Community-Based Positive Supports

Using a Public Health Model that Emphasizes Three-Tiered Prevention and Includes a Continuum of Intervention Intensity

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A traditional approach for addressing challenging behavior is to schedule a training that addresses a positive support practice and to send one or more people to that training. Expecting the sudden adoption of a new positive support based on one workshop or training is not realistic. This “train and hope” approach does not result in significant changes in an organization because it is difficult to take new information from a training and apply it in a successful manner without ongoing support and practice.

In addition, sending a large number of people to a training and assuming they will become experts in a practice is not a good use of resources. Instead, designing trainings for people across an organization who will use the information based on their role makes more sense. Some people do need to have a high level of expertise but others may benefit from understanding universal elements of a practice and learning to work in a team with someone who has mastered a new practice like positive behavior support. One way to build a practice like positive behavior support into a setting is to use a public health model that emphasizes a continuum of increasingly intensive interventions used to meet the needs of each child or adult who is supported in a setting.

Public health leaders have long recommended that to promote health and well-being it is important to consider three tiers of prevention. This three-tiered model involves increasing the intensity of interventions for each person. A variety of different mental health, public health, early childhood, and educational settings are using a three tiered approach to improve academic, social, and emotional outcomes for people across the lifespan. The logic for using this type of an approach involves investing in universal strategies for promoting social, emotional, and physical health and wellness for everyone in a setting. Universal strategies focus on prevention, are less costly, and easier to use compared to individualizing plans for every person.

Pyramid showing the model of tiered supports. The bottom says all people, the middle says some, and the top says few.

Tier 1 - At tier 1, all people (children and/or adults receiving supports, staff, managers, family members and caregivers, and people receiving supports) in each setting are working together to improve their social and emotional skills by building positive relationships, recognizing and celebrating success, and responding to challenges that arise in a consistent manner.

Tier 2 - Strategies at tier 2 are used to monitor and problem solve when minor challenges occur that have an impact on social interactions and quality of life. Simple strategies are used at tier 2 to help people who need a little more support.

Tier 3 - There are times when someone needs more intensive and individualized support at tier 3. A few people will need more intensive plans at tier 3 and a more structured way to address complex challenges across important life transitions. At tier 3, a team forms around a child or adult to help in problem solving. Different types of practices are used at tier 3 based on each person’s strengths and needs. A person-centered or wraparound plan is often a good place to start before beginning positive support planning.

Settings Where Three-Tiered Positive Supports are Used