Making the plan work – effectively

Engaging the people needed to make a behaviour support plan work

HomeMaking the plan work – effectively

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Listen to advice from behaviour support peer, Doug Payne from SAL Consulting

Doug Payne, Senior Clinical Consultant, Behaviour Support Practitioner
(SAL Consulting – Darwin, Northern Territory)

So, this idea of having one plan that'll be everything, I think is naive.

We, as behaviour support practitioners, need information. Either directly from the person – or from talking to a psychiatrist or file notes or whatever it might be – to try and get an understanding, to try and put ourselves into that person's shoes.

Our job is a little bit different because, well – my view – as a behaviour support practitioner, my view is that if you're a psychologist and you're doing counselling with someone, you're working one-on-one with that person, you're an individual therapist, you're doing individual therapy.

A behaviour support practitioner is very different because what we do is we work with the system; the person and all the things that envelope around that person: the family, the day program, the group home – whatever it might be.

People who know me, you know, I say we are systems therapists. We work with the system.

So, we need not only understand the client, but the group home, the system that is the group home, the staff that are in the group home. What are the things that hold them to the behaviours that they have in order to support the person?

And so if you only work with the client and have a behaviour support plan that is written for the client alone… my view is you would make no difference.

It has to be a systems approach.

A behaviour support plan is the long game. Behaviour has taken a long time to develop in a person and it's become behaviour, which is just habituated ways of responding to a situation.

Our job is to somehow change that habituation and some of it is working with the client and giving them skills. Some of it is working with the group-home staff or the parents or with the day program or whoever or the community.

Because they need to change the way they respond to the client, because it may well be how the family responds is maintaining the challenging behaviour.

So, working with the client and not working with the family is going to make little or no difference – and, in fact – probably will make things worse, more frustrating for the client. Because they have worked out new ways of thinking and responding. However, the people around them in their support system are still stuck.

A behaviour support plan is ever evolving. And so, what you write is the best guess you can, now.

There are things you don't put in the behaviour support plan because some people aren't ready to hear stuff, so you have to be strategic. So, behaviour supports, practitioners are strategists. And they have to think, ‘When is the right time?’

And it sounds like… power hungry. However, you need to make a clinical decision about, ‘When do I raise certain things?’ because not all people are ready to his stuff.

So, when you're talking with a family who's just been informed that their son or daughter has a significant disability, you don't give them everything.

And that sounds a bit harsh, but at the time they’ve been told they're going through grief and loss. And to overload them with information is not an appropriate thing to do.

So, in terms of behaviour support, it's a strategy, It's a long game. Because what you're trying to do is undo years and years of habituated behaviour.

So, it will take years and years and years to turn that ship around. And if you take a quality-of-life approach, then if the person's having a good life and they can see the benefits of going out now, I think, ‘Well, I either go out now or I stay at home. I'd rather go out.’

It seems fairly simple.

Closing thought for listeners:

How will you use these ideas to improve engagement in your behaviour support practice?

Planning for practitioners engaging the people needed to make a behaviour support plan work

Ensuring the behaviour support plan works effectively once it has been prepared relies on the right people being involved in the plan and engaging with it at the right times in the right ways.

Successfully engaging people in the behaviour change process that underpins a behaviour support plan is more likely to happen when you involve people (most importantly, the participant who the plan supports) in:

preparing the plan from the outset,
understanding the need for the plan, and believing in the plan and the difference it can make,
the details of the plan and what it might involve,
what they need to do as part of the plan and identifying what they need to feel confident in implementing the plan, and
checking in, celebrating successes and supporting needs.

You can explore this further in terms of how to apply it to the behaviour support process in The Right Direction resources on engaging participants in change and engaging support networks in change.

Preparing the plan

Communicating the plan with the participant and other key members of their support network connects the people the plan needs and enables them to work together on the plan.

By taking into consideration and addressing these key steps, you will be able to gain input and feedback about the plan. You will also be able to identify any required changes to the plan based on the insights gathered from the people who will be involved directly with the plan, through:

ensuring those involved understand the plan;
gauging people’s readiness and skills to implement the plan;
seeking constructive feedback; and
identifying any unforeseen barriers.

Key steps for preparing the behaviour support plan

Identify a complete list of the people required to make the plan successful. This includes the participant, people with active roles in the plan and other people who need to be aware of the plan.
Review the participant’s wishes and input, including their needs and preferences about their degree of involvement (eg: using the Spectrum of Participation) and their ideas and permissions for including their support network in their plan.
Consider how best to communicate with each person, based on their needs, preferences and role. What communication style is most likely to positively engage them in the behaviour support plan implementation?
Clarify their contribution to the plan’s success. Ensure you communicate to them their importance in the plan so that they understand the value of their contribution and what the value of that contribution is to the participant.
Plan when and how often to communicate with people involved – starting with the participant and key trusted people, to embed engagement into the behaviour support plan and review process.

Engaging with each person

1. Check the plan’s details and strategies with the participant

Always follow their agreed level of involvement and ensure they have a trusted member of their support network present if needed. This is especially important for people who need support from people who know them well to interpret their communication methods.

You may need to include an independent advocate. Some states and territories require a formal independent person to be present.

The participant and other key members of their support network must have the plan explained to them and they must have the opportunity to ask questions and identify any issues. You must also explain to each person their rights to have the plan explained to them and reviewed. As the behaviour support practitioner, you must also communicate with them about any changes to the plan and ensure that they agree.

Time and resourcing can be a barrier to implementing the behaviour support plan for many people involved in the process, including family carers and support workers. Speaking with them about the practicality of the proposed process is critical to successfully and consistently implementing the strategies.

2. Remember the power imbalance

As a behaviour support practitioner, you have a lot of influence over what will happen in the participant’s life.

Without a solid basis of trust, people may not feel able to voice any disagreement with the plan or speak up if they don’t understand. It is your role to overcome this through engaging effectively in 2-way communication and practices that promote respect and build trust such as Yarning to ensure everyone can communicate honestly and openly to get the best outcome for the participant.

3. Show your respect for each person

You can show your respect for each person and their choices by listening, responding to their ideas and thoughts, and taking them seriously. Think about and prepare for the most suitable way to do this before any meetings.

4. Ask open-ended questions

Questions that can be answered with a simple ‘yes’ or ‘no’ can prevent people from expressing how they really feel.

It can be difficult to gauge their true views based on one word and people may not tell you they don’t feel the plan will work or they don’t like it.

You could ask:

How do you feel about this plan?
What do you think will work?
What in here is unlikely, or least likely, to work? Why?
What can we do to change this to be more effective?
What would you add to the plan?
What would you change about the plan?
What do you need to help you with your part in the plan?
When is the best time for us to check in to see how you’re going with the plan?
Can you explain back to me in your own words your role in this plan?
When X happens, what’s the plan?

5. Things can (and probably will) change.

Invite feedback, not only when the plan is first explained, but also as it is implemented.

The plan can be adapted if things aren’t working well – or if particular things are working very well – there are different strategies that can improve the behaviour support plan if you work together as a team and communicate successes and barriers.

Emphasise you are open to change and that the plan can (and will) be reviewed, not only as part of a process but also if the designed plan isn’t moving the participant toward achieving their goals over an agreed period of time.

The participant and others in their support network should be aware of this timeframe and when/how to contact the practitioner.

Ensure that people know how to contact you and also when you will next be in touch with them.

Next steps

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