What is PBS and how can it help people who challenge services?

1. What is PBS and how can it help people who challenge services?

2. What is Positive Behaviour Support? ‘ Positive behavior support (PBS) is an applied science that uses educational and systems change methods (environmental redesign) to enhance quality of life and minimize problem behaviors’ Carr et al (2002)

3. Feature of PBS (Carr et al 2002) • comprehensive lifestyle change • a lifespan perspective • ecological validity • stakeholder participation • social validity • systems change and multi-component intervention • emphasis on prevention,

4. Key elements of PBS in practice • Focus on antecedent intervention • Focus on changing the environment/ altering demands – ‘goodness of fit’ • Multi element approach • Long term focus • Quality of life/ O’Brien’s 5 Accomplishments

5. We learnt which things annoyed Jamie and the early signs that he was getting upset Jamie • doesn’t like noise, especially from other people are upset. • becomes irritable if he got hungry or tired. • prefers dim light

6. And more! • Doesn’t like being ignored, especially by people who are supporting him. • Doesn’t like staff using their mobile phones. • Doesn’t like being nagged

7. How did we alter the environment at Mayo House? • We made sure that it wasn’t too noisy for Jamie. • We eventually were able to give him a flat which was farther away from noisier people and could access without going through the building

8. What else? • Although Jamie is an active young man, we were more careful about making sure that his activities didn’t go on too long. • We made sure that people knew not to use their phones when working with Jamie. • We tried not to ‘nag’!

9. Jamie’s medical needs • With the help of his consultant we looked at his medication and started reducing it so that he had more energy. • We ensured that Jamie had treatment for a debilitating and embarrassing sinus condition

10. Fragile X We made sure that people knew that Jamie had a condition called Fragile X which meant that he found it more difficult to cope with: Changes and transitions Noise Bright lights Stressful situations/transitions Communication

11. Working with other ‘stakeholders’ and multi component approach • Mum, Dad, Clare, Katherine, Hayden, Kane, Cally, Izzy and Leyton • Psychiatrist • GP • ENT specialist • Employers • College tutors

12. Long term focus • Allow time to learn new things and to ‘grow up’ • Some strategies inevitably take time – e.g. medication reduction • Maintaining strategies indefinitely e.g. noise management; ensuring activity/rest balance

13. Teaching new skills • Anger management/ relaxation • Self help: laundry, cleaning, cooking, money management

14. Being Proactive • Debriefing after incidents • Reflective Diary • Praise, praise, praise!

15. Self Esteem We tried to help Jamie develop a greater sense of self esteem and confidence: Jobs Fund raising Socialising Interviewing Flat College

16. Dreams We helped Jamie achieve the things that he really wanted to do: Family contact Bugsy! Dublin Paid Job Own Flat

17. Being Positive • We encouraged Jamie to reflect on all the good things that he did during the day, every evening. • We made sure that everyone involved with Jamie were respectful towards him and celebrated his achievements/ development