Positive Behavior Supports

There are many resources for professionals on positive behavior supports, and much of it is available online.  The Center for Positive Behavior Interventions and Supports at the University of Oregon is a good place to begin.  Another source is the Center for Effective Collaboration and Practice.  Both websites contain suggestions, strategies and alternatives for best practices that have been useful elements of successful positive behavior support plans. 

Many state and national advocacy organizations have adopted excellent policy statements regarding positive behavior supports, including The Arc of the United States and TASH.  This guideline is an attempt neither to duplicate these sources nor to create another policy statement.

The rest of this guideline is for people with disabilities and their families who must select a positive behavior support provider who best suits their needs, based on the information they can find.

At its simplest level, all behavior is communication.  It is what people do to get what they want or need, or to get away from something, someone or some place they do not want.  People do not engage in problem behaviors because they have developmental disabilities or other cognitive disabilities.  They engage in behaviors that have worked for them. 

People do not "have" behaviors; rather, they use behavior for very specific reasons.  Whenever people use behavior, they are communicating how they are feeling or what they are thinking.

Positive behavior support is a way to help people get what they want or to get away from what they do not want, in a way that is helpful and safe for them and others.  Its goal is to create environments and patterns of support around people to help them look upon their problem behaviors as wastes of time and energy.

A professional who uses positive behavior supports will conduct a range of assessments to determine the function of the person’s behavior.  The professional then will support the person to find new ways to achieve his/her goals in ways that are pleasing, or that in the least do not cause harm or injury to themselves and/or others. 

The purpose of a positive behavior support plan should be to listen to what the person is saying with their behavior and then to respond to their communication in a way that uses their strengths to meet their needs and does not harm themselves or others.

A good positive behavior support strategy may be as simple as changing where a person is sitting in a classroom or in the work place.  It may recognize that some people learn best by seeing, others by doing, others by hearing.  It may include giving people something they like when they engage in a desired behavior.  

Positive behavior supports never use "aversives”, or things people don't like or give them pain. 

In summary, a plan for positive behavior supports addresses and supports the person, not just the behavior. 

Key Ingredients of an Effective Positive Behavior Support Plan

1. A written, functional assessment studies the environment (schedules, activity patterns, curriculum, support staff, physical settings) and the behavior of the person.  The assessment helps the person and everyone involved to understand why the problem behaviors occur and develop workable ways to achieve better alternatives.  If there is no assessment, there is no plan.

2. The person served by the plan participates in its creation and implementation to the greatest possible extent.  The plan gives the person it serves the means and/or skills to accomplish the goals and directions that he or she has chosen.  If one exists, the guardian also supports and participates in the plan.

3. Everyone else who relates to the person served in any important way receives training on how to participate in the plan.

4. Data collection and analysis determine if the plan is achieving its desired results.  People often make important progress one tiny step at a time.  Similarly, only someone who is tracking, documenting and reporting can catch problems early.

5. Whenever people make progress in meeting their plan’s goals, the team reports and celebrates it.    

A support person should spend the majority of time and effort in finding and using these positive strategies, training others in their use and analyzing the data. 

Unfortunately, what passes as positive behavior support is often nothing more than indiscriminate positive reinforcement with no real plan or creative thinking to guide it, and no tracking to monitor its progress. 

Whatever techniques are used, they must show dignity and respect for the person.  Use of Crisis Intervention Techniques and Aversive Interventions

Another common mistake is to confuse crisis intervention with positive behavior support.  None of the techniques below has anything to do with positive behavior support.  Crisis intervention should only be used as a last resort to make sure people are safe.  When they are used inappropriately, they can result in serious physical injury or death. 

If you observe intervention techniques that are in conflict with any of the following guidelines, feel free to share this information with the provider.  If you are not satisfied with the results, you may want to consider following the procedures for reporting abuse in your state.  If you do not know what these procedures are, you should contact the state chapter of The Arc, another state advocacy organization for people with disabilities or TheArcLink.  Some states have laws or regulations that set limits on the amount of time that people can be restrained.  You should find out if your state has set such limits as another way of monitoring the quality of the crisis intervention of your provider.  

Several states, including Minnesota and Tennessee, have prohibited restraint on the floor.  Minnesota regulations go so far as to prohibit restraint on the floor in community-based programs.  The General Accounting Office and the Harvard Center for Risk Analysis have researched deaths due to restraints, and estimate that 50 to 150 people a year die because of restraint on the floor or mechanical restraints.  If restraint on the floor and/or mechanical restraints are proposed as an emergency response, check with an advocacy organization to see if there are limits in your state. 

Manual or Mechanical Restraints

If an individual’s behavior has the potential to cause serious harm or injury, the professional should only consider methods for manual or mechanical restraint that keep the person safe and free from harm.  Mechanical restraints are any type of restraint other than human contact, like a belt, strap or sash.

Staff must administer manual restraint in a way that maintains the normal body alignment for that person and causes no pain.  Hyperextension of joints is never an acceptable component of manual restraint. 

Some guidelines suggest that manual restraints should be time-limited to one minute or less, with a maximum time limit of five minutes.  The goal of manual restraint should be to protect people from harm, not to restrain people until they are “calm”.  Restraints that last longer than five minutes put both the individual restrained and the individual(s) doing the restraining at serious risk of harm.

Manual restraints of all four limbs or mechanical restraints of any part of the body are highly intrusive procedures that should be used only in cases of extreme pending danger to the safety of the individual and/or others.  They are traumatizing events that pose serious risk of injury to all concerned.  The use of these restraints should always be accompanied by due process procedures, including but not limited to prior approval by the legal guardian and/or individual served. 

Most guidelines suggest that the maximum amount of time which mechanical restraints are used should be no more than one hour. 

Seclusionary Time-out

Seclusionary time-out (placing an individual into an area from which they cannot leave until others decide they can) is another highly intrusive procedure that should only be used as a last resort where there is a risk of immediate danger to others. 

The use of seclusionary time-out should always be prohibited in cases of self-injurious behavior. 

This procedure is likewise a traumatizing event that poses serious risk of injury to all concerned.  It should always be accompanied by due process procedures, including but not limited to prior approval by the legal guardian and/or individual served.  Most guidelines suggest that the maximum amount of time which seclusionary time-out is used be limited to one hour. 

Please note:

Before anyone authorizes the use of crisis intervention, the individual served, the legal guardian (if any), the professional authorizing the use of the intervention and staff implementing the intervention should experience the intervention and receive training in its use.

If a person’s behavior is so threatening that, after one hour in either mechanical restraint or seclusionary time-out, the behavior of others and/or self is at risk, then the person may have a neurological, psychological or medical issue that must be addressed.  The use of physical restraint should be discontinued until an individual treatment plan has been developed that considers these issues.

TheArcLink is deeply indebted to Bob Bowen, who wrote and revised the original draft of this guideline.  He is the author of the Positive Behavior Support module that is currently taught as part of The Mandt System®.  Thanks also to the following people who made written suggestions and comments regarding this statement when  it was featured in an online forum: Peter Alexander, Ron Rubin, Sharonlyn Harrison,  David Rotholz, Bridget Walker, Gene McConnachie, Alan J. Petersen, Ellen Russell, Nancy Weiss, the Executive Director of TASH and Fredda Brown, Tim Knoster and Rob O’Neill, members of the TASH Positive Approaches Committee, and to “Jake ”, “Karen” and “Lyleromer” (whoever you are).

Copyright 2003 by TheArcLink Incorporated.  TheArcLink permits informational reprints of information published on this website by non-profit or governmental organizations as long as the copyright reference and the web page address are included in the reprint.  Express permission, on a case-by-case basis, must be obtained from TheArcLink Incorporated for inclusion in any publication that is sold or used for fundraising.