Examples of Skill-Building in Positive Supports

Creating Supportive Environments

An important first step when implementing any positive support is to make sure we are creating a supportive environment. Let’s begin with this question in mind: What are elements of a supportive and person-centered environment?

We often think of comforting, empowering, and nurturing spaces when creating a supportive context. What social and environmental features should we consider as we develop these types of supports with the children and adults we serve?

An important first step is to make sure that everyone understands that what is supportive for their own needs may not be the same for another person. Each person's cultural background, beliefs, and values impact what we believe is supportive. Once you understand what is important to and for a person, you can help that person choose positive supports that work well within a supportive environment.

Think about the routine or setting you find most comforting in your life and write down the key elements of this routine. Include details about what needs to be present, the temperature and noise levels, how many other people are present in the room, and what major colors are present. Share this with someone else at work or at home. Now consider adopting the other person's comforting environment. How does this make you feel? Would you feel comforted in this person's comforting routine?

Positive Supports are evidence-based approaches that are implemented using person-centered and culturally responsive values with data that can show improvements occurring over time. A few examples include:

Assertive Community Treatment

Assertive Community Treatment (ACT) improves outcomes for people with severe mental illness and may be more likely to be at-risk of hospitalization and other negative life outcomes including possible involvement in the criminal justice system. The practice involves forming a multidisciplinary team including community outreach and action planning.

LifeCourse (Charting the LifeCourse)

A person-centered planning process is a framework with tools that can be used to help people organize ideas, values, and goals in order to problem solve and improve quality of life over time. Parents, case managers, mental health professionals, teachers, family members and friends, and anyone interested in exploring ways to problem solve, navigate their life, advocate for changes in supports can use Charting the LifeCourse. Although not an evidence-based practice, person-centered strategies include the values that are part of positive supports.

Person-Centered Practices

Three elements of person-centered practices:

Person-Centered Strategies that everyone can use to help people learn about what brings joy to someone and makes life worth living. These tools are also used to find out what is important to a person as well as understanding their needs for health, safety, and well-being.
Person-Centered Planning is a process that is used to create a plan for a positive and meaningful life for someone by building on their interests and strengths. There are different methods that can be used to help a person create their dreams for a better future.
Person-Centered Organizational Changes address how services and supports are planned and delivered. Changes that are made include fixing policies, adding ongoing opportunities for learning, and building community supports. Services for people across the lifespan are changed in ways that improve quality of life outcomes.

Although not an evidence-based practice, person-centered strategies include the values that are part of positive supports.

Positive Behavior Support

A framework used to improve the quality of a person’s life and prevent or decrease challenging social interactions. The tools and strategies used in positive behavior support encourage social and communication skills and involve changing social settings to prevent challenging behaviors. Positive behavior support is based on research from areas including biomedical and behavioral science. Research also guides how positive behavior support is implemented in education and human service settings using a tiered model with interventions that gradually increase based on each person's unique needs. The universal level, or tier one, includes interventions for improving the quality of life and social interactions for everyone within a provider setting. The second tier involves monitoring HCBS data to identify problems that a person might have as early as possible and to intervene when challenges are still minor. The third tier is used to create individualized plans for each person who needs more intense supports.

Trauma-Informed Support

Systems, training, and tools embedded in organizations to shift the viewpoint towards an understanding that trauma is a widespread issue and that it is important to recognized signs and symptoms of trauma in people receiving services. This information is integrated into policies, procedures, trainings, and practices in order to avoid re-traumatization.

Wraparound Planning

A process created to support parents of children and young people with mental health needs and challenging behavior are often expected to communicate with a number of different service systems. Each of these services require parents to complete forms, attend meetings, and respond to requests related to services. Juvenile justice, children and family services, special education, mental health, and developmental disabilities are all examples of these different services. The wraparound plan is mean to help youth and their parents by improving service coordination. Wraparound planning is a team-based approach that is child and family driven. Team members include natural supports (friends, family members, and people who know the child or young person well). Individuals from formal supports might include a parole officer, counselor, psychiatrist, or special education teacher. The goal of wraparound is to assess the child and family strengths in order to build a plan of support that will improve quality of life.

Response to Intervention or RTI

An educational practice that involves early identification of the academic and social supports needed for all students in school. An increasing continuum of interventions is provided to students needing more educational and behavioral support to ensure academic success. The RTI model has three tiers of academic interventions that increase in intensity across each tier. RTI involves effective instruction for all students and universal screening in general education classrooms. Students struggling with academic goals are provided with interventions based on what they need to improve learning outcomes. Student progress is monitored on an ongoing basis with each child receiving the needed intensity and duration of instruction based on the data that are being collected to monitor and improve progress.

Systems of Care

A system of care is a coordinated network of community-based services and supports designed to meet the challenges of children and youth with serious mental health needs and their families. These partnerships of families, youth, public organizations and private service providers work to more effectively deliver mental health services and supports that build on the strengths of individuals and fully address children’s and youths’ needs. These systems are also developed around the principles of being child-centered, family-driven, strength-based and culturally competent, engaging youth and involving interagency collaboration.

Being person-centered means that we are thinking about what is important to a child or adult while making sure that planning processes also address what is important for their health and safety. Balancing what is important to and for someone is an important element needed to create a supportive environment. A supportive environment takes into account the physical, personal, and social and emotional aspects of a particular setting.

What is important to a person includes feelings related to:

Comfort: Feelings that are soothing and ease distress, experiencing routines or activities that are well known to someone, the sense of assurance freedom from pain
Cultural Values and Beliefs: Our feeling of connection to a larger community and being able to feel that we are acting on our values and beliefs everyday.
Enjoyment: The pleasure or satisfaction we feel from being part of a group of people, completing something important, experiencing a positive emotional state
Relaxation – Events and activities that help decrease stress or tension
Wellness: Achieving or working towards a healthy mind and body
Social Connection: Forming meaningful connections with others, building relationships and feeling valued by others
Personal Development: Growing as a person and achieving the ability to feel self-actualized and confident in one's own abilities
Belonging: A feeling that one is accepted and contributes to a one or more individuals or a community of people
Pursuit of Happiness: The opportunity to seek contentment, pleasure, joy, or good fortune, and what brings such

Four overlapping circles. In the middle is supporting what is important to and for a person. Surrounding that is physical environment, personal environment, and social emotional environment.

Skill-Building Activity: Creating a Supportive Environment

These slides provide one example of how you can help someone learn more about this topic. Think about who might benefit from learning more about creating supportive environments. You might meet with a family member informally, bring this activity to a staff meeting, or organize a breakout activity where several people can talk and share their ideas. The main goal for this activity is to help people think about what a supportive environment is to them personally. Sharing personal ideas about supportive environments shows us how different our beliefs and values are and help us learn about different cultures.

You can watch how this skill-building activity called Creating a Supportive Environment was presented in a webinar setting.

The goal is to help others think about how their own preferences can sometimes interfere with supports for the children or adults they serve. Imagine living in a setting where every day a new person is present in your life who expects you to engage in a different morning routine. This is a common experience for people with disabilities, traumatic brain injury, and mental health issues who receive support from different staff. Each staff applies their own experiences when assisting someone in their morning activities. If the person is not consulted about what is important to them during their morning routine, life can feel chaotic, and driven by the decisions of others.

Cultural values are an important part of the preferences we develop over our lives because these deeply held beliefs help us feel connected and contribute to our quality of life. In our efforts to be person-centered, we may forget that a community mindset rather than an individual decision-making approach may be more important to some people.

For instance, in some cultures, the family and larger community are held in high regard and decisions are made together. Decisions are made within the context of this larger community or within an entire family. the emphasis on individual decision making is not considered to be as important. Not realizing this different cultural frame can contribute to feelings of disconnection, confusion, conflict, and trauma.

Use person-centered tools to help people gather information and build stronger relationships
Ask the person you are supporting about everyday routines that are important
Spend time learning more about the cultural background of each child or adult supported
Use active listening skills when interacting with the child and adult and the people who are important to them
Organize times for each person involved in supporting a person to reflect on the cultural values and beliefs they have so that everyone has a chance to learn from each other
Set aside some time to observe a child or adult who may not be able to communicate what is important to them
Ask people who know the child or adult well about what a supportive environment might look like, especially if the child or adult has trouble communicating these details

Visit the Module 3 Resouce Page for more ideas, tools, and resources that can help you gather information.