Challenging preconceptions.

Two recent Royal Commissions shocked Australians by exposing the over-reliance on chemical and physical restraints to manage people’s behaviour in disability and aged care settings, with evidence presented of aversive practices where people were physically bound and routinely medicated.

Both the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability and the Aged Care Royal Commission highlighted the need for alternative approaches to behaviour support that put people foremost and protect human rights.

Flinders University Disability and Community Inclusion researcher Dr Alinka Fisher is committed to building and promoting values-driven and rights-based supports using a Positive Behaviour Support (PBS) approach.

PBS might offer one solution to concerns regarding behaviour support practice in Australia, although there is significant work to be done to shift attitudes, build a capable PBS workforce and establish the systems required to support evidence-informed practice.

“PBS provides a framework to guide a very individualised and person-centred approach to behaviour support and is recommended internationally,” says Dr Fisher.

“Challenging behaviours can have a significant impact on a person’s quality of life – for example, their relationships, community participation and opportunities. They may also present risk of harm to the person and others.

“These behaviours might include physical or verbal aggression, property destruction and inappropriate social or sexual behaviour – but other behaviours like reduced initiation and apathy may also present significant challenges for the person and those providing support.

“We refer to these as ‘challenging behaviours’ because they challenge the service system to come up with an appropriate response…we are certainly not labelling the person as a ‘challenge’.

Dr Fisher explains the importance of addressing attitudes and improving environments as a first step towards finding a solution.

“Sometimes those providing support may be quick to blame the person, as if their behaviour is a problem that needs ‘fixing’ – but this feeds stigmatisation around behaviour that is not accurate or helpful.”

“Behaviour support plans are very much focused on systemic improvements – in fact, they are much less about changing the person’s behaviour than changing the behaviours of support networks.

The origins and causes of challenging behaviour are many and varied. There may be organic contributors relating to behaviour change, for example mental health issues, brain injury or early-onset dementia.

As Dr Fisher describes, ‘challenging behaviours’ are the result of interactions between the person, their environment and broader systems. We need to understand this relationship to inform effective support strategies.

Often, she says, challenging behaviours can be a result of ineffective systems that do not adequately address a person’s support needs, and then a person might express this unmet need through challenging behaviours.