HCBS Training

Integrating Person-Centered Strategies and Other Positive Supports

diverse people with hands interlocked

In addition to person-centered practices, organizations often use other positive supports to help improve the lives of people receiving Home and Community-Based Services (HCBS). These practices are meant to improve emotional and behavioral health outcomes for people and to improve quality of life. The term positive supports refers to strategies and practices that are:

  • Person-centered in nature, sensitive to the unique cultures and backgrounds of each individual, and respectful towards people receiving support,
  • Evidence-based or promising practices,
  • Adapted and improved over time using assessment processes as a guide, and
  • Often implemented with more than one practice as part of a team-based approach.

You may not recognize all of the different positive supports listed on this page because positive supports are used to support the unique needs of people across human services and across the lifespan. Some examples of positive supports include:

teacher supporting student with down syndrome in an inclusive classroom

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 can use ABA to help their children learn new social skills. Teachers use ABA in classrooms with groups of students or with one child who needs more help to improve academic outcomes. ABA can help adults with disabilities who are living on their own in the community.  Businesses organize work settings using ABA so that employees can get more work done. Applied Behavior Analysis can be used to prevent challenging social interactions and improve quality of life. In fact, ABA can be used by people of all ages who want to change behavior in some way.  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. Over time, this practice has been expanded to support people with a range of issues that are related to self-regulating behavior. People who learn to self-regulate can recognize and cope better with 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 that help people 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 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.

RTI is 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. Strudents 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.

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.

Learning more about different types of positive supports can help your organization both improve services and connect with other types of practices that can help improve quality of life for people.

You can visit the Minnesota Positive Support Practices website to learn more about some positive support practices that are common in Minnesota.