If you require mental health crisis support, please contact your local mental health services, your GP, or telephone 111 or the emergency services.

Home > Positive Behaviour Support plan example 1

Positive Behaviour Support plan example 1

Below are two examples of positive behavioural support plans for you to look at: 

Positive Behaviour Support Plan – Mr M

Need

  • Communication needs.
  • Physical and verbal abuse can at times affect Mr M’s level of support.
  • Sensory needs.
  • Other patients can sometimes upset Mr M, particularly if they are in very close proximity.
  • To maintain family contact.

Aims

  • Mr M to have his personal care and hygiene needs met
  • To be more familiar with the environment
  • To limit aggression towards staff
  • To be able to live comfortably with other patients on the ward
  • Increased quality of life
  • Regular review of this Positive Behavioural Support plan (plan to be reviewed using metrics)

Functional assessments have identified that Mr M’s behaviours often occur as a means to escape or avoid individuals, or certain situations.  They have also been known to occur on occasion as an attempt to gain attention.

A) Interventions.

1) Primary preventative strategies. These are the things that we do all the time to improve quality of life and reduce the likelihood of behaviours that challenge.

Following formulation and observations of Mr M, he should be supported in the following ways:

Activities: Mr M should be encouraged to engage in activities he finds meaningful throughout the day.  He often likes to organise areas in the activity room, he additionally enjoys watching the football and he likes to assist staff with tasks where appropriate.  His mood particularly lifts when his children come to visit him.

Personal care: Mr M likes to attend to his own personal care and hygiene.  Even if he has not attended to this as usual, Mr M dislikes it if staff try to intervene.  If staff wish to prompt Mr M to take more care of his appearance etc. then only one member of staff should approach him in a calm manner.  It is important that this staff member does not physically intervene as it can distress him when staff get too close.   

Personal space: When staff interact with Mr M, he prefers it if there is only one individual with him at a time.  Should two members need to be present, Mr M prefers if only one member of staff communicates with him.  If more than one member of staff talk at the same time, this can result in confusion for Mr M. Mr M enjoys his own company.  Staff should facilitate this by enabling Mr M to have periods to himself, at various times throughout the day. Staff should be aware of Mr M’s whereabouts during these times to ensure that other patients are not causing him distress.

Support with communication: Mr M suffers with periods of confusion and can have difficulty understanding staff on occasions.  Staff should talk to Mr M in a slow and calm manner, and utilise objects of reference where possible to facilitate understanding

Environment: As Mr M can become upset at seeing his own reflection in the mirror, following discussion with carers, it has been agreed not to have a mirror in Mr M’s bedroom area. Mr M responds well to dementia friendly features across the ward.

Family contact: Mr M is usually visited by his children on Mondays, Wednesdays and Fridays, between 10am and 12pm.  Prompts should be used if required, to support Mr M in being dressed for this time.  Medication should have been administered to Mr M prior to this time so that his visit is not delayed.

B) Interventions.

1) Triggers to behaviours that challenge. These are the circumstances behaviour may occur in (e.g. being told an activity is cancelled, receiving bad news.)

2) Warning signs & behaviour in crisis. How the service user presents (e.g. sullen facial expression, pacing, hands in pockets… throwing chair.)

3) Secondary preventative strategies. These are the things we do when we notice warning signs to avoid a behaviour getting worse.

Triggers.

  • Lack of activity.
  • Invasion of personal space by either staff or other patients.
  • Lack of understanding.
  • Confusion.
  • Seeing his own reflection.
  • Excessive noise.

Warning signs.

  • Begins to raise his voice.
  • Becomes frustrated or disengages with activities that he would normally enjoy, including watching the football.
  • May start to bang doors and pace.

Secondary Prevention Strategies.

  • Mr M should be supported to have time and space on his own.  This may involve encouraging other patients to move to a different area of the ward. If no harm to himself, Mr M should have 20 minutes to calm down on his own.
  • If Mr M requires additional support, only one member of staff should approach him and should do so in a calm manner.
  • This staff member should utilise reassurance and distraction techniques.  Mr M has responded well previously when the calm down box has been utilised.  He particularly likes the stress balls and pebbles.
  • Should another member of staff be required to attend, only one individual should communicate with Mr M at this time.
  • It often helps Mr M if chatting to him about his children. 
  • Mr M has a my life book, which as a visual aid often induces positive memories and enables him to reminisce about his past.
  • If staff need to support Mr M to an alternative area on the ward, he should be ushered using hand gestures only, whenever possible

C) Interventions.

Tertiary strategies. These are the things we do when a service user is in crisis to keep him/her and others safe.

Following discussion with Mr M, it’s been agreed that the following approaches should be utilised if all primary and secondary strategies have been unsuccessful.

  • If unduly distressed and all secondary prevention strategies have failed to calm Mr M, then oral medication should be offered.
  • Arm holds should be used only when absolutely necessary and for the minimum amount of time possible.

Evidence Base.

Here detail information about any policies and guidelines that have informed the development of the plan. Also include a statement that makes reference to the formulation completed as part of the pathway process (including specifically where to find the case note entry/ report on PARIS).

Positive and Proactive Care report.

Formulation on 16th January 2016.

Functional Assessments performed on 12th February 2016.

Discussions with Mr M on 07/01/16 and 10/02/16.

Consider more:

  1. What are your thoughts on this example of a positive behavioural support plan?
  2. What do you think you would like to see in your own positive behavioural support plan?