Positive behaviour support (PBS) is an evidence-based approach that focuses on understanding the social context and underlying causes of behaviours of concern in individuals with disabilities. By addressing these factors and implementing appropriate interventions, we can improve the quality of life for these individuals and reduce the occurrence of challenging behaviours. In this article, we’ll discuss the concept of behaviours of concern, their functions, and how positive behaviour support can help.
What are behaviours of concern?
Behaviours of concern are those behaviours that occur frequently and at a high enough level of severity or for a long enough time that they have a clear impact on the quality of life of the individual and those around them. These behaviours may include self-harm, aggression, property destruction, or other actions that can be harmful to the person themselves or those around them.
Behaviours of concern could be understood better by taking into account the person’s vulnerabilities, functions of behaviour and immediate environment.
Vulnerabilities
Vulnerabilities can be categorised into two: biological vulnerabilities and psycho-social vulnerabilities
1. Biological vulnerabilities
To understand what triggers a behaviour of concern, it is important first and foremost to conduct a physical health check alongside, or before, any assessment of behaviour of concern.
A person may have difficulty following instructions due to limited hearing. Without a physical health check, carers or people who spend time with the person may believe that he or she is being difficult, stubborn or has an ‘attitude’. Likewise, a person who hit themselves due to a health-related pain that they cannot communicate may be dismissed as attention-seeking or violent without context or explanation having been provided by a health check. Genetic influences could also be behind behaviours of concern.
Screening for, and ruling out physical health or sensory causes is vital in getting the full picture of the causes and/or triggers of a person’s behaviours of concern.
2. Psycho-social vulnerabilities
External vulnerabilities in a person’s environment can act as triggers of behaviours of concern. Hastings et al in the paper A conceptual framework for understanding why challenging behaviours occur in people with developmental disabilities has set out five main factors within psycho-social vulnerabilities that people with intellectual disabilities are likely to experience:
- Negative life events: exposure to life events such as bereavement, illness, bullying, abuse predict risk for challenging behaviour.
- Limited communication skills: a person who lacks communication skills may be forced to use means such as behaviours of concern to get attention or illicit a response from people around them.
- Impoverished social networks: a limited access to social networks and support can lead to increased risk of abuse and reduced protection which could result in loneliness and depression in addition to behaviours of concern.
- Lack of meaningful activity: not having an activity to occupy a person’s time and attention leads to a sense of not having a purpose and increases risk of depression.
- General mood problems: people with intellectual disabilities are at an increased risk of mental illness. Due to a lack in communication skills, they may find it difficult to self-report mental health symptoms.
Functions of behaviour
According to behavioural science, there are four primary functions of behaviour: sensory/stimulation, social attention, avoidance/escape (including escaping pain), and access to tangibles (items, activities, places). Understanding these functions can help identify the reasons behind behaviours of concern and develop appropriate interventions.
In behavioural science, there are four functions of behaviour:
- Sensory/Stimulation
- Social attention
- Avoidance/Escape (including escaping pain)
- Access to tangibles (items, activities, places)
The above functions are not independent of each other. Some people may exhibit just one of the above functions, or a combination of any of the four.
Positive Behaviour Support and the Immediate Environment
Positive behaviour support practitioners play a crucial role in improving the quality of life for individuals with disabilities by facilitating social interactions, meaningful activities, and access to care. The immediate environment, including the people around the individual, can significantly influence the effectiveness of PBS interventions.
Therefore, the behaviour of the people around the person with behaviours of concern can be very influential and powerful. If done right and ethically, carers and people involved hold the power to increase a person’s quality of life and independence to the extent that challenging behaviour may be lessened. However, without a full understanding of the reasons behind the behaviours of concern, they can inadvertently worsen it.
Conclusion
Understanding and addressing behaviours of concern is a crucial aspect of supporting individuals with disabilities. By implementing positive behaviour support strategies and considering the social context and functions of behaviour, we can improve the quality of life for these individuals and reduce the occurrence of challenging behaviours. As a positive behaviour support practitioner, it’s essential to stay informed and up-to-date on the latest research and best practices in the field.
Resources:
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