Reactive strategies within a positive behavior support framework for reducing the episodic severity of aggression

As a model of intervention for people with disability and challenging behaviour, positive behavioural support (PBS) is strongly supported by a growing base of evidence.

A key value within PBS is the avoidance of aversive and restrictive practices (Gore et al, 2013). However, when responding to maintain safety during behavioural crises involving aggression, aversive and restrictive practices are too often the strategy of choice instead of alternative non-aversive crisis management techniques. A common rationale offered by practitioners and support staff for this choice is the concern that problem behaviour followed by a preferred event will lead to the reinforcement of that behaviour.

Method: Plans based on comprehensive functional assessments, utilising a range of proactive strategies and non-aversive reactive strategies (NARS) for maintaining safety during behavioural crisis, were introduced in support of 24 people for the problem behaviour of physical aggression.

Results: The 24 multi-element PBS plans demonstrated significant reductions in occurrence, episodic severity, restraint and the elimination of seclusion. These outcomes demonstrate the efficacy of NARS within a PBS framework for maintaining safety without resorting to aversive or restrictive practices.

Conclusions: This paper provides support for the use of NARS when managing a behavioural crisis involving aggression and suggests that unwanted reinforcement can be avoided in the context of the multi-element PBS plan.