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

5/06/2020 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 2 The aim of positive behaviour support is: 1. To increase quality of life 2. To decrease the intensity, frequency and duration of behaviours of concern, and 3. To reduce and eliminate the use of restrictive practices 3 1

5/06/2020 To change lives for the better, NOT manage behaviour in the context of unacceptable lifestyles (Myers & Park, 1999) 4 https://www.communityservices.act.gov.au/__data/ assets/pdf_file/0006/1460058/Att-A-Positive- Behaviour-Support-Plan-Guideline.pdf 5 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) 6 2

5/06/2020 Planning cycle Identify Evaluate Assess Monitor Plan Implement 7 What is a “good” behaviour support plan? 8 Behaviour Support Plans Practice Standard Outcome: Quality Indicators Behaviour Support Plans  Consistent with evidence-informed practice, including Each participant’s quality of proactive strategies life is maintained and  Developed in consultation with implementing providers improved by person-centred, evidence-informed  Given to implementing providers for their consideration behaviour support plans that and acceptance are responsive to their  If contain a regulated restrictive practice, provided to needs the Commission in the time and manner prescribed in the NDIS (Restrictive Practices and Behaviour Support) Rules 2018 9 3

5/06/2020 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  Undertake a functional behavioural assessment and take all reasonable steps to: Developing  Reduce/ eliminate the need for the use of RRP, including environmental changes or reviewing  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 10 PBS Capability Framework The capability domains: Interim 1. Interim response Response Functional 2. Functional assessment Assessment CPD & Supervision 3. Planning Principles & Values 4. Implementation Reduce & Eliminate Planning Restrictive 5. Know it works Practice 6. Restrictive practice Know it works Implement 7. Continuing professional development and supervision 11 1. Interim Behaviour Support Plans Core Level Practitioner Skills Proficient Level and Above Practitioner Skills  Record and report accurately  Develop an individualised immediate response  Provide guidance on protective actions related plan to environment, setting and circumstances  Use a range of strategies that can be safely adjusted once full assessment and planning concludes  Document and implement ethical reactive strategies 12 4

5/06/2020 2. Comprehensive Behaviour Support Plans Core Level Practitioner Skills Proficient Level and Above Practitioner Skills  Minimise or eliminate the use of restrictive  Use data to for a theoretical and ethically practices sound BSP  Include strategies  Identify those responsible for implementing a  That remove conditions likely to promote BSP and collaborate to develop strategies BOC: environmental modifications, active  Develop proactive strategies to improve engagement quality of life  For replacement behaviours  Necessary adaptations to a person’s  That are preventative: relaxation, environment and routine distraction  Increase the person’s skills  That are reactive for when behaviours are  Include an escalation mechanism not preventable 13 Foundations of a good plan Evidence- informed / Person-centred Systemic focus Goal oriented Accessible format Assessment based Collaborative Outcome Multi-element Strengths based Action oriented measurement supports and co-designed Positive and Contextualised Written with proactive focus Solution focused and supports Data systems purpose, clarity implementation and respect (RRP last resort) Reflective practice and supervision 14 Person-centred and Systemic focus 15 5

5/06/2020 Goal setting  Using the Miracle Question  Writing SMART goals Specific What do you want to achieve? Measurable How will you track and measure progress? Is this possible / realistic? Does the system Achievable have the skills, knowledge and resources needed? Relevant Why are you doing this? Does it matter? Time-oriented When will you have achieved this? 16 Goal-oriented and Outcome focused 17 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? 18 6

5/06/2020 Multi-element Support Framework REACTIVE PROACTIVE AND PREVENTATIVE STRATEGIES STRATEGIES Skill Building / Environmental Focused Support Response Teaching Strategies Strategies Strategies Strategies Systems Support (La Vigna & Willis, 1995) 19 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 20 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 21 7

5/06/2020 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 22 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 They are not aimed at teaching, but are a necessary Relate component while proactive strategies are put in place and take effect. Regulate 23 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 24 8