CQL | The Council on Quality and Leadership

Creative Approaches in Positive Behavior Supports

Posted 5/30/19 via Capstone e-Newsletter
By Angela Rapp Kennedy | CQL Vice President of Systems Transformation

When looking at the provision of behavior supports, there are numerous traditional approaches of great familiarity to those in the human services field. As CQL continues to work with organizations and systems to eliminate restrictive methods, we value the exploration of creative options to consider. There are a variety of emerging practices that organizations are exploring and implementing to take a fresh perspective involving Positive Behavior Supports. Interestingly many of these "new" and "emerging" practices are rooted in historical, and even ancient concepts. Regardless of the organizational initiative, as you'll read below there is a correlation between implementing positive strategies and overall quality at an organization. For example, we found that organizations that have Positive Behavior Supports present in both Systems and Practices, are expected to have 88.2% of total Basic Assurances® present.

As the pace and complexity of our world increases so too does the level of stress, anxiety, and even fear for us all. How we deal with these are critical to the quality of our lives. We are devoting this edition of Capstone e-Newsletter to look beyond more typical methods of formal behavior supports, implemented in response to what are often characterized as "challenging behaviors," to share creative and potentially new concepts to help support people. Our hope is that you will discover alternative ideas for helping the people you support, the people you employ, and yourself in understanding, navigating, and managing the world in which we live in ways that enhance quality of life.



By Carli Friedman | CQL Director of Research

As part of the Basic Assurances®, we examine if and how organizations provide Positive Behavior Supports to people (Factor 8c). For this Capstone e-Newsletter we were interested in exploring organizations’ utilization of Positive Behavior Supports in more depth.

We examined the relationship between organizations providing Positive Behavior Supports and data involving the Basic Assurances®. Findings revealed, when organizations have systems or practices present to provide Positive Behavior Supports, or when they have both systems and practices present, they have higher overall scores on the Basic Assurances® – they do better at enhancing health, safety and human security – than when they do not provide Positive Behavior Supports (see figure below).

The Relationship Between Positive Behavior Supports (PBS) and Total Basic Assurances®

The Relationship Between Positive Behavioral Supports and Total Basic Assurances®

What other impact can Positive Behavior Supports have on the services and supports agencies provide? Well one example is health – according to our analyses, organizations that have systems and practices present for Positive Behavior Supports have more effective health services and supports (see figure below). While having Positive Behavior Supports in systems or practices are useful, doing both is associated with the biggest impact on health services and supports.

The Relationship Between Positive Behavior Supports (PBS) and Best Possible Health

The Relationship Between Positive Behavioral Supports and Best Possible Health

Another example of the beneficial effects of Positive Behavior Supports involves dignity and respect. Our analyses revealed that organizations who score better in terms of dignity and respect (Factor 2 indicators present) are more likely to have practices present utilizing Positive Behavior Supports. For example, an organization that has 0 of the 10 dignity and respect indicators present only has a 34% probability of having practices present for Positive Behavior Supports, whereas an organization that has all 10 of the dignity of respect indicators present has a 98% probability of having practices present for Positive Behavior Supports. In fact, for every 1-point increase in dignity and respect, organizations are 1.6 times more likely to utilize Positive Behavior Supports.


The Relationship Between Dignity and Respect and Utilizing Positive Behavior Supports

The Relationship Between Dignity and Respect and Utilizing Positive Behavioral Supports

Clearly our findings indicate putting Positive Behavior Supports into practice can have a significant impact on human service organizations and especially the people they support. To help advance and expand these efforts, we’ve shared some approaches beyond the typical behavior management strategies that we hope will help agencies increase their impact in this area of support provision.


Bridging The Gap, A Therapeutic Approach

By Tracy Boland | Brothers of Charity Services Ireland – South East
Yoga Teacher & Relaxation Therapist, Supervisor
Connect With Tracy On Facebook

The move from the medical model to the social model of service delivery for people with intellectual and developmental disabilities (IDD), has finally given scope to introduce some alternative mechanisms and skills to help people in learning to cope with anxieties and stress in today’s world. Now the pace is faster than it has ever been and we cannot escape this, however it is time to open minds, ideas and our hearts to the endless possibilities of those we serve.

For thousands of years yoga and some alternative therapies have been around and are now at our fingertips to draw into our lives and to those we support. For the most part, these are now scientifically proven to de-stress and reduce anxiety for everyone. Here in Waterford, Ireland, The Brothers of Charity Services Ireland South East has begun to incorporate these practices into our service delivery. The success of this has lead us to note that it is helping to address the deficit in the professional services of psychology and psychiatry which are under extreme pressure due to long waiting lists.

Yoga poses at Brothers of Charity Services

When we realize that beneath every behaviour is a need, we can truly support people in safety, exploration and growth to live their optimum life. Although we do not claim that this is the answer to all people’s needs or challenging behaviour, there is suggestion that these behaviours are often the manifestation of a dysregulated nervous system and more often than not, as staff we tend to focus on the observable behaviour without looking beyond that, to the person’s internal state of being.

Studies show that regular yoga practice can help ease stress and lower levels of the stress hormone cortisol, as it helps to decrease the symptoms of anxiety by balancing the nervous system. The practice effectively does this by increasing the coordination between the mind and body through the physical postures, breathing techniques and conscious relaxation methods that help stimulate the parasympathetic nervous system. A program of eight weeks of yoga is proven to show benefits and we begin to see an improvement of quality of life. Several studies have also shown that yoga may decrease the symptoms of depression, reduce chronic pain and promote sleep quality. Continual practice helps with both physical and mental flexibility and balance. Yoga places emphasis on mindfulness and promotes mindful eating and the development of healthy eating habits.

All of this is done through action therefore the type of communication here is extremely beneficial to people who use our services, we begin to reach inside and connect with who they are and embody the greatness of their essence with courage and fierce determination.

Yoga poses at Brothers of Charity ServicesAs a student and practitioner of yoga and an array of complimentary therapies for over 20 years, as well as from my experience working with the Brothers of Charities, I strongly suggest we employ the services of yoga teachers with special training involving people with IDD. Sometimes the simple class of “smelling the flowers and blowing the candles” can be just as relaxing and therapeutic as any one-to-one therapy.

Relaxation therapies such as Reiki, reflexology and meditation to name a few also have been found to reduce stress and anxiety levels to a degree that we are seeing a significant increase in people’s ability to manage the challenges in their life, reducing the need for more formal behavioural interventions. It is important however to get a therapist to refer people to the appropriate therapy as each has something different to offer and not all therapies are for everyone.

Not only is the quality of life of those supported improved, it has a positive impact on Direct Support Professionals (DSP) as well. A comment from one DSP who supports people in class had this to say, “It benefits me and my job because I also take part in the class and have always felt relaxed and more positive after the class. The individuals I support have very different needs so my job can be challenging at times, therefore the opportunity to feel more relaxed and content is very beneficial to me and the individuals I support.”

Bringing awareness to the deeper needs and changes in service provision takes a degree of empathy and compassion that must start with us. We must allow ourselves to practice the pause within. By using therapeutic approaches, our core values, bringing the best expression of who we are, and helping to empower people to make new choices about themselves, we can then watch the lives of others flourish.


Dialectical Behavior Therapy

By Joanne Cropper | The Center For Family Support (CFS)
Director of QI and Training

There is a technique used by The Center For Family Support (CFS) to help mothers and other individuals with disabilities in dealing more effectively with life challenges. This technique is called Dialectical Behavior Therapy (DBT), which is designed to help people overcome negative behavior and feelings that are triggered by family and relationship issues, as well as other stresses of daily living.

CFS craft projectsCombining mindfulness, coping strategies and emotional support, the DBT groups began in 2018 and will become available in different CFS locations.

“We use relaxation techniques, meditation and yoga, as well as encourage physical fitness, healthy eating and drinking plenty of water to help the people we support balance their lives,” says Jennipher Solis, a behavior intervention specialist who has been trained in DBT and helped create the DBT curriculum. The program is conducted in two-hour sessions every other week.

“We even use visualization exercises and tactile projects like crafts and baking to help guide the sessions and release stress,” Jennipher adds. “We found that some individuals are receptive to less talking and more doing. We tailor elements of DBT to deal with the needs of specific individuals, particularly zoning in on coping mechanisms.”

Supporting Mothers with Disabilities

Like anyone else, mothers with intellectual disabilities want to be good parents but often need both practical and emotional support. Those women who are part of the CFS family and have children or are pregnant have different needs and backgrounds that shape their emotions and abilities with babies and children. Some have had a history of trauma and little parental involvement in their lives when they were young.

CFS Treasure Box“As an agency we’ve become more sensitive to dealing with these traumas as young women, with babies of their own, realize they don’t always know how to deal with the emotional challenges and stresses,” says Linda Schellenberg, Director of Community Services at CFS, who supported the idea to start a mom’s group.

“We help moms with coping and communication skills and we work together and share concerns and problems with each other to provide the support they need,” explains Brittney Riley, a behavior intervention specialist, who helped start the group.

“Since these moms have various intellectual disabilities, we use creative ways to improve engagement,” Brittney adds. For example, participants use arts and crafts to build a treasure box, in which they put items that comfort them when they’re feeling challenged and stressed.

As a result of the group’s support and activities, many of the moms are now connecting on their own and forming deeper bonds as they continue learning from each other and having fun together. They’ll even go bowling together!


Learning Through 'Gentle Teaching'

Gentle Learning WebsiteAnother possible strategy to explore is the concept of Gentle Teaching. Dr. John J. McGee was the Founder and Director of Gentle Teaching International and the primary author of, “Gentle Teaching,” “Being with Others,” “Beyond Gentle Teaching,” and “Mending Broken Hearts.”  Dr. McGee spent more than three decades writing articles and teaching about this non-punitive approach to supporting people with severe behavioral and emotional challenges. He lectured throughout the United States, Canada and the world. Dr. John J. McGee passed away in November 2012 yet his legacy of Gentle Teaching continues to impact people around the globe. 

According to Gentle Teaching International’s website:


Gentle Teaching incorporates compassion as an alternative to the reactive and restrictive practices that are commonplace in working with those who present with complex needs. The central purpose is to nurture; teach; and sustain a sense of companionship, connectedness, and community for those who have repeatedly experienced an existence of disconnectedness, isolation and loneliness.

Gentle Teaching is based on the premise that all individuals have a right to feel safe and valued in their homes; with their families and caregivers; and at their job, school, or other forms of meaningful day activities. Those who are most vulnerable require predictability and structure in their day. They also need to experience interactions from others that are overwhelmingly positive and uplifting (vs. critical and demanding). This is truly a cultural shift to, or in some cases a deepening of, those principles that provide a solid base for helping individuals experience companionship and connectedness. It serves as a foundation for other models of treatment or teaching specific to the needs of the individual.”

Gentle Teaching is the expression of what McGee describes as the Psychology of Interdependence. According to this psychology, every human being needs to live connected with others in an equal and mutual relationship and embedded in a loving and caring community. This community invites the individual to develop his/her qualities for the benefit of himself/herself and the community.

A Psychology of Interdependence looks at human beings from a social perspective. Essentially, we all are social beings who can only develop our inherent potentials and intrinsic qualities by interacting with others. As social beings, being and interacting with others is our natural inclination. A Psychology of Interdependence affirms four basic assumptions about our human nature:

  1. All human beings long to feel engaged in an unconditional and interdependent safe and loving relationship with a few important others
  2. Around our circle of important others, human beings are social beings and each needs to feel a sense of belonging to a safe community where people respect, and care for each other.
  3. The quality of loving and caring for others is intrinsic to our human nature; experiencing this love and care begins to cultivate one’s feeling and perception that (s)he is socially accepted. (As this experience becomes integrated, the person can feel unconditionally accepted, and respond/reciprocate this back to others.)
  4. Every individual is gifted with personal qualities and potentials, that can only develop in a genuine and natural way if the person feels safe and loved and gains a sense that (s)he is part of a safe and loving community.

There are many Gentle Teaching resources you can explore, to see what might be gained from this approach and what tools you could add to your toolbox, as you strive to improve the quality of life for the people you support:



Print edition of Capstone e-Newsletter 

CQL is offering a version of Capstone e-Newsletter that can be downloaded, printed, and shared. This online edition still contains the most robust information with hyperlinked resources, but this PDF version provides another way for you to share best practices.

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