Behaviours which challenge

We can help you to design and commission training about positive behavioural support (PBS), to ensure that your workforce has the right skills and knowledge to provide high-quality care and support for people who display, or are at risk of displaying, behaviours which challenge. 

Our 'Guide to arranging and paying for PBS training' explains what workers need to know and do to deliver high-quality PBS, outlines standards for PBS training and gives you tips about commissioning and/or designing PBS training. 

You can find more useful information below, including videos, case studies and the latest news. 

 

Introduction

Behaviours which challenge always happen for a reason and might be the only way a person can communicate - it can arise for different reasons which are personal to the individual.

People who display or are at risk of displaying behaviours which challenge might need care and support which involves both positive support, such as positive behavioural support, and some form of restrictive practice or intervention, such as physical restraint or use of devices, medication or seclusion.

Any restrictive intervention must be legally and ethically justified, be absolutely necessary to prevent serious harm and be the least restrictive option. 

Before you get started, read these FAQs from the Challenging Behaviour Foundation to find out more about how PBS can help you deliver high quality support. 

What is PBS? 

PBS is a recognised way of supporting people who display, or are at risk of displaying, behaviours which challenge.

It involves understanding the reasons for the behaviour and considering the person as a whole - including their life history, physical health and emotional needs - to implement ways of supporting them. It focuses on creating physical and social environments that are supportive and capable of meeting people's needs, and teaching people new skills to replace the behaviours which challenge. 

It’s based on recognising each person’s individuality andtheir human rights, the importance of self-determination, and accepting that behaviours which challenge develop to serve animportant function for people. It rejects the use of aversive and restrictive practices, but acknowledges that for some people, at some times, an authorised restrictive practice (possibly including a physical intervention) may be necessary – but only when it’s legally and ethically justified to prevent serious harm to the person or others.

Watch this short video from the Challenging Behaviour Foundation about what is PBS. 

 

 

 

The UK PBS competency framework explains the things that you need to know and the things that you need to do when delivering best practice PBS for people with a learning disability and/or autistic people who display, or at risk of displaying, behaviours which challenge.

The PBS Academy has also developed Standards for Services which outlines the standards that services should meet when delivering PBS. 

Functional assessment

One part of PBS is to understand why the behaviour happens, how it's been learned and how it's maintained - this is called a functional assessment

Watch this video from the Challenging Behaviour Foundation about understanding behaviour and the importance of functional assessments. 

 

PBS plan 

When you've found the reason, you should produce a PBS plan that includes ways of intervening when people are at risk of displaying behaviour that challenges, and includes teaching new skills. 

PBS plans should be co-produced and followed by everyone involved in supporting the person, including the person and their family. 

Watch this video from the Challenging Behaviour Foundation about putting PBS into practice. 

 

The Centre for the Advancement of PBS at BILD has also created an animation that gives an overview of PBS and how PBS approaches work in practice when supporting an individual.

 

Adult social care workers, including managers, need to have the right skills and knowledge to support people who display, or are at risk of displaying, behaviours which challenge.

Standards for training

PBS training should reflect the PBS competency framework, which was developed by the PBS Academy in 2015. 

They've also designed the Standards for Training for all those involved in the delivery, purchase or commissioning of PBS training. 

Guidance and best practice

A positive and proactive workforce guide will help adult social care commissioners and employers to make decisions when planning, purchasing or providing learning and development that will help your workforce to work in a positive and proactive way, and minimise the use of restrictive practices, when supporting people who display behaviours which challenge.

A guide to arranging and paying for PBS training is for people involved in designing, delivering and/or commissioning PBS training in adult social care organisations. It explains what workers need to know and do to deliver high-quality PBS, outlines standards for PBS training and gives you tips about commissioning and/or designing PBS training. 

 

In 2019/20 we're running a pilot project to develop and test a peer review process for PBS training.

This will involve a number of learning providers who peer review each other’s training, to give feedback and share ideas. We hope that this will be a successful model to improve the quality of PBS training across the sector.

  • At the beginning of this project, we did a survey to understand more about PBS training and learning provision in adult social care. Download the findings from the survey here

  • Watch this recorded webinar to find out more about the pilot. You can download the slides, with notes, here

We envisage that the peer reviews will take place in Autumn 2019, and we'll publish the findings in early 2020. If you want to find out more about the pilot project, please email us.

 

When it’s done properly, PBS can have a big impact on the quality of life of individuals who display behaviours which challenge. Here are three case studies. 

  • Eldertree Lodge supported J who has a mild intellectual disability and emotionally unstable personality disorder. They developed a positive behaviour support (PBS) plan and as a result, number of incidents of behaviour that challenges decreased and she’s more engaged in meaningful activities both in and out of the ward. Read her case study here
  • Rebecca has a rare genetic condition which presents as a severe learning disability, autism, an eating disorder and mild self-harm. When Rebecca moved into a shared residential home, the number of incidents of behaviours which challenge increased, so her support team introduced PBS to support her. Since then her wellbeing has improved and she is more active in her community. In this case study, her Mum explains how PBS has supported Rebecca and what her PBS plan includes. 
  • Michael has complex needs including autism, a learning disability and oppositional defiance disorder, and displays behaviour that challenges services. His supported living placement followed a PBS plan, which included an adult education programme focused on building his life skills, and his quality of life has improved. Read his case study here.
  • Gloucestershire County Council has implemented a county-wide approach to PBS. They set up a ‘Challenging behaviour working group’ to develop a Challenging Behaviour Strategy which outlines their strategic approach to supporting individuals with learning disabilities and/or autistic people who display behaviours which challenge - PBS is strongly featured in the strategy. Read the case study here

The PBS and autism training fund in 2016-17 was used to explore the use of 'personal workforce budgets' to train and develop the workforce to better support people with learning disabilities and/ or autistic people, who display or at risk of displaying behaviours which challenge. It was funded by the ‘positive and safe programme’ to contribute to the aims of the Transforming Care programme.

A personal workforce budget is an amount of money allocated and spent specifically on developing the skills of the workforce that support an individual, including: 

  • developing ‘skills around the person’
  • interagency/ multi agency work at a person centred level
  • providing training in line with PBS competency framework or good autism practice
  • contributing to the discharge (or avoided likely admission) of one or more persons.

Download the evaluation report.

Read these case studies to find out how organisations used the fund to improve outcomes for people with learning disabilities and/ or autistic people who display or are at risk of displaying behaviours which challenge. 

  • Read how The Lifeways Group used the fund to train staff who support Keith, who has a learning disability, complex autism and related anxiety. They worked with staff to develop a positive behaviour support plan, communication skills and ways they could encourage Keith to engage more. As a result, Keith now leads a more fulfilled life, with reduced levels of anxiety and his behaviour patterns have changed. 

  • Read how The Lifeways Group used the fund to train staff who support Jeremy, who has a severe learning disability, Downs Syndrome and Klinefelter syndrome. They used the fund to improve communication between Jeremy and staff, including developing a video of the Makaton signs that Jeremy uses. As a result, Jeremy accesses the community every day and the number of incidents of behaviour that challenges has decreased. 

  • Read how Wirral Evolutions used the fund to train staff how to better support autistic people who display or are at risk of displaying behaviour which challenges. They trained over 100 staff on courses ranging from an 'introduction to positive behavioural support, to 'coaches training'. 

The Restraint Reduction Network (RRN) Training Standards (2019) provide a national benchmark for training in restrictive practices.  

  • If you're a learning provider, you can use this audit tool to compare your existing provision against the standards. 
  • If you're a provider or someone who needs care and support, you can use the audit tool to understand what training should be provided and ask the right questions to ensure that the training you commission, meets the standards. 

About the standards

The standards focus on the fundamental principles that apply to all populations (people with a mental health condition, learning disability, autism or dementia) and settings (across education health and social care).

Certification

The RRN encourages learning providers working in the education, health and social care sectors to become certified against these standards. Certification against the standards will be mandatory for all learning providers (commercial and in-house) working with the NHS or NHS funded services from April 2020.

Bild ACT has been licensed by the RRN to certify learning providers as complying with the training standards. Bild ACT runs a free awareness day workshop for anyone that wants to find out more about certification.

Guidance for adult social care commissioners, service providers and learning providers

Although not currently mandatory for adult social care, the Care Quality Commission (CQC) and Skills for Care are keen to ensure that the standards are adopted across the adult social care sector.

We advise that: 

  • local authority commissioners include ‘UKAS accredited certification of training services to demonstrate they meet the RRN Training Standards’ in commissioning requirements whenver staff will be trained in restrictive interventions
  • service providers ensure that they commission and/or deliver training that complies with the standards, and use external learning providers that have been certified (you can find a list here)
  • learning providers deliver training that complies with the standards and have become certified. 

Clarification about certification costs for adult social care service providers

Skills for Care has received a number of enquiries about the standards and certification, and what is classed as 'in-house' training, and therefore has a fee attached to it, under the certification scheme. 

When service providers commission or deliver training, it usually falls into one of these three categories.

  1. Develop, design and deliver their own training - in this instance full certification is needed. Find out more about certification here. For the purposes of certification this is described as ‘in house’ training.

  2. Use a commercial learning provider and either:

2.1. upskill their own staff to become trainers who deliver a commercial learning provider’s programme (e.g. through ‘train the trainer’) – in which case, the service provider does not need full certification, but the learning provider does need to pay a fee for the service provider to become an affiliated organisation, which they may pass on to the service provider (Bild Act charges the learning provider £450 for each affiliate service provider)

2.2. the learning provider delivers the training directly to the service provider’s staff. This could be by the learning provider sending their trainers into the service, putting on a course for the service's staff or the staff attending an open course organised by the learning provider. In any of these cases the service provider does not need to become an affiliated organisation or pay a fee. The affiliated organisation fee only applies where service provider’s own staff are licensed to deliver a commercial learning provider’s programme.

The most common confusion appears to be around scenario 2.1 and differentiating between the terms ‘in house’ training and affiliated organisation.

We think that some adult social care service providers would class scenario 2.1 as delivering ‘in house’ training and would therefore presume that they need full certification. However, in terms of this certification scheme, this is not classed as ‘in house’, and, therefore, the service provider would only need to ensure that the learning provider has applied for them to be approved as an ‘affiliated organisation’ and paid the fee (£450). The learning provider may pass this fee onto the service provider.

For further information please contact RRN@bild.org.uk

 

Local networks can help you share what’s worked well and learn from others, to improve best practice.

We've put together this list of networks and communities of practice

They have different focuses including supporting autistic people, people with learning disabilities/intellectual disabilities, and/or the use of PBS – or a combination of the above. Each network is different so make sure you ask how they’re run and who can join.

If you want to join a local network, use this list to find their details and get in touch.

If you want us to add your details to the list, please email us