Abstract

Positive Behaviour Support (PBS) has evolved over the past two decades and in 2014 it received UK government endorsement as the chosen health and social care practice model Positive and Proactive Care: reducing the need for restrictive interventions coincided with this evolutionary development.
In the UK, the Winterbourne View Care Home case was the main reason for improving the support of people with living with autism. From a pragmatic perspective the majority of autism practitioners undertake only what lies within their immediate scope of practice. Without established practice standards, organisational policy and practice has the potential to be misinterpreted and wrongly applied. Understanding these key pragmatic attributes of effective care for practitioners is crucial in protecting vulnerable people; this study investigates the rhetoric and reality of what has been lost in translation at organisationally macro, meso and micro levels.
PBS enables the recognition that in order to ensure quality of life and restrictive practice reduction, a focus on leadership and management is critical. The ‘Holistic Positive Behaviour Support Practice Framework for Autism Practitioners’ focuses on promoting tangibly effective PBS and autism practice through leadership training.
An ecological systems theory perspective is considered and synthesised within situational analysis as a methodology. A mixed methods approach is adopted in a single social care organisation in the UK that provides autism services. Semi-structured interviews were undertaken with 8 leaders and managers to extrapolate policy and practice interpretations. 48 autism practitioners engaged in focus groups and the completion of questionnaires. Leaders and practitioners were re-tested to capture the impact of the PBS framework. Practitioners completed pen portraits to provide information on the qualitative impact of the PBS Framework in practice. Discourse analysis and reflexivity were considered to be essential approaches to extrapolate findings and complement the situational analysis.
79% of practitioners considered organisational policy to have improved, alongside levels of incident recording improved by 96%. The qualitative outcomes captured holistic improvements to quality of life for people with autism and relevant wider societal outcomes in statutory regulation and compliance.