Why We Use PBS

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Positive Behavior Support (PBS) is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person’s environment. PBS is for anyone who wants to solve a problem, make life better, or get “unstuck” from their current scenario.

Branches focuses heavily on PBS’ adherence to a respectful and ethical approach; relying on evidence-based assessments, strategies, and assistance that’s catered to each individual’s needs and goals.

Our PBS team can also be engaged in third-party neutral evaluations to help determine quality of life, quality of content services, and supports measured against best practices.

Our Six Step PBS Client Process

#1 - Support Assessment

As a team, we develop a targeted list of concerns for an individual, observe their reactions to particular situations, and collect baseline data of current support required to manage safety.

#2 - Strategy Development

The team brainstorms a variety of theories that contribute to the targeted behavior as well as potential solutions.

#3 - Recommendations

The team has conversations about additional improvements needed and makes decisions about what is possible at the time. Then, a chosen solution is determined.

#4 - Technical Assistance

A PBS Facilitator sources, researches and designs the materials necessary to carry out the chosen solutions.

#5 - Training and Support

The PBS Facilitator works with the team to train, encourage, model and help support the team to implement and successfully accomplish the goals they set for as long as the team wants to continue working forward.

#6 - Ongoing Documentation

Regular check-ins to review progress, create formal PBS plans, crisis support plans and protocols to support the focus person consistently across multiple services.

Who We Work With

PBS services are highly customizable and seem more like an ongoing, low-stress relationship where we work together at a pace that feels comfortable to chip away at larger projects.

We are suited for a team of supporters who are anxious to learn and willing to invest the time necessary to improve the life of the person we are working for. It is best to use PBS services when the person is largely stable, and there is time and energy available to take proactive approaches.

We are poorly suited for crisis supports, quick fixes, or a team that prioritizes compliance and obedience over learning and support.

Because services are not direct client therapy, it’s important that these teams are looking for support to curate a full and rich life.

Positive Behavior Support (PBS) Facilitation:

  • Requires learning through experiences of everyone working and thinking together
  • Strives to eliminate separating people from the community or controlling someone else’s life
  • Is a collaborative process that involves participation from everyone who is actively involved in the life of the person we work for – including that person
  • Should be helpful, non-judgmental and focused on removing barriers and solving problems, not laying blame or getting into supporter contests
  • Requires accountability, creativity, honesty and some vulnerability*

*POSITIVE BEHAVIOR SUPPORT (PBS) FACILITATION: This language was developed under Grant No. 1LQCMS300080, FY 2006 Systems Transformation Grant from the US Department of Health and Human Services, Centers for Medicare and Medicaid Services, to the VA Dept. of Medical Assistance Services (DMAS). However, the contents herein do not necessarily represent the policy of the US Dept. of Health and Human Services, and you should not infer endorsement by the Federal government.

People Seeking Services:

  • No age requirement
  • Resident of the Tri-Cities / Greater Richmond
  • Funded through the Family and Individual Supports Waiver or the Community Living Waiver, or able to pay privately for services

Our PBS Specialties Include:

– More effective interactions with others
– Transition help
– Increasing communication abilities
– Developing coping skills and strategies
– Increasing access to meaningful activities
– Stress reduction techniques
– Disability information, resources and teaching
– Help with public interactions
– Presentations and public speaking
– Conflict resolution tools
– Negotiation strategies
– Family dynamics support
– Supportive networking with other families
– Personality matching
– Environmental matching
– Personal Attendant / Respite care employee training
– Healthy relationship building
– Sexuality education and problem-solving
– Workplace interactions
– Job readiness behavioral support
– Creating visual supports for learning
– Encouraging independence
– Social skill development
– Modifications and accessibility (including AT requests)
– Explaining complex ideas
– Facilitation with community service providers
– Social stories and visual narratives
– Teaching supports best practices
– Team training
– Finding solutions to frustrating daily routines
– Mindfulness and deliberate approaches
– Cause & Effect teaching to people with ID / ASD
– Alternatives to restraint or therapeutic holds
– Explaining difficult topics to people with ID/ASD
– Person-centered, restraint free crisis plans
– Safety support recommendations
– Age-appropriate, relevant solutions
– Breaking big ideas down into achievable steps
– Support from SLPs or OTRs

We also offer assistance with:

  • Stress Reduction for Supporters and Families
  • Teaching Healthy Relationships to people with ID and ASD (w/ take home adapted curriculum)
  • Teaching Self-Regulation to people with ID and ASD (w/ take home adapted curriculum)
  • Teaching Advocacy Skills to people with ID and ASD (w/ take home adapted curriculum)
  • Parent and Carer Support Group
  • Early Communicator / AAC implementation Support Course

Frequently Asked Questions:

PBS is for anyone who wants to increase the quality of their life, solve a problem, or get “unstuck”. PBS services are also good if you want a third-party neutral evaluation of quality of life or quality of current services and supports measured against best-practices.

No. People use different names to describe what we do, like behavior therapist, but that isn’t exactly right. We don’t just work with the individual demonstrating the difficult, we work with the entire support team to help eliminate concerning behavior.

We are consultants and facilitators, using research-based PBS strategies to collect information and make recommendations.

Teams are made up of the people that surround and provide care for the focus person. This usually includes the focus person, a member of their family, guardian or caregiver, friends, supporters (day support employees, supervisors, residential employees, supervisors), other service providers (employment services, educational services, OT / SLP services), and their support coordinator.

That’s okay! Learning how to make good decisions is a skill that takes practice. Our job is to support people to make their own choices – even bad choices – in a way that doesn’t jeopardize their health or safety.

The PBS process is ongoing and can take as long as the team needs to make things happen. Some teams are fast moving and some have more complexities and take more time. Typically, the process lasts 4-6 months, but we move at the pace that the team agrees is best.

PBS works for everyone. The best time to start something is when the focus person is not experiencing crisis and the team has the stability to take proactive, new approaches to help build skill and make changes that will avoid crisis in the future.

Therapeutic Consultation is a Medicaid waiver service that PBS services operate under. We used trained and endorsed PBS facilitators, and that system of PBS is how we practice therapeutic consultation.

There are many professionals who provide Therapeutic Consultation services and each person has their own approach.

We identify as PBSFs (Positive Behavior Support Facilitator).

No. Branches of Life as an organization is ethically against any form of physical restraint or therapeutic hold, and will not condone its use as a part of a support plan.

Chances are, yes! The beauty of TC is that it can help someone overcome difficult habits or behaviors that are getting in the way of their success and happiness, AND it can also be used to help boost an already-successful person to new heights – maybe they want to go to college, or learn to read, or make new friends – we can support with that, too.

Your Support Coordinator should complete a Referral. If someone other than the Support Coordinator completes a referral, you must immediately notify your Support Coordinator as they are the only person that is able to initiate services.  Support Coordinators must inform the service user  and Substitute Decision Maker so they are aware of the referral and the process.

A Referral Form must be completed, preferably by your Support Coordinator.

  1. If your Waiver qualification is not met, A Notice of Decision (NOD) letter be sent to the person who submitted the Referral. The referral process will stop here. 
  2. If your Waiver qualifications are met, your Support Coordinator will be contacted and sent additional forms to complete the Referral process. 
    1. Forms must be completed by the Support Coordinator and submitted to Branches of Life (BOL).
    2. Upon receiving the completed forms, an Intake Packet will be provided to the Support Coordinator to send to the service user & their Substitute Decision Maker (SDM). 
    3. Upon completion of ALL Intake forms, the SDM will receive an email through SignRequest for an electronic signature. 
    4. Support Coordinator will need to add Branches of Life as a new provider in WaMS in order to submit a new service authorization .
    5. A Service authorization will indicate the start date of services.

We are poorly suited for people experiencing a crisis. Our services often take longer than most people in crisis are able to wait, and changes in service sometimes occur in these scenarios. We recommend that you contact REACH through your service coordinator, and when the crisis has stabilized and you are able to make more permanent solutions, please contact us.

No. We often work with psychiatrists and PCPs on the team to give them additional information or seek their feedback, and we might make recommendations to speak to a doctor about, but we are not able to prescribe medication.

Our role is to help the team lay out a plan – we figure out what the problem is, what the real cause of it is, and then figure out, together, ways to avoid the problem and ways to help the focus person get what they want in a way that works well for their life and the life of those that support the focus person.

We can work together to try to get the team on board and explain the benefits of this process. If that doesn’t work, we can help provide guidance and support to find a different team that will be more supportive.

The focus person needs support, and that might mean they need to learn new skills – even if that’s the case, they will need someone to teach those skills. Often it’s easier to change things than a person – and it’s more respectful that way, too.

Quality of life is not about how cared for a person is, but is measured by how satisfied they are with their life and how much freedom and power they hold in decision making for themselves.

PBS is the most ethical form of behavioral support available. Besides, if you’ve tried everything and nothing has worked, there is still a problem that needs to be addressed, and we can help.

We learn in a lot of ways. We believe that all behavior is meaningful, and often learn a lot about a person’s desires based on what they show us.

One step at a time! We work at the pace that feels right for the group, and don’t move forward with anything until everyone is on board and feels ready to try new things.

We stay with a team as long as there is still work to do. We move on when the work is done, or when the plan we agreed upon is not being ethically or consistently followed-through, or when there are not enough team members able to carry out a plan.

The Substitute Decision Maker (SDM) will be contacted and sent additional forms to complete the Referral process. 

  1. Forms must be completed by the SDM and submitted to BOL.
  2. Upon receiving the completed forms, an Intake Packet will be provided to the SDM.
  3. Upon completion of ALL Intake forms, the SDM will receive an email through SighRequest for an electronic signature. 

We accept Family and Individual Supports (FIS) and Community Living (CL).