Enhancing Lives Through Positive Behaviour Support: A Conversation with Accomplish’s PBS Lead, Ben Adkins

Improving quality of life is the main focus of positive behaviour support, a goal which is being achieved every day across Accomplish. We spoke to Positive Behaviour Support Lead Ben Adkins to find out more.

“Positive behaviour support has been embedded across Accomplish for more than seven years now. Our then ‘behaviour advisors’ undertook diplomas in PBS.

“People often think that positive behaviour support is about reducing incidents of concern. But it’s main focus is on quality of life – although, if a person’s quality of life has improved then it is a side-effect that incidents of concern are likely to reduce. Behaviour is communication and if a person is experiencing behaviours of concern, then it is likely they are trying to communicate a need that is not being met.

“The theory sitting behind PBS is to look at some main factors having an impact on an individual’s life and how changes to those would increase their quality of life. That might be how do we reduce restrictions or increase time in the community. How do we help them to have more options for activities and doing things they like to do?

“We also recognise that some people have been supported in services for such a long time they may not know what they want to do. Some people would prefer to stay in bed and do nothing and then it often comes down to a balance between their choice and best interests and sometimes we will be pushing towards activities in a gentle way because we think it’s in their best interests.

“It is well-established that it’s much better for your mental health to be engaged, both mentally and physically but we need to look closely at why might someone choose to spend a lot of time in their bedroom, for example?

“If a person with learning disability and autism might find great solace in their bedroom because it’s predictable and safe, we have to look at how can we help them to have an active life in a predictable and safe way while meeting their needs  and while helping them to have greater options.

“We might take a number of approaches. The key is research and to find out who is likely to get the best results in terms of the relationship they have with the person and the best chance to encourage them to go out and have a good day.

“We look at what are the ingredients of a best day for that person and what approach is best for them? Is it laughing and joking, is it soft manner and tone, or being very polite? Then it’s ensuring consistency across the staff team, the same personalised approach every day.

“We talk to the staff team and really get them to understand that although it’s a choice for a person to stay in all of the time, it’s an ill informed choice. While we will respect their right to choose we are going to follow a best practice approach and push gently in the right direction.

“And we approach it positively – this is going to be a good day, this is what we’re going to be doing. You’re making a statement. It doesn’t take away a person’s choice – they can still choose to rejet. But using this method gives us a much better chance of a person making a positive decision.

“And if it doesn’t’ work one day you keep going! Belief in yourself and belief that this is in the person’s best interests are essential and become a self-fulfilling prophecy. My beliefs will affect my behaviour, which will impact other people’s beliefs and their behaviour which will affect my belief.

“We’re playing the long game – we’re trying to instill positive expectation and that’s not based on what happens today, it’s much more about how you’re helping them to make positive decisions in their life.

“We’re also trying to get co-production within the home. Staff love to do things for people – it’s part of caring. But doing things for people can deskill them and that takes away a sense of purpose and self-esteem. A big part of PBS is people doing things for themselves and being independent in very small practical ways.

“We should be like a piece of the jigsaw, we should only be the bit that’s needed.

“We have to have confidence in the people we support and allow for positive risks. Risk assessment shouldn’t be risk prevention. Just because someone might have a bad day today doesn’t mean they can’t do that thing any more. It’s about us how can we help them do it safely?

“As we continue to grow as an organisation, so do our plans for further embedding PBS. We plan to increase our training and we are currently working on evaluating our value and getting measurable feedback.

“A lot of the people we work with are less able to voice how PBS has impacted their lives directly but are more able to demonstrate that in their behaviour. When someone is flourishing we would see that as a success – when they don’t need to experience behaviours to communicate their needs any more and living their best and fullest lives. That’s success.”