ࡱ>  JbjbjcTcT 9>>B+XX8L3)OOeee. l)n)n)n)n)n)n)+M.Nn)d"n)ee)eel)l)&|l(e ]ԓp'X))0)'.j.$l(l(,.(n)n)).X a:  Report of the First International Conference for Research and practice in Positive Behaviour Support , convened by BILD The first International Research and Practice Conference held in Malahide, Dublin on 6th and 7th May 2010 marked the 10th annual behaviour support event hosted by the British Institute of Learning Disability (BILD). These conferences have in the past focused on best practice in the use of physical interventions and the drive to create and further raise standards in training and practice. This conference offered delegates the opportunity to hear a number of speakers and attend practice based workshops. Delivered over two days following an established and successful format, it proved to be a very popular event and great opportunity to hear from acknowledged experts in the field and to gain a wealth of knowledge, engage in debate and exchange new ideas over two busy days. Despite attempts by volcanic ash to disrupt the proceedings, the event was attended by in over 150 delegates and speakers over the two days, many using alternative modes of transport to ensure they could attend the event, Dr Brodie Paterson and colleagues possibly set a record travelling via several countries by modes of various transport which he claimed included a donkey! Day One Chaired by Sue Hatton, who most ably stepped into the breach when Professor Nigel Beail was delayed by the volcanic ash, day one opened with a keynote address from Dr Jeffrey Chan from Australia, entitled Reducing restraint: A legislative approach to protecting the rights of people with disability in Victoria Australia. Jeffrey has a unique role, called Senior Practitioner; to protect the rights of people with a disability when they are subjected to restraints including the use of seclusion, chemical and mechanical restraint, at present this does not extend to physical restraint although Jeffrey is working to define the practice at this time. His presentation highlighted how important data can be in supporting organisations to review practice and how this can also be used, in turn at departmental level to shape policy and practice. In Victoria there is a five year strategy to reduce restrictive practices. In the past three year his department has reviewed more than 600 chemical restraint protocols, 4000 behaviour support plans and requested over 100 medication reviews. One of the most interesting aspects of his work is the award of dignity grants offered to practitioners often as small grants of up to $2000. These grants focus on changing practice and improving outcomes for service users and the grants have been used to decommission seclusion rooms, create relaxation rooms, activity rooms or introduce alternative therapies as a way to reduce reliance on aversive approaches. This innovative approach impressed delegates who informally continued to discuss this approach throughout the event. Professor David Allen from Bro Morgannwg University in Wales, presented a national perspective on positive behaviour support; this key note presentation discussed how his work is being implemented across intellectual disability services in Wales. Initially he set the context by highlighting the Mansell Report and the need for specialist provision to be developed throughout the UK. Professor Allen highlighted how it is possible to develop and expand services through: Building competence and capability; by developing to workforce skills and increasing the focus on lifestyle outcomes for people with intellectual disabilities who use services Assessing outcomes; at an individual level, service level and locality level Sharing good practice; sharing practice between professionals through network meetings that have been attended by over 300 professionals to date Professor Allens presentation discussed the challenges, dilemmas and some of the solutions in developing service-wide competencies in order to meet the complex needs of all the people with intellectual disabilities who exhibit behaviours that are challenging. An collaboration of two very expert professionals and speakers delivered the third key note presentation on day one of the conference, Richard Mills, Director of Research at The National Autistic Society and Dr Andrew McDonnell of Studio III. Entitled Low Arousal Approaches and ASD, the key note explored the reasons why adopting low arousal approaches when supporting people with autism may lead to improved outcomes for individuals. Highlighting the need for an autism friendly approach, the presentation went on to discuss what this might actually mean for individuals, making reference to the role of staff behaviour within low arousal approaches and also discussed mindfulness. Mindfulness as an approach was a theme that emerged a great deal over the two days, having been referenced earlier in the day by Dr Chan as well. Mr Mills and Dr McDonnell discussed how low arousal approaches can be delivered within a SPELL framework: Structure Positive Approaches and Expectation Empathy with the individual, understanding autistic thinking Links, creating consistency in responses and support They also concluded that confrontation anxiety and sensory processing are factors which may relate to causes of behaviour that is challenging for some people who experience autism. Personalised approaches will also depend on the ability to understand the individual and the skills needed to support the person. Importantly they recognised that managing the strength of arousal within team members can be just as important in delivering a low arousal approach. The next speaker is one of the most moving key note speakers to address the annual event in the past ten years. Sally Meadows is a woman who experiences autism and has a long history of having lived within a variety of services. Supported by Mark Wakefield, and illustrated by her own art work, her presentation told her story, which was described as funny, poignant, aggravating but hopeful, it clearly moved the audience at times but also provoked laughter at points. From her experiences in a school for maladjusted young girls to her experiences in psychiatric services as well as therapeutic communities until finally living in her own home Sally gave an interesting insight into a life lived in services. Sally described a life shaped by and directed by various service provisions and the assumptions made by professionals about her and the cause of her unusual behaviours and experiences. Sally gave an interesting insight into her own experiences of autism: I felt like an alien............I knew my body was human; it confused me, as if Id been born into the wrong planet and wasnt supposed to be here. Sally described how at 19 she was pensioned off to live in a residential care home and labelled as psychotic and schizophrenic, until finally she was able to access some therapy and the therapist entered her world. Finally Sally was diagnosed as having autism and epilepsy. As she learned more about both labels, Sally felt able to understand herself more and to get improved support and help. Sally described how this new label has helped her to better live in this world. Sally movingly told delegates at the conference how the only label that matters above all others is the label of Sally and the fact that she has now, through diagnosis learnt to be herself. Integrating Traumagenic Neurodevelopmental Information into Positive Behaviour Support Plans was the title of the fifth, and final key note presentation of the first day. This presentation, delivered by Bob Bowen of Mandt Training from the USA, explored the neurological changes that occur as a result of traumatic life experiences and discussed how this information can be integrated into positive behaviour support plans. The presentation enabled delegates to have increased understanding in relation to trauma and the effect on neurological development. Bob discussed the fact that people with complex needs are often people who have experienced trauma in their lives; this will affect how they view the world and their environment. Bob concluded that emotional, psychological and physical safety must be a part of every behaviour support plan. The evening - the presentation of the first BILD Positive Behaviour Support Leadership Awards The evening dinner started with the presentation of the first leadership awards to be given by BILD for positive behaviour support. The winners were: Anne MacDonald in the category of Innovative Practice in Services for Adults, Annette Hames and Chris Rollings, for Innovative Practice for Children and Young People and Dr Oussama Abdallah (Syria) awarded as the Leader of the Future. More information on the leadership award winners can be found on the BILD web site. Day Two Chaired by Kevin McKenna of Dundalk Institute of Technology in Ireland, the second day started with a large number of delegates in attendance. Due to a change in programme to accommodate various travel arrangements caused by volcanic ash, the day opened with a short presentation by Sharon Paley, Development Manager for Positive Behaviour Support at BILD. Sharon outlined how BILD had progressed on the new mission announced in York in 2009; in particular BILD has delivered a revised third edition of the BILD Code of Practice. This edition emphasises the need for commissioners of training to take more responsibility in terms of policy development, behaviour assessment and restraint reduction planning. Sharon highlighted that BILD has convened a small research group, (a number of the key members of this group were at the conference), has worked to develop new publications in this area, reviewed the information available on the BILD web site and intends to explore opportunities to share good practice. Sharon summarised by concluding that BILD was in the early stages of a change in direction, influenced by Professor David Allen who in 2009 asked BILD to move strategically towards a restraint reduction message with emphasis on positive behaviour support. BILD will emphasise a human rights approach in all aspects of our work. BILD has made a strong commitment to driving change forward, those changes may not be welcome by all........this is the start of that process........we hope you will actively support us was her concluding request to delegates at the conference. Applied Behaviour Analysis The Irish Debate was the title of the key note given by Dr Mickey Keenan, Senior Lecturer at the School of Psychology at the University of Ulster and fellow of the British Psychological Society. He is the author of a large number of publications and journal articles and has overall responsibility for the Masters in Applied Behaviour Analysis at the University of Ulster. The presentation was introduced by a short case study and personal message from Cillian, with whom Dr Keenan has worked to enable him to experience an improved quality of life. The emphasis within this presentation was a strong personal belief that the science of behaviour should be available to those families who would like access to programmes of support that include applied behaviour analysis. Dr Keenan discussed how much more could be done throughout Ireland to highlight the true nature of scientific discourse so that politicians can be properly informed when it comes to making policy decisions ( in relation to implementing applied behaviour analysis). He also highlighted a number of concerns he has with regard to the over commercialization of the various products marketed at parents. Dr Keenan informed the conference that it was his belief that judgments and decisions regarding the potential application of approaches in applied behaviour analysis are not funded by government departments due to preconceived beliefs about the approach that are not based in fact or hard evidence but rather opinion and concluded that prejudice is better eliminated through education. Dr Brodie Paterson Director of CALM Training Services in Scotland has spoken at a number of the national events delivered previously by BILD, he is always a popular speaker and this year discussed Corrupted Cultures of Care. He discussed the concept of a toxic culture, Wardhaugh and Wilding (1993). How does an organisation become toxic? Dr Paterson discussed that such services are a product of corruption within services marked by: Depersonalising and dehumanising processes Power inequalities An ethos of compliance, official or not Failed management (lack of leadership) A lack of accountability As in a number of presentations throughout the event the presentation highlighted how mindfulness as a concept may be useful in combating toxicity within organisations. Dr Paterson told delegates that good services can go bad - the key is changing everyones behaviour, importantly that of team members and leaders within the organisation. Training alone will not fix the problem. In conclusion organisations will need to: Focus on values and integrity Focus on developing a respectful culture Focus on people Focus on leadership Focus on knowledge and evidence base Be A LEARNING organisation The first winner of the Leader of the Future award, Dr Oussama Abdallah, delivered a short key note presentation to the conference. Dr Abdallah is in his fourth year as a PhD Student at Northumbria University. Delegates were impressed to hear about his research project, and practice backed by the Syrian Ministry of Health, and the World Health Organisation, his work is also supported by UNICEF. Dr Abdallah outlined for delegates how work was underway in developing services, planning strategy and improving the quality of life for people with learning disability in the Syria. Dr Abdallah is designing a national strategy for children and young people with autistic spectrum disorder and learning disabilities in Syria. Dr Abdallah is motivated to attract expertise from the UK and other European countries to have interest in his work and my vision for my lovely, peaceful country, Syria. A full transcript of his winning submission will be made available on the BILD web site. The conference closed with a key note paper and presentation from Gary LaVigna, Clinical Director of the Institute for Applied Behaviour Analysis in Los Angeles, USA. In his presentation, Exploring Non linear Applied Behaviour Analysis: implications for supporting people with challenging behaviour he looked beyond the approach of the simple linear approach of antecedents, behaviour and consequences (a,b,cs). Delegates were told how this approach can improve outcomes for individuals with an emphasis on non aversive approaches and positive support to enable the individual to have their needs met by alternative means. Gary discussed how more research is necessary to demonstrate that non linear, multi element approaches to positive behaviour support will reduce episodic severity and not reinforce the target behaviour, stating that research with episodic severity as a variable has been missing from the literature on applied behaviour analysis and physical management literature. The Conference was closed by Kevin McKenna and Sharon Paley who both highlighted the importance of BILDs work in continuing the journey towards improving practice, reducing aversive approaches and increasing positive behaviour support as the primary response in services that support the most vulnerable people. They pointed out to delegates how the conference had highlighted how cultures within organisations are important in shaping both outcomes for those people who come into contact with the services, people with intellectual disabilities or autism, as well as influencing the response and support offered by staff. Most key note speakers highlighted skills deficits within organisations as a contributor to poor practice, toxic cultures and abusive practices. Summary The conference opened with a key note presentation from Dr Jeffrey Chan that highlighted the need to adopt a human rights approach at a strategic level and in common with all the key note presentations leadership was highlighted as a factor in ensuring the approach is disseminated throughout the service. His role enables him to encourage leadership with ideas flowing freely in both directions through the creative dignity grants. Delegates heard from a wide range of experts from Europe, North America, Syria and Australia, and had opportunity to discuss a range of practice topics through the 17 workshops delivered over the two days. Initial feedback following this first International Research and Practice in Positive Behaviour Support has been overwhelmingly positive, it will be followed by a National conference in May next year - a call for workshop papers is now available on the BILD website, www.bild.org.uk . The International research and practice event will return in 2012. 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