How can PBS support individuals living with schizophrenia and experiencing behaviours of concern?

POSITIVE BEHAVIOUR SUPPORT GUIDE

Positive Behaviour Support (PBS) is a person-centred approach used to understand and support individuals with behaviours of concern by focusing on improving their quality of life. When supporting a person living with schizophrenia, PBS can play a crucial role in supporting the person to maintain stability, build meaningful relationships and routines, and - if they decide - support on how to manage hearing voices, seeing visual stimuli, experiencing tactile stimulation and more.

In this guide, Jasmine, our Behaviour Support Practitioner, discusses:

• How PBS aims to provide support for people living with schizophrenia and experiencing behaviours of concern

• Positive behaviour support for a person who feels distressed when experiencing hearing voices

• Real-life example: how Jasmine supported a person who reported to, at times, fear the voices he would hear

Positive Behaviour Support aims to provide support for a person living with schizophrenia and experiencing behaviours of concern by:

1. Understanding the Person

Positive Behaviour Support will start with a comprehensive assessment to understand:

• The person’s history, preferences, strengths, and goals.

• Specific behaviours of concern and their triggers

• The function of those behaviours — what are these behaviours communicating for the person?

2. Conducting a Functional Behaviour Assessment (FBA)

This aims to assess:

• What triggers certain behaviours (antecedents).

• What the behaviour looks like (frequency, intensity, duration).

• What happens afterward (consequences).

• An FBA can help uncover patterns and help explain why a behaviour might be happening (e.g., stress in noisy environments might lead to a person experiencing unwanted thoughts and feelings, increasing the likelihood of behaviours of concern)

3. Developing a Support Plan

Based on the assessment, a Positive Behaviour Support Plan (PBSP) is created. It typically includes:

• Preventative strategies: Modifying the environment to reduce triggers.

• Teaching new skills: Helping the person learn coping strategies (like relaxation techniques or asking for help) and improving communication or social skills.

• Reinforcement: Encouraging positive behaviours through praise, privileges, or activities they enjoy.

• Response strategies: Safe, respectful interventions for managing crises without punishment or restraint, upholding the rights of the person.

4. Helping to create a supportive environment

PBS encourages creating a supportive environment:

• Stable routines to reduce confusion and stress in order to promote feelings of predictability and safety.

• Predictable social settings.

• Adjustments in lighting, noise, or tasks to match the person’s needs.

• Using evidence-based strategies to support the person in feeling safe.

5. Working as part of a holistic, multi-disciplinary support team

PBS works best as part of a team approach, involving:

• Mental health professionals (e.g., psychiatrists, psychologists, mental health nurses).

• Support workers.

• Family or carers.

• The person living with schizophrenia themselves — involving them in decision-making whenever possible.

6.  Providing person-centred support

• Some people report enjoying some the voices they hear, reporting that these voices help keep them safe.

• Some people report that they would like support to help manage voices, tactile stimulation, visions, etcetera that cause them distress.

• It is important to ensure that the person’s wishes are respected when delivering supports.

• It is important to ask the person’s consent to discuss their experiences.

7. Building quality of life

PBS prioritises the person’s overall well-being:

• Supporting access to hobbies, education, or employment.

• Encouraging social connections and community involvement.

• Fostering independence and self-worth.

How might PBS support a person who feels distressed when experiencing hearing voices?

A person living with schizophrenia may become distressed and engage in behaviours of concern when experiencing hearing voices. PBS would aim to:

• Identify early signs of distress.

• Modify the environment to reduce stimuli and promote feelings of safety (e.g., quiet time when needed).

• Teach grounding techniques to support the person.

• Support caregivers and/or support workers to engage in proactive and response strategies.

• Support caregivers and/or support workers to respond appropriately to a person experiencing hearing voices or seeing visions.

• Support caregivers and/or support workers in engaging in de-escalation strategies to support the person’s return to baseline and foster feelings of choice and control and safety.

• Involve the person in making choices to feel more in control.

Real-life example: how Jasmine supported a person who, at times, reported to fear the voices he would hear

Jasmine, Activ8 Mind Behaviour Support Practitioner, supported a male living with Schizophrenia who, at times, reported to fear the voices he would hear. Following the steps discussed in section 1 of this guide, Jasmine was able to discover the triggers for hearing a voice that created fear.

Jasmine provided individualised support for the male participant

Jasmine and the male participant worked together on skill-building regulation strategies. She placed reminders on his walls to support him remaining at baseline (being able to reduce feelings of distress when they arose).

Jasmine coached and supported his support workers

Jasmine provided support to support workers; they were responding to the man’s distress over hearing voices, seeing visions, and his beliefs by telling him that what he was experiencing was not happening. This was quite an invalidating experience for him.

Jasmine provided the support team with co-regulation strategies that helped them validate what the male was experiencing without confirming that his belief was actually happening.

The outcome

At their next session, the male participant was very excited to tell Jasmine how he had woken up feeling frightened and began hearing the voice that he feared. Before he became more distressed, he engaged in the regulation activities. This stopped the voice in its entirety and allowed him to fall back to sleep.

Do you – or an individual that you’re supporting – need support with behaviours of concern?

Our team of behaviour support practitioners provide support for individuals with Improved Relationships (IR) funding, or for those applying for IR funding (Pre-PBS assessment) in Adelaide, Melbourne, Geelong, and Ballarat.

Learn more about our team members or view related positive behaviour support content, including guides on school refusal and self-injurious and physically aggressive behaviours.

To request support from our team, please fill in the NDIS referral form, or contact us directly on 8292 5300 / 1300 575 329, or at info@activ8group.com.au.

Please note: the example in this guide shares a top-level overview of the positive behaviour support provided. It does not include detail about the FBA, the tailored positive behaviour support plan, and the number of individualised strategies included within it. Remember that everyone is unique, and the reasons behind behaviours of concern may vary, even if they appear similar. If you – or a loved one – is experiencing behaviours of concern, please see a qualified professional for personalised support.

Author: Meet Jasmine

Behaviour Support Practitioner

Jasmine brings more than 6 years of experience in the disability sector to the Activ8 Mind team, with strong expertise and interest in schizophrenia and symptoms of psychosis, and autism (ASD).

To learn more about her professional qualifications, clinical experience, and approach to positive behaviour support, visit Jasmine's team profile.