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A day in the life of an Intensive Positive Behaviour Support Team

Posted: 20/11/19

Our Intensive Positive Behaviour Support (IPBS) Team recently held a launch event for their service, where they presented ‘a typical day in the life’ of their team. The service is provided by a group of experienced staff, working with families of children with learning disabilities and autism who are struggling with lots of challenging behaviour.

Sarah, the Community Nurse for the Intensive Positive Behaviour Support team, is up bright and early today, to visit Ben at 8:00am. “This is Ben’s second week with the service. He’s been struggling to get to school; his Mum, Laura tells us that when the bus arrives Ben can have some challenging behaviours, and as a result often misses school. Part of my job is to observe these difficult times at home, to help the family identify triggers and hopefully find ways to ease them. Today, I discuss Ben’s morning routine with Laura and leave her with an ‘ABC’ exercise to complete – this stands for Antecedents (the context the behaviour is happening in), Behaviour, and Consequences. Ben and I have a good morning, and both agree that the green power ranger really is the best one.”

“I’m Dionne and it is 9:00am -ish! As the service’s Pathway Manager, my day often starts with meetings, and today I am attending a consultation with a community team. This session is to discuss local young people who may be experiencing increased difficulty at the moment, and assess who is likely to require further assessment and intensive support. Not every young person discussed in consultations will be supported by the IPBS service, but we always try to offer advice and support to community teams.”

At about 10:00am Carol, the Clinical Nurse Specialist, is at John and Susan’s house to complete a Positive Family Intervention session. Fred, their golden retriever, insists on lying on her lap the whole time! “This is our third session together, where we begin to look at some of the data we have collected, including some ABC charts that they family have done together. Last week we talked for quite some time about their beliefs and feelings, as they both realised that it had been a long time since they had thought about their feelings – they had ‘just been getting through’. We often get invited into people’s lives and homes at their most difficult, emotional times. Today I’m hoping they have managed to fill out the ‘self-talk journal’ that I left with them, helping us to look at situations that were a success or difficult through the week with their son, their beliefs and feelings around these events and what happened as a result. Susan told me last week that she is beginning to see things differently now, so hopefully we can continue to work on that today.”

Following a previous assessment of one child’s motor skills Francis, an Occupational Therapist, is joining in with a PE session at school at 11:00am. “I’m hoping to work on increasing this child’s independence skills. This lesson covers lots of areas, with dressing and undressing to get changed for PE, and working on motor skills as they’re playing a ball game today. Developing these will help this child to take part in leisure activities with family and friends.”

Emma, the Higher Assistant Psychologist, says that by midday she’s usually onto her third cup of coffee and is starting to look at the data that the IPBS team and parents have been collecting. “This involves a lot of concentration, so I need the coffee! The data may be in various forms as what we collect depends on the needs of the young person and their family.”

At 1:00pm Gary (an Assistant Practitioner) arrives at Freddy’s house – his school is on holiday this week. “I have brought some games and activities that will engage Freddy but also allow him to complete some tasks independently, working on his own for 1 minute to start with and gradually increasing over time. We’re working on this as Freddy’s parents have shown us that he struggles a lot when they cannot offer him constant attention. After about two hours I finished up our games, and left the family with some resources and a sand timer to use to continue the activities themselves. We’ll also ask the family to collect same basic data so we can see whether these are helping to reduce Freddy’s challenging behaviours.”

Emily is now on her way to a 2:00pm appointment to assess a young person’s ‘emotional literacy’. “As part of their functional assessment, we identified that their anxiety is leading to behaviours to avoid and escape situations. Today, we’ll work together to assess their ability to identify when they actually feel anxious, so that we can then work on skills they can use when they feel this way.”

By 3:00pm, Occupational Therapist Francis has left school and is meeting with some parents. “After some initial assessment of their child’s productivity and play skills, I am discussing this in more detail with their parents. I will be planning some further sessions of activities to help increase the child’s independence, such as making a snack and drink for herself. I’m also going to talk to these parents about a standardised assessment of their child’s sensory processing, to help me adapt activities and environments to help them not be overwhelmed or underwhelmed by sensory experiences. It will also help tailor the motor skills sessions I’m doing.”

Emily, our Community Practitioner, is arriving at another school. “I have come to observe Catherine at afterschool club, at about 4:00pm. She can find this environment challenging, as she doesn’t appear to know how to initiate play with her peers and often gravitates towards adults in the room. Working with an adult she responds well to, we do some modelling of playing games with peers and slowly progressing with this. Over time they will be able to build upon her skills during her time at afterschool club, and soon Catherine will hopefully not require adult support to initiate play with her classmates.”

Carol, Clinical Nurse Specialist, is also on her way to a meeting at another school, at about 5:00pm. “I’m not keen on meetings generally, but this type workshop I really enjoy. The team of people from different services supporting Rebecca are meeting to discuss her behaviour and how best to support her. We have asked mum and dad to attend, as well as the grandparents who look after Rebecca through the week, and her teacher. There is usually a good supply of hot drinks and chocolate biscuits, which helps! I’m hoping for us to look at what it is ‘important for Rebecca’ and what is ‘important to Rebecca’. It’s really important when formulating a plan that these can be considered alongside each other.

“After approximately an hour and half, everyone feels that they have contributed and learnt at least one thing. We are all at the start of formulating a plan to support Rebecca – and are very full of biscuits.”

The team work from 8:00am to 8:00pm, and after a long but very rewarding day it’s finally home time!
(Please note that this is only a representative day in the life of the team, and names/scenarios have been changed and anonymised to ensure confidentiality.)

To find out more about what the IPBS team do, you can watch this short video: