As well as a framework for individually based intervention, PBS can also be implemented via a system-wide approach. In fact, some would argue that without a system-wide approach, individually based interventions are unlikely to result in optimal outcomes. PBS must focus on the context in which challenging behaviour occurs and therefore systems change should be seen as a key feature of implementation.
The development of school-wide PBS in the USA has attempted to attend to this broader system-wide approach with a more explicit focus on prevention of challenging behaviour. The approach adopts a three-tiered continuum of behaviour support practices in order to prevent problem behaviour. These tiers can be seen in the diagram. Read more...
We believe that this tiered continuum provides a useful model for application of PBS across different settings and populations. Tailoring the tiers to the specific requirements of the setting and the people it supports can aid successful implementation of PBS.
The diagram provides some brief considerations for developing system wide PBS.
- System Wide PBS Strategy
- PBS Strategy components
- Strategy implementation support
- Supervision, coaching and mentorship
An example of system wide PBS strategy was with a small private provider of residential care homes.
At the time of referral, the organisation was under special measures from the local authority and CQC had issued an NOP on the home (putting it at risk of closure).
We have worked with the organisation an average of 5 days per month over a 12 month period.
Here’s what we did:
- We started with individual consultancy by working directly with two key people living at the service
- We rolled out introductory training programmes on 1) working with people with autism, and 2) PBS
- We set up a strategy cabinet and developed a PBS strategy in partnership with the team
- Developed and delivered a work-based leadership training programme on promoting wellbeing
- We are in the process of trialling a bespoke data system to enable the monitoring of outcomes (and progress against the strategy)
We were incredibly grateful to receive the following feedback and feel it gives a good indication of how we support services:
“I recently worked with PBSuk when I was in post offering turnaround operational support to a specialist Autism and LD residential service in crisis. It was clear that the service and support staff were lacking the skills to manage the very complex behaviours of some of the people being supported at the service; where PBS plans were in place, they were not person centred and did not give support staff the tools to really understand the behaviours of the people they were supporting, or implement any valuable or effective intervention or support techniques.
"Paddy and Tia were fantastic from the outset. Rather than offering a ‘prescriptive’ process, they met with us and listened to where we felt we were failing and what we wanted to achieve. They presented us with several options and provided thorough feedback at each step of the process. There was continued open dialogue and they remained completely flexible in their approach. If they felt something wasn’t working, they approached us with evidence and an alternative solution.
"When we identified that staff needed support with implementing the plans, they delivered the training in a super responsive timeframe.
"I can confidently say that the work PBS UK did with thepeople we support and the staff team, was key in driving up the standards of care delivered at the service and enabling the staff to support people to a better quality of life. I wouldn’t hesitate in encouraging providers to utilise this incredibly knowledgeable, effective and professional resource when looking to improve quality of life for people we support and push forward standards of care being delivered to people with complex needs."
Operations Manager, Residential Support Provision
An example of support to develop a component of PBS was when we were approached by a teacher in mainstream education, who was feeling that the current strategy around detentions didn’t feel like it had a developmental gain to pupils.
We worked with them to develop reflective practice sessions based on the principles of acceptance and commitment therapy.
This provided a platform to engage with pupils around the root cause of incidents leading to detention.
The goal was to empower pupils to recognise the impact of their perception on a situation and to ultimately regulate their behaviour.
We hope it also supported the staff to do the same and potentially support a more compassionate ‘system’ that provided a more developmental approach.
Another example of supporting a setting to develop a component of a system wide approach to PBS in a CAMHS hospital setting.
The brief for this project was to develop a PBS pathway for CAMHS services including resources, metrics, templates and timescales
Initially we developed an outline of the pathway before working with one of the hospitals to pilot and refine it.
This ensured that the pathway was realistic and usable within the busy hospital setting. By the end of this process we were able to present a complete PBS pathway; from initial referral through to transition out of the hospital; that included instructions, examples and tools that could be utilised throughout the wider company. The pathway was designed as a model to support the organisations in-house PBS coaches.