The Positive Programme System: a framework for positive behaviour support.
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Transcript of The Positive Programme System: a framework for positive behaviour support.
The Positive Programme System:
a framework for positive behaviour support
Context of Project Stephan Van Vlijmen, Director of Accommodation, Nulsen
Background to project Collaboration within sector Support of DSC
Purpose of Project
Aim to build capacity within the direct support staff and front line managers in PBS
Staff are supported by the framework to achieve the outcomes to improve the quality of life for people with disabilities.
Restricted Practice
Currently no specific legislation in WA Recognition that Restricted Practices
were being used without approval Desire for cultural change and a self
regulation model for Restricted Practice authorisation
What are Restricted Practices?
Practices which reduce or restrict the rights or freedom of a person with a disability. These would not be acceptable to a non-disabled person in the community.
Illegal in some cases, and breaches the human rights of people in all cases.
What are Restricted Practices?
• Seclusion• Chemical Restraint• Mechanical Restraint• Physical Restraint• Restricted access• Punishment• Withdrawal of privileges
What are Restricted Practices?
The INTENT of the practice:
To punish?To teach a lesson?To teach a skill?To manage risk?
Restricted Practice Audit
Amnesty period
Consciousness raising
Education
Cultural Shift
Restricted Practice Audit Outcomes
Group Homes Alternatives to Employment
Respite Service 0
20
40
60
80
100
120
140
160
Number of Clients Audited
Number of Clients with Restricted Practices Applied
Total Number of Restricted Prac-tices Identified
Restricted Practice Committee
•Practice use
Review
•Assessments Completed
•Documentation in place
Check
•Staff training planned
•Plan to fade practice planned and review date
Consider
•Approve with Review date
•Interim Approval
•No Approval granted
Decide
•Informed consent sought
Consent
Restricted Practice Committee
Aim is to eliminate all restricted practices over time, AFTER ensuring that effective alternatives have been put in place.
Restricted Practice Approvals
Mechanica
l
Physica
l
Seclu
sion
Response
Cost
Chemical
Restrict
ed Access
0
1
2
3
4
5
6
7
Total SubmittedApprovedNot Approved
Question is:
What do we replace these practices with?
Answer:
Positive Behaviour Support Framework
A Framework for Systemic Positive Behaviour Support
Process Content Materials
Systemic Support Plan
Change Overtime
PPR Client Design and Evaluation
Procedural Reliability
Critical Change
Restricted Practice Audit
• PPR• Frontline Managers
• Support Staff• Specialized staff
• Support Staff• Families• Frontline
Managers• Specialised staff• Clients
• Frontline Managers
• Support Staff• Specialised Staff• Families
General Training
Specific Training
ComplianceContinuum of
Supervision
Reduction in unapproved Restricted
Practice
Reduction in Severity and Frequency of
Challenging Behaviour
Minimized Client Risk Behaviour
Increased application and Quality of Positive
Programming
Increased individual Multielement support
elements clients
Increased Procedural Reliability support staff
Assessment
Systemic Support Plan
Mediation
Dep
ende
nt V
aria
bles
Inde
pend
ent V
aria
bles
Positive Programme Review –
Initial Outcomes
Based on Periodic Service Review – LaVigna, Willis et al (1994)
Group homes – 52 Standards Alternatives to Employment – 52
Standards Respite Centre Based – 48 Standards Respite In home – 33 Standards
PPR Scores per Unit
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 190
10
20
30
40
50
60
70
80
Round 1 Score
Round 2 Score
Round 3 Score
Decreased Challenging Behaviour
• Upon starting the project limited data collection existed, mainly in the form of incident reports
• Graphing of frequency data was introduced
• Programme managers can see data in real time using Nulsen document management system
• Data is sent to treating doctors, families and others as appropriate
Frequency Chart - Behaviour
29/11/2
010
8/12/2
010
17/12/2
010
26/12/2
010
4/01/2
011
13/01/2
011
22/01/2
011
31/01/2
011
9/02/2
011
18/02/2
011
27/02/2
011
8/03/2
011
17/03/2
011
26/03/2
011
4/04/2
011
13/04/2
011
22/04/2
011
1/05/2
011
10/05/2
011
19/05/2
011
28/05/2
011
6/06/2
011
15/06/2
011
24/06/2
011
3/07/2
011
12/07/2
011
21/07/2
011
30/07/2
011
8/08/2
011
17/08/2
011
26/08/2
011
4/09/2
011
13/09/2
011
22/09/2
011
1/10/2
011
10/10/2
0110
1
2
3
4
5
6
7
Aggression Staff
Linear (Ag-gression Staff)
Aggression Resident
Linear (Ag-gression Resi-dent)
Risk Management – Group Home
0
10
20
30
40
50
60
70
80
90
100
Risk Present
Risk Plan Present
Risk Management - ATE
0
2
4
6
8
10
12
14
16
18
Risk Present
Risk Plan Present - Aug 2011
Risk Plan Present - Nov 2011
Procedural Reliability
• Also known as Specific Training• Addresses the issue of procedural slippage• Quality and quantity reviewed through
Positive Programme Review• Verbal, simulated and in situ reliability
monitored for procedures across the organisation
Overall Reliability
1% 3% 4% 5% 3
%
84%
<30%80859095100
Reliability Cross Check Five standards on the PPR provide a cross check of
Procedural Reliability
• Verbal reliability – reactive strategy• Independent procedural reliability check• Reviewer observes skill training session• Check of notes to match reactive strategy use
to last incident• Reviewer records any incidents occurring at
home and cross checks with staff recording
Awareness Training
• Online – easy access• Lower cost – administration and replacement
costs• Units recycle for ongoing accreditation• Can be customised for individual services
Staff Coping and Resilience
• Measure the job related stress of staff twice yearly
• Identify staff groupings who may be experiencing stress or burnout related to work
• Provide support or respite for these staff
Emotional Exhaustion
0
5
10
15
20
25
30
35
40
Model Strengths
Advantages of a Multi-Element, Non Linear model –
• All of the framework elements provide cross checking
• Eg. Risk is captured in the audit, examined in restricted practice approvals, risk management is checked in Positive Programme Reviews
• Implementation of elements for each person’s support plan is encouraged in each of the activities required for the framework implementation
Barriers
Stephan Van Vlijmen, Nulsen
• Length of Project timeline – 1 year• Service design not always conducive to the
framework• Cultural issues• Organisational structures• Skilled staff availability
Future Directions
• 7 months of project time left• Contributing to the development of WA
policy for restricted practice• Some small side line research projects
happening• Ongoing take up of the framework
within the sector in WA
Contacts
Stephan Van VlijmenDirector, [email protected]
Cindy WiemanManager, Positive Behaviour [email protected]
