8/17/16 Building capacity to implement posiBve behavior ... · Building capacity to implement...

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NevadaPBISTechnicalAssistanceCenterNVCenterforExcellenceinDisabiliBesUniversityofNevada,Reno

BuildingcapacitytoimplementposiBvebehaviorsupportwithlong-

termsustainabilityDonaldA.Jackson,Ph.D.ElaineC.Brown,Ph.D.


LARGE-SCALEIMPLEMENTATIONOFSCIENCE-BASED,INDIVIDUALIZEDPOSITIVEBEHAVIORALHEALTHSUPPORTS

Thefirst20yearsarethehardest


Outline

•  PosiBvebehavioralhealthsupports•  Research:whatweknowanddon’tknow•  PBSinNevada•  StatusofimplementaBon


Context–circa1966•  Vietnamwar(1955-1975)•  JFKassassinaBon(1963)•  LBJ&TheGreatSocietyprograms,“waronpoverty”

•  CivilRightsAct&theEconomicOpportunityAct(1964)

•  HeadStart•  VISTA•  1968:King&KennedyassassinaBons;democraBcconvenBoninChicago


KalamazooPsychiatricHospitalaka

WesternMichiganAsylumMichiganAsylumfortheInsane

KalamazooRegionalPsychiatricHospital(KRPH)


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“InthetenyearsthatbehaviormodificaBonhasexistedasanidenBfiablediscipline,workersintheareahaveproducedawidevarietyoftechniqueswhicharequiteeffecBvetomodifythebehaviorsofabnormalpopulaBons.TheireffecBvenessindevelopingtechniquestoproducBvelymodifythebehaviorsofprofessionalandadministraBvepersonsisnotasapparent.Perhapstherewillbeanimprovementinthisproblemduringthenexttenyears.Akerall,thefirsttwentyyearsarethehardest.”

-B.L.Hopkins,1970 14

MontroseWolf

ToddRisley

DonaldM.Baer


AppliedBehaviorAnalysis1960s

•  “BelerapplicaBons,itishoped,willleadtoabelerstateofsociety.”

•  Appliedresearch“isnotdeterminedbytheresearchproceduresusedbutbytheinterestwhichsocietyshowsintheproblemsbeingstudied.”

-Baer,Wolf&Risley,1968


“…ThemostimportantsourceofourcurrentdisappointmentisthefactthatourtechnologyhasbeensuccessfulinchangingthebehaviorsofthespecialpopulaBonsbutgovernmentserviceagentshavenotwidelyboughtorusedourtechnology.”

(COMMENTSONTHEFUTUREOFAPPLIEDBEHAVIORANALYSIS,B.L.HOPKINS,JABA,1987)


Earlylarge-scaleprograms

•  AchievementPlace– MontWolf,DeanFixsen,etal.

•  BehaviorAnalysisFollowThrough–  DonBushell,Jr.

BUT…

Ittook28yearstounderstandtheneedforthesite-basedexperBsemodel(fixsen,2016)


Thenatureofsystems“AllorganizaBons[andsystems]aredesigned,intenBonallyor

unwiqngly,toachievepreciselytheresultstheyget.”-R.SpencerDarling

“Thetyrannyofthestatusquo.”

-FritzOser•  Healthcare•  Prisons•  GreatSocietysocialiniBaBves•  NAEPdata–mediocremean•  Behavioralhealthcare–ACEStudy

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CitedbyFixsen,2016 hlp://www.cdc.gov/violenceprevenBon/acestudy/ace_graphics.html


THEMISSIONANDVISIONOFPOSITIVEBEHAVIORSUPPORT/ABA

Areweontarget?


PosiBvebehavioralheathsupportsHistorical/FoundaBonalPerspecBve

•  BehaviormodificaBon/conBngencymanagement•  Appliedbehavioranalysis1970s-80s•  Disability/civilrightsmovementsmid/late80s•  PBSbeginnings:severedisabiliBes–“nonaversivebehaviormanagement”mid80s

•  PBSapproachwellestablished1990s•  Circa2000:ExpansiontomulB-Beredsystemsofsupport/prevenBonmodel


Science,Values&Visionv PosiBvebehaviorsupport(PBS)isagreatandworthyideapredicatedonthenoBonthatcreaBngalifeofqualityandpurpose,embeddedinandmadepossiblebyasupporBveenvironment,shouldbethefocusofoureffortsasprofessionals.”

v Carr,E.G.,(2007)TheexpandingvisionofPosiBveBehaviorSupport:ResearchperspecBvesonhappiness,helpfulness,hopefulness.JournalofPosi/veBehaviorInterven/ons,9,3-14,p.3.

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StandardsofPracBce

•  ReducBonofproblembehaviorisanimportant,butnotthesole,outcomeofsuccessfulintervenBon:effec<vePBSresultsinimprovementsinqualityoflife,acquisi<onofvaluedskills,andaccesstovaluedac<vi<es.

hlp://apbs.org/files/apbs_standards_of_pracBce_2013_format.pdf


DefiniBonofPosiBveBehaviorSupport

•  Includesresearch-basedassessment,intervenBon,anddata-baseddecisionmaking

•  Buildingsocial&othercompetencies,creaBngsupporBvecontexts,&prevenBngproblembehaviors

•  Strategiesrespectul&drawnfrombehavioral&othersciences

•  AmulB-Beredframeworkatindividualorlargersystemslevel

Kincaidetal.,2016


TheprocessesofPBSThreeBersofimplementaBon

•  Individual:–  Individualized(intensive)behaviorsupportplan

•  Group/targeted:– Buildingcompetenceinspecificareas(e.g.,social)

•  System/universal:– Program-wideorschool-wide,providedforall

All/ersareneededforop/mumimplementa/on


ConBnuumofservices

IntensiveSupport

TargetedFollow-Up

UniversalTraining

QualityofLife


LinkalleffortstoQualityofLifeAgoodqualityoflifeexistswhenpeoplewithdisabiliBes:

•  Receivethesupport,encouragement,opportunityandresourcestoexploreanddefinehowtheywanttolivetheirlives;

•  Chooseandreceivetheservicesandsupportsthatwillhelpthemlivemeaningfullives;

•  Directtheservicesandsupportstheyreceive;•  Leadaliferichwithfriendships;•  Havetheirrights,dignityandprivacyprotected;•  Areallowedtotakerisksintheirchoices;and•  Areassuredofhealthandsafety.•  AdaptedfromAAIDDathlp://www.aamr.org/content_143.cfm


EXTENDINGTHEREACHOFPBSPBSandRelatedFieldsofStudy–HowRelevantandImportant?

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MissionandVision

•  “PosiBveBehaviorSupportisasetofprocessesthatcombineinforma<onfromsocial,behavioral,andbiomedicalscienceandappliesthisinformaBonattheindividualand/orsystemsleveltoreducebehavioralchallengesandimprovequalityoflife.”

–  apbs.org/about-apbs

“…seekcollaboraBvepossibiliBeswithourcolleaguesinmanydifferent

sciencessothatwecantranscendoursuperficialdifferencesandfocuson

deepercommonaliBes.”-Carr,2007,p.12)

"Thehistoryofscienceisrichintheexampleofthefruitulnessofbringingtwo

setsoftechniques,twosetsofideas,developedinseparatecontexts,forthepursuitofnewtruth,intotouchwithone

another.”--J.RobertOppenheimer



PBSandNeuroscience

•  BuildsynergybetweenABAandbiomedicalintervenBontoadvanceassessment&treatment,andpromotebroadchangesinqualityoflife(Carr&Herbert,2008)

•  Nowabletoassembleaclearpictureoftheneurologicalunderpinningsoffear&anxiety(Pilman,etal.,2015)


Fortunately,studiesinneuroplasBcityandgeneexpressionsuggesttheremaybeapotenBalforreversal

SotheneedforposiBvebehaviorsupportsand

nurturingenvironments,especiallyearlyinlife,isnot

justamalerofhappiness,butamalerofphysicalhealthandlongtermwell-being


ResearchonIndividualPBS

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IndividualPBS•  LargebodyofresearchoncomponentsofPBS•  FuncBonalassessmentcanleadtosuccessfulintervenBons

•  Assessmentofseqngevents,contextualfit,etc.canbebeneficial

•  Person-centered-planning•  FuncBonalequivalenceandfuncBonalcommunicaBontraining

•  BuildingfuncBonalskills•  ManipulaBonofantecedentevents•  MulB-componentPBSintervenBons

Dunlap&Carr,2007;Dunlap,Jackson&Greenwald,inpress NevadaPBISTechnicalAssistanceCenterNVCenterforExcellenceinDisabiliBesUniversityofNevada,Reno

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Preschool

Children

Adolescents

Adults

Au<sm/DD

BxDisorder

ProblemBx

MH

AdultJus<ce

JuvJus<ce

ADHD

Sleep

1999-2003TOTAL2010-2014TOTAL

JPBIResearch–PopulaBonsPercentofArBcles


PosiBveBehaviorSupportandAppliedBehaviorAnalysis

2016

•  ScaleupeffecBveinnovaBons&intervenBons

•  Improvehumanservicesystems

-Fixsen,2016


LargerscalePBS

•  Structuresforcapacitybuilding•  MTSS/School-widePBS•  ModelsofPBSImplementaBon

– PTR– PTR-YC


Researchonlarge-scalePBS


0.0%

10.0%

20.0%

30.0%

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50.0%

60.0%

70.0%

80.0%

90.0%

School

Home

Correc<onal

Comm

unity

Preschool

Residen<al

Lab

College

MH

1999-2003TOTAL2010-2014TOTAL

JPBIResearch–SeqngsPercentofarBcles–early&mostrecentyears

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Whatweneedtoknowmoreabout:Gapsinresearch&appliedstrategies

•  PopulaBons&venuessBlllimited•  Maintenance•  Wellbeingofcaregivers/familyfuncBoning•  Lifestylechange•  QualityoflifeconBnuestobeachallenge•  Scalingup–fewevaluaBonsoflarge-scalePBSimplementaBon

•  OrganizaBonalsystemsvariables

Dunlap&Carr,2007;Dunlap,Jackson&Greenwald,inpressNevadaPBISTechnicalAssistanceCenterNVCenterforExcellenceinDisabiliBesUniversityofNevada,Reno

IMPLEMENTATIONWhatwe’relearning

Scalingup


ImplementaBon

•  Evidenced-basedinnovaBons•  Evidence-basedimplementaBonofevidence-basedprograms

•  ScalingposiBveoutcomesinhumanservicesystems

•  Arewedeliveringtheservicesweintendedtodeliver?WithFIDELITY?

•  ThesystemdeterminesouroutcomesFixsen,2016


DegreesofImplementaBon

•  PaperimplementaBon•  ProcessimplementaBon•  PerformanceimplementaBon

Fixsenetal.,2005

“ImplementaBonoccursinthecontextofcommunity.”

“Thecommunitybothdefinestheproblemtobesolvedandteststheadequacyoftheanswer.”

-Felner,1997



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SchoolsusingPBISAugust,2015 21,278

0

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25000

00 01 02 03 04 05 06 07 08 09 10' 11' 12' 13' 14' 15' 16' 17' 18'

Horner,Sugai&colleagues



StructuresforBuildingCapacitytoImplementPBS

•  ImplemenBngwithfidelity•  Comprehensivestatewidetraining•  Raiseyoursites…•  TheNevadaexperience


BuildingPBSImplementaBonCapacityNevada’s20-yearexperience

>Geographically&poliBcallydiverse>7thlargeststate;80%rural>35thmostpopulous;88%liveinurbanareas>Highgrowthrate>Lowfundingforschools&disabilityservices,butalsonolargesystemofinsBtuBonalcare

TotalPopulaBon:2.7million


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ThelargercontextinNevada

•  1980s-90s:Fullcommunityinclusion(Inclusiveclassrooms;grouphome“placements”)

•  Early1990s:Firstsupportedlivingarrangements(SLA)withindividualizedplan&budget

•  Somecapacity-buildingefforts&useofPBS•  ConBnueduseofaversiveintervenBons•  1999:LegislaturepassesAB280–aversivesstrictlylimited,traininginPBSrequired


•  ImpactoftheOlmsteaddecision(1999)•  AccreditaBonCouncil–seqng,teachingandevaluaBngstandards


GrowthofPBSinNevada•  1999:PBS-Nevadafounded•  NVacceptedintoResearch&RehabilitaBonTrainingCenter(RRTC)

•  Totalof26statesparBcipated•  RRTC–naBonalexpertspreparedstatewidePBStrainingteam&assistedinimplemenBnglocalcapacityinPBS–  Familymembers,schoolandIDDagencystafftrainedasateam

– Upto60hrstolearnPBS,createandimplementsupportplan

ExpertsupportforNevada

•  RobHorner*•  RickAlbin•  AnnTodd•  RachelFreeman•  HeatherGeorge•  GlenDunlap**•  KentMcIntosh•  JackieAnderson

**

*


Strategies&achievements•  ManypresentaBons/meeBngs,legislaBvehearings,stateadvisorycommileereportstobuildbuy-in&support

•  EndorsedbyNVCommissiononMH&DS•  IncludedaskeystrategyinGovernor’s10-yrplanforIDD(2002Olmsteadplan)

•  Statutoryauthorityforfunding(2002-present)•  Supportedbystakeholdersanddecisionmakers•  Numeroussourcesoffinancial/in-kindsupport


OtherPBS-NevadaprojectsandacBviBes

•  AssisBnginwriBngpolicy•  TrainingoflocallybasedstaffasPBStrainers•  School-widetraining•  OpenedregionalPBS-NevadaofficeswithBCBAs•  Developed3-Beredapproachtoservices(basedonintensityofneeds)

•  ParBcipaBon/collaboraBonwithnaBonalnetworkofresearchers&pracBBoners

•  Projectsinschools(SWPBS,Schoolmentalhealth),auBsm,juvenilejusBce,aging,courtmandatedparenttraining

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Nevada’sVision(1999)

v PeoplewithdisabiliBesparBcipatefullyintheircommuniBes

v Peoplechoosepersonalgoalsandservicesv Peopleliveintypicalfamilyorothernaturalsupportseqngs

v ServicesaredesignedusingbestpracBcesbasedonresearch

v Peoplearesafe,respectedandexercisefullrights


VisionforPBS/Behavioralhealthsupports(1999-present)

v Increasechoices,independence,andqualityoflifeofconsumersthroughtheapplicaBonofposiBvebehavioralsupports(PBS)acrossseqngs

v DevelopanetworkofindividualsthroughouttheStatethatcanprovideleadership,training,andconsulBngonPBSandrelatedtopics

v Buildthecapacityofindividualsprovidingdirectcare,treatment,oreducaBonforindividualswithdisabiliBestoprovidePBS

v Createadurablestateandregionalnetworktosupporttrainer/consultantsindeliveringPBSservices


CurrrentstatusofPBSinNevada•  RenamedtheNevadaPosi/veBehavioralInterven/onsandSupports(PBIS)TechnicalAssistanceCenter

•  100%grantfunded–stateandfederalfunds•  OperaBngbudgetofover$1million/year.•  Arrayoftrainingandtechnicalassistanceservicesinavarietyofseqngs,acrossmanystateagencies,andwithdiverseclientele.–  PBS-NVFamilyServices,PBS-NVAgingServices,juvenilejusBceandtheSchoolClimateTransformaBonProject.

•  Currentlyemploysatotalof12BoardCerBfiedBehaviorAnalysts(BCBAs)acrossthestate

•  EveryacBvity/projectofthecenterisfocusedonbuildingPBScapacity.


Figure1.3PBSServiceRegions–NortheastwithcoordinaBoninElko,NorthwestwithcoordinaBoninReno,andSouthernwithcoordinaBoninLasVegas.


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PBS-NVPeopleServed,TrainingsandBudgetDataFY08-FY13

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LocalizedLeadership

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Budget FI Trainings

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Figure2.Numberoffocusindividuals(FI)supported,numberoftrainingsheld,andoverallbudgetperyear,beforeandakerregionalizaBon.*FY13isaprojecBonbasedondatacollectedthroughquarter2.


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Clark

Washoe

Humboldt

Pershing

Lander

Douglas

SchoolClimateTransformaBon

Project93schools,7schooldistricts


Tier1PracBces

•  Focusesonthe“smallestfuncBonalunits”requiredforgeneraBngoutcomes– Contextuallyandculturallyrelevant

•  E.g.definingandteachingexpectaBons

•  Matrix– EstablishessBmuluscontrol&discriminaBonbyteachingsocialskillsinthenaturalcontextandprovidingbehaviorexamples

Tier2/3PracBcesTier2:•  Designedforstudentsthatwouldbenefitfrom:– Moresalientandfrequentantecedentprompts

– AddiBonalstructure–  Increasedrateofreinforcement

–  Enhancedsupportinteachingappropriateskills

IntensityofServicesIncreaseasbehaviorsincreasein

frequency,intensityand/orco

mplexity

Horner&Sugai,2015

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TwoTypesofEvaluaBon

1.   Evalua<ngImplementa<on–  ArewefollowingtheAcBonPlan?–  ArewemeeBngtheneedsofourstaff?

2.   Evalua<ngSW-PBSanditseffects–  Arewegeqngtheoutcomeswewant?–  ArewemeeBngtheneedsofourstudents?–  Arethereproblemareastoaddress?

76 NevadaPBISTechnicalAssistanceCenterNVCenterforExcellenceinDisabiliBesUniversityofNevada,Reno

SixKeyFeaturestoAchieveLarge-scaleApplicaBonofEvidence-basedPracBces

1.Focusoncomprehensiveoutcomesdefinedbythevaluesofthesocialsystem

2.Expandtheunitofanalysis3.Measureprocessaswellasoutcome4.MakeABAprinciplesmoreaccessible5.Focusonsustainedeffects6.Defineproceduresforscaling-upeffecBvepracBces.

Horner&Sugai


School-widePBIS

2.Expandtheunitofanalysis– Wholeschool

• Classroom– Groupsof�at-risk�students

» Individualstudentsneedingintensivesupport

Students=unitofimpactSchools=unitofintervenBon

Districts=unitofimplementaBon


School-widePBIS

4.MakeEvidence-basedPracBcesAccessible–  UsethelanguageoftheimplementaBoncontext–  Combinetechnologiesneededtoachievevaluedoutcomes.

•  ABA+Person-centeredplanning+OrganizaBonalSystems+Bio-Medical

–  Collaboratewithotherdisciplines•  MentalHealth,JuvenileJusBce,SchoolPsychology,Sociology

–  StudyimplementaBonaswellasapplicaBon•  FuncBon-basedintervenBon•  Contextualfit Bergstrom

Benazzi

Ingram

McIntosh

McKenna


Nevadapbis.org


ThepromiseofPBSArewemeeBngit?

•  “WeneedtodevelopamuchbroaderandricherdatabasesothatthepromiseofPBSasanapproachtoallhumanbehaviorchallengescanbemorefullymet.

•  Toaccomplishthisgoal,weneedtolink[our]behavioranalyBcandspecialedmethods…withconceptsstrategies,andproceduresderivedfromotherrelevantsciencesanddisciplines.” (Carr,2007,p.8)

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Takehomepoints

•  PeopleweserveneedanddeserveaposiBvehomeandcommunityclimate(predictable,posiBve,safe,consistent

•  Climatechangehappensatasystemslevel•  MulB-BeredbehaviorframeworksallowformaximizaBonofresourcesinimpact

•  PBShappensacrossthecountryandeachstatehasavailableresourcesandsupport


20YearsLater…(SeguetoElaine’ssecBon)

•  Whatwelearned…•  Didwesustaincapacity-buildingstructures?•  Whatsurvivedfor20years...•  Whatdidnotsurvive...•  OrganizaBonalsystemsvariables

•  BarriersandopportuniBes...(Elaine)

Theproblem


ThankYou!

Namaste

DonJackson,[email protected]

8/17/16 Building capacity to implement posiBve behavior ... · Building capacity to implement...

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