Considerations for Working with Parents in Behaviour Support
Introduction
Working directly with parents and family members in Positive Behaviour Support (PBS) can require a different approach to working with paid support staff. There may be more emotion involved, different practical pressures, and a need to think particularly carefully about how our recommendations are experienced by the family.
In this article, I want to share some of my experiences and recommendations for working alongside parents and family members of PBS participants. In particular, I’ll explore how I try to work holistically while considering family burnout, capacity, and the way parents or carers may be thinking and feeling about their child — and themselves.
What’s Different About Working Directly with Parents and Family within PBS?
One crucial difference when working with parents and family members as the direct implementers of PBS strategies is the level of emotional involvement. This can be incredibly positive when parents are proactive and keen to try strategies for their child. However, it also means we need to think carefully about what is appropriate and emotionally safe for everyone involved.
If you don’t reflect before working with this participant or their family, you run the risk of putting people offside, or even worse, genuinely causing them distress. And this needs to be ongoing reflection - while you’re getting to know them, while you’re asking them to complete behaviour recording, while you’re writing your PBSP and giving it to them for feedback, etc.
There may also be more practical and educational differences too. This might include:
Increased face-to-face time and deeper connection with the participant for strategy implementation
Reduced understanding of NDIS processes and legislation, especially around restrictive practice
Possible hesitation to commence services or invite you to their home (as a parent, I also feel a bit awkward and uncomfortable when a strange professional comes into my home to talk about my kids)
Needing to more heavily adjust your approach to suit their preferences and what works for them (e.g. prefers to tell you about incidents at visits rather than complete a behaviour record)
Working your visits around school, daycare, after school activities, etc (expect lots of appointments between 7-9am and 3-6pm)
Chance of reduced visits and communication around school holidays
Fewer workarounds when mum and dad are busy; you may sometimes just need to wait for them to get back to you and this has sometimes taken months in my experience when something happens within the family
In my experience, these differences mean that good family-centered PBS isn't simply about developing appropriate strategies — it's also about developing strategies that a particular family has the capacity, confidence and willingness to implement.
How Might You Need to Approach Your Practice Differently?
Firstly, I try to approach this work with the mindset that it is a privilege to be invited to work with someone's child — because it really is. We're being trusted to enter what can be a very sacred space and look at parts of family life through a professional lens.
I think it's important to remember that this can feel intimidating, exposing or stressful for parents. We're potentially asking questions about difficult moments, observing family interactions, discussing behaviour and eventually making recommendations about what might need to change.
This is very different from working with a paid staff member who implements strategies as part of their professional role. For that reason, I find that working directly with families often requires a gentler and more considered approach.
To help with this, my communication and visits are focused on:
Showing that I’m there to understand and help, not to judge - my priority initially is helping the family understand that I'm there to understand and support them, rather than assess or judge their parenting. So I might chat away or play a game with the family before I start shifting into more behaviourally-relevant topics of discussion
Sometimes sitting and observing the family dynamics to see how everyone is working together (or not working)
Trying to gauge the parent’s understanding of what they think is going on and what their child is communicating and experiencing (as this helps you know how much foundational work you may have to do here)
Connected to the above, understanding what successful strategies already exist that I can show to the parents as a positive (‘see, you’re already doing great with this’) and build upon this
Noticing how tired, stressed or busy the parents seem to be, because this helps me decide how many strategies it is realistic to introduce at once, and whether something needs to be delayed, simplified or reduced
If I’ve noticed a potential restrictive practice, asking some questions about it to understand why it’s in place and what it means to this family.
For me, this isn't separate from good behaviour support practice. Understanding the capacity, confidence, priorities and existing strengths of the people who will actually implement a PBSP helps me determine which strategies are likely to be realistic and sustainable in that family's everyday life.
Noticing a Restrictive Practice
As a note on the above, if you see a restrictive practice, don’t come out guns blazing saying ‘That’s a restrictive practice!’ as you’ll most likely stress out the family and bring up all sorts of feelings that you might not be equipped or ready to help them handle. Parents are much less likely to know what this jargon means and it sounds awful from the outside of this space, like prison or abuse or like they’re doing something wrong to their child.
This is where you put your question cap on and ask them to tell you what something is locked for, why this is out of reach, why they locked the door behind them, etc. And don’t forget, sometimes these things can be developmentally appropriate! I have a young child at home so keeping things out of reach and my front door locked at all times is something I do for safety.
So rather than immediately labelling something as a restrictive practice, I first try to understand exactly what is happening, why it is happening, and the context around it. If I identify that a restrictive practice may be occurring, I then explain the concept carefully rather than assuming the family already understands the terminology. My approach with this is to preface it by explaining what it is, agreeing that it has a horrible name, and it’s referring to something we’re doing to keep the child safe right now because of past concerns (which is a very normal parenting response).
I also want to understand what this restriction means for this family. For example, I visited a new family where I found my participant was prescribed an antipsychotic but didn’t have any relevant diagnoses (so, a potential chemical restraint). I asked more about it and found out that dad was really worried about the long-term effects of the medication, but mum seemed distressed at even the thought that this medication might not be forever. She could distinctly remember what life was like before this medication was prescribed and had negative memories that were still very present in her mind.
So when I wrote this participant’s PBSP, I thought about how to word this in a way that respected the participant and the views of his parents, while outlining a fadeout process that might work for everyone. This involved medical reviews, psychiatrist consultation, and the opportunity to allow PBS to start working for this participant so we could slowly assess over time and consistently move towards reduction instead of pulling the rug out from underneath.
I’ve talked about this part more than I expected, but I really can’t overstate the importance of being a gentle protector for the parents as well as the participant. Scaring or worrying them will have flow on impacts which can impact your ability to work with the participant.
Before Beginning a Report or Visit, Put Yourself in their Shoes Each Time
The best thing you can do is to practice shifting your perspective into the eyes of a parent or family member. I’ve read PBSPs before where I’ve known the parent is going to read it, and I’ve seen the BSP link the parent or parenting approaches to increases in the behaviour. The observation may be relevant to our formulation, but that doesn't necessarily mean it needs to be communicated in that way. We still need to consider how we describe what we're seeing, how the parent is likely to experience it, and whether our wording will help or hinder our ability to work together.
Before I say or write something about a family, I find it helpful to mentally change seats for a moment and imagine receiving that information as the parent. I might ask myself:
If I was this person’s parent, how would I feel to read this information? What if I didn’t already know what it meant?
What would I think when I see my child’s behaviours written down on paper?
What if my involvement in this is described too? I might even be listed in the triggers or setting events.
Does reading or hearing this suggest that my parenting may not have been good enough?
Could what I'm reading or hearing make me feel as though I've failed or done something wrong as a parent?
Most of us can imagine what it feels like to fail at something or realise we've made a mistake (unless you've somehow never once been wrong in your life!). Now imagine that feeling being attached to something as deeply personal as your parenting or your child's wellbeing. For some parents, that can make conversations about behaviour, risk and support particularly sensitive.
Practical Considerations for Writing the PBSP with Parents and Family as Key Implementers
Once I've considered how my recommendations might be experienced by the family, I can move onto the practical questions about whether those recommendations are actually realistic:
Does this person have the mental capacity to do this?
Do they have the physical capacity and time too?
Will they be getting torn between lots of competing priorities so implementation might not be consistent?
Will failing to be consistent in doing this make them feel a certain way about themselves or their parenting?
Will we have both parents or multiple family members on board, or will the pressure of this work be sitting with one person?
Importantly, what is this family already doing successfully that we can build upon?
These questions will help you understand how your PBSP needs to be written, especially how many proactive and reactive strategies you can realistically provide here. I often tell my supervisees that, when you're working with burnt-out parents, one strategy implemented well and consistently can be far more valuable than five strategies they simply don't have the capacity to manage right now.
People who feel like they’re failing can sometimes withdraw to protect themselves, so we must avoid setting up our parents for failure. Instead, let’s work out what they’re already doing, and add things bit by bit, helping them to feel like they’re doing a good job already and we’re just taking it to the next logical step. This approach tends to be much more empowering.
Make It Work For Them
Something that you must consider in your approach is how you’re going to prepare and present the resources to the family. If we don't consider this, we can end up giving parents the same resources we might provide to paid staff who are already familiar with the NDIS and behaviour support. As we've already established, though, these implementers aren't necessarily starting from the same place.
Handing a parent a 50+ page document focused on laying their child’s life and its perceived faults out on paper could be a confronting experience for them. It also runs the risk of immediately switching off a parent who sees that giant report and thinks, “I can’t follow all that!”, Or even worse, “this report is just covering compliance and what the government needs, it’s not for helping my child at all!”
To reduce the chances of the above happening, I always preface the PBSP by explaining the purpose of this document as a living document that covers all sections we need for success. Then I show them the other resources I’ve already prepared in advance to make their job as implementers easier to reference. This might look like a PBSP Summary Guide containing the key strategies, or a PBS Parent Guidebook that also incorporates opportunities to record data, information about support and resources available to the family, and additional context about their child's likely functions of behaviour.
The PBSP may need to meet formal requirements, but that doesn't mean it has to be the only resource we expect a family to use in their everyday life. You can develop your own resources depending on what will work for the family. Each PBSP is unique, so the supporting resources may need to be unique too. A bit of creativity can go a long way in helping implementers understand and remember what you're recommending.
In Summary, Considering Your Approach with Parents includes Asking Yourself:
1. How will this feel?
Consider how the parent might experience what you're saying or writing.
2. Can this realistically work?
Consider capacity, time, competing priorities, family dynamics and implementation barriers.
3. What can we build on?
Identify what the family is already doing successfully and introduce manageable change from there.
4. How can we make this information easier to understand and use?
Consider how the PBSP and supporting resources can make the key strategies clear, accessible and practical for the people implementing them.
Additional Factors You May Need to Navigate
There is a massive range of other factors that come into play when working directly with parents and family members, and each one of them potentially needs their own article!
However, I just want to mention some of the scenarios I’ve come across as a Practitioner or as a Supervisor that I’ve had to navigate.
One parent or family member has a completely different experience of the child to the other parent, and both may be correct too
Someone may be reluctant to accept that their child is having difficulty, or may refuse their diagnosis
The parents may be separated and the child is moving between different homes and environments (which can lead to different concerns and inconsistent strategies)
There may be siblings intertwined in the behaviour dynamics
There may also be siblings with additional needs which require parents to divide their attention depending on the highest risk at the time
Family violence may also be present or form part of a family's history, which can significantly affect family dynamics, safety, risk and how we approach our work.
This is just a drop in the ocean, and each of these situations can become quite complex. This is where I'd involve my supervisor — not necessarily because I don't know what to do, but because another experienced practitioner can help me test my reasoning, consider perspectives I may have missed, review how I've worded sensitive information, and act as a sounding board before I have a difficult conversation.
Conclusion
Overall, take things slowly when you're engaging with a new family. Take the time to understand the people involved, their dynamics, capacity, strengths and concerns before deciding what good behaviour support needs to look like for them.
Most importantly, keep reflecting on how a family member is likely to read or hear what you're about to say. Something can be clinically relevant and still need to be communicated thoughtfully. A technically sound strategy can also be completely unrealistic for a family to implement right now. Good professional judgement means considering both.
A useful set of questions I've come across, often attributed to Craig Ferguson, is:
Does it need to be said?
Right now?
By me?
And I’d also add a fourth question: Is this the kindest way this can be said?
Want a space to think through complex family work?
Working with families can involve situations where there isn't one obvious “right” answer. Supervision can provide a space to test your reasoning, think through sensitive conversations, consider how your PBSP might be experienced by the people reading it, and work through implementation barriers.
If you're looking for a space to develop these skills, you can learn more about my PBS supervision or book a free 20-minute chat to see whether it might be a good fit.
