Positive behaviour support

Positive behaviour support is a widely accepted evidence-based approach to behaviour support for people with intellectual and developmental disability. Positive behaviour support involves functional assessment of behaviour by a behaviour support practitioner, followed by the development and implementation of clinical, educational, environmental and other therapeutic strategies that focus on reducing and preventing the occurrence of the challenging behaviour and securing the person’s human rights¹, wellbeing and quality of life. Positive behaviour support relies on evidence-based person-centred strategies that are respectful of an individual’s preferences, and their exercise of choice and self-determination.

Initial assessment by the general practitioner (GP) should be included in a referral to a behaviour support practitioner. National Disability Insurance Scheme (NDIS) funding may be available for behaviour support. The GP should exclude commonly missed causes of challenging behaviour (see Commonly missed causes of challenging behaviour in people with developmental disability) before referral.

A positive behaviour support plan will typically address:

• identifying and defining the target behaviour for intervention (ie plans can fail where they try to focus on too many behaviours or issues at a time)
• a working hypothesis as to why the person might be using the behaviour, and what they might be trying to communicate; see Defining the target behaviour
• agreed goals
• preventive (environmental) strategies including communication strategies, enhanced routines consistent with the person’s preferences, and promoting social connectedness with significant others
• reactive or emergency strategies (see emergency plan)
• pharmacological interventions and monitoring for effectiveness and any adverse events
• teaching the person new skills (eg alternative [adaptive] behaviours)
• monitoring interventions for effectiveness and any adverse events.