A clinical psychologist said to me recently: “We always recommend the implementation of Active Support when providing Positive Behaviour Support guidance to staff teams supporting a person whose behaviour is challenging”. I’ve asked around and discovered:
- such a recommendation is quite common
- but to see Active Support as a result is rare
Why would external challenging behaviour specialists, concerned about the implementation of support that will reduce the occurrence of challenging behaviour, be proposing Active Support? And indeed why would the “”Detailed Pathway and Policy Specification” (McGill, 2013) from the recent LGA and NHS publication describing commissioning principles for services for individuals with challenging behaviour indicate that organisations need to “provide an active support model of care” (p. 28)[i]?
The answer is three-fold:
- Active Support has a beneficial effect on challenging behaviour – and, at least for some people, it’s sufficient to deliver substantial improvements
- there is considerable overlap in the scope, focus and techniques involved in the two approaches
- Successful implementation of Positive Behaviour Support depends on services working in particular ways
As Julie Beadle-Brown indicated in her blog on this site on the 25/3/14 (https://personcentredsupport.wordpress.com/2014/03/24/what-would-jim-have-said/), United Response, The Avenues Trust and the Tizard Centre have produced a document describing the close relationships between Positive Behaviour Support and Active Support. This document is now freely available (http://www.unitedresponse.org.uk/wp-content/uploads/2014/04/Final-UR_BestPractive-PBS_AS.pdf) and you should consult it for further details and references supporting this view.
The essential point is that we believe that while Positive Behaviour Support is undoubtedly vital it can only be realistically implemented in situations that are already amenable to its particular requirements and Active Support is an effective way to attain this.
All too often the only response to challenging behaviour is a set of reactive strategies intended to put a stop to the behaviour and/or contain the person. Positive Behaviour Support requires a shift in focus and thinking to enable the development of a range of, sometimes counter-intuitive, reactive strategies which bring about a return to calm.
But even more important is Positive Behaviour Support’s recognition that this is a necessary but inadequate approach because it does nothing to reduce the likelihood of the behaviour occurring again, and so it demands an array of proactive strategies in addition to those that are reactive.
These proactive strategies need to be developed from an understanding of the difficulties the person concerned has in their life, and more often than not they aren’t technical and obscure – for example, changing the sequence of relevant events through the day or improving our methods of communication, etc. The problem is that the implementation of even very common-sense or simple proactive strategies requires a systematic and coherent approach to support. This is something that social care settings are not naturally good at. To the people they support they are more likely to feel chaotic, unreliable and inconsistent places, with long periods of inexplicable inactivity: all features that are likely to induce confusion, fear, boredom and distress, and that are resistant to structured, orderly change.
Active Support focuses closely on these issues, and by doing so it removes many of the conditions that precipitate and maintain challenging behaviour. But additionally it creates an expectation in those providing support that as well as being person centred, they will be working with a purpose and planning, implementing and reviewing relevant approaches in a systematic way.
These are also requirements of Positive Behaviour Support – they’re what external challenging behaviour specialists ask for when making recommendations about support for people with challenging behaviour.
Making both Positive Behaviour Support and Active Support a reality in services will require:
- the alignment of policies and procedures
- the development of standards, training, and practice leadership
- focused inspection and monitoring from a range of people, including commissioners and care managers, care providers, quality assessment agencies and families and friends
In our document we expand these requirements in a series of recommendations for central government, service providers, families and friends, commissioners and care managers, and regulatory and workforce development agencies.
Active Support is good support for people and it’s also what’s needed if Positive Behaviour Support is to be implemented successfully.
[i] McGill, P. (2013) Detailed Pathway and Policy Specification, in Local Government Association and NHS England: Ensuring quality services: Core principles for the commissioning of services for children, young people, adults and older people with learning disabilities and/or autism who display or are at risk of displaying behaviour that challenges. Downloaded from http://www.local.gov.uk/documents/10180/12137/L14-105+Ensuring+quality+services/085fff56-ef5c-4883-b1a1-d6810caa925f on 14/4/14