervention. It consists of an education phase followed by individualized sessions during which the family is supported to develop and implement a PBS plan. Methods: A mixed-methods design was utilized, with feedback obtained from family members via short questionnaires and semi-structured interviews post education phase and individualized sessions, and at three-month follow up. Results: Two family members completed the full FAB-PBS program and reported high satisfaction with the program and increased confidence in providing behavior support. Findings also suggested an increase in desired behaviors and a decrease in challenging behaviors presented by family members with ABI. Conclusions: The FAB-PBS program may be an acceptable and feasible approach to increasing the capability of family caregivers in providing behavior support following ABI. Further pilot testing is required to inform the development of a larger feasibility study.

Use of positive behaviour support plan for challenging behaviour in autism

The aim of a positive behaviour support (PBS) plan is to improve the quality of a person's life by supporting the person to lead a meaningful life and learn new skills without unnecessary restrictions. PBS uses person‐centred values as well as behavioural science and evidence to inform how to work with people who are at risk of displaying behaviour that challenges. Here, the authors describe how a PBS was effectively used to reduce anxiety and challenging behaviour in a person with autism.

Using Data Collection Applications in Early Childhood Settings to Support Behavior Change

Social–emotional development in early childhood (EC) is an important factor to their later development and adjustment. While all young children display unwanted behaviors at some time during development, challenging behaviors that occur across settings and over a period of time should be identified and intervened; thus, data collection efforts need to be efficient and accurate as time can be a barrier. There are currently applications for children in a K–12 setting that can be used to collect data and share positive behavior support plans; however, they may not necessarily be tailored to the EC population. A variety of data collection apps will be discussed as they relate to identifying a behavior to data collection skills. Suggestions will be given on what apps should contain for data collection and how to make them applicable to EC settings as well as collaborating with multiple professionals.

The potential role of nurses in leading positive behaviour support.

Positive behaviour support (PBS) has become the preferred intervention in the management of challenging behaviour in learning disability and mental health services. However, there is an absence of literature on nurses' views and experience of PBS. Nurses are passive in PBS plan development while other professionals, such as clinical psychologists, often take the lead. While nurses see clinical psychologists as experts in PBS, they feel this could create a barrier that hinders its full potential and a more multidisciplinary approach would be beneficial. Nurses could take a pivotal role in delivering PBS plans if they were able to take a leading role, and this would benefit service users as nurses work far more closely with them than other professionals.

Using functional assessments to involve service users in their positive behaviour support plan

Using functional assessments to involve service users in their positive behaviour support plan

Transforming care in Cornwall: A review of the quality of the lives of people with learning disabilities a decade post‐discharge from hospital

Accessible summary The government wants people with learning disabilities and/or autism to move out of hospitals back to their homes. Cornwall did this in 2007, and we asked the people who moved and their carers how they are now. They have generally done well, and nearly all have stayed in their homes with lots of support. Various factors such as accommodation, social network, skill acquisition and impact of their past were explored. AbstractBackgroundIn the light of the current national guidance to reduce the number of inpatient learning disability beds, a review was completed of the quality of lives of the people who had been former inpatients in Cornwall at the time of closure of the learning disability inpatient facilities almost 10 years before transforming care.Materials and MethodsAll former inpatients who were discharged from the learning disability inpatient setting in Cornwall were invited to participate either directly or through their carers or family members. Measures of current activity levels and semi‐structured interviews on quality of life were conducted.ResultsThe majority interviewed had person‐centred plans, health action plans and positive behaviour support plans. Guernsey Community Participation & Leisure Assessment showed overall the study group did not meet comparative standards laid out by the scale in any of the subdomains (p < .05). Peoples' lives were varied, with a lack of informal relationships, meaningful occupation, homeownership and advocacy being relatively poor for all. Alongside this, to enable people to have safer lives, restrictive practices were commonplace particularly continuous supervision and use of psychotropic medication to manage behavioural risk.ConclusionsThis study highlights that people with complex concerns with a history of placement breakdowns and past institutionalisation can be settled successfully and safely in local communities. However, it is difficult for many of them to achieve a satisfactory quality of life long term. The obligation for this lies with service providers to provide adequate support to overcome that difficulty.

The use of positive behaviour support plans in mental health inpatient care: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT?: There is a drive to use positive and proactive approaches to mental health care to reduce the use of restrictive practices such as seclusion and restraint. Positive behaviour support plans have been used successfully to do this in learning disability services, and in England, it is now a regulatory requirement that anyone with challenging behaviour should have an individualized behaviour support plan. However, positive behaviour support plans specifically have not been evaluated as part of routine mental health care and mental health nurses' and relatives' attitudes towards them are unknown. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This evaluation of positive behaviour support plans in routine mental health inpatient care found that they had not been widely implemented or completed as intended. Barriers to the use of the plans included confusion among nurses and relatives around the principles of positive behaviour support, including how, when and for whom the plans should be used, difficulties in being able to describe the function of a patient's behaviour and lack of engagement with relatives and patients. Nevertheless, nurses and relatives valued the plans, in particular for their potential to facilitate holistic care. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To use the plans successfully, mental health nurses will need training to understand fully the rationale behind the positive behaviour support approach and will need to engage more with relatives and patients. Commitment to the approach from the whole care team and organization will be needed to implement the plans consistently for all patients. Abstract Introduction An international drive is to minimize restrictive practices in mental health care. Positive behaviour support plans (PBSPs) help staff prevent behaviour which would require restrictive intervention. Originating in learning disability services, data within mental health care are limited. Aims To evaluate PBSPs within a mental health inpatient service; understand mental health nurses' and relatives' attitudes to them; and understand the barriers and facilitators for their use in routine mental health care. Methods Mixed methods-quality ratings and interviews with relatives and nurses. Results Positive behaviour support plans were poorly implemented. Relatives and nurses valued the potential of PBSPs to facilitate holistic care, though no relative had contributed to one and not every eligible patient had one. Barriers to their use included confusion around positive behaviour support, including how, when and for whom PBSPs should be used, and difficulties describing the function of a behaviour. Discussion The potential of PBSPs to improve mental health care is recognized. However, there are barriers to their use which should be addressed to ensure that PBSPs have been properly implemented before their impact on patient care can be assessed. Implications for practice Mental health professionals implementing PBSPs should engage with relatives and patients, gain organizational commitment and ensure that those involved understand fully the positive behaviour support approach.

Development of a behavioural assessment tool for use in forensic mental health services

This article presents the Forensic Functional Assessment Measure (FFAM): a tool to assess the triggers and functions of behaviours that challenge in a medium-secure mental health setting. The measure was designed by a group of practitioners in the field who were implementing positive behaviour support (PBS). The aim was to replace other widely used tools that were designed for use with a learning disability population.The FFAM is a semi-structured interview tool and informant-based assessment. Preliminary testing of the tool was carried out by four staff members with seven service users. Findings indicate that the FFAM successfully identified triggers and functions of behaviours that challenge and that it could be used to develop PBS plans. This was a pilot study focusing on a small sample; additional research is required to determine the reliability and validity of the FFAM.