Positive behaviour support and supported decision-making: People with behaviours of concern and forensic disability Supported Decision-Making Conference, Office of the Public Advocate, 18 th October 2013, Victoria University Jeffrey Chan, PhD Chief Practitioner, Yooralla and Adjunct Professor, University of Queensland

Aims of the presentation 1.What is positive behaviour support? 2.What is “mediator analysis” in positive behaviour support? 3.Why supported decision-making is important to people with behaviours of concern and forensic disability? 4.What are some of the practical applications of supported decision-making in clinical practice in relation to behaviour support?

What is positive behaviour support (PBS) ? Evidence-based therapeutic approach = applied science Value-based Preventative and drives change in the person’s context Collaborates with a range of partners (“agents of change”) to deliver the systemic change and behavioural change Consistent with the CRPD Evolving with new technologies and research

What is mediator analysis? Traditionally the model is PBS practitioner as consultant, mediators as “anyone with the reinforcers” and the target as “anyone with the problem” (note terminology) Simply defined as an analysis of the people (partners) and factors that influence or impact on the delivery and implementation of PBS Supported decision-making presents a new context in PBS Range of partners – key to successful implementation and delivery of PBS Collaborative relationship throughout the process of assessment, implementation, monitoring and review process, rather than as “experts”

Why supported decision-making is important to people with behaviours of concern and forensic disability? Behaviours of concern can result in – Restrictive interventions - physical, mechanical, chemical and seclusion but also “other” restrictive practices such as access to the refrigerator, larder, free access to front door etc Compulsory treatment - detention orders Contact with the criminal justice system - Incarceration Limitation of their rights re dignity of risk Abuse

What are some key qualities required in this area in relation to supported decision-making? Know the person very well - a positive relationship with the person, such as a high level of mutual trust and confidence Other partners to know you well and have confidence in the “plan” Know the “subject matter” very well Advocacy – “don’t give up” Tiered approach

What are some of the practical applications of supported decision-making in clinical practice in relation to behaviour support? Preventative approach Saul is a young man with autism and who presents with a long history of elopement. There have been some occasions where there had been minor accidents with motorists and cyclists. Given this history and advice from the local police, Saul is often secluded and the front door is locked. He lives with three other men. Miriam had lived in an institution for most of her childhood and early adult years. She recently moved into supported community living. She presents with self-injurious behaviour of skin picking left side of her head and hitting her left side of her head with left palm or wrist. She also presents with a history of physical aggression against staff. She is mechanically restrained. She will request for her restraint.

What are some of the practical applications of supported decision-making in clinical practice in relation to behaviour support? Advance planning Gina is a young woman mild intellectual disability and a history of trauma re severe sexual assault over several years. She presents with a extensive history of self-harm such a cutting arms, inserting objects into her wounds, swallowing small objects etc. She is subject to medication and seclusion often, and often requests to be secluded. Tobias is a 40-year old man who had lived for most of his life in an institution, there is no record of family history. He has been diagnosed with bipolar disorder and mild-low moderate intellectual disability. He presents with high level physical aggression and subject to a range of psychotropic medications.

Supported decision-making – what next? Lack of research in this area – exciting field and a particular relevance to people with behaviours of concern To date – people with mild to moderate level of intellectual disability and some functional level of expressive language and comprehension Can benefit from drawing on other paradigms re cross-disciplinary approach Fundamental – a person exercising his/her rights and responsibilities

Readings Alllen, D. (1999). Mediator analysis: an noverview of recent research on carers supporting people with intellectual disability and challenging behaviour.. Journal of Intellectual Disability Research, 43(4), Chan, J., French, P., & Webber, L. (2011). Positive behavioural support and the UNCRPD. International Journal of Positive Behavioural Support, 1(1), Chan, J., French, P., Hudson, C., & Webber, L. (2012). Applying the CRPD to safeguard the rights of people with a disability in contact with the criminal justice system. Psychiatry, Psychology and Law, 19(4), French, P., Chan, J., & Carracher, R. (2010). Realising human rights in clinical practice and service delivery to persons with a cognitive impairment who engage in behaviours of concern. Psychiatry, Psychology & Law, 17(2), Gooding, P. (2012). Supported decision-making: a rights-bsed disability concept and its implications for mental health law. Psychiatry, Psychology & Law, DOI: / Pathare, S., & Shields, L.S. (2012). Supported decision-making for persons with mental illness: a review. Public Health Reviews, 34(2), Hogren, K.A., & Broussard, R. (2011). Exploring the perceptions of self-determination of individuals with intellectual disability. Intellectual and Developmental Disabilities, 49(2), Webber, L., McVilly, K., Fester, T., & Chan, J. (2011). Factors influencing the quality of behaviour support plans and the impact of quality of BSPs on the use of restrictive interventions in disability services in Australia. International Journal of Positive Behavioural Support, 1(1), Wills, S., Shephard, J., & Baker, P. (2013). Evaluating the impact of positive behavilour support training on staff knowledge, attributions, emotional responses and helping behaviour: capturing hearts and minds. International Journal of Positive Behavioural Support, 3(1), Woolls, S., Allen, D., & Jenkins, R. (2013). Implementing positive behavioural support in g practice: the views of mediators and consultants. International Journal of Positive Behavioural Support, 2(2),