What is the PBS+PLUS approach?

Challenging behaviours including aggression, reduced initiation, and socially inappropriate behaviours are common consequences following an Acquired Brain Injury (ABI). These changes are distressing and impactful on the individual living with a brain injury as well as their families, support teams and the wider community.

Positive Behaviour Support (PBS) is an intervention approach with a focus on understanding and addressing the reasons the behaviours occur and proactively preventing the behaviours through environmental modification and skill building. PBS is a commonly used approach in helping people with learning and development disabilities. Since the 1990s, Mark Ylvisaker and Tim Feeney have applied and developed this approach specifically for young people and adults with ABI. There have been many case studies and program evaluation studies which have examined the efficacy of PBS in people with ABI.

Working together with Tim Feeney, our group was the first to conduct a randomised controlled trial of PBS in adults with ABI. We call our approach PBS+PLUS as it includes a combination of both commonly used PBS principles and also a range of cognitive and communication strategies relevant to people with ABI. PLUS is also an acronym for the fundamental principles of Person driven, Learning together, Uniting supports and Skill building. The overall aim of this evidence-based intervention is to help people build a meaningful life and self-regulate their behaviour after ABI.

PBS+PLUS is a person-driven approach where clinicians work collaboratively and on an equal level with the individual with ABI and the people in their everyday life. PBS aims to meaningfully improve quality of life and explore challenging behaviours as they present as obstacles to the person in working towards the life they want. Clinicians facilitate a shared understanding of the individual’s current and desired positive personal identity and meaningful outcomes. A flexible and individually designed framework is used to guide the intervention plans and strategies towards personalised meaningful outcomes. The active inclusion of everyday people (family, carers, therapists and important others) ensures that all relevant persons can contribute to the understanding, planning and implementation of individualised strategies and promotes shared expertise in the short and longer-term.

Our research has identified that PBS+PLUS is associated with reductions in challenging behaviour, improved close other self-efficacy in addressing challenging behaviour, attainment of personal goals and positive intervention experiences in adults with ABI. Clinicians who delivered this intervention strongly identified with the values of this approach and found it positively shifted their clinical identity. We continue to conduct studies to further expand this evidence base.

*No intervention is 100% effective for everyone. Please consider if this approach is right for you.