What Dr Jack Dikian’s Behaviour Support Systems Review can teach us about systems thinking across behaviour support, counselling, occupational therapy, speech-language practice and education
There is a familiar point in clinical and educational practice when we begin to wonder why a carefully considered intervention is not producing the change we expected. The behaviour support plan has been reviewed, the counsellor has taught regulation strategies, the occupational therapist has recommended sensory or environmental supports, and the speech-language pathologist has addressed communication needs. Teachers and caregivers may have recommendations, visual supports have been created, and data may be collected regularly.
Yet the same difficulties can continue, and our instinct is often to return to the individual and try something else. We reassess the behaviour, adjust reinforcement, add another visual, teach another coping strategy, change the sensory support or rewrite the plan. Sometimes that is exactly what good practice requires, particularly when the evidence suggests that our original formulation or intervention needs to change.
At other times, however, we may be concentrating so heavily on the individual intervention that we overlook the conditions surrounding it. The intervention itself may be reasonable, while the difficulty lies partly in the system we are asking to implement it.
A student may know how to request a break but receive a different response depending on which teacher is present. A child may use AAC effectively with their speech-language pathologist but rarely have the device within reach during recess. An occupational therapist may recommend proactive regulation supports that gradually become something offered only once the child is already overwhelmed, while a counsellor may teach emotional regulation strategies in a quiet office that the student is later expected to retrieve independently during peer conflict in a noisy playground.
In each of these situations, we could conclude that the person has failed to generalise the skill or that the intervention simply isn’t working. We could also widen the lens and ask a different question: what is happening around the intervention?
Dr Jack Dikian and Behaviour Support Systems Review
The work of Dr Jack Dikian and Behaviour Support Systems Review (BSSR) offers a particularly useful perspective here. Developed through Dikian’s work with the Statewide Behaviour Intervention Service in New South Wales, BSSR provides a structured way of looking beyond an individual behaviour support plan to examine the broader service system responsible for delivering behaviour support.
In his work on BSSR, Dikian draws attention to the capability and capacity of the service system itself. That broader system includes the people, processes, resources and conditions involved in providing support, as well as the interactions between them. This shifts the question from simply asking whether a plan is technically sound to also considering whether the surrounding system can realistically deliver what the plan requires.
I think that distinction is important because even an excellent plan does not implement itself. Its success depends on people understanding it, having the knowledge and resources to implement it, communicating effectively with one another and working within environments that make implementation possible.
BSSR has its own history, methodology and purpose within behaviour support, and I am not suggesting that other professions simply take the BSSR name and apply it to their own work. What I think has considerable value across disciplines is the systems thinking that Dikian’s work brings into view. Occupational therapists, speech-language pathologists, counsellors, educators and behaviour practitioners all develop interventions that ultimately have to work outside the conditions in which they were designed.
Although our professional lenses are different, we often encounter the same underlying problem. There can be considerable distance between what we recommend and what the person actually experiences.
A Good Plan Does Not Implement Itself
One of the easiest mistakes to make in multidisciplinary practice is to confuse a recommendation being documented with that recommendation actually being delivered. We see “access to movement breaks” in an OT report and assume movement breaks are occurring, or “AAC available across environments” in an SLP recommendation and assume the communication system is accessible throughout the day. Similarly, we might see “use coping strategies when frustrated” in a counselling goal and assume the student has meaningful opportunities and support to use those strategies when frustration actually occurs.
There can be a significant gap between what a plan says should happen and what happens in everyday practice. Unless we examine that gap, we risk repeatedly changing interventions that may never have been implemented under the conditions we originally imagined.
Consider a student who regularly leaves the classroom during difficult academic tasks. The counsellor has helped the student recognise early signs of frustration, the student has a break card, the occupational therapist has recommended movement and sensory strategies, and the teacher has created a regulation space. On paper, the intervention appears well considered, yet the student continues to leave the classroom.
Before adding another strategy, it may be useful to follow the existing one into the student’s actual day. Where is the break card during maths, what happens when the student uses it, and is the response consistent across teachers? Does a substitute teacher understand what the card means, and is the regulation space actually available when it is needed? Perhaps accessing the support requires verbal negotiation at precisely the moment when the student’s language and regulation are under the greatest pressure.
In that situation, the student may not have failed to learn the strategy at all. The pathway between knowing the strategy and being able to use it may be unreliable, which presents a very different clinical problem.
What This Can Look Like in Occupational Therapy
Occupational therapy recommendations often depend heavily on the conditions surrounding their implementation. A sensory or regulation strategy may be clinically appropriate but still have limited impact if it is unavailable at the right time, difficult to access, inconsistently understood or poorly integrated into the person’s natural routines.
Imagine an OT recommends noise-reducing headphones during periods of high auditory demand. The headphones have been purchased and are kept in a sensory bin at the back of the classroom, so from an implementation perspective it may appear that the recommendation is in place.
Now consider what the child actually needs to do when the classroom suddenly becomes loud. They need to recognise that the auditory environment is becoming overwhelming, stop what they are doing, cross the classroom, locate the correct bin, find the headphones and perhaps ask permission to use them. If regulation, communication, executive functioning or self-advocacy becomes more difficult under stress, those steps may become hardest at precisely the moment the support is most needed.
The headphones may therefore be technically available without being functionally accessible. The same problem can arise when proactive movement or regulation strategies gradually become reactive interventions offered only once significant dysregulation has already occurred. Before deciding that a recommendation “doesn’t work,” it is worth establishing whether it has actually been implemented under the conditions for which it was intended.
What This Can Look Like in Speech-Language Practice
Communication makes systems thinking particularly relevant because communication does not occur solely within the communicator. It also depends on communication partners recognizing, interpreting and responding to what the person communicates.
Imagine a child who has learned through AAC to communicate “more,” “wait,” “stop” and “finished.” These responses occur increasingly often during speech sessions, yet staff continue to report hitting in everyday environments.
A closer look may reveal that the AAC system is not always nearby when preferred items are removed. One adult may recognise the child’s early gesture for “wait,” while another does not. One staff member may respond immediately to “stop,” while another interprets the communication as task avoidance and continues the activity. At other times, adults may prompt the AAC response only after hitting has already occurred.
The child may have learned a safer and more functional communication response, while the surrounding environment has not yet made that response consistently effective. This raises an important systems question for the team: how can we make the safer communication response easier, faster and more reliable than the behaviour it is intended to replace?
Answering that question requires more than teaching the child another communication skill. It also requires us to examine communication partners, access to the communication system, opportunities to communicate and what happens when the person actually attempts to communicate.
What This Can Look Like in School Counselling
School counsellors frequently work with students who understand therapeutic skills but struggle to use them when those skills are most needed. The distinction between knowing a strategy and being able to access that strategy under pressure becomes particularly important here.
Consider a student who can identify five coping strategies during counseling but uses none of them during peer conflict. During the counseling session, the student is sitting with a trusted adult in a quiet room, has time to think, is relatively regulated and may be receiving subtle prompts from the counsellor without either person really noticing them.
Now place that same student in a crowded hallway after another student makes an embarrassing comment in front of their friends. The student is angry, socially threatened, physiologically activated and may have only seconds before responding. The coping skills have not necessarily disappeared; the conditions under which those skills need to be accessed have changed considerably.
That distinction should influence intervention. Rather than automatically providing another worksheet about coping strategies, the student may benefit from rehearsal under progressively more realistic conditions, an agreed cue from a teacher, earlier recognition of escalation or a discreet way to leave the situation without increasing social embarrassment.
What This Can Look Like in Behaviour Support
Behaviour support already places considerable emphasis on understanding function, antecedents, consequences and the conditions associated with behaviour. A systems perspective extends that inquiry by asking whether the wider service environment has the capability to deliver the support described in the plan.
Consider an individual living in supported accommodation whose behaviour support plan includes predictable routines, advance notice of changes, opportunities for choice and reduced verbal demands during escalation. The plan may be technically sound, yet significant incidents continue to occur several evenings each week.
A closer examination might reveal that staffing changes frequently during the evening shift. Experienced staff recognise subtle early signs of distress, while casual staff identify escalation only once it becomes obvious. Some staff naturally offer choices and allow processing time, while others move quickly through routines because evenings are busy. New staff may also be expected to implement a lengthy behaviour support plan after reading it rather than receiving practical coaching.
It is easy to summarize this as “staff aren’t following the plan,” but that observation does not tell us why implementation is inconsistent. The underlying issue might involve training, communication, resources, staffing, competing demands or the complexity of the plan itself, and each of those possibilities requires a different response.
When Different People See Different Things
Another aspect of Dikian’s BSSR work that I find particularly useful is the emphasis on gathering and comparing information from different sources. In multidisciplinary practice, disagreement can initially feel inconvenient, particularly when professionals appear to be describing completely different versions of the same person or problem.
A teacher may report that a student never asks for help, while the SLP reports that the student asks consistently. A family may describe significant dysregulation at home while school staff see very little distress, or an OT may observe sensory avoidance that other team members have not noticed. Our instinct can be to determine which account is correct, but sometimes the more useful question is whether both accounts could be accurate under different conditions.
For example, a student may request help consistently during speech-language sessions because the AAC device is directly in front of them, the SLP recognises early communication attempts, provides intentional wait time and responds quickly. In the classroom there may be more people, greater academic pressure and fewer opportunities for immediate one-to-one response, while the device that is technically “available” may be sitting underneath a worksheet.
Rather than deciding that one professional has the more accurate picture, the team can compare what changes between those environments. The discrepancy itself becomes useful information, which leads to one of the questions I find most valuable in multidisciplinary work: What is different when this works?
Agreement deserves curiosity too. If several staff members describe a student’s aggression as unpredictable, for example, it may still be worth looking for exceptions. Perhaps there is one staff member who rarely sees it, one part of the day when it occurs less frequently, or one environment in which the person is consistently more regulated.
Those exceptions should not automatically be dismissed as anomalies. They may reveal differences in timing, communication, processing demands, relationships, environmental conditions or adult responses that help us understand what successful support actually looks like.
Multidisciplinary Involvement Is Not the Same as Integration
Multidisciplinary practice creates another systems challenge because several professionals can make individually reasonable recommendations that become collectively difficult to implement. An OT may recommend regular movement opportunities and reduced sensory demands, an SLP may recommend frequent communication opportunities and aided language modeling, a counsellor may recommend predictable emotional check-ins, and a behaviour professional may recommend proactive prompting and reinforcement.
None of those recommendations is necessarily unreasonable. Together, however, they may create a support package that is extremely difficult for a teacher, parent or support worker to deliver while also managing everything else occurring in the natural environment.
There is an important distinction here between multidisciplinary involvement and multidisciplinary integration. A stack of professional reports is not the same thing as a coordinated support system.
Integration requires us to look for overlap and consider how recommendations fit together. Perhaps the OT’s movement recommendation and the counsellor’s regulation goal can be supported through the same predictable routine, while the SLP ensures the student has a functional way to request that routine and the behaviour professional considers whether successful communication reduces the need for more challenging behaviour.
No discipline needs to surrender its individual expertise for this to happen. The opportunity lies in connecting that expertise so that the person receiving support experiences one coherent system rather than a collection of separate professional recommendations.
Before We Change the Plan
When an intervention isn’t producing the outcomes we expected, it can be useful to resist the immediate urge to add another strategy. Instead, I think there are several questions worth considering: Is the strategy actually being implemented as intended? Can the person realistically access it when they need it? What changes when it works, and what changes when it doesn’t?
It is also worth asking whether outcomes vary according to the person, setting or time of day, and whether the people implementing the recommendation understand both what they are being asked to do and why. We should consider whether the recommendation is realistic within the natural environment, whether recommendations from different disciplines complement or compete with one another, and what the person receiving support tells or shows us about their experience.
Another important question is whether the information we collect actually changes what we do. Data have limited clinical value if they accumulate in folders and spreadsheets without prompting new questions, testing hypotheses or changing decisions.
Perhaps one of the simplest questions is also one of the most useful: What is already working that we should understand before we change anything? Clinical review should not only search for failure, because sometimes the conditions surrounding existing success tell us where some of the answers may already be hiding.
Looking at the System Isn’t About Blame
There is an important caution in all of this because looking beyond the individual should never mean simply moving blame from the person receiving support to the teacher, parent, therapist, support worker or organisation. If we do that, we have relocated the problem rather than understood it more deeply.
A teacher may genuinely want to implement an OT recommendation while managing an entire classroom. An SLP may make an appropriate recommendation without realising that an AAC device cannot be positioned as suggested during lunch, while a counsellor may teach a useful strategy without knowing that the student feels embarrassed using it around peers. A behaviour practitioner may develop a technically strong plan that proves too complicated for rotating or casual staff to implement consistently.
Accountability still matters, but it becomes much more useful when accompanied by curiosity. Rather than stopping at “Why aren’t they following the plan?”, we can ask what would need to be different for the plan to be implemented consistently and well.
For me, the more useful systems question is therefore not about identifying who has failed. It is about understanding where the pathway between need, intervention, implementation, experience and outcome may be breaking down.
Sometimes We Need a Wider Lens
Systems thinking does not replace individualised assessment, nor should it become an explanation that is automatically applied whenever an intervention is unsuccessful. Behaviour, communication, regulation and participation can be influenced by health, development, learning, sensory experiences, mental health, relationships, neurological differences, reinforcement histories and many other factors that require careful assessment within each professional’s scope of practice.
There will also be situations where the individual intervention genuinely needs to change. The value of widening the lens is not that it tells us in advance where the problem lies; it simply prevents us from assuming that the entire explanation must reside within the individual.
People do not experience our interventions in the neat conditions in which we write them. They experience them in classrooms, homes, playgrounds, cafeterias, workplaces and community settings, with familiar professionals and unfamiliar staff, on calm days and difficult ones, and sometimes when the carefully prepared visual support has somehow disappeared behind a bookshelf.
A behaviour support plan therefore does not implement itself, just as an AAC system does not communicate by itself. A sensory recommendation does not become accessible simply because it appears in an OT report, and a coping strategy does not become usable during distress simply because a student can explain it to their counsellor. Between the recommendation and the outcome sits an entire system.
This broader perspective is one of the most valuable lessons I take from Dr Jack Dikian’s work on Behaviour Support Systems Review. The point is not that every profession should become behaviour support, that every difficulty is caused by the environment or that individual intervention no longer matters. Rather, BSSR reminds us that there are times when better clinical reasoning requires us to widen our field of view.
When a student succeeds with one teacher but struggles with another, there is something worth understanding. When AAC works in therapy but not at lunch, the discrepancy matters; when a regulation strategy exists but cannot be accessed during dysregulation, accessibility matters; and when several excellent professionals make recommendations that collectively overwhelm the people expected to implement them, integration matters.
When an intervention isn’t working, sometimes the person does need another skill or a different intervention. At other times, the people implementing the support may need greater clarity or practical coaching, an environmental barrier may need to be addressed, communication between professionals may need to improve, or the team may need to look at the available information differently. Very often, more than one of these things is contributing at the same time.
The question “Why isn’t this working?” can sometimes be too narrow on its own. A systems perspective encourages us to ask a second question alongside it: “What else do we need to understand about the system in which we are asking this to work?”
That shift does not take our attention away from the person. In many ways, it brings us closer to their actual experience because we begin looking not only at what we intended to provide, but at what support genuinely looks and feels like in their everyday life.
Sometimes better support begins not by looking harder at the individual, but by widening the lens around them.
Widening the Lens
One of the things I value most about Dr Jack Dikian’s work on Behaviour Support Systems Review is the way it challenges us to think beyond the quality of an intervention in isolation. A plan can be thoughtful, evidence-informed and clinically appropriate, yet its success will still be influenced by the people, processes, environments and resources surrounding its implementation.
Although BSSR was developed within behaviour support, I believe the systems thinking it highlights has something valuable to offer professionals across disciplines. Occupational therapists, speech-language pathologists, counsellors, educators and behaviour practitioners may use different assessment processes and intervention approaches, but all of us eventually face the same practical question: can what we are recommending actually work within the person’s real life?
For multidisciplinary teams, this means being willing to look at the spaces between our individual areas of expertise. An OT may understand something important about sensory or environmental demands, an SLP may identify a communication barrier, a counsellor may recognize the emotional experience surrounding the situation, and a behaviour practitioner may identify patterns in antecedents and consequences. Each perspective has value, but there is often even more to learn when those observations are considered together.
It also means being willing to become curious about inconsistency rather than immediately treating it as failure. If a person succeeds in one environment but not another, communicates effectively with one person but not another, or accesses a strategy during therapy but not during everyday life, those differences may contain some of the most useful information available to us.
Dikian’s work provides a valuable reminder that good behaviour support involves more than developing a good behaviour support plan. For me, its broader contribution is the invitation to remain curious about the system surrounding intervention and to recognize that what appears to be an individual problem may sometimes be telling us something important about the conditions in which that person is being asked to succeed.
References
A note on attribution
Behaviour Support Systems Review (BSSR) is associated with the work of Dr Jack Dikian and the Statewide Behaviour Intervention Service in New South Wales, Australia. The original BSSR work and methodology should be consulted for an authoritative account of the approach.
The occupational therapy, speech-language pathology, counselling, education and multidisciplinary examples discussed in this article are not being presented as components of Dikian’s formal BSSR methodology. Rather, I have used them to reflect on how the broader systems perspective demonstrated within BSSR can encourage professionals from different disciplines to think more carefully about the environments, people and service conditions surrounding intervention.
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