NAPPI Positive Behaviour Support Model

The complexity in the way PBS is often presented can be a barrier to understanding and effective implementation, so many NAPPI clients find the NAPPI PBS Model’s traffic light system is easy to use and to remember.

Amber Section

The Amber Section identifies reasons why an individual becomes distressed. It is the start of the model and records an individual’s stress factors, the triggers that may lead to distress such as communication difficulties. Increased awareness of how an individual is affected by stress will enable employees to provide proactive support that will reduce stress that an individual may experience and will increase their quality of life.

The Amber Section also explores the effects of trauma, which is recognised as a likely cause of behaviours of concern. Furthermore, employees involved in supporting individuals who display behaviour of concern could themselves experience trauma, and/or become retraumatised. When employees and organisations are aware of the potential impact of trauma, they can deliver Trauma Informed Care.

Red Behaviour Scale

Secondary prevention strategies closely relate to the levels of the Red Behaviour Scale, used as a tool to assess the level of behaviour of concern. It can be populated with a wide range of behaviour from slight changes to facial expression, to extremely assaultive presentations.

A NAPPI trained employee understands the communication of presenting behaviour and is able to select appropriate responses from a range of options. Behaviour is understood as a form of communication, with each level being associated with a differing degree of self-control. The appropriate selection and effective use of bespoke responses to behaviour will support the individual's return to the safety and psychological comfort of their Green Behaviour Scale.

Care Team Responses

The section at the bottom part of the Amber Section and is where the wider team reflects upon the organisation, care team, and individual working practices to ensure quality of service delivery. For example, by reviewing risk assessments and making necessary changes following an incident. An essential part of this process is Post-Incident reviewing that should result in clear actions that leads to learning and improves quality of life.

Functional Assessments are completed to identify the purpose of behaviour, enabling employees to understand why this occurs. For example, a person will either ‘seek’ or ‘avoid’ something in order to relieve their distress. Behaviour Coaching is used to support a service user to communicate their need in a less challenging way. For example, enabling them to use a picture or symbol to request a drink. Trauma-Informed Care is one of the most important elements of a wider team approach. When an organisation provides Trauma Informed Care, they should do so to everyone, whether or not trauma is known about.

Green Behaviour Scale

A primary prevention strategy populated by activity that represents quality of life. Understanding the positive impact of quality, and negative impact of the absence of quality is essential to fully understand an individual and any associated escalation of their behaviour.

To varying degrees the need to belong, contribute, make a difference and feel that life is good, is common to us all. The Green Behaviour Scale highlights the communication associated with being in each column and employees can support an individual to build upon this quality of life with supportive responses. Employees who know how and when to create opportunities, to influence and recognise contribution made by each individual, make effective role models of positive behaviour. When quality of life increases, the need for restrictive practice decreases.

SMART Principles

The NAPPI approach to PBS includes the Five SMART Principles, a framework of considerations when interacting or intervening with a service user who at times can become distressed. Employees need to know how to Stay One Step Ahead and provide effective support using a person-centred approach. Moving One Step at a Time reminds employees to communicate at a level and pace that the service user can understand, especially when under stress. Attending 100% reviews how negative attitudes can affect the language that employees may use to describe service users and their behaviour. Refocusing the Attention is changing the direction someone looks, thinks or moves. The fifth Principle is working Together, not just as a team, but working together with each service user and working together with their family.

Finally, consideration of TLC (Tender Loving Care) is used in this instance to relate to promoting Human Rights and not enforcing personal values upon others. These are the areas in everyone’s life where we need to achieve balance.