PBM – What is PBM?
Positive Behaviour Management (PBM) was originally devised within the NHS in Wales in response to concerns about existing training approaches to managing challenging behaviour in adults with intellectual disabilities. The prevailing forms of reactive training available at the time were designed for use with populations of service users who presented with qualitatively and quantitatively different levels of aggression. Hence, there was often a mismatch between the techniques taught in training and the forms and severity of aggression presented by people with intellectual disabilities.
Particular problems were evident in relation to physical intervention techniques that worked by deliberately inflicting pain upon service users. These techniques were felt to be unnecessary with persons with intellectual disabilities and it was also felt that their use could be challenged on both ethical and legal grounds. PBM was created in response to these concerns. The types of aggressive behaviour posed by people referred to a specialist behavioural support team were analysed, and then members of the team worked with a Judo expert in order to devise non-painful physical responses for the behaviours concerned.
Why is it important that we use it in the support we provide?
It is important that PBM is used with the people we support as it is devised to deal with many forms of challenging behaviour. The previous model of behaviour management did not include diversionary tactics and focused more on staff overcoming the behaviour via physical intervention. Since the introduction of PBM into the services there has been a dramatic reduction in the use of physical interventions. Staff have reported that they feel more confident within the services and are able to more effectively support clients when they begin to display challenging behaviour. With the employment of the diffusion and distraction techniques which are taught the staff are able to recognise known triggers and how the client we support reacts to being introduced to these triggers. This allows for the planning of activities and community access to be more carefully examined in order to enhance a calm and positive experience for the client and the staff.
How do we train staff?
Staff are trained over a consecutive 3 day period. Day 1 and the morning of day 2 focus on the theory. This covers the history of PBM, understanding challenging behaviour and an introduction into Positive Behavioural Support, the time intensity model or assault cycle, primary preventions, secondary preventions, individualised risk assessments, the law around physical interventions, post incident support. These units are paramount in understanding why behaviours exist, what they mean to the client and what they are attempting to communicating. Without this element of training the physical element would not work as staff have to follow a process of diffusing challenging behaviours without the use of physical interventions.
The afternoon of day 2 and all of day 3 focus on breakaway techniques which enable staff to protect themselves when behaviours become physically aggressive and an assault is imminent. This looks at behaviours such as punches, kicks, pinches, hair pulls, clothes grabs, wrist grabs, bites, strangle holds and chokes. The staff are trained in safe holding and removal of the client form one area to another. Although staff attend the training not all staff pass the course successfully. This is to keep up a high level of standard within the services and to promote confidence amongst the staff teams. It also eliminates the risk of injury to both staff and client
What are some of the successes we have had using it?
There has, within the northwest adult services been a reduction in the use of restraint. As a result of this reduction, relations between staff and clients have improved allowing for the client to live a happier and more enjoyable life. Although there are still some instances where restraint is employed the speed in which staff have been able to restore a calm and safe environment has continued to decrease meaning that restraint is used for less time and has a greater impact on reducing the challenges being presented by the clients
Steve is a Positive Behavioural Management (PBM) Trainer and his role involves supporting staff teams to develop their understanding and response to people with behaviours which challenge the service. This includes people with mental health issues, young people and people with a learning disability.
It is within this role that Steve was introduced to a staff team who support 2 women Jane and Vicky in their home. It is Vicky that we will focus on. Vicky is diagnosed on the autistic spectrum and communicates non-verbally; her behaviours are extremely challenging to those who support her, with daily expressions of aggression and violence. The team have worked alongside Vicky for many years and prior to their PBM training, saw her behaviours as "just what she does!"