Importance of Building Rapport in Effectively Delivering Positive Behavior Support Plans (PBSP)

In a recent newsletter, we explained the purpose of a Positive Behavior Support Plan (PBSP) and the importance of effective training.  In this newsletter, we will build upon this and highlight a critical component or successful PBSP implementation: rapport. While PBSPs provide a systematic approach to addressing challenging behaviors in an individual, the effectiveness of the plan relies on more than the technical skills of the support team. To truly support individuals with disabilities, professionals must cultivate positive, trusting relationships with those they support. 

What is Rapport, and Why does it Matter?

In 1979, Edward S. Bordin proposed “that the working alliance between the person who seeks change and the one who offers to be a change agent is one of the keys, if not the key, to the change process.”  In the context of behavior interventions, one of the keys to a successful PBSP is the positive relationship between the client and their supports. More recently Rajaraman (2022) developed a framework for trauma- informed applications of behavior analysis, including rapport building as a key element. This framework includes the importance of “curating environments that ensure safety and trust by building and maintaining rapport with clients”. Rajmaraman goes on to reference the importance of pairing a staff person with positive reinforcing stimuli, or “positive pairing”, as a key element of rapport building. In other words, rapport is developed when an individual associates a support person with a preferred activity. 

We would be amiss to discuss rapport building without addressing the implication of cultural factors.  Qinaʻau and Masuda (2020) remind us that understanding cultural norms, communication styles and values is essential to establishing meaningful rapport with individuals from diverse backgrounds. This process involves creating an environment of understanding, that is created through verbal and non-verbal communication, and an awareness of cultural differences in communication styles. Improvements in rapport can also be made with awareness of identity factors and barriers clients may face. 

In 2005, McLaughlin & Carr found that improvements in rapport between individuals with developmental disabilities and their support person correlated with a decrease in problem behaviors, and an increase in task completion, in the presence of the individual support person with whom the relationship had been developed. With this in mind, all behavioral interventions should include rapport building as a foundational component of proactive strategies to prevent challenging behaviors to improve a client’s quality of life. 

Rapport as a Proactive Strategy

A PBSP can and should include rapport to proactively address challenging behaviors by:

• Acknowledging the preferred activities that can be engaged in to be positively paired with supports.

• Identifying regularly scheduled, intentional time for supports to engage in these preferred activities apart from other non-preferred activities.

• Reinforcing the importance of clients working with supports with whom they have developed rapport.

• Including a lens by which supports can look through to identify their role in the presence and escalation of challenging behaviors. 

• Encouraging supports to review client documentation, especially as it relates to their history, diagnoses and trauma in order to understand the client’s identity and experience in the world. 

• Emphasizing the need to build relationships with the greater family and community with which the client exists, with client consent of course. 

• Addressing communication styles that supports should utilize in order to establish and maintain rapport, including an emphasis on empathetic and respectful language and maintaining a calm voice and demeanor.

Where to Start

Empathy, curiosity and intentionality is key to rapport building. For staff wondering where to begin, start by spending time with the individual. Be curious about their interests, offer choices and observe their preferences. Rapport is key to the effectiveness of a PBSP, lasting behavioral change and improvement in quality of life.

References

Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, research & practice, 16(3), 252.

McLaughlin, M., & Carr, E. G. (2005). Quality of rapport as a setting event for problem behavior. Journal of Positive Behaviour Interventions, 7(2), 68–91. https://doi.org/10.1177/10983007050070020401

Qinaʻau, J., & Masuda, A. (2020). Cultural considerations in the context of establishing rapport: A contextual behavioral view on common factors. In Handbook of cultural factors in behavioral health: A guide for the helping professional (pp. 75-92). Cham: Springer International Publishing.

Rajaraman, A., Austin, J. L., Gover, H. C., Cammilleri, A. P., Donnelly, D. R., & Hanley, G. P. (2022). Toward trauma‐informed applications of behavior analysis. Journal of Applied Behavior Analysis, 55(1), 40-61.

Amanda Deering- Miren Behavior, Behavior Specialist