Positive Behaviour Support and Restrictive Practices –
a personal perspective of working in Queensland and WA

Christopher Stuhmcke, Operations Manager for Interchange, shares his personal perspective and comparisons of the differences between working within the Disability Services Sector in Queensland, which has a legislated Positive Behaviour Support (PBS) framework, and Western Australia, which has not regulated Positive Behaviour Support.

Queensland instigated systemic change to their approach to supporting persons with challenging behaviours through the adoption of a legislated Positive Behaviour Support Framework. This change was initiated after the 2006 Carter Report revealed persons with challenging behaviours were the most marginalised, possessed the most complex needs and presented significant challenges.

One implication of this highly-regulated approach is stringent data collection and reporting obligations. By observation, however, driving compliance in itself is not enough; the key component to effective PBS is in fact organisational values and ethos rather than government regulation, with cultural transformation being the critical success factor to implementing sustainable PBS practices.

In short, PBS can succeed within an organisation, regardless of whether the organisation operates within a heavily regulated PBS environment or a code of practice system.

With an emphasis on cultural transformation, Interchange is progressing on its journey to embedding PBS practices within the organisation. The implementation plan involves multiple stakeholders, from the Board through to direct support staff.

Why Interchange invested in PBS

Interchange firmly believes positive behaviour support is predicated on the notion that creating a life of quality and purpose, embedded in and made possible by a supportive environment, should be the focus of our efforts as professionals. The focus of concern is not with problem behaviour, and certainly not with problem people, but rather with problem contexts (Carr, 2007) .

The structured approach to the implementation of Positive Behaviour Support (PBS) and identifying/reducing Restrictive Practices (RP) at Interchange began in January 2015.

We have taken steps to redesign counter-productive and unfair environmental contexts and provide customers with the skills, coping strategies and the desire to deal with the frustration that is an inevitable part of life.

With support from Disability Services Commission (DSC) Sector Development staff, Interchange has introduced several key initiatives including:

• The establishment of a PBS Committee, with a representative from each of Interchanges seven Service Centres attending monthly PBS Committee meetings;
• The allocation of weekly time slots for PBS Representatives to provide updates in their team meetings, designed to increase PBS awareness, discuss PBS concerns that customers/ staff may be experiencing, provide suggestions that will be referred to the PBS Committee, build capacity and further embed cultural change within their Service Centre, alongside their peers and management;
• Training in PBS with topics that cover functional communication, acquiring knowledge and skills in writing quality person-centred behaviour support plans and opportunities to develop and assess the quality of a behaviour support plan for a person supported by Interchange;
• Policy and procedural development relevant to PBS and reducing restrictive practices through the free DSC and disability sector PBS Tool Box; and
• Collaboration between the PBS Committee and the Occupational Safety and Health (OSH) Committee to ensure that matters involving challenging behaviours are approached from both a safeguarding and safety perspective.

Cultural changes and other benefits that have been noted in relation to the implementation of PBS initiatives include:

• Positive Behaviour Support Plans (PBSPs) are constructed and delivered in a manner that respects the individuals human rights.
• Increased quality of life for individuals we support, by promoting opportunities for people to be included in their community.
• Behaviour Support strategies underpin the pre-existing person-centred approach and lead to increased independence, social integration and inclusion.

Taking a proactive approach (better equipped to deal with incidents) versus reactive approach (crisis management when incidents occur).

From a workforce perspective, we’ve seen:

• An increase in the confidence of staff resulting from their professional development;
• An increase in staff morale and retention;
• A reduction in incidents;
• A reduction of injuries and workers compensation claims;
• A reduction in absenteeism;
• More buy-in from staff, and staff supporting in a least-restrictive manner.

Interchange has identified a number of key ingredients that can help organisations implement their own Positive Behaviour Support and reduce or eliminate restrictive practices that apply, regardless of the presence of legislative regulation of restrictive practices, including:

• Engagement from the Board and Executives of the organisation;
• Values and ethos of the organisation that reflect person-centred values and Positive Behaviour Support principles;
• Understanding and modelling of these PBS principles at all organisational levels, as this ensures that they underpin everything the organisation and staff do; and
• Building in-house capabilities by capturing knowledge and ensuring no single point of failure (if a key person leaves the organisation), not relying on the skills and experience of a single individual, creating support structures for internal teams (staff, PBS Committee, Managers), and developing policies and procedures that support organisational processes and structures.

How Interchange has benefited

The manner in which PBS is embedded within organisational policies, procedures and processes emphasises Interchanges focus on supporting employees to work in a culture where attitude and beliefs are clearly stated, values are upheld and people are encouraged to work alongside individuals who sometimes experience challenging behaviour in a way that is developmental and constructive as opposed to controlled and restrictive.