'Positive Behavior Support' begins transforming human services in Johnson County

LAWRENCE — Researchers from the University of Kansas have teamed up with corrections and social service agencies in the state’s most populous county to improve outcomes and make life better for area residents.

In a pilot program, the Kansas Institute for Positive Behavior Support has brought evidence-based tools and strategies to Johnson County’s Department of Corrections, Mental Health Center and Developmental Supports. The KIPBS work aims “to increase both quality of life and the likelihood that youth and adults with challenging behavior related to mental health, substance use, or intellectual or developmental disability will be able to remain successfully in their home, school, work and community settings.”

In February, the collaboration of the KIPBS and Johnson County saw the graduation of the first 10 employees to have completed Intensive PBS Certification.

“Johnson County has some unique features that make it a perfect place to pilot countywide positive behavior support,” said Matt Enyart, director of the Kansas Institute on Positive Behavior Support and investigator with Beach Center on Disability at KU’s Life Span Institute. “Contrary to most counties in Kansas, where independently operated nonprofits administer core human services, all of the core human service departments in Johnson County are centrally administered by the county government. This central oversight in Johnson County makes implementation of positive behavior support possible countywide. Nowhere else is someone using positive behavior supports across mental health, corrections, substance-use disorder treatment and intellectual-disability services.”

KIPBS trains county staff to acknowledge and reward positive conduct versus being reactive or punitive, according to the KU researcher. For instance, employees in Johnson County’s Department of Corrections Therapeutic Community now are “catching” clients exhibiting good behavior and rewarding them.

“If we were to highlight the biggest benefit so far, it has been in the Department of Corrections,” Enyart said. “We’re running a pilot program in the adult Therapeutic Community program — a court-ordered substance-abuse program. They once had a highly punitive, corrections culture where all disciplines were sanctions-based. Residents reported it was too punitive. They had difficulty making progress. Once they implemented the PBS framework, they removed all punitive aspects of their program.

According to Chelsea Hunter, senior substance abuse counselor and PBS leadership coach at Therapeutic Communities in Johnson County, the shift from punitive to positive approaches in her agency already has resulted in more positive outcomes.

“Our previous, more punitive approach diminished motivation for recovery for many of our clients,” she said. “PBS has allowed my treatment team to spend more time focusing on helping clients gain the personal insight necessary for long-term recovery and improved the clinical progress being made by our clients.”

Enyart likens KIPBS’ collaboration with county agencies to putting together furniture from IKEA.

“I tell a new team when we’re implementing with them, imagine we’ve gone to IKEA and you’ve picked out something you like,” he said.  “We’ve got this box, and we’re going to open it. In this task, our job at KIPBS is to make sure the engineering is right when putting it together. Their job is to make sure it fits what their needs are. It’s critical that we build it together, but they get to decide where they put the emphasis. Everything is data-based — we’re always collecting information. We focus on democratic principles and combine them with implementation science.”

Following this model, Johnson County Mental Health now is using positive behavior support with its clients experiencing psychological and substance-use problems in the Crisis Recovery Center, Adolescent Center for Treatment and Adult Detox Unit. KIPBS also is guiding a pilot PBS program in residential and day programs for Johnson County Developmental Supports, which supports more than 500 county residents with intellectual and developmental disabilities.

According to the KU researcher, the next steps for KIPBS in Johnson County involve expanding the pilot programs and collecting more data. Enyart said a key goal of implementing PBS programs is to improve the quality of life for people who face systemic disadvantages. 

“We built this program using research on historically marginalized populations in restrictive systems,” he said. “For individuals with disabilities or individuals of color, we need to focus on systems practice and how people are evaluated. We can address some of those issues around social constructions of target populations, such why are so many individuals with mental illness ending up in corrections, and why are people with disabilities ending up in corrections? This way, we can look at data and ask, ‘Are community supports not effective enough?’”

Going forward, the work in Johnson County will serve as a model for expanding PBS programs to other communities.

“That’s absolutely our hope — to scale up in other counties and continue to learn,” Enyart said. “This is a comprehensive, complex project, and we’ve been really happy with what we’ve done so far. Right now, we have data-evaluation teams doing more in-depth research on different populations and taking a deeper look at outcomes. We still have a lot to learn. We hope to manualize this, to look at lessons learned, to see what worked, and then refine our procedures and methods. But it’s critical there’s an implementation-science piece. Every county is going to need to contextualize this to make sure it fits with their programs.”

Top photo: In a pilot program, the Kansas Institute for Positive Behavior Support has brought evidence-based tools and strategies to Johnson County’s Department of Corrections, Mental Health Center and Developmental Supports. Credit: Pexels.com.

Top right photo: On Feb. 8, Matt Enyart, KIPBS director, joined Johnson County Community-wide Positive Behavior Support (CWPBS) Project partners to celebrate recent graduates of the Intensive Positive Behavior Support (PBS) Training and successful Organization-wide Positive Behavior Support (OWPBS) implementation at all six of the pilot programs. Photo courtesy of Matt Enyart.

Bottom right photo: In July 2018, Antonio Booker, adult residential center director, shared new signage, reflecting that all Therapeutic Community Program clients and staff can achieve their GOALS. Credit: Matt Enyart.