Behaviour Support Planning Workshop 5 June 2020 Debra Corfield - - PDF document

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Behaviour Support Planning Workshop

5 June 2020

Debra Corfield Donna White Assistant Director Behaviour Support A Director Behaviour Support NSW/ACT

Workshop Overview

• The purpose and principles of positive behaviour support
• The planning cycle
• What is a “good” behaviour support plan?
• NDIS Commission requirements
• The foundations of a good plan
• Funding considerations
• Reflection and planning for implementation

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The aim of positive behaviour support is:

• 1. To increase quality of life
• 2. To decrease the intensity, frequency and duration
• f behaviours of concern, and
• 3. To reduce and eliminate the use of restrictive

practices

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To change lives for the better, NOT manage behaviour in the context of unacceptable lifestyles

(Myers & Park, 1999)

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https://www.communityservices.act.gov.au/__data/ assets/pdf_file/0006/1460058/Att-A-Positive- Behaviour-Support-Plan-Guideline.pdf

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Principles of positive behaviour support

• Person-centred - ensuring the person’s (or child’s) life goals are at the centre of the process
• Partnership - collaborating with the person and all key stakeholders shapes the process of change.
• Planned - creating a clear document to ensure shared understandings and accountability.
• Positive - focusing on preventative, rather than reactive, strategies.
• Proactive - placing the responsibility for changing behaviour on both the person and their supporters.
• Purposeful - using a functional behavioural assessment approach to identify the reason for the behaviour.
• Process driven - cycling iteratively through a process of identifying, assessing, planning, implementing,

monitoring and evaluating data. (Office of the ACT Senior Practitioner, 2019)

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Planning cycle

Identify Assess Plan Implement Monitor Evaluate

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What is a “good” behaviour support plan?

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Behaviour Support Plans

Practice Standard Outcome: Each participant’s quality of life is maintained and improved by person-centred, evidence-informed behaviour support plans that are responsive to their needs Quality Indicators Behaviour Support Plans

• Consistent with evidence-informed practice, including

proactive strategies

• Developed in consultation with implementing providers
• Given to implementing providers for their consideration

and acceptance

• If contain a regulated restrictive practice, provided to

the Commission in the time and manner prescribed in the NDIS (Restrictive Practices and Behaviour Support) Rules 2018

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Behaviour Support Plans

NDIS (Restrictive Practices and Behaviour Support) Rules 2018 Who

NDIS behaviour support practitioner engaged by an NDIS provider

Timeframe

From the time the behaviour support practitioner is engaged:

• 1 month for an interim plan
• 6 months for a comprehensive plan

Developing

• r reviewing
• Undertake a functional behavioural assessment and take all reasonable steps to:

 Reduce/ eliminate the need for the use of RRP, including environmental changes  Consider previous behaviour support and other assessments  Consult with the person with disability, their family, carers, guardian or others including the NDIS provider who may use the RRP and other relevant specialists

• If contains RRP

 Communicate the intention to use a restrictive practice in an accessible format  Recommend in accordance with conditions and any State or Territory authorisation process

Contents

Strategies that are evidence-based, person-centred and proactive and address the person’s needs and the functions of the behaviour

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PBS Capability Framework

The capability domains:

• 1. Interim response
• 2. Functional assessment
• 3. Planning
• 4. Implementation
• 5. Know it works
• 6. Restrictive practice
• 7. Continuing professional development and supervision

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Principles & Values

Interim Response Functional Assessment

Planning

Implement Know it works Reduce & Eliminate Restrictive Practice CPD & Supervision

• 1. Interim Behaviour Support Plans

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Core Level Practitioner Skills Proficient Level and Above Practitioner Skills

• Record and report accurately
• Provide guidance on protective actions related

to environment, setting and circumstances

• Develop an individualised immediate response

plan

• Use a range of strategies that can be safely

adjusted once full assessment and planning concludes

• Document and implement ethical reactive

strategies

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• 2. Comprehensive Behaviour Support Plans

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Core Level Practitioner Skills Proficient Level and Above Practitioner Skills

• Use data to for a theoretical and ethically

sound BSP

• Identify those responsible for implementing a

BSP and collaborate to develop strategies

• Develop proactive strategies to improve

quality of life  Necessary adaptations to a person’s environment and routine  Increase the person’s skills  Include an escalation mechanism

• Minimise or eliminate the use of restrictive

practices

• Include strategies

 That remove conditions likely to promote BOC: environmental modifications, active engagement  For replacement behaviours  That are preventative: relaxation, distraction  That are reactive for when behaviours are not preventable

Foundations of a good plan

Person-centred Strengths based Solution focused Systemic focus Collaborative and co-designed Contextualised and supports implementation Goal oriented Outcome measurement Data systems Evidence- informed / Assessment based Multi-element supports Positive and proactive focus (RRP last resort) Accessible format Action oriented Written with purpose, clarity and respect Reflective practice and supervision

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Person-centred and Systemic focus

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Goal setting

Specific

What do you want to achieve?

Measurable

How will you track and measure progress?

Achievable

Is this possible / realistic? Does the system have the skills, knowledge and resources needed?

Relevant

Why are you doing this? Does it matter?

Time-oriented

When will you have achieved this?  Using the Miracle Question  Writing SMART goals

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Goal-oriented and Outcome focused

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Collaboratively Prioritising Interventions

It’s not possible to do everything at once!

To prioritise consider: 1) Person-centred - What is most important to the person? What will have the greatest impact in improving quality of life? 2) Safety - What can be done to reduce risk of harm whilst maintaining dignity and upholding the person’s right? 3) Capacity – What recommendations fit the their needs and goals of the system? What is their readiness for change and barriers to implementation? What can be funded now? 4) Impact - What is likely to be the easiest and quickest to implement and make the biggest impact?

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Multi-element Support Framework

PROACTIVE AND PREVENTATIVE STRATEGIES REACTIVE STRATEGIES Environmental Strategies Skill Building / Teaching Strategies Focused Support Strategies Response Strategies Systems Support (La Vigna & Willis, 1995)

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Environmental Strategies

Address the discrepancies between a participant’s needs, goals and preferences, and their environment. For example:

• Making changes to the physical environment
• Reducing or eliminating triggers and setting events
• Developing consistent routines
• Opportunities for choice
• Access to an increased variety of activities
• Interaction guidelines
• Communication strategies

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Skill Building / Teaching Strategies

Involve teaching the person skills and behaviours which are functionally equivalent, functionally related, desirable and / or increase skills, independence and quality of life. For example:

• Building adaptive living skills
• Teaching new communication strategies
• Developing coping or distress tolerance skills
• Teaching social skills
• Teaching replacement skills and behaviours

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Focused Support Strategies

Are designed to produce a rapid and short term reduction in behaviour. But not address the function of the behaviour and do not teach new skills. For example:

• Reinforcement schedules

Differential Reinforcement of Other Behaviour (DRO), Differential Reinforcement of Lower Rates of Behaviour (DRL) Differential Reinforcement of Alternate Behaviour (ALT-R)

• Antecedent control strategies
• Medication adjustments
• Dietary changes

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Response Strategies

Aim to diffuse and resolve situations as quickly and safely as possible whilst persevering dignity and upholding the person’s rights.

Reason + Reflect Relate Regulate

They are not aimed at teaching, but are a necessary component while proactive strategies are put in place and take effect.

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Systems Support

Supporting knowledge, skills, values, attitudes, confidence, consistency and wellbeing of people involved in designing and implementing the plan. For example:

• Training, coaching and mentoring
• Resources to support implementation
• Supervision and professional development
• Communication pathways
• Feedback (e.g., re strategies, data and changes)
• Self-care and well-being supports

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Evidence- informed, proactive and multi- element supports

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Integrating other theoretical and practice frameworks – some examples

E.g., Trauma Informed Practice

Perry’s 6 R’s of positive developmental, educational and therapeutic experiences:

• Relational (safe)
• Relevant (developmentally-

matched)

• Repetitive (patterned)
• Rewarding (pleasurable)
• Rhythmic (resonant with neural

patterns)

• Respectful (child, family, culture)

E.g., Systemic Practice Mapping systems and:

• Taking a meta-position (bird’s eye view)
• Exploring Relationships (structure and

quality) and Interactions (sequences and patterns)

• Remailing neutral and respectful curiosity
• Circular questioning
• Hypothesising (non-pathologising)
• Empathy generating

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Writing behaviour support plans

Examples from POOR plans Tips to improve  They are clearly emotionally disturbed  Use clear and descriptive language. Do not pathologise, judge or

• label. Build systemic empathy.

 They are not capable of …  Be strengths focused. Replace or at least balance with what they can do.  Engage with them about a preferred topic  Don’t assume information in known. Provide examples.  They have a dog  What is the purpose of including this information? Translate into meaningful action or remove.  Teach them about safety  Be specific – what does this mean? How, who, when, where & why? Make sure this links to your assessment & formulation.  All response strategies start with “Don’t ….”  Replace or at least pair with what to do instead.  Help them to calm down  How? This will look differently for everyone. Provide individualised rather than generic strategies.  Support them to transition  Who? How? Where? Break things down into a step by step procedure and allocate specific tasks and responsibilities.

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NDIS Commission Templates

• Interim BSP Template -

https://www.ndiscommission.gov.au/document/1446

• Comprehensive BSP Template -

https://www.ndiscommission.gov.au/document/1441

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Written with purpose, clarity and respect

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Who What How When or Where Why

Regulated Restrictive Practices as last resort ONLY

Person-centred Strengths based Solution focused Systemic focus Collaborative and co-designed Contextualised and supports implementation Goal oriented Outcome measurement Data systems Evidence- informed / Assessment based Multi-element supports Positive and proactive focus (RRP last resort) Accessible format Action oriented Written with purpose, clarity and respect Reflective practice and supervision

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BSPs containing Regulated Restrictive Practices

NDIS (Restrictive Practices and Behaviour Support) Rules 2018 PBS Capability Framework Practitioner Skills – Core Regulated restrictive practices must:

• Be communicated in an accessible format
• Be clearly identified in a BSP
• Be authorised if there is a State/ Territory process
• Be used as a last resort after applying evidence-based,

person-centred and proactive strategies

• Be the least restrictive response possible in the

circumstances

• Reduce the risk of harm to the person or others
• Be proportionate to the potential negative

consequences or risk of harm

• Be used for the shortest time possible
• Be reduced and eliminated over time
• Prescribe restrictive practices under the direct

supervision of a person at the practitioner level of proficient or above PBS Capability Framework Practitioner Skills – Proficient or above

• Provide a statement of intent to include a restrictive

practice in a BSP

• Develop a BSP

 Based on a functional behaviour assessment  In collaboration with the person and others  Include strategies that are proactive, outcomes- focused, person-centred, address the person’s needs and the functions of the behaviour, and include fading strategies for RRP

• Lodge with the NDIS Commission

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Funding Considerations

• Funding does NOT change what is evidence-informed practice is but may

change HOW you provide it.

• Practitioners need:
• To be flexible and be prepared to do things differently
• To map out their work at the outset

What support is required? What hours are available? Then allocate hours for each component, ensuring a buffer for the unexpected

• Always plan for some kind of implementation support. A plan alone is NOT enough.
• Know the limits of what is possible and when to request a review

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Positive Behaviour Support Capability Framework – Planning for Implementation

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Core Level Practitioner Skills Proficient Level and Above Practitioner Skills

• Identify barriers to implementation
• Write a BSP that is usable by those

implementing it

• Develop data collection systems that are
• bjective, understandable and usable
• Include a continuous cycle of monitoring
• BSP based on the literacy and communication

needs of the target audience

• Strategies compatible with the ability and

resources of the implementers

• Develop data measurement for implementation
• Responsibilities and timeframes clearly

articulated

• Use supervision to increase knowledge and skills

for prescribing and implementing RRP

• Identify and discuss practice issues which are

challenging, and skills and knowledge that need developing

• Take responsibility for seeking support
• Be available for support between formal

supervision sessions, especially for newer behaviour support practitioners

• Facilitate reflective practice
• Share knowledge of the regulatory context and

evidence-based practice with supervisees

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EVIDENCE USABILITY SUPPORTS NEED FIT CAPACITY

Where to next? Implementation

Adapted Hexagon Tool

NIRN (2019) https://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/imce/documents/NIRN%20Hexagon%20Discussion%20Analysis%20Tool%20v2.2.pdf

IMPLEMENTING INDICATORS CAPACITY TO IMPLEMENT

• Knowledge and skills
• Able to sustain training, coaching,

staffing, data systems, monitor performance, resource

• Buy-In

FIT

• Contextualised to setting
• Aligned with priorities and

needs

• Fits with values
• Impact on other programs and

supports NEED

• Targets a need
• Informed by data and assessment
• Shared understanding and perception of need

for the intervention

• Address service or system gaps

PLAN INDICATORS EVIDENCE

• Strong evidence base
• Data informed
• Outcomes are worth it!
• Cost-effective

USEABILITY

• Well-designed, clear and

logical

• Actionable and practical
• Contextualised to

settings SUPPORTS

• Physical resources
• Staffing
• Training
• Coaching t
• Supervision
• Data Systems
• Administrative systems
• Communication and

feedback loops

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Q&A

For further information please contact: ACTBehaviourSupport@ndiscommission.gov.au 1800 035 544

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