Presentation by Kathryn Falloon, Dr Serene Teh and Tracy Coward - A positive behavior support approach for mental health consumers. Presented at the Western Australian Mental Health Conference 2019.

1. A Positive Behaviour Support Approach for
Mental Health Consumers
20 November 2019
Kathryn Falloon, Consultant Clinical Psychologist
Department of Communities, Disability Services
Dr Serene Teh, Clinical Psychologist
HECS, Department of Health
Tracy Coward, Clinical Nurse Specialist
HECS, Department of Health
Government of Western Australia
Department of Communities

2. Overview
• What is Positive Behaviour Support?
• Graylands Hospital Positive Behaviour
Support Project
• Case example
• Where to from here?

4. What is Positive Behaviour Support?
Positive Behavior Support (PBS) is a set of research-
based strategies used to increase quality of life and
decrease challenging behavior by teaching new skills
and making changes in a person's environment.
(Code of Practice: A Guide for the Elimination of Restrictive Practices 2019)
PBS may be applied within a multi-tiered framework at
the level of the individual and at the level of large
systems.
(Kincaid, Dunlap, Kern, Lane, Bambara, Brown, Fox, Knoster 2015)

5. What is Positive Behaviour Support?
“This is the expanding vision of PBS,
• a vision that impels us to create meaningful lives and
not simply to eliminate psychopathology,
• a vision that spurs us to change systems and not just
people,
• a vision that motivates us to seek collaborative
possibilities with our colleagues in many different
sciences so that we can transcend our superficial
differences and focus on deeper commonalities.”
Source: Carr, Horner 2007 (emphasis added)

6. Challenging Behaviour:
The Tip of The Iceberg
Behaviour is just the tip of the iceberg.
To change it we have to look at what lies beneath .
Behaviour
The Person
Families
Interactions
Health
Relationships
Communication &
Individual SkillsEnvironments

7. Focus on meeting needs
instead of focusing
on behaviour

8. Working Together
This Photo by Unknown Author is licensed under CC BY-SA

9. Hospital Extended Care Service (HECS)
Graylands Hospital

10. HECS PBS Project
• Hospital Extended Care Service
(HECS)
• MHA 2014: least restrictive care
• Collaboration with Department of
Communities, Disability Services in
2015

11. What did we do?
Focused on multi-level intervention:
• Individual level
• Employee level
• Organisation level

12. What did we do?
2015
• Project Steering Group and meetings established
2016
• PBS workshop
• Pilot study in Murchison West unit with 2 patients
• Monthly PBS sessions in unit commenced
2017
• Patients in pilot study discharged
• Addition of a third patient to the pilot study

13. What did we do?
Early 2018
• Whole of unit approach
• Working Party established
• PBS workshops
Late 2018
• Weekly practice sessions held in each unit
• PBS workshops held
• Review Steering Committee membership to rep all disciplines
2019
• Working party reviewed operational documents to reflect PBS
approach

14. What were the outcomes?
• Individual level
• Employee level
• Organisation level

17. PBS Case Example
Knowing the person
• How did we get to know Mr X?
• What did we find out?
• What were the unmet needs?

18. PBS Case Example
Matching supports to needs
• What did we do to better meet Mr X’s needs?

19. PBS Case Example
Working together
• How did we work together to support Mr X
and improve his quality of life?

20. PBS Case Example
Outcomes
• Quality of life
• Challenging behaviour
• Restrictive practices

22. What’s Next?
• Expansion to additional HECS wards
– More PBS workshops
– More practice sessions
– More team collaboration
• Involve Case Managers from CMHS
• Disability Sector organisations
• Consultative role

23. Further information on PBS
• British Institute of Learning Disabilities website
http://www.bild.org.uk/capbs/pbsinformation/
• Hamlett, Carr, Hillbrand 2016, “Positive
behavioral support planning in the inpatient
treatment of severe disruptive behaviors: A
description of service features”, Psychological
Services, Vol 13 (2), pp178-182

24. References
• Department of Communities 2019 (3rd Edition),
“Code of Practice: A Guide for the Elimination of
Restrictive Practices
• Kincaid, Dunlap, Kern, Lane, Bambara, Brown, Fox,
Knoster 2015, “Positive Behavior Support: A
Proposal for Updating and Refining the Definition”,
Journal of Positive Behavior Interventions, Vol 18(2)
• Carr, Horner 2007, “The expanding Vision of
Positive Behavior Support: Research Perspectives
on Happiness, Helpfulness, Hopefulness”, Journal of
Positive Behavior Interventions, Vol 9 (1), pp3-14

25. When a flower doesn’t bloom,
you fix the environment in which it grows,
not the flower.
-Alexander den Heiger-