In many western countries, Behaviour support is traditionally the domain of disability support services that evolved over several generations from the days when families supported their children and banded together to form volunteer associations. The needs they carried attracted the attention of many different professionals. Over time society shifted away from centralised institutions, where behaviour support was often the domain of nurses and mental health practitioners. Community based models of support further evolved into humanist and person centred models, aligning with interdisciplinary efforts in education, counselling, social work, and psychology.
The practice of behaviour support relies on many standardized methods but also quite a variable field of practice tailored to the person needing support. Being an interdisciplinary practice we take behaviour support from the counselling psychotherapy and educational frameworks – deciding on an approach that champions person centred support and positive strengths based methods.
Supporting behaviours of concern requires understanding the hidden drivers of behaviour and not only behaviour but also relationships to people, places, things, and to past, present, and future. Behaviour is not simply a psychological science. Behaviour happens within a living ecology of relationships. Understand the relational origins and ways that concerning behaviours are sustained, and you are a step closer to supporting the person in safe and positive ways.
We find that counselling therapies and psychotherapies are very useful for people with intellectual and cognitive disabilities. Tailored to the person’s capacity the therapy approach may include use of creative methods, and may appear “non-traditional.” As you can imagine, working with children in traditional talk therapy is not usually very helpful. In the same way, working with a 40 year old with cognitive capacity of a 4 year old cannot rely on traditional counselling in an office.
The “floortime method” by Dr Greenspan is one example of tailored solutions for people with autism that changes the approach to allow for and engage the person at their own level and understanding. Taken as a metaphor, the method is where our practice has explored various play therapies, music, arts, and creative methods including horticultural activities, drumming and percussive activities, singing (yes we are musical and can engage a story in song that has therapeutic benefits), symbol work and sandplay methods, walking and exploring a park as part of therapy, and engaging various methods that encourage healing for example, the use of neuro-linguistic language to assist in neurological development, or appropriate naturalised Ericksonian hypnotherapeutic language scripts used to encourage relaxation or to address phobias or other unconscious issues that cannot be addressed by other means.
One person said a few months ago, rare are the people experienced or qualified to work with complex needs and various diagnosis including intellectual disabilities. Even more rare are the people engaged in providing proactive and reparative therapy around cases of trauma recovery and the many social and emotional issues associated with living with disabilities and difference in our society. Many have said that the education system has a long way to go to support people with unique needs. As much as there are efforts to support children and young adults with special needs in educational settings and beyond, the general everyday social stigmas and remaining attitudes toward difference and ability or disability may cause over time a great deal of suffering.
Being sensitive to these issues and having suggestions for treatment are two related but distinct domains. They come together for us when we are engaging behaviour support and therapies within counselling and psychotherapy. The two areas are offered now under the NDIS as separate funding allocations. One is clustered under “improved relationships” and the other under “improved daily living.” While simply administrative, the latter clusters a range of therapies including for example occupational therapy.
Insightful for us that relationships is flagged specific to behaviour support. This appears to be a wise move by those in positions to give names to these things. Rarely have we heard of services offering both behaviour support and counselling. Most agencies appear to focus on the first and do not offer the second, or focus on counselling alone without engaging the former. We find that doing a behaviour support assessment and support plan are excellent ways to gather information to help with in-depth counselling and/or psychotherapy intervention. Where funds lack in one area, having both areas in a participant’s NDIS plan provides adequate time to address both the safety and behavioural issues arising plus begin to address therapeutic needs.
Curious that the NDIS has costed behaviour support at a higher rating than counselling. This implies that the former is somehow more involved than the latter, which may be true from a clinical perspective. Behaviour support is usually considered a specialist field. But the crux of the matter here is that counselling with people who have disabilities is also a highly specialised field of practice. When we do counselling work under the NDIS banner we are engaging the same and even higher level of expertise because we combine fields of knowledge into a holistic and professionally advanced model of service. It seems odd to get paid less per hour for counselling than for behaviour support. But such is life and we are grateful that clients can pay for service through these schemes.
Western countries Australia included have not developed counselling therapies within disability services as a field of expertise by any means. Government agencies did not offer these kinds of therapeutic counselling services in past, and the NDIS is likely the first time that such services are available to people with disabilities. Behaviour support has largely been the domain of government departments who developed senior expertise in disability support overall. Translating into the future will entail a great degree of change and hopefully diversity of services that develop these practices further.
There is so much work to be done here to up-skill and train practitioners. Much of this work cannot be done in classes and programs on campus. Specialist services often demand real life practice and experience at the coal face, under well designed and longer term internships. For our part we are writing a book on behaviour support and counselling methods, which we hope might provide resources and practical insights in future.
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