Feature Issue on Person-Centered Positive Supports and People with Intellectual and Developmental Disabilities
Implementing Evidence-Based Positive Support Practices in Applied Settings
Rachel Freeman is Director of State Initiatives at the Research and Training Center on Community Living, Institute on Community Integration, University of Minnesota, Minneapolis. She may be reached at firstname.lastname@example.org.
In the past decade, there has been an increasing value placed on using evidence-based practices to improve quality of life for children and adults with intellectual and developmental disabilities (IDD). While great strides have been made during this time in the development and identification of evidence-based practices, difficulties translating these research-based strategies into everyday settings continue to be problematic. In fact, some experts suggest that translation of research into practices that are meant to support people in real-world settings can be delayed up to 20 years or more (Metz & Bartley, 2012). A growing interest in improving the impact of evidence-based practices in home, school, work, and community settings has led to a science of implementation.
The purpose of this article is to describe how the principles of implementation science can help ensure the effective and sustainable use of evidence-based positive support practices by organizations working with persons with IDD.
The Meaning of Positive Support
The term positive support is used in this article to refer to practices that have these characteristics:
evidence-based and evidence-informed
implemented in a manner that allows for ongoing evaluation and monitoring
Each of these characteristics is further described below.
Evidence-based practice is a term used across education, medical, and human service systems. The American Psychological Association definition states that evidence-based practice is “…the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA, 2002). According to the Association for Positive Behavior Support, “Evidence-based practice….is defined as the integration of rigorous science-based knowledge with applied expertise driven by stakeholder preferences, values, and goals within natural communities of support.” (APBS, 2016). Although there are slight differences, many evidence-based practice definitions have the same major themes. Evidence-informed practices are strategies that have not established the amount of research necessary to be considered evidence-based, but have data collection systems in place to evaluate their effectiveness in applied settings.
In the past, there was an assumption that people received services and, as consumers, should be placed into existing services and supports that were considered by others to be the best fit. The opinions and preferences of people with disabilities were often ignored in this older paradigm of service provision. Person-centered values place the person at the center of important decisions that impact his or her life. In this new paradigm, people with IDD have the right to live life in the same manner as any other person within their communities. Supports are tailored to meet the needs of each person.
The development of cultural competence refers to the ability of a person or system to respect, understand, appreciate, and interact with the people who live or work within a setting. Examples of cultural differences include age, abilities, religion, beliefs, ethnicity, geographic or social groups, race, gender identity, sexual orientation, and socioeconomic status.
Ongoing Evaluation and Monitoring
Positive support practices include systems to assess whether practices are increasing quality of life over time. Fidelity of implementation, the extent to which a practice is being implemented in the manner intended, is an important tool in the evaluation process. Quality of life data, the frequency and intensity of incidents related to problematic events, staff climate, satisfaction levels of people being supported, and staff and retention/tenure data are all examples of types of information used to evaluate a positive support.
A growing interest in improving the impact of evidence-based practices in home, school, work, and community settings has led to a science of implementation, which can help ensure the effective and sustainable use of evidence-based positive support practices by organizations working with persons with IDD.
The Multi-tiered Systems of Support Model
The term three-tiered systems of support refers to a conceptual model from the field of public health, where it describes a strategy designed to prevent the spread of disease by outlining three levels of prevention (Gorden, 1983). The model has been adapted for education and human service settings as a way to encourage success and prevent failure in achieving positive academic, social, and/or quality of life outcomes for children and adults across a number of different settings including schools, mental health services, juvenile justice, and residential supports.
The terms primary, secondary, and tertiary prevention are used to describe each of the three levels. Primary Prevention refers to the use of universal strategies for all people within a setting. These universal strategies increase the use of positive supports and decrease the need for more intensive strategies. Secondary Prevention involves using data for early identification so that people can benefit from positive supports before academic, social or quality of life problems are encountered. At the Tertiary Prevention level, people receive more intensive supports based on their unique needs. When more than one type of practice is being implemented using a three-tiered model, it is referred to as multi-tiered systems of support. Figure 1 provides an example of person-centered practices and positive behavior support strategies implemented using multi-tiered systems of support.
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