Module 1: Lesson 11 – High Quality Care and Support Environments and the Primary Tier

In our previous lessons, we explored the foundational concepts of Positive Behavioural Support (PBS), which adopts a holistic and tiered approach to prevention and support across different levels of need and risk. PBS models are often structured around primary, secondary, and tertiary levels:

The Primary Tier focuses on broad strategies applicable to all individuals within a service. The goal is to enhance the overall quality of care environments and promote policies and practices that support the well-being and rights of people with learning disabilities.

The Secondary Tier involves targeted strategies for individuals showing signs of increased need or risk, aiming for early identification and prompt intervention to prevent the escalation of challenging behaviours.

The Tertiary Tier provides intensive support for individuals with the most complex needs, utilizing specialized, highly personalized interventions to address specific challenges.

Capable Environments and Active Support fall within the primary tier, representing the kind of high-quality support you’d expect in excellent care environments. These approaches are integral to creating settings that enhance life quality and reduce the risk of behaviours that challenge. By focusing on capable environments and active support, we aim to ensure physical and social settings that promote positive interactions, engagement, and personal development.

Capable environments are designed to enhance the quality of life for individuals, especially those with disabilities or challenging behaviours. The concept, championed by Peter McGill from the Tizard Centre, aligns closely with Positive Behavioural Support. The primary goal of PBS is to improve a person’s quality of life, thereby reducing the occurrence of challenging behaviours. When people’s needs are met, behaviours that challenge are less likely to emerge.

Capable environments are structured around several key areas that together create a supportive and enriching atmosphere. These areas include positive interactions, effective communication, meaningful activities, predictable routines, choice and autonomy, relationships, skill development, health and personal care, the physical environment, and organisational support.

Positive interactions foster a culture of respect and positivity within the support team. Frequent and meaningful social interactions tailored to the individual’s preferences help build trust and rapport. Effective communication involves using clear and consistent methods, ensuring the individual understands and can express themselves. This might include communication aids or atypical methods of communication if necessary or preferred.

Providing a variety of activities that the individual enjoys and finds meaningful helps keep them engaged and stimulated. Establishing consistent and predictable routines helps individuals know what to expect, reducing anxiety and improving overall well-being. However, it is important to balance this with opportunities for choice and autonomy, allowing individuals to make decisions about their daily lives, big or small.

Encouraging and maintaining relationships with family, friends, and the community supports social integration and emotional well-being. Offering opportunities to learn new skills is important for personal growth, regardless of the individual’s abilities. Meeting health and personal care needs is fundamental, as physical well-being directly impacts quality of life. Ensuring the physical environment is suitable, including meeting sensory needs and providing a comfortable living space, is also crucial.

Organisational support is essential. A well-supported and trained staff team that works cohesively can provide better care and support. The rationale behind capable environments is grounded in the understanding that the environment plays a significant role in shaping behaviours. By creating an environment that meets the needs of individuals, we can significantly improve their quality of life and reduce challenging behaviours.

Active Support is a model designed to assist individuals with intellectual and developmental disabilities in engaging with their environment and participating in meaningful activities. It focuses on enabling individuals to lead fulfilling lives by fostering skills, independence, and a sense of inclusion within their communities.

Active Support is built on four key principles that guide the approach to engaging individuals in meaningful activities: Every Moment Has Potential, Little and Often, Graded Assistance, and Maximising Choice and Control.

Every Moment Has Potential encourages recognising every moment as an opportunity for engagement, even in routine tasks. This principle promotes creative thinking about how to involve individuals in ongoing activities. Little and Often supports participation in small parts of activities frequently throughout the day, helping individuals build confidence and skills over time. Graded Assistance involves providing just enough help to enable successful participation, and adjusting the level of support based on the individual’s current needs and the task at hand. Maximising Choice and Control offers opportunities for individuals to make choices and take control over their engagement, respecting their preferences and allowing them to decide how, if and when they participate.

To effectively implement Active Support and capable environments, break activities into smaller, manageable steps. Identify which parts of an activity an individual can do independently, which parts they can do with prompting, and which parts require full assistance. Take into account the individual’s skills, interests, and preferences to tailor activities to their capabilities and make them more engaging. Be flexible and creative about the location, timing, and method of activities to make them more accessible and enjoyable.

Graduated guidance, or graded assistance, is a crucial aspect of Active Support. This involves providing the right level of support, gradually reducing assistance as the individual becomes more capable. This approach encourages independence while ensuring safety, success and confidence.

While structure and routine are important for predictability and security, it is equally important to introduce new activities and opportunities. This balance helps individuals grow and experience new things, preventing stagnation and promoting a richer quality of life. Understanding the history of the person you support is crucial. Many individuals may not have had opportunities to try new activities or develop certain skills due to their disabilities and discrimination. Encouraging them to explore new activities, visit new places, and learn new skills can be highly beneficial. Predictability and routine should not be excuses to avoid introducing novel experiences.

Creating capable environments and implementing Active Support is about ensuring that every aspect of an individual’s life supports their well-being and growth. By focusing on these key areas, support teams can provide comprehensive, effective, and person-centred care that truly enhances the quality of life for those they support.