All individuals have the right to aspire toward their own personal goals and desires. At times, mental health conditions and problem behaviors, such as aggression or property destruction, can create barriers to reaching those goals.
Fortunately, a number of treatment practices exist that can assist an individual in adopting positive behaviors. If you or a loved one has been diagnosed with a mental health condition and has problem behaviors, consider talking to a mental health provider about the benefits of Positive Behavior Support (PBS).
What is PBS?
Positive Behavior Support (PBS) is a philosophy for helping individuals whose problem behaviors are barriers to reaching their goals. It is based on the well-researched science of Applied Behavior Analysis (ABA). A key component is understanding that behaviors occur for a reason and can be predicted by knowing what happens before and after those behaviors.
PBS interventions are designed both to reduce problem behaviors and increase adaptive, socially appropriate behaviors. These outcomes are achieved through teaching new skills and changing environments that might trigger problem behavior. Prevention of problem behaviors is the focus, rather than waiting to respond after a behavior occurs. PBS strategies and interventions are appropriate for children and adults diagnosed with a variety of mental health conditions such as schizophrenia, depression, autism, and intellectual disability.
Who is Trained in PBS? What Do They Do?
Mental health professionals, such as psychologists and behavior analysts, are trained to complete assessments and design PBS interventions. They conduct assessments, called structural and functional behavioral assessments, to determine when, where and why problem behaviors occur. For example, a mental health professional may conduct an assessment of a student who is identified at risk for expulsion and alternative school placement due to profanity and disruptive behavior in the classroom. The goal would be to learn what the student is achieving by using those behaviors.
A typical assessment would include several observations in different locations to determine which behaviors are problematic. It then would identify the environmental triggers that predict when those behaviors will and will not happen. The mental health professional would talk with the student, his or her family, teachers, other treatment providers and friends to answer questions about the problem behaviors.
From there, the professional would develop treatments that match the reason that the student is using the problem behaviors. These treatments include developing strategies to replace problem behaviors with appropriate behavior.
By learning and using new skills, an individual can stop using problem behaviors. For example, an individual diagnosed with schizophrenia may break the ceiling fan in her home because she believes that the fan is yelling at her. The mental health professional will teach her coping skills such as mindfulness, deep breathing, journaling, asking for help, or muscle relaxation. This gives her other, more acceptable behavior options to use the next time she believes that the fan is yelling at her.
While the mental health professional may lead the development of PBS treatments, the individual leads the implementation by learning and using these new skills or replacement behaviors. Additionally, key people in the individual’s life such as family, friends and co-workers learn how to implement PBS treatments to change the environment to support the individual.
Why use a PBS Approach?
PBS emerged in the 1980s to understand and address problem behaviors. As a holistic approach to treatment of mental health conditions, PBS has many attributes:
- It is person-centered. Using a person-centered approach, PBS addresses the individual and respects his or her dignity. This includes listening to the individual, recognizing the individual’s skills, strengths, and goals, and the belief that the individual can accomplish his or her goals. Treatments are developed to fit the specific individual rather than a “cookbook” approach.
- It causes positive changes. Through environmental changes and reinforcement of adaptive behaviors, individuals can reduce problem behaviors. Coping mechanisms such as relaxation can take the place of the problem behaviors. PBS minimizes the need for punishment or restrictiveness such as restraint, seclusion, or removal of privileges.
- It is outcome-focused. PBS places an emphasis on outcomes important to the individual and to society. These behavioral outcomes, such as fewer aggressive incidents, have the ability to make homes, communities, hospitals, and schools safer.
- It provides collaborative support. PBS involves collaboration with those who support an individual, including caregivers, support providers, doctors, nurses, teachers, aides, nurses, social workers, and team leaders. This collaborative process keeps everyone involved in the individual’s treatment and allows for new behaviors and skills to be supported in all settings.
Does PBS Work with Other Treatments?
PBS may be practiced alongside other treatment interventions as part of a multidisciplinary approach to mental health treatment. For example, an individual who is prescribed medication by a physician or psychiatrist for mental health conditions such as schizophrenia, autism or impulse control disorder could benefit from PBS. An individual who sees a dietician to help with specific nutritional needs such as in Prader-Willi Syndrome, or receives occupational, speech, or physician therapy, may also benefit from PBS techniques.
PBS is consistent with other treatment approaches that are person-centered or recovery-based. This means that they can work well when used together. PBS interventions are inconsistent with restrictive or punishment-based interventions. PBS interventions are used instead of these approaches.
Since PBS is a holistic approach, and clinicians consider all aspects of an individual when assessing and developing interventions, it is helpful for a PBS clinician to become a member of an individual’s interdisciplinary team. PBS-trained professionals have experience working directly with other health care professionals to design treatments. For example, a PBS-trained professional may work with speech therapists to develop communication boards for non-verbal individuals who engage in self-injurious behaviors such as head-banging or skin-picking.
Without treatment, the consequences of mental illness are astounding: disability, unemployment, substance abuse, homelessness, incarceration, and suicide. While medication and other interventions have proven to be beneficial in many mental health conditions, a multidisciplinary approach that includes a behavioral component can offer support mechanisms critical in the treatment process.
Talk to a mental health professional about the benefits of PBS.