Tuesday, 16 September 2014

Some additional context for the proposed PBS Academy for England

The content of this blog is mine and not the responsibility of any of the other contributors to the proposal for a Positive Behaviour Support (PBS) Academy (see here if you have not yet read the proposal).

There has been a lot of interest in our publicly posted proposal/suggestion for a PBS Academy for England. Some interesting questions, including several relating to issues we touched on in our short paper. However, it is clear that for some readers the proposal is not yet linked with other aspects of context that would be helpful. Specifically, some have asked what PBS is or have wondered what the Academy authors mean by PBS. Others have asked what the roles of various professional groups might be. Finally, many people have been in contact to say that they have been working locally on projects and ideas that chime with much of what is said in the Academy proposal. 

This final class of responses reinforces our point that much of the Academy’s role would be to connect existing excellence and resources within the framework of carefully defined quality and competencies. That is, we’re not simply proposing a co-ordinating role. Instead, we believe that clear standards and competencies need to be established and that then local/regional work that meets these criteria, or aspires to, would be facilitated in communities of practice across England. The Academy would encourage/support all excellent practice. It would also have high standards – people with learning disability and their families deserve nothing less. My personal view is that this means some people/groups currently professing to be PBS experts or PBS competent may not meet the Academy’s standards. Basically, there has to be a line… The proposed Academy will need to be a mark of quality that various stakeholders can trust. Not an easy job, but it needs doing.

What is PBS?

In trying to influence the debate, some of the UK’s leaders in PBS put together a series of articles in BILD’s International Journal of Positive Behaviour Support in December 2013. One of these papers focused on the defining features of PBS. It did not really say anything new, but it was intended as a clear description of what PBS is about. Many organisations around England received a copy of the special issue of the journal, and so you may have access already to all of the articles. The link to the special issue is here. If you cannot access the journal, but would like to read the paper on what PBS is, you can email me (R.Hastings[at]Warwick.ac.uk] or any of the other authors.

Our PBS Academy proposal needs to be read in that context of how we see PBS. We did not re-state definitions in our proposal and perhaps we should have done. We have, though, already been clear about a definition of PBS for the UK. One point is that unless you are delivering (have competencies in) all dimensions of the PBS defining features, you ain’t “doing PBS”. The defining features contribute to an integrated framework – it is not possible to pick and choose to say (for example) that 7 out of 10 will be good enough.

The roles of various LD professions

I hope that we already were clear enough in the proposal that working alongside people with LD and their families/carers would be a founding aspect of the PBS Academy. Granted, there are again few details about how that would be achieved and such detail would have to be developed early on. At this stage, we had some family/carer input to the proposal but none from people with LD.

Interestingly though, various professional groups in the LD community in England have wondered about their role in a PBS Academy. My answer is actually to take one step backwards to a broad framework (sometimes, I’ve grandly called this “theory”) or model that links together the evidence relating to challenging behaviour. I’ve blogged about this before, arguing why it is important for people to care about “theory” in generating high quality services to support people with behaviour that challenges. Check out my What Use is Theory blog.

It is clear from a working model of challenging behaviour that PBS plays a central role because it is built upon much of the existing evidence about the inter-personal and broader environmental contexts in which challenging behaviours emerge. However, it is not the full story by any means. For example, there is good evidence that physical pain, co-existing mental health or developmental disabilities (e.g., autism), and various genetic syndromes are associated with increased chances of people engaging in behaviours that challenge. These associations mean that a comprehensive service supporting people with challenging behaviours will need strong medical assessment and management of health issues that may be causing or exacerbating challenging behaviour. I personally would not want to see PBS kicking in until such health causes can be ruled out.

We also argued that a lack of communication skills is associated with more challenging behaviour. Speech and Language Therapists would clearly have a role in helping to develop these skills. A further example is the association between challenging behaviour and a lack of meaningful activity in people’s lives. My understanding would be that Occupational Therapists would have competencies relevant to this issue. Psychologists would hopefully have skills to deliver non-pharmacological “treatment” of underlying mental health problems (e.g., through various evidence-based psychological therapies) associated with challenging behaviour. Learning Disability Nurses will also have competencies in many of these areas I’ve used as examples.

My point is that a multi-disciplinary group of people is needed, working to a shared model of challenging behaviour, to be able to deliver excellent services. This is not the same thing at all as saying that everyone needs to be “doing PBS”. Not everyone can develop the depth of competence in PBS to lead on that aspect of the challenging behaviour model. Specialists (from whatever professional background) are needed in PBS roles. Those PBS practitioners need to be a core part (probably the largest part) of all multidisciplinary challenging behaviour teams.

Another important point to make is that the Academy proposal is not just about supporting adults. We were clear that challenging behaviour has its roots often earlier in life, and so significant work is needed with a focus on children. Explicitly, early intervention services are also needed that are informed by the same basic model of challenging behaviour.

Back to the PBS Academy proposal

So, please read the Academy proposal alongside those two other aspects of context – what PBS is, and also how PBS fits into a wider model of challenging behaviour. I hope that the whole package, with the PBS Academy proposal at the centre, offers a way for all stakeholders in the learning disability community to come together and to make something significant happen!