HCBS Training

Assessment of Positive Supports Used in Services

Starting point

Teams completing a self-assessment can create a list of positive supports the organization currently uses. Each service tends to use positive supports that match the needs of the people receiving services. Positive supports are selected based on the age of the person receiving services and the physical and behavioral healthcare that is needed. Think about the key elements of each positive support currently used in the services you provide:

  • How is training provided to staff members?
  • Do trainers attend events to update their positive supports skills?
  • What details are included in onboarding and in-service training for staff?
  • Are there strategies for evaluating whether a positive support is being used as intended (Fidelity of Implementation)?
  • Is there a summary of positive support practices and outcomes that happen over time?
  • How does each positive support align with person-centered practices?

Some examples of positive supports are included below.

Applied Behavior Analysis (ABA) is an example of a positive support. People use this practice to change social behavior and improve lives. For instance, parents learn to use ABA to help their children learn new skills, sometimes in the context of early intensive intervention provided by a team of staff. Teachers use ABA in classrooms with groups of students or with one child who needs more help to succeed. ABA can help adults with disabilities live on their own in the community. In fact, this positive support can be used to support people of all ages who are learning new skills and different ways of doing things to improve the quality of their lives. Businesses organize work settings using ABA so that employees can get more work done. Applied Behavior Analysis is also used to prevent challenging behaviors and improve quality of life. It is important to ask people how they use ABA since it can be used in so many different ways.

Dialectical behavior therapy is a type of cognitive behavioral treatment originally used to support people with borderline personality disorder that has been expanded to support people with a range of issues that are related to self-regulating behavior. People who learn to self-regulate learn to recognize and handle strong emotions. Dialectical Behavior Therapy or DBT has been used to address a number of mental health issues including post-traumatic stress, binge eating, depression, and substance misuse. The main goal of dialectical behavior therapy is to learn four strategies: 1) develop skills to regulate emotions, 2) practice mindfulness skills to live in the moment, 3) increase the ability to tolerate distress, and 4) expand relationship-building skills. Therapeutic settings for Dialectical Behavior Therapy involve working in groups to learn new behavioral skills, meeting for individual therapy, and engaging in coaching sessions.

Positive Behavior Support is 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.

Parents of children and adults 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. 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  person well) and formal supports such as a parole officer, counselor, psychiatrist, or special education teacher. The goal of wraparound is to assess the strengths of the person and their family  in service of building a plan of support.

RTI is an educational practice that involves early identification for all students in school and an increasing continuum of interventions 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 Struggling learners are provided with interventions based on what they need to improve learning outcomes. Student progress is monitored on an ongoing basis with each student receiving an intensity and duration of instruction based on the data that are being collected.

Traumatic life experiences such as child or domestic abuse, natural disasters, or other negative life events can have a lasting impact on a person’s health and emotional wellbeing. Trauma-Informed Cognitive Behavior Therapy is an evidence-based practice that addresses this issue. Trauma-Focused Cognitive Behavior Therapy is a positive support that teaches children and adults skills to recognize negative or unhealthy thoughts associated with past experiences and to engage in stress management and coping strategies when these thoughts occur. This approach can also include teaching new skills for parents and caregivers of children involved in therapy. A family therapy approach is used to help recognize family dynamics, teach new parenting skills, support stress management for both child and family members, and work on improving communication skills.


  • Please continue working through item #13 in the MN Team Checklist (the self-assessment) using the HCBS Planning Tool.

Deeper Dive into Self-Assessment of Positive Supports.

  • What positive support practices are used by your organization to improve quality of life?
  • How is training provided to staff members?
  • How do trainers maintain and improve their skills over time?
  • Are there strategies for evaluating whether a positive support is being used as intended (fidelity of implementation)?
  • Is there a summary of the outcomes of positive support practices over time?
  • How does each positive support align with person-centered practices?

Minnesota Team Checklist

HCBS Planning Tool

If you haven't already done so please use these links to access the tools.