Positive Behaviour Support (PBS) Following Brain Injury: What, Why, and How?

Background and aims: Positive behaviour support (PBS) is gaining increasing attention, with a number of intervention experiments demonstrating its effectiveness for individuals with brain injury. However, it seems the foundations of PBS are often misunderstood, which could result in interventions that are not consistent with its theory and practices. The aim of this review was to provide a current perspective regarding the PBS in the context of brain injury, which is important in informing evidence-based practices.

Methods: Literature review

Results: PBS has evolved from the science of Applied Behaviour Analysis (ABA), and is based on principles of person-centred care and normalisation. The primary goal of PBS is to improve an individual's quality of life through (1) functional behaviour assessment and analysis (2) skill development, (3) environmental modification and (4) contingency strategies. However, PBS interventions for individuals with brain injury often emphasise antecedent-based strategies, as individuals may have difficulties learning from the consequences of his or her behaviour. There is increasing evidence supporting PBS interventions following brain injury; however, a majority of PBS studies have been conducted in institutional or residential environments, rather than unstructured community settings.

Conclusions: PBS provides a comprehensive framework for supporting individuals with brain injury who present with behaviours of concern. In implementing evidence-based practices, it is important for interventions to be true to the theory and practices of PBS, and that these clinical approaches are transferred to community-based settings.