This project highlights that it is possible to significantly reduce the use of restrictive practices through: gaining senior level organisational support for the introduction of Positive Behaviour Support providing appropriate training supporting emerging leadership at all levels within disability sector organisation, but particularly at the operational through the introduction of leadership/mentor roles specific to the area of behavioural support implementing robust and consistently applied organisational systems and processes that support and embed good behaviour support practices fostering cross-sector and inter jurisdictional collaboration recognising and responding to the critical importance of timely, accessible support to organisations from professionals with experience in Positive Behaviour Support. This report finds that the many of the restrictive practices in place are often not recognised as restrictive and have emerged over time in response to Occupational Health and Safety and issues of staff injury and welfare. There has been a need for a clear and evidence based decision making process that provides the justification supporting the use or non-use of a restrictive practice. The Voluntary Code of Practice for the Elimination of Restrictive Practices has arisen in response to this need and future training will be needed to reinforce defensible and transparent decision making process that recognises the rights of people with a disability and the welfare needs of all concerned The outcomes set for the project reflect what the literature suggests would, ideally, be in place for a service system to reflect best practice in Positive Behaviour Support (See footnote 2) (see footnote 3 on next page). Footnote 2 Allen D, “Positive Behavior Support as a Service System for People with Challenging Behavior”, Psychiatry Volume 8.1, pp 408–412 Rotholz D and Ford M “Statewide system change in Positive Behaviour Support”, Mental Retardation, Volume 41, 5 pp354–364 Reid D, Rotholz D, Parsons M, Morris L, Braswell B, Green C and Schell R, 2003, “Training Human Service Supervisors in aspects of PBS: Evaluation of a Statewide, Performance Based Program”, Journal of Positive Behavior Interventions, Volume 5,35, pp 35–45 trial trial
Behaviour support plans were predicated on an understanding that it is highly unlikely that any single strategy will achieve the desired outcomes in relation to an individual’s challenging behaviours. They included four components, three proactive and one reactive, which in combination, are intended to achieve the desired outcomes. These were: Ecological changes – planned environmental changes that over time, produce a change in behaviour, for example, lifestyle and routines, background stimuli and environmental pollutants. Focused support strategies – strategies that should result in more rapid effects including, for example, schedules of reinforcement, stimulus control or satiation and background stimulus change. Positive programming – to change the person’s behavioural repertoire to better deal with their environment through changes to communication systems, coping and tolerance strategies and functional related or equivalent skills development. Situational management – reactive strategies to establish control and prevent harm when a situation occurs. The proactive strategies were consistent with the model outlined in the Effective Service Design Report and designed to achieve reduction in the frequency of the challenging behaviour, therefore reducing the need for reactive strategies. The reactive strategies were those which manage the challenging behaviour when it occurs. Both sets of strategies play a role in reducing episodic severity, but it is the proactive strategies which maintain the reduction in the longer term. The model includes a role for a specialist support person (a behaviour support consultant) in the settings in which a Positive Behaviour Support plan is being introduced, to model support strategies and provide immediate support and advice to those implementing the plan. As the service providers become competent in carrying out the plan, direct contact is progressively reduced and the specialist role becomes one of review. Formal reviews occur at regular intervals to monitor client progress and identify any barriers to progress, and make changes as necessary. The ultimate aim is the service provider has the necessary internal skills to manage the plan. In summary, the model is grounded in Applied Behaviour Analysis and related fields, is evidence based, person centred, has multiple elements and is strongly outcomes focused. The key elements in the model are: front-line leadership training/skills development; (e-learning and onsite client specific practice, mentoring) current state assessment through a comprehensive audit of restrictive practices that addresses both organisational and individual service practices
working with families to provide home based respite services through the Intensive Family Support (IFS) had more direct contact with families than their colleagues in the centre-based service, but also encountered more difficulties around the use of behaviour support plans. All IFS staff except for the coordinators reported it was difficult to engage casual staff in the project. Many were students who were most comfortable in engaging with the children in activities that gave families a break and were enjoyed by the children. Coordinators reported that staff were not sufficiently ‘on board’ with the project and did not feel sufficiently skilled or ethically mandated to initiate major changes in practices in the family’s home, when they were in the home for relatively short periods. Their observation was that practices ‘worked’ for families that were often experiencing very high levels of stress related to the care of children whose disabilities were profound. They questioned whether they should challenge these practices given that their contact with the child was limited and families were the primary caregivers. In some cases, in both on site and IFS respite, family users were reported to have firm ideas about what was best for their child and family, and refused to consider change, even though staff encouraged them to try other, less restrictive options. The model has a capacity to engage with families and includes material directed specifically to families. However, the pilot project itself was neither designed nor resourced to provide the family, as natural mediators (or teachers as professional mediators) with the information, support and resources to motivate them to fully engage so that a new Positive Behaviour Support plan could be consistently followed. To achieve the necessary level of engagement and involvement with families and schools would have required a level of training and support to families in their homes and the child’s teachers at school that was outside of the pilot project’s scope. Notwithstanding the difficulties of implementing the model, staff interviewed at the conclusion of the project consistently reported that the project had given them a different way to think about their roles and practices. Although not systemically successful, the project was reported to have resulted in new/improved relationships with a small number of families and has helped them to move forward. Staff noted the value of having access to LLC’s specialist psychologist (the project team leader) to support the development of their skills and knowledge about Positive Behaviour Support – access to specialists was identified as a success factor across all three service types.
restrictive practices Procedural reliability procedures - % of completed trials Management reports reporting Positive Behaviour Support data and Positive Behaviour Support related issues survey tool (averages and trends at each location) (Data will pick up on 12 training sessions conducted in each quarter of the pilot – good data set) * Via Specific Training Procedure recording sheets, specific training measures that are checked (Practice Leaders and Team) include role plays and on the job performance . Re-accreditation training is based on set periods, some 6/12 and others 24/12. recruitment practice – get the right person) Changes in staff MBI scores at 6 monthly intervals Changes in attribution scales (CHABA) pre and post (12 month interval) (Interpret in the context of the literature, CHABA not designed as a tool to measure psychological change) Changes in rates of retention of direct care staff pre and post (12 month interval) The Positive Behaviour Strategy Sector and Workforce Development Project: Outcomes and Measures Final Feb 2012 6. Constructive and sustained consumer routines in place and followed in pilot agencies 7. Reduction in use of restrictive practices in pilot agencies 8. Reductions in no of occurrences and severity of adverse incidents related to challenging behaviours in pilot agencies 9. Compliant, consistent and accountable services in pilot agencies