Behaviour Support – Understanding the Person Behind the Behaviour
Participants are referred to positive behaviour support due to engaging in distressed behaviours of concern, and the pervasive and significant impact that this has on their everyday quality of life. Positive behaviour support practitioners, along with other allied health therapists (including occupational therapists, speech pathologists and physiotherapists), play a crucial role in supporting the participant to improve their quality of life by strengthening the systemic supports and environments around the participant, while also providing direct skill building therapeutic interventions.
It can be a challenge working in highly complex and burnt-out systems around the person, as managing distressed behaviours of concern can be emotionally draining. At times, the person and their underlying need can be forgotten as the emphasis turns to the behaviour of concern they are engaging in and making attempts to extinguish the behaviour.
In this blog post, we’ll explore strategies to support allied health professionals to go beyond the behaviour and embody a truly person-centered approach.
The reasons why behaviours of concern occur
Behaviour is how someone conducts themselves. It is everything that a person does. It can refer to actions, reactions, and how someone functions in their everyday activities and environments. Each behaviour arises from an underlying need or function. For example, when you are feeling hungry (function), you get something to eat (behaviour).
Sometimes, when a person does not have the appropriate skills to engage in socially adaptive behaviour, they may engage in distressed behaviours of concern. Generally, most behaviours of concern serve at least one of the following five functions:
- Attention: “I want to connect more with the people around me”.
- Tangible: “I want that item or preferred activity”.
- Escape: “I don’t want to do that”.
- Non-social: “I’m bored and want something to do”.
- Physical: “I’m in pain / not feeling well”.
Understanding and assessing the function of the behaviour of concern is an integral part of the behaviour support role. This quote by Ashleigh Warner, psychologist, sums up the importance of understanding the underlying function of the behaviour:
‘Beneath every behaviour there is a feeling. And beneath each feeling is a need. And when we meet that need rather than focus on the behaviour, we begin to deal with the cause, not the symptom.’ ~ Ashleigh Warner, psychologist.
A person-centered approach into practice
A person-centered approach is just as the name suggests. It places the person at the heart of what we do. It reminds us that the person is more than their disability. They are a person, first and foremost. When someone is engaging in behaviours of concern, it is integral to hold this mindset. They are more than the behaviour they engage in. They are trying to tell us something is not working for them by what they do.
Carl Roger’s first identified three core values that underpin a person-centered approach in the 1950’s. These are:
- Empathic Understanding: Attempt to genuinely see the person and what they are going through, to understand them and where they are coming from.
- Congruence: Being authentic to genuine to our own image of self.
- Unconditional Positive Regard: holding the person with genuine care and understanding, and therefore being accepting of who they are as a person.
Translating a person-centered approach into practice
In everyday practice, this looks like:
- Talking with the participant using kind and respectful language. Adapt your language or use augmentative and alternate communication (AAC) to meet the person at their communication ability. Check that the person has understood what you have said.
- Use open-ended questions and reflective listening to understand it from the person’s perspective.
- Understand what is important to them, what are their likes, what are their goals and aspirations? How can this information be used to inform your plan?
- Facilitate choice and control of the person. How can they be supported to make their own decisions?
- Include the person in the development of their therapy and behaviour support plan. What do they want included? How do they like to be supported?
- Focus on the person’s strengths, abilities and skills. How can these be strengthened to support goal achievement?
- Focus on finding strategies and solutions that work for the individual person.
- Strengthen the person’s support, including informal support, formal support and community support.
- Being an advocate for the person and their needs. Providing information to them and their networks that support understanding of why they are engaging in behaviours of concern.
- Use of person-centered tools to provide structure to conversations.
Reference
Rogers, C. R. (1951). Perceptual reorganization in client-centered therapy.
National Disability Practitioners. (2016). NDP factsheet: What is a person-centered
approach? https://www.ndp.org.au/images/factsheets/346/2016-10-person-centred-approach.pdf
NDIS Quality and Safeguard Commission. (ND). Participant factsheet 1: What is positive behaviour support? https://www.ndiscommission.gov.au/sites/default/files/2023-02/Easy%20Read%20Fact%20Sheet%201%20-%20What%20is%20positive%20behaviour%20support.pdf
NDIS Quality and Safeguard Commission. (2021). Practice review: Consulting with people with disability during a practice review. https://www.ndiscommission.gov.au/sites/default/files/2022-07/consulting-people-disability-during-practice-review-fact-sheet-practice-reviews.pdf
About the author
Sonia is KEO Care’s PBS Clinical Excellence Lead. She is an experienced paediatric occupational therapist and specialist positive behaviour support practitioner. She specialises in working with children and families, focusing on supporting children to achieve their goals in their everyday life. She has had experience working across multiple settings, including specialist schools, in clinic environments and in the community.
