1 / 33

Mediators: how can they be supported to implement Positive Behavioural Support?

Mediators: how can they be supported to implement Positive Behavioural Support?. Objectives. What is Positive Behaviour Support? What role do mediators play in implementing PBS? What factors detract from the effectiveness of mediators? What support do carers need and how should it be given?.

kendalll
Download Presentation

Mediators: how can they be supported to implement Positive Behavioural Support?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Mediators: how can they be supported to implement Positive Behavioural Support?

  2. Objectives • What is Positive Behaviour Support? • What role do mediators play in implementing PBS? • What factors detract from the effectiveness of mediators? • What support do carers need and how should it be given?

  3. 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)

  4. Sources of PBS (Carr et al 2002) Applied Behaviour Analysis Normalisation/ Inclusion Movement Person Centre Values

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

  6. Characteristics of PBS and PBS Planning • Assessment based • Comprehensive • Proactive • Lifestyle enhancement/inclusion • Person Centred Values • Everyday application • Teaching of alternative skills Bambara and Knoster 1998

  7. Principles underlying effective PBS plans • Multiple interventions or support strategies • Hypothesis based • Person Centred • Personalisation

  8. Triadic Approach • Consultant • Mediators • Focus person Significance of natural v artificial environments (Tharp and Wetzel 1969)

  9. Characteristics of the 3 types of participants • Consultants: ‘any one with the knowledge’ • Mediators: ‘anyone with the reinforcers’ • Targets people: ‘anyone with the problem’ Consultant skills given away to people in natural relationships with focus people – family members and carers.

  10. Contextual fit Congruence between PBS plan and variables related to: • Focus person • People implementing the plan • Environment and systems

  11. Reasons why PBS plans may fail • Not comprehensive enough • Not technically sound • Poor fit • Poor implementation (Bro Morgannwg 2009)

  12. Constraints on the effectiveness of mediators Key areas to consider: • Emotions • Knowledge • Skills • Attitudes

  13. Immediate impact of challenges • Fear; anger; embarrassment • Muscle tension • Feelings of nausea • Heart palpitations/ racing • Sweating • Confusion • Post incident phenomena (physical and mental exhaustion, depression, guilt)

  14. Impact of emotions (1) ‘Negative’ emotions associated with aggressive challenging behaviour: • Sadness: 38% • Annoyance: 41% • Despair: 22% • Anger: 24% • Fear: 19% • Disgust: 0% Bromley and Emerson (1995)

  15. Impact of emotions (2) Negative emotions associated with self injury: • Sadness: 38% • Annoyance: 15% • Despair: 32% • Anger: 15% • Fear: 11% • Disgust: 15% Bromley and Emerson (1995)

  16. Impact of emotions (3) Negative emotions associated with destructiveness: • Sadness: 39% • Annoyance: 22% • Despair: 33% • Anger: 17% • Fear: 9% • Disgust: 6% Bromley and Emerson (1995)

  17. Long term effects of exposure to challenges • Anger • Fear • Guilt • Blame • Unwarranted expectation of aggression • Irritability • Coping by avoidance or confrontation • Loss of interest in job; apathy • Decrease in performance quality • Sickness and absence

  18. BURNOUT Burnout is characterised by three elements: • Emotional exhaustion • Depersonalisation; cynicism • Reduced personal accomplishment (Thompson and Rose 2011)

  19. What do staff report as being stressful? • Behaviour that is wearing over time(82%) • Perception that there is no effective way to deal with the behaviour (68%) • Unpredictable behaviour (71%) • Behaviour that is difficult to understand (68%) • Effect of challenges on other service users’ quality of life (43%) • Self Injury (61%) • Aggression aimed at others (50%) • Physical strength of challenging service users (50%) Bromley and Emerson 1995

  20. Gaps in knowledge • PBS principles • Mental Health needs • Physical health needs • Autism • Specific conditions – Fragile X; epilepsy • Impact of abuse

  21. ATTRIBUTION THEORY suggests that ‘Helping’ behaviour is: LEAST WHEN GREATEST WHEN A person’s behaviour is viewed as being internal to them and controllable A person’s behaviour is viewed as being external to them and uncontrollable Gives rise to a positive approach, (sympathy/empathy) Gives rise to avoidance, negative affects (disgust, anger)

  22. Relationship between attributions and staff behaviour

  23. What helps? Appointing the right people in the first place Characteristics of the ‘Hardy’ personality: • Commitment, the belief that one’s life and activities have meaning and value; • Control, the conviction that one can control events; • Challenge, change in one’s life is likely and should be embraced as being beneficial.

  24. Significance of Emotional Intelligence Emotional intelligence in carers, an attribute which incorporates the abilities to • attend to, • understand, • regulate and • repair one’s emotional states

  25. Predictors for effective carers BenevolenceEmpathyIntroversion ‘Benevolence and empathy didn’t surprise me but I didn’t expect introvert to come up at all. I realised that extroverts don’t empower individuals. It made sense that you had to be an introvert because you have to be a good listener. It’s about being a person who is more reflective and observational.’ Bill Mumford (Managing Director, MacIntyre care organisation)

  26. Coping styles Wishful thinking versus practical, solution based problem solving Importance of sense of ‘self efficacy’

  27. Teaching immediate coping skills • Self awareness of appropriate body language • Deep breathing exercises • Active listening and problem solving • Vulnerability points

  28. Effective Post Incident Support • Post crisis support Immediate Medium/long term • Critical Incident Analysis

  29. PBS Planning • Sense of ownership • Comprehensive • Ongoing support and review

  30. What I have found helpful in practice • Planning with teams • Matching support to individual teams • Attending to ongoing team needs • Ensuring grasp of theoretical principles • Adequate data gathering and analysis • Create momentum • Regular review • Facilitator knowledge • Clear, understandable language

  31. Specific Training Needs • Core Values training • PBS principles inc understanding of functionality • Mental Health Needs • Physical Health needs • Service User histories • Individual conditions and their impact

  32. Teaching/facilitating specific stress relieving/ coping strategies • Muscle relaxation • Mindfulness • Assertiveness • Deep Breathing • Cognitive Therapy • Acceptance • Access to counselling

  33. Leadership and Management • Positive regard • Celebrating success (SPQC) • Praise and appraisal • Supervision/PDP • Team days; away days; stress management days • Creating cultures of support • Measuring stress levels routinely • Cohesive and consistent organisational culture

More Related