"It’s Too Hard, Too Slow, Too Much”: Addressing the Real Concerns About PSA

Implementing the Positive Systems Approach (PSA) in caregiving settings offers a transformative path to managing disruptive behaviour. However, resistance to change is a common hurdle. This guide addresses specific concerns caregivers and staff may have and provides actionable strategies to overcome them.

Understanding Resistance to PSA

Resistance often stems from uncertainty, past experiences, or perceived threats to established routines. Recognizing these concerns is the first step in addressing them effectively.

1. Lack of Knowledge in PSA and Applied Behaviour Analysis

Challenge: Caregivers and staff may feel unprepared or skeptical about adopting new methodologies.

Solutions:

• Tailored Training: Develop concise, role-specific training modules that fit into existing schedules. Utilize various formats—videos, workshops, and quick-reference guides—to accommodate different learning styles.

• Peer Learning: Encourage knowledge sharing through mentorship programs or peer-led sessions, fostering a supportive learning environment.

• Resource Accessibility: Ensure that educational materials are easily accessible, perhaps through an online portal, allowing staff to revisit content as needed.

2. Perceived Inadequacy of Resources

Challenge: Staff may believe they lack the necessary tools or time to implement PSA effectively.

Solutions:

• Resource Audit: Conduct an assessment to identify existing resources and gaps. This helps in reallocating or acquiring necessary tools without overburdening the budget.

• Pilot Programs: Start with small-scale implementations to demonstrate effectiveness and resource requirements, building a case for broader adoption.

• Time Management Training: Offer workshops on efficient time management to help staff integrate PSA practices into their routines without feeling overwhelmed.

3. Environmental Constraints

Challenge: Staff may feel that the current environment isn't conducive to PSA strategies.

Solutions:

• Environmental Modifications: Make small, cost-effective changes to the physical space to better support PSA practices.

• Flexible Implementation: Adapt PSA strategies to fit within the existing environment, emphasizing that perfection isn't required for progress.

• Feedback Mechanisms: Establish channels for staff to suggest environmental improvements, fostering a sense of ownership and collaboration.

4. Slow Observable Results

Challenge: Staff may become discouraged if they don't see immediate improvements.

Solutions:

• Set Realistic Expectations: Educate staff on the typical timelines for behavioural change, emphasizing that patience is key.

• Track Progress: Implement simple tracking systems to monitor and celebrate small victories, reinforcing the value of persistence.

• Regular Check-Ins: Hold brief, regular meetings to discuss progress, address concerns, and adjust strategies as needed.

5. Lack of Management Support

Challenge: Without visible backing from leadership, staff may feel unsupported in their efforts.

Solutions:

• Leadership Training: Before working with a staff team, first educate managers on PSA principles to ensure they understand and can advocate for the approach and monitor it’s use and effectiveness.

• Visible Commitment: Encourage leaders to participate in training sessions and openly support PSA initiatives, demonstrating their commitment.

• Feedback Loops: Create systems for staff to provide feedback to management, ensuring their voices are heard and considered in decision-making.

6. Intensity and Attention Demands

Challenge: Staff may feel that PSA requires more attention than they can afford, risking neglect of other duties and other individuals they support.

Solutions:

• Integrate into Routine: Identify ways to incorporate PSA strategies into existing workflows, minimizing additional burdens.

• Prioritize Tasks: Assist staff in identifying and focusing on high-impact activities, ensuring efficient use of time.

• Support Networks: Establish peer support groups to share strategies and provide mutual assistance, reducing individual pressure.

Additional Sources of Resistance and Solutions

Fear of Change:

• Open Communication: Maintain transparency about the reasons for change and the expected outcomes to alleviate fears.

Past Negative Experiences:

• Acknowledge History: Recognize previous challenges and outline how current strategies differ and aim to improve upon past efforts.

Cultural Resistance:

• Inclusive Planning: Involve staff from diverse backgrounds in the planning process to ensure cultural considerations are respected and integrated.

Case Study: Overcoming Resistance to PSA in a Group Home Setting

Background:Jacob was a 22-year-old man with a developmental disability and a long-standing history of aggression and self-injurious behaviour. He had lived in a group home for over two years. Staff described him as unpredictable, explosive, and dangerous. His behaviours included hitting, biting, and banging his head against walls, often requiring multiple staff to intervene.

Initial Situation:

The group home staff were emotionally exhausted. Incidents involving Jacob were frequent—often daily—and staff turnover was high. Management introduced the Positive Systems Approach (PSA) to address Jacob’s behaviour, but frontline staff were immediately resistant.

Sources of Resistance and How They Were Addressed

1. Lack of Knowledge or Trust in PSA or ABA

Staff Concerns:

“We’ve been through dozens of training sessions before. Nothing changes.”“These ideas might work in a perfect world, but not here.”

What We Did:

• Delivered brief, hands-on PSA training sessions focused only on Jacob’s behaviour and context—no abstract theory.

• Used video modeling and real-life scenarios from the group home to build relevance.

• Paired newer staff with one or two "champions" of PSA who had seen success in other homes.

Result: Staff began to see PSA as a practical, realistic approach rather than a theoretical burden.

2. Perception of Inadequate Resources

Staff Concerns:

“We don’t have enough people. We can’t run specialized plans.”

“Where are the tools we need? We’re improvising everything.”

What We Did:

• Worked with management to reallocate existing staff during Jacob’s peak activity times rather than request additional hires.

• Designed a low-effort behaviour support tool: a simple visual chart to track triggers and responses in under a minute.

• Identified and provided essential resources—protective gear, communication tools, and a calm room—without overwhelming the budget.

Result:Staff felt they had what they needed to start, and the first successful de-escalation using the new approach helped shift attitudes.

3. Belief That the Environment Was Inappropriate

Staff Concerns:

“This home isn’t set up for someone like Jacob.”

“He needs a more specialized facility.”

What We Did:

• Conducted an environmental fit analysis and involved staff in small environmental changes: soft wall padding, adjusted lighting, and designated quiet zones.

• Focused on modifying interactions, not just the environment: how staff approached Jacob, how they gave directions, and how they supported transitions.

Result:Jacob’s frequency of outbursts dropped slightly after these changes, reinforcing that even small adaptations made a difference.

4. Frustration at Slow Results

Staff Concerns:

“We’ve been trying this for two weeks. Nothing’s working.”

“It’s just the same chaos, but now with more paperwork.”

What We Did:

• Set micro-goals: e.g., “Can we reduce one head-banging incident this week?”

• Used visible progress charts (updated daily) in the staff room to track success. Green dots showed “wins,” even tiny ones.

• Scheduled weekly debriefs to celebrate small steps forward and refine the plan.

Result:When staff saw even a small decline in incidents—and realized they could influence Jacob’s behaviour—they felt re-energized.

5. Lack of Management Support

Staff Concerns:

“The supervisors want us to use PSA, but they’re never around when it goes bad.”

“We’re stuck holding the bag when this doesn’t work.”

What We Did:

• Required supervisors to attend the same PSA training.

• Management began shadowing frontline shifts, assisting during crisis moments—not observing from afar.

• Created a formal recognition system where staff using PSA effectively received public acknowledgment.

Result:Staff began to feel like PSA wasn’t being “pushed” from above—it was part of a unified team approach.

6. PSA Felt Too Demanding

Staff Concerns:

“We don’t have time to do data tracking and cook dinner and deal with meds.”

“This system takes too much of our attention.”

What We Did:

• Streamlined data collection to a one-minute checklist using a QR-code on mobile devices.

• Built PSA strategies into daily routines—mealtime, transitions, hygiene—rather than add-ons.

• Reinforced that not all staff had to do everything all the time: roles were divided to prevent burnout.

Result:Staff reported the PSA plan felt “doable” once they weren’t expected to be superheroes. They could focus on quality over quantity.

Outcome After Three Months

• Aggression incidents dropped by 65%.

• Self-injury decreased by 50%.

• Staff turnover slowed, and several who had considered quitting decided to stay.

• Jacob began using a few functional signs and visual cues to communicate distress before escalating.

• Staff described him as “more reachable,” and one senior worker admitted:

“I didn’t believe it would work. But it did. We just needed the right support.”

Key Takeaways

• Resistance is rarely about laziness or indifference. It’s usually about fear, fatigue, and feeling unsupported.

• Real change comes when staff feel respected, involved, and equipped.

• The Positive Systems Approach succeeds not just because it’s evidence-based—but because it’s adaptable and human.

Conclusion

Overcoming resistance to the Positive Systems Approach requires a multifaceted strategy that addresses specific concerns and fosters a supportive environment. By providing targeted training, ensuring resource availability, adapting to environmental constraints, setting realistic expectations, securing management support, and integrating PSA into daily routines, organizations can facilitate a smoother transition and enhance the effectiveness of behavioural interventions.

For more resources and support on implementing PSA, visit drbobcarey.com and check out our book on Amazon:  “Managing Disruptive Behaviour with a Positive Systems Approach”.