Welcome to our third episode in season one. We are excited to share a two part discussion on Integral Behaviour Support. By the way, we are soon launching Ability Academy Australia’s first program in a Diploma of Integral Behaviour Support.
We’ve mapped the season to ten episodes released fortnightly. We hope you enjoy this new audio adventure.
Below see the full transcript of this episode.
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Ability Awakens Podcast S1 E3 Integral Behaviour Support Part 1
Welcome to Ability Awakens, a podcast about provocative insights in the arts of therapy, behaviour and spirituality as meaning making.
Gooday, Dr Joseph Randolph hours here and I’m asked by several people to talk about what is behaviour support and particularly, I’d like to emphasise integral behaviour support.
This talk goes out to parents and support workers and people that are dealing with behavioural concerns and who need behaviour support. The insights in this talk could be helpful to a whole range of people. And we’re not just talking about disabilities here, we’re talking about everyone really. Because behaviour is a human phenomenon, and that means that it is relevant to all of us in daily life.
And no one in this universe is truly an expert. We are all, in one sense, the only expert on our own personal experiences, and parents are the experts in terms of knowing, understanding, living with what their child has been going through for years. In a similar way, support workers who are, you know, in the trenches day-to-day with people and supporting them, they have their own level of expertise and insights as well to offer.
So, everybody has their perspectives and the individual that struggling with behavioural issues is also an expert in their own experiences and that needs to also be respected. This is central to the notion of integral behaviour support that draws in a range of perspectives into the method. The first part of integral behaviour support, and perhaps the most important part, is called person centred support.
And person-centred support comes from a long tradition in the western psychotherapy as well as the helping professions. Within the psychotherapy field Carl Rogers founded the field of person-centred psychotherapy and he talked about core values in therapy that we’re really orienting the therapist and helping the client towards useful outcomes and goals.
One of those core values is unconditional positive regard and this is incredibly important in our work and lives to have an attitude of unconditional positive regard. In older cultures we might have called this a compassion and a loving kindness, and a great deal of patience. In the modern sense, unconditional positive regard is about holding in abeyance our critical ideas, critical thoughts and our critiquing of ourselves and other people and actually highlighting our strengths and capacities and what we do in a positive sense and looking at that, looking at that in a positive way and holding that up and affirming that. Having an affirmational attitude is really important. Having an attitude of gratitude is also equally important and a central components of this concept, this practise, actually of unconditional positive regard, which is really at that level a daily practise, reorients our life towards other people. And it reorients our mind and our hearts towards ourselves in a much more positive way.
Another core value of person-centred support is listening. Listening is one of those core skills that people need to have. And that is so overlooked and often underrated, and listening is probably one of the most important values and it is central to unconditional positive regard and it’s really highly central to person-centred support.
When we actually listen to somebody, we’re not just hearing what they have to say, we’re actually taking in the whole person, seeing them in their context, affirming them as such, and building them up and, and highlighting their positive aspects while we are attempting to understand and being curious about what they’re saying or expressing, not just through words, but nonverbally, through their actions and through their behaviours.
Listening is a deep, abiding respect. It’s a practise of mindfulness really. It’s a mindfulness that is active and participatory and it is an orientation of the self towards curiosity that is continual. This doesn’t end. We don’t sort of get the answer and then we move on. Listening is a way of life that is continual and ongoing. And so, each new day we learn something new from each individual that were with, our partner, our friend, our colleague, the person that we support, the person that we struggle with, our teacher… or a part of ourselves internally that we’re struggling with or that is frustrating or stops us up in some way. These parts of ourselves are also our teachers, the more we come to terms with that, the more we can listen to what’s really going on.
Listening in this sense is becoming awake. It’s, it’s awakening to a new perspective on life and it’s learning. So, it’s a learning and a growing that is opening the self to new experiences. Listening never closes us off from life. Listening always opens us up and I think this is a central value of unconditional positive regard and person-centred support. That power of listening opens us up to having a deeper and more authentic relationship with ourselves and with another person.
The next aspect of person-centred support is highlighting the values of the person and this really means that and individual’s values takes time to learn. We can’t just assume we understand or we know what the person values. What is important to that individual will take time to understand and that time needs to be given in a relationship in a context of support and genuine concern.
Human rights and human gifts are also really central to person centred support. The layer of human rights is that we each have inalienable rights, and this is true of people also with disabilities, mental health concerns, chronic health and illness issues, medical concerns, learning capacity concerns and difficulties as well in the education field. So, this crosses a lot of different areas in life and society. Human rights are central to person-centred supports. We want to highlight an individual’s basic human rights. And make sure that these are attended to and addressed on a day-to-day basis and the decisions that we make in the way that we support an individual fits within that framework. That’s really important in terms of the international and also Australian standards.
The giftedness level of human capacities is that we’re highlighting the individuals capacities, strengths and abilities as well as looking at these as gifts in a very authentic and integral away because we are taking a strength based approach and we’re going to talk about that a bit more later, but at this level we’re looking at things in a very positive light, that even a person with profound disabilities does have gifts and strengths. And you know we see that. We experience that. We hear that. We know that. If and usually only if we take this holistic approach that reframes our core presuppositions and core values and gives us a sense of positive strength-based work and of perspective.
The next core area of person-centred support is that the person has insight and decision making ability. This is really important to highlight as well that every person regardless of their strengths and weaknesses. Even individuals with profound disabilities, for example, with intellectual disability, where a person can’t function alone in society and needs the support of systems and people around them, even that individual has the human right and capacity to make decisions on a daily basis within their capacity, within the framework or the understanding of what their capacity is and how they exercise that on a day-to-day basis.
Obviously, you know, we don’t, don’t expect an individual who can’t manage their financial life to, to make financial decisions and manage a budget on a weekly or monthly basis. You know they are supported through a disability pension, for example, and through the public guardian in Australia that provides for that financial management level of life to make sure that their income is secure and it is funnelled to the very necessary areas like rent and food and medical care and whatnot. So, there are aspects in which we support the person. So that we understand their limitations and strengths and how they actually, you know, in a concrete way, can exercise their decision-making ability on a day to day basis.
Another core area that that person-centred support highlights what is important to the individual. And what is important for the individual. And understanding these two different areas is really important. There’s a sense of duty of care, as well as dignity of risk. And what that means is that what’s important to the individual comes from their own personal values of what an individual might really love and enjoy. A certain television show or certain actors or they might really enjoy a certain kind of food, and that really gives them a great deal of joy and happiness on a day-to-day basis and you know allowing the individual. Supporting that, that interest and that that aspect of what’s important to them, whether the food or the entertainment or the particular relationship that they’re drawn to etc. These things are important to the individual and they need to be respected and an integrated into their support profile as much as you can do that right.
And important for is a little bit more broad kind of perspective. This is the perspective of the support person or family member who can see the bigger picture and understands what, what is important for the individual. We often find that the important to and important for can be at loggerheads or in conflict with each other when they are pitted against each other. But when we look at things in a way of integral support, we want to bring these values together and see them as a circular process where each have their place and each can be honoured and supported.
The next major area, in integral behaviour support is the strength-based method. And the strength-based method is really about having an approach and attitude of empowering an individual towards their best life, towards their best outcome, their best skills and capacities. It’s about allowing and supporting choice and control at whatever level that can be exercised on a day-to-day basis, and also whatever ways that can be supported in a planning process in terms of making you know, larger life decisions. And why not? For example, where a person lives, what kind of place they live in, who they live with, you know, at that level, however, an individual could contribute to those parts of decision-making processes would seem pretty important to highlight and respect in whatever way you could.
The strength-based methods highlight an individual’s strengths obviously, and their capacities and their skills. It’s an affirmational approach. It’s diversional in the sense that we would divert an individual towards their strengths when questionable sort of behaviours are coming up, for example, if an individual is expressing risky behaviour and may harm themselves, we attempt to divert them towards an area of their strengths and interests instead of sort of taking a negative approach and focusing on what is happening that is wrong, quote unquote. We would focus on, we would focus on diverting them in a circular fashion, moving around that issue in a way that creates another opportunity for growth and change or just a change of orientation or behavioural perspective.
The next major area for integral behaviour support is that it is a holistic, an ecological approach or method. This means that we look at people in context, in their environments, and in the context of their relationships. And we look at them as being independent at some level. And we look at them as being dependent at some level. But we ultimately come to his perspective where we see them as being interdependent, which is a way of thinking, a way of looking at life that we see both dependence and the independence and we see how these are interrelated. And we see that ultimately, we’re all in one sense or other interdependent on one another, on our environment, on our relationships. And those relationships are, you know, in the concrete, in terms of they can be observed in our environments, in a relationship with things and places, for example.
But there are also internal relationships with the parts of ourselves, our relationship, for example, with our emotions versus our memories versus our reactions to certain stimulus or to things that we are reactive to in the environment like allergies or what not. And it’s understanding those interrelationships and understanding that we’re all in some sense interdependent and this gives us a really clear, or at least a clearer view of what a person is dealing with and how to work with that on a day-to-day basis. Basically, we’re looking at how to orient those relationships toward positive outcomes wherever possible.
The next major area that we’re going to discuss in terms of integral behaviour support is looking at a solution focused approach. Solution focused approaches are looking for how to. They’re practical, pragmatic, they’re simple in a lot of ways, or at least they attempt to simplify complex situations into doable chunks, things that can be done stepwise and perhaps in certain orders. And it’s a down to earth perspective. It’s a can-do attitude kind of approach.
Solution focused work is really central to person-centred support because you know at the end of the day you’re not going to have behaviour specialist, therapist or clinician whispering in your ear what to do. You’re going to be given a behaviour support plan. At some level, if a plan is actually written by the clinician. And you are going to have to interpret that yourself and you’re going to have to put it into practise yourself and it’s important to understand then what the core principles are of that behaviour practitioner’s approach. And I’m not saying their approach will be my approach. They may not have the core values or methods that I’m discussing today here. But they in some sense will be manifesting a behaviour support plan that you need to implement and I’m saying that, you know, you could take on these core functional and positive attitudes yourself, and you could interpret just about anything they might throw at you or put at you in their behaviour plan. And you could interpret it in a positive way. And you could apply it in a way that’s actually functional and it works for you and works for the individual that you are working with, which is really the key, you know, it’s really the most important thing.
How does it work? How does behaviour support work?
Well, that’s a complex question.
It depends on what level you’re asking the question.
I’ll give a global answer at the moment in the sense that generally behaviour support in modern society today works, in the sense that we have three levels. We have a senior assessment. A senior clinical assessment. And we have a junior assessment and junior perspectives on what’s going on. And we have day-to-day behaviour support implementation. These three different levels happen in different cases at different times.
In my role, I am a Senior Clinical Specialist in Behaviour Support, that means that I come at things from a very holistic and complex perspective. I often work with some of the most complex cases that exist. And so, these cases may include for example complex disabilities, complex mental health conditions, and complex medical and chronic health conditions. And all of those three different aspects of what a person is dealing with overlap and interact in really, as I say, complex ways.
A person with profound disabilities and mental health conditions and chronic illness and disease has a lot to deal with in life and their issues overlap and interact in very profound and significant ways. And the more that we can understand the complexities and how they overlap and interact, the better off we are to provide more adequate support and more of a support that’s practical and actually makes a difference.
It’s often very difficult to understand what will make the most difference in a complex situation. And one of the principles I use to help me in assessment and in orienting people towards helping on a daily basis with implementation of behaviour support is that it’s not always the big issue that makes the most difference in terms of positive directions. It’s often the smallest change in a system or a person’s life that makes the biggest difference. But the key and the kind of magic of daily behaviour support and making it work is finding the smallest thing that can be changed that makes the most difference.
Sometimes that’s providing a level of comfort, or sometimes it’s distilling a level of stress and anxiety. Or sometimes it is providing an object of enjoyment. Or at other times, it’s taking away an object and replacing it with something that’s more fun and interesting. Or at other times it’s providing more physical stimulation, like exercise or engagement in the environment or getting out. More often, sometimes it’s an issue with sleep or with some other aspect of daily life and health and lifestyle. And you know, often the solutions are not necessarily directly related to the behaviour of concern and it takes a talented clinician with a lot of years of experience to be able to look at what’s going on in a complex situation and provide suggestions for how to move forward, how to potentially diffuse the behaviours of concern and the risks and dangers that are happening in the person, in their, in their environment and how to move that forward in a positive sense to build a positive lifestyle, a more functional lifestyle health approach to supporting the individual.
At that first level of senior assessment, we look at creating a functional kind of perspective that leads to the writing of a behaviour support plan. And really, the core of the behaviour support plan is about implementing support strategies and preventing risk and harm wherever possible. This is to help family and staff on how to support a person in day-to-day life. And so, we look at in this analysis, a whole range of areas. But some of those parts are looking at the history of the individual an in that sense provides us with a sense of the origin of certain issues where that came from and how it evolved over the years.
We look at the individual’s strengths and their weaknesses and this is kind of an in depth process. It’s not just, it’s not skimming the surface here, we really looking at, but looking at the strengths of the individual and discussing those and listing them, and this can be quite a lengthy list. And one of the most exciting areas for me in doing a clinical review like this is that when I ask people about the strengths of the individual, they kind of find it difficult sometimes to highlight or to articulate those things. And so that’s a process of helping the people around the individual to build a strength-based approach in their attitudes. You know. And you know that’s part of reality really. We all deal with the ins and outs of supporting people from day to day. We live with our, you know, in everyday life, we live with our partners and we see there not so good aspects. You know, we smell their farts. We see them wake up in the morning with wrinkled faces and wrinkles around their eyes and we see them yawning and tired, and we see them getting frustrated and angry. And we have conflicts with them, and we are in the trenches in our relationship. So, it’s kind of no wonder that we don’t necessarily see and articulate the strengths of our partner and actually going through that exercise and really looking at that, in an in-depth way is really helpful. And that’s true amongst people that are supporting, supporting others who have behaviours of concern and looking at their strengths are really useful thing to do.
Of course, we need to understand the weaknesses of the person and these need to be framed in a person-centred positive way as well. Everybody has weaknesses. We all have areas where we’ve got capacity and other areas in life where we really don’t have capacity, where it’s a learning edge or where it’s frustrating or difficult. Or where we’re just not capable of doing certain things, and this is part of our humanity. We need to acknowledge this in a positive light and work with it effectively.
Another aspect of the clinical review will look at conditions that the person has, medical or otherwise, and we’ll need to look at their medications and see how the medications interact and and what their functionality is in terms of helping the individual.
We need to understand and map out what the behaviours of concern actually are, what they look like, how they function. Then we also need to understand strategies to work with those behaviours of concern, and we also need to have some prevention strategies to help prevent risk and harm if that is a part of the situation. And the behaviour support analysis will also look at what’s called restrictive practises, and these are areas that restrict an individuals liberty and freedom in some manner in their day-to-day life and that are called restrictive because there’s actually, in Australia at least, there’s laws and policies that govern these areas and how they are applied or not applied.
Part Two will continue this discussion looking at the core values and attitudes that underpin and support positive integral behaviour support. We look forward to you joining us for this discussion.