Contents of Portfolio Packet - West Virginia Association for ... · Web view2016/12/02 · WVAPBS...

Positive Behavior Support Professional Portfolio

Expedited Application

Contents of Portfolio Packet

Signed and Notarized Application (which includes Cover Sheet, Statement of Interest, Ethical Commitment, Liability Disclaimer)

Summary of Requirements

Checklist of Portfolio Contents

Résumé or Abbreviated Vitae

Copy of Degree or Transcript of Highest Degree Earned

Copy of any Qualifying Licenses or Credentials

Theory, Knowledge, Skills, and Abilities

Documentation of Training

PBS Plan with FBA and Implementation Data (redacted)

FBA and PBS Plan Scoring Checklists (for applicant to complete)

FBA and PBS Plan Criteria Checklists (for reviewer to complete)

Recommendation Forms (in sealed envelopes with signature)

Other

Submit Portfolio to:

WVAPBS

WVAPBS PBS Professional Portfolio- Expedited version

PBS Endorsement Board PO Box 490Milton, WV 25541

Adapted from the Virginia PBS Endorsement Process 1


2

EXPEDITED PROCESS


Application Cover Sheet

NOTE: IF ENDORSED, THE INFORMATION LISTED BELOW WILL BE LISTED IN THE PBS PROFESSIONAL REGISTRY. YOU WILL BE LISTED AS AVAILABLE FOR MENTORING UNLESS YOU INDICATE OTHERWISE. IF YOU DO NOT WANT YOUR INFORMATION LISTED IN THE REGISTRY, PLEASE INDICATE THAT OPTION AND YOUR REASONS IN THE COMMENTS SECTION HERE.

Comments:

Name:

Address:

Phone: _ Email: _______________________

Agency/Affiliation: _________________________________________________

Mentoring Status: ___ Available ___ Already Contracted ___ Unavailable

Completed by Applicant

PBS Funding: __ Private Pay ___ Insurance ___ Title XIX Waiver __ Other

Region(s) Covered: (check all that apply)

☐Northern Panhandle

☐Eastern Panhandle

☐North/Central WV

☐Metro/Kanawha Valley

☐Ohio Valley

☐Potomac Highlands

☐New River/Greenbrier Valley

☐Southern WV

☐Specific counties (list)

___________________________________________________________________________

☐Other (identify) ___________________________________________________________________________

Experienced with: (check all that apply)

☐Birth -5

☐School Aged

☐Adults

☐Seniors

☐Families

☐School-Wide

☐Developmental Disabilities

☐Autism Spectrum Disorders

☐Emotional/Behavioral Disorders

☐Other _______________________________________________________________________________________

Date of Review by Endorsement Board:

Date of Interview:

Type of Certification: Expedited Process

STATUS:

· Endorsed

· Conditionally Endorsed: Must complete:

· Did not meet criteria as of this submission ___________________

Date of Portfolio Submission:

Completed by Office


EXPEDITED PBS APPLICATION -2

Narrative Statement of Interest

(In a paragraph or two, discuss your interest in obtaining PBS endorsement)

Experience:

Years of experience providing PBS

Education:

List highest degree from accredited university and field of study

Credentials:

List qualifying licenses or credentials

EXPEDITED PBS APPLICATION – 3

Ethics Commitment

In signing below, the applicant pledges their commitment to ethical standards, APBS Practice Standards and the WVAPBS Ethical Guidelines in their work and attests that the information contained within is true and accurate.

Liability Disclaimer and Waiver

This Disclaimer and Liability Waiver serves to accurately document that, if PBS Endorsement is granted, it indicates only that the applicant listed below has met the minimum standards for PBS Endorsement and does not warrant or guarantee the undersigned’s competence to provide professional services. The undersigned agrees to fully disclose this fact and to indemnify the WVAPBS Network and PBS Endorsement Review Board from and against any liability that may arise from the issuance of a PBS Endorsement and any resulting professional practice. The undersigned applicant for PBS Endorsement understands and agrees that they will obtain liability protection and/or assume all liability risk and that the PBS Endorsement Board and the WVAPBS Network and its members will be held harmless and that any potential clients will be fully informed of this prior to providing services.

Agreement to Mentor

Fees are waived for expedited applicants in recognition of mentoring responsibilities. As an experienced PBS Professional, it is an important part of your role to mentor and support emerging professionals in the field to assure quality and fidelity of services. In signing below, all expedited candidates commit to offering mentoring at no cost for one year to at least one person going through the standard PBS endorsement process. Furthermore, the undersigned candidate understands that this mentoring must be documented on the appropriate forms and consist of a total of twelve sessions of at least one hour each to be held monthly.

Typed Name:

Signature:_________________________________

Date: _________________________________

State of ____________________

County of __________________

Signed and sworn to before me on _______ (date)

by __________________________________ (name)

Signature

Stamp

Title

My commission expires on:

5


Checklist of Portfolio Contents

Office use:

EXPEDITED PROCESS APPLICATIONcheck if located

Notarized ApplicationPages

Résumé or Abbreviated VitaePages

Copy of degree or transcriptPages of highest degree earned

Credentials – copies of licenses Pages

certifications or credentials

Theory, Knowledge, Skills Pages

And Abilities

Training documentation and Pages _____________

Certificates

Positive Behavior Support plan Pages

FBA Scoring Checklist Pages

Applicant version (completed)

A

PBS Plan Scoring Checklist Pages

Applicant version (completed)

FBA Scoring CriteriaPages applicant Re Reviewer version (completed)

PBS Plan Scoring Criteria Pages

Reviewer version (blank)

Recommendation Form 1Pages

Recommendation Form 2Pages

Other Pages

6

Résumé or

Abbreviated Vitae (4 pages maximum)

Insert after this page

19

Copy of Degree or Transcript of Highest Degree Earned

(Must have at least a Bachelor’s degree from an accredited university)


Professional Credentials

(Check any applicable credentials and include copies of licenses or certifications after this page.)

BCBA or BCBA-D

Licensed Psychologist

Professional Licensed Counselor

Licensed Social Worker

Certified Special Educator

(If you have a graduate degree in Behavior Analysis, please check below)

Masters or Doctoral degree in Behavior Analysis

Theory, Knowledge, Skills and Abilities

(TKSA)

· Please list specific training beside each TKSA on the TKSA Form including coursework, dates, location and instructor.

· After the TKSA form, include documentation of the trainings listed. Please include completion of the facilitated Overview of PBS, completion of an approved 32 hr. PBS curriculum with mentoring, and all other trainings

· Exemptions: Please note that with the Expedited Process, specific credentials will be recognized as exempting the candidate from some or all of the Theory, Knowledge, Skills and Abilities (TKSA) documentation. In other words, the specified credential will be accepted as documentation of these TKSA. If you are exempted from a TKSA section or sections based on one of these specific credentials, please indicate the credential in the shaded portion of major heading designated by a letter. For sections not exempted, please list specific training for each item and include documentation TKSA after the TKSA form.

· Those with a graduate degree in Behavior Analysis or those with a BCBA or BCBA-D credential may submit their credentials AND documentation of a minimum 3 hr. Overview of PBS training in lieu of TKSA documentation sections A through G (All TKSA).

· Those holding a Master’s degree or higher and license in SW, LPC, or Psychology or certification in Special Ed may submit their credentials in lieu of TKSA sections F and G, along with documentation of completion of an approved 32 hr. PBS training with mentoring or comparable training for TKSA’s A through E in lieu of the entire TKSA form/documentation.

The chart below may be helpful in determining any TKSA exemptions:

TKSA Recognized Credential

TKSA EXEMPTIONS

Documentation Needed

BCBA or BCBA-D

A,B,C,D,E, F, G

(All)

Credential AND minimum of 3 hr. Overview of PBS

Graduate degree in Behavior Analysis

A,B,C,D, E, F, G

(All)

Credential AND minimum of 3 hr. Overview of PBS

Graduate degree AND Social Work License, Licensed Professional Counselor, Licensed Psychologist, or Special Ed Certification

F, G

Credential AND approved PBS training with mentoring or comparable training for TKSA A,B,C,D,E


· If you are exempted from a TKSA section or sections based on one of these specific credentials, please indicate the credential in the shaded portion of major heading designated by a letter. For sections not exempted, please list specific training for each item and include documentation TKSA after the TKSA form.

Theory, Knowledge, Skills, and Abilities Form

Expedited Process

Theory, Knowledge, Skill, Ability

List coursework or training session, location, date, and instructor

A. Basic Underlying Principles

1. Behavior is communicative

2. Considers and refers persons for evaluation when underlying biological, social and medical issues might precipitate and/or exacerbate challenging behavior.

3. Behavior is part of the person’s social context

4. Positive strategies are effective in addressing challenging behavior

5. Responsibility for behavior is shared between the caregiver and the person

6. Interventions should increase competence of the person and should result in increased quality of life for the person

7. Intervention plans must fit with the values and abilities of the team who will implement them

8. Intervention plans must include multiple components, including antecedent interventions, strategies to teach replacement behaviors, positive consequences to increase the replacement behaviors, and, if necessary, crisis management strategies

9. The people who will implement the intervention plan should be involved in its development

Expedited Process



10. The role of the facilitator is to support the team

11. It is essential to assess the behavior and the system supporting the person

12. PBS strategies and outcomes should match the values of the person, their family and support network, and the community

13. PBS techniques do not cause pain or humiliation or deprive the individual of basic needs

B. Identify problem behaviors for assessment and intervention

1. Identify behavior

2. Prioritize behavior

3. Operationalize behavior

4. Develop baseline data collection method for behavior

C. Complete Functional Behavior Assessment

1. The goal of functional behavior assessment is to understand the connection between the behavior and the social, physical and personal environment

2. Develop indirect assessment methods that include record reviews, structured interviews, rating scales, checklists.

3. Participate in indirect assessment methods

4. Develop direct assessment methods (ABC analysis, scatter plot, setting event analysis, etc.) to identify the function of behavior

5. Collect data and report perceived function

6. Develop functional analysis protocol when necessary

7. Analyze all data collection methodologies

8. Develop functional behavior hypothesis

9. Test functional behavior hypothesis

10. When outcomes are not met, review, revise, modify positive behavior support assessments and strategies; do not resort to punitive or aversive strategies

D. Develop Positive Behavior Support plan

1. Behavior support plans are driven by the results of person centered planning and functional behavior assessments

2. Develop setting event, motivating operations, and antecedent interventions

a. Curricular modifications

b. Instructional modifications

c. Behavioral precursors as signals

d. Modification of routines

e. Increase predictability through scheduling

f. Opportunities for choice/control throughout the day

g. Clear expectations

h. Pre-correction

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3. Errorless learning

4. Develop teaching plan for alternative replacement, coping, and general skill behaviors

5. Develop consequence strategies to increase new alternative behaviors

6. Develop consequence strategies for problem behavior

7. Develop crisis management plan

8. Crisis management is a short term solution to keep people safe and not a behavior change strategy

9. Develop strategies to address the generalization and maintenance of skills across settings and time

10. Develop plan to increase quality of life including achieving dreams, improving health, increasing self-determination, increasing inclusion, promoting social interactions and relationships, increasing fun and success, and improving access to leisure, recreation, and relaxation

11. Develop an action plan and training methods to assist team in implementing complete multi-component PBS plan

12. Develop plan evaluation, data collection methods

13. Assess goodness of fit of PBS plan


Expedited Process



E. Implement PBS Plan

1. Implement strategies developed in PBS plan

2. Collect data to evaluate plan effectiveness to decrease problem behavior

3. Collect data to evaluate plan effectiveness to increase alternative behavior

4. Collect data to evaluate plan effectiveness to increase quality of life

5. Display data graphically to demonstrate effects of intervention

6. Evaluate data an report on plan effectiveness

7. Revise plan when necessary in consultation with the team

F. Facilitate Person-Centered Plans

1. Select team process to use to develop plan (MAP, PATH, Essential Life Style Planning, Plan for Life, etc.)

2. Identifies the strengths and gifts of the individual


Expedited Process



3. Identifies the level of independence and support needs of the individual

4. Considers the health and medical/biophysical

needs of the individual

5. Identifies the dreams and goals of the individual and their circle of support.

6. Identifies the barriers to achieving the dreams and goals

7. Considers the importance of the above information on problem behavior

8. Prepares the team and venue for facilitation

9. Facilitates team

10. Works with team to support implementation

11. Follow-up with team to support implementation

12. Reschedule and revise with team as necessary

G. Team Facilitation Competencies

1. PBS team meetings should be facilitated in a productive manner employing multiple constructive problem solving strategies

2. The focus person and their support network are active participants in the process and the focus person has the choice of participating in all meetings about them

3. Uses skills needed for successful collaboration and communication including communicating clearly, establishing rapport, being flexible and open and supporting the viewpoints of other

4. Uses essential team processes including facilitation, coaching, mediation, consensus building, meeting management and team roles and responsibilities

5. Addresses barriers to team success

6. Develops problem solving strategies for teams

7. Seeks support and supervision when necessary to move team when blocked

Training Documentation

(Please insert after this page)

Include documentation of the trainings listed.

Please include (check those that apply):

· Completion of the facilitated Overview of PBS AND

· Completion of an approved 32 hr. PBS curriculum with mentoring OR

· Documentation of at least one of the following (check one):

· Completed or taught a complete four day standardized PBS workshop training through an accredited university prior to 2015

· Completed or taught a standardized PBS curriculum for 3 hours of professional development credit through an accredited university which included coaching

· Completed or taught equivalent individual PBS training approved by other state PBS networks or endorsement boards

· Completed or taught the WV Early Childhood Pyramid Model (PBS) Curricula

· Completed the Kansas PBIS Modules with 15 hours face to face training and a mentoring component through an accredited university

· Completed a graduate level course in individual PBS that follows APBS standards from an accredited university

· Received a University of South Florida (USF) Graduate Certificate in PBS

· Received a Certificate of Completion of an Approved (Waiver) PBS Curriculum by qualified instructor with mentoring component

· Completed other training that meets APBS standards and is recognized by the WVAPBS Endorsement Board



PBS Plan with Implementation Data and Narrative Cover Letter

Note: Please assure confidentiality by redacting these documents

PBS Plan Checklists


In this section, please include:

· Narrative describing the team process and any details that aren’t included in the plan but are on the checklist

· Positive Behavior Support plan

· Functional Behavior Assessment including data, graphs, and, other relevant information

· Completed Applicant Checklist indicating the page number of the plan where the information is located and the section. Do NOT put N/A or leave any item blank as it will result in your portfolio being returned for incompletion.

· Blank “Reviewer” Checklist – Please FILL IN YOUR NAME ONLY in the space provided. The remainder of the reviewer checklist will be completed by the reviewer. These are included in the portfolio so applicants will know what will be evaluated and to prepare the portfolio for the review process.


FUNCTIONAL BEHAVIOR ASSESSMENT SCORING CHECKLIST

APPLICANT VERSION

Applicant’s Name: ____________________________Date: ______________________

Instructions: Please note the page(s) and the section where the listed information can be found. If any item receives a score of 0, reviewing of the document will cease and you will not be eligible for expedited endorsement. If the FBA does not meet passing criteria, 28 out of 30, the PBSP will not be reviewed.

Page number(s) and section

1

Functional Behavior Assessments (FBA) results include information related to the member’s communication and learning needs, as well as an analysis of routines. The results must also address relevant history, diagnoses, living situation, health and safety concerns, personal preferences and interests, community involvement and onset of current challenging behavior.

2

Person centered planning should include more than hopes and dreams. It should also include lifestyle enhancements, development of relationships, and social inclusion.

3

The person’s FBA process must be completed by the member, their family and treatment team and it must reflect the member’s gifts and strengths.

4

Quality of Life Assessment (QoLA) utilizes interviews and biographical information to identify opportunities for choice, social interaction and goal development.

5

Baseline data must be clearly represented, accurate, and meaningful.

6

Indirect assessment data is obtained and described using at least two of the following: Interviews, record reviews, checklists, rating scales, inventories.

7

Direct observation must occur and be applied to the hypothesis statement.

8

All challenging behaviors targeted for intervention in the BSP must be defined in observable and measurable terms.

9

Setting events and antecedents of challenging behavior are identified and analyzed.

10

The reinforcing consequences of challenging behavior are identified and analyzed.

11

The context(s) in which challenging behaviors are likely to occur and least likely to occur is identified.

12

All hypothesis statements are comprehensive and include relevant setting events, antecedents, consequence(s), and operationally defined challenging behavior, as well as the perceived function(s) of the challenging behavior.

13

A summary of how data supports each hypothesis is provided.

14

The FBA is clear, well-organized, and grammatically correct, which permits the reader to follow the FBA.

15

All supporting materials necessary for a full understanding of the FBA are included.

Adapted from the Kansas Institute for Positive Behavior Support scoring criteria and APS Healthcare, Inc. I/DD Waiver Provider Review Tool.

POSITIVE BEHAVIOR SUPPORT PLAN SCORING CHECKLIST

APPLICANT VERSION

Applicant’s Name: _______ ____________________________Date: ______________________

Instructions: Please note the page(s) and the section where the listed information can be found. If any item receives a score of 0, reviewing of the document will cease and you will not be eligible for expedited endorsement.

Page number(s) and section

1

Plan includes evidence that a team-based process was used.

2

Plan identifies and defines functionally equivalent replacement behaviors or alternative behaviors for all targeted challenging behaviors.

3

Plan identifies the method and timeline for team review of data and progress.

4

The plan describes methods for providing opportunities for choice and social interaction.

5

The plan describes setting event and antecedent intervention based on the targeted challenging behaviors.

6

Positive consequence interventions include an explanation of how they relate to the perceived function stated in the hypothesis.

7

Safety/emergency procedures for what to do if/when crisis occurs is addressed.

8

Measurement method of each targeted challenging behavior and what data will be gathered for the intervention effectiveness assessment are described (including replacement behaviors once dated are collected on them).

9

Process for monitoring the intervention plan is described and includes, at a minimum, the timeline for meetings, what needs to be completed, when it must be done and by whom (responsibilities).

10

Selecting effective reinforcers and/or maximizing positive reinforcement for desired behavior is included.

11

At minimum one intervention relates specifically to increasing quality of life based on the Quality of Life Assessment.

12

At least one intervention supports minimizing reinforcement for challenging behavior.

13

The plan includes how each intervention will be implemented and step-by-step directions that include the sequence of actions for implementation.

14

Plans for staff training, generalization of skills, and dealing with life changes are included to sustain success.

15

The plan is clear, well-organized, and grammatically correct, which permits the reader to follow the plan.


FUNCTIONAL BEHAVIOR ASSESSMENT SCORING CRITERIA

REVIEWER VERSION

Applicant’s Name: ___________________________________

Endorsement Board Member Name: ___________________________________

Instructions: Please rate each of the following questions by assigning a point value of 0, 1, or 2. If any item receives a score of 0, cease reviewing of the document as the applicant is no longer eligible for expedited endorsement. If the FBA does not meet passing criteria, 28 out of 30, the PBSP will not be reviewed.

Unacceptable

0

Minimally Done

1

Comprehensive

2

Score

1

Functional Behavior Assessments (FBA) results include information related to the member’s communication and learning needs, as well as an analysis of routines. The results must also address relevant history, diagnoses, living situation, health and safety concerns, personal preferences and interests, community involvement and onset of current challenging behavior.

Less than six of the listed areas are addressed in the FBA.

More than six of the listed areas are addressed in the FBA but not all.

All areas are sufficiently assessed in the FBA results. If particular events do not apply, it is stated.

2

Person centered planning should include more than hopes and dreams. It should also include lifestyle enhancements, development of relationships, and social inclusion.

No mention of hopes/dreams or other person-centered planning information.

Hopes, dreams and other person-centered planning information are identified but there is no explanation of how these were addressed.

Clear statements of objectives, from hopes and dreams and other person-centered planning information are included.

3

The person’s FBA process must be completed by the member, their family and treatment team and it must reflect the member’s gifts and strengths.

No evidence of team involvement or no information about the person’s gifts and strengths were included in the FBA results.

The FBA results reflect team involvement or information about the person’s gifts and strengths but not both.

The person’s FBA process was completed by a team and the person’s gifts and strengths are included in the FBA process.

4

Quality of Life Assessment (QoLA) utilizes interviews and biographical information to identify opportunities for choice, social interaction and goal development.

A Quality of Life Assessment (QoLA) is not included.

Some baseline data related to Quality of Life (QoL) are provided, however, the assessment does not include all areas.

Quality of Life Assessment (QoLA) data is clearly defined and includes information about opportunities for choice, social interaction, and goal development.

5

Baseline data must be clearly represented, accurate, and meaningful.

Baseline data is not provided.

Baseline data is unclear, inaccurate, or not meaningful.

Baseline date is clear, accurate, and meaningful.

6

Indirect assessment data is obtained and described using at least two of the following: Interviews, record reviews, checklists, rating scales, inventories.

No information is provided or assessment methods are implied without reporting results or only significant other are interviewed.

All information from one assessment method is provided or results are listed but not explained.

Results from at least two methods are explained in detail. Specific assessment tools are identified.

7

Direct observation must occur and be applied to the hypothesis statement.

No information regarding direct observation is available.

Direct observation conducted by only one person and/or completed on only one occasion.

Direct observation is conducted on more than one event and by different individuals.

8

All challenging behaviors targeted for intervention in the BSP must be defined in observable and measurable terms.

None of the targeted challenging behaviors are defined in observable and measurable terms.

Not all targeted behaviors are defined in observable and measurable terms.

Targeted challenging behaviors are defined in observable and measurable terms.

9

Setting events and antecedents of challenging behavior are identified and analyzed.

No information on setting events and antecedents is provided or the information provided is difficult to understand.

Setting event and antecedents of challenging behavior are provided, however they are not related to assessment data.

The information on setting events and antecedents of challenging behavior is clearly explained and analyzed.

10

The reinforcing consequences of challenging behavior are identified and analyzed.

No information about the reinforcing consequences is provided or the information provided is difficult to understand.

The reinforcing consequences of challenging behavior are provided, however they are not related to assessment data.

The information about the reinforcing consequences of challenging behavior is clearly explained and analyzed.

11

The context(s) in which challenging behaviors are likely to occur and least likely to occur is identified.

No information is provided on context or the information provided is difficult to understand.

Some information on context is provided, however, the information does not analyze how these factors influence behavior.

The contextual description of challenging behaviors must be an in-depth analysis which includes location, time of day, people present and activities that have occurred. The description must also identify the context in which the person is least likely to utilize the challenging behavior.

12

All hypothesis statements are comprehensive and include relevant setting events, antecedents, consequence(s), and operationally defined challenging behavior, as well as the perceived function(s) of the challenging behavior.

No hypothesis statements are included or all the included hypothesis statements are missing the required components (relevant antecedents, setting events, consequence(s), perceived functions(s), and operationally defined challenging behavior).

Some of the hypothesis statements do not contain the required components.

Each hypothesis statement contains all of the required components.

13

A summary of how data supports each hypothesis is provided.

Data is presented is disorganized and without a clear explanation of its relationship to hypothesis.

Data presented does not support each hypothesis.

Data is provided in an organized format (table, graph) and clearly explains/supports the hypotheses.

14

The FBA is clear, well-organized, and grammatically correct, which permits the reader to follow the FBA.

Serious organizational or grammatical issues interfere with the reader’s ability to follow the FBA.

The FBA has organizational or grammatical issues, however, the issues don’t interfere with the reader’s ability to follow the FBA.

The FBA is well-organized and grammatically correct with only minimal spelling, grammar or punctuation errors.

15

All supporting materials necessary for a full understanding of the FBA are included.

There were no supporting materials provided and these are necessary for a full understanding.

Some, but not all of the pertinent materials are included.

Questionnaires, graphs, and other pertinent materials necessary for full understanding are included or no other materials are needed for full understanding.

A total score of at least 28 out of 30 is required to be considered a complete FBA.

Total Score

Reviewer comments:


POSITIVE BEHAVIOR SUPPORT PLAN SCORING CRITERIA

REVIEWER VERSION

Applicant’s Name: ___________________________________

Endorsement Board Member Name: ___________________________________

Instructions: Please rate each of the following questions by assigning a point value of 0, 1, or 2. If any item receives a score of 0, cease reviewing of the document as the applicant is no longer eligible for expedited endorsement.

Unacceptable

0

Minimally Done

1

Comprehensive

2

Score

1

Plan includes evidence that a team-based process was used.

Plan not developed with a team or evidence is not presented.

Evidence of team involvement in collection of information, however not for selection of interventions to be used (team participation evidenced by participant signatures and limited evidence of team involvement).

Evidence of team involvement in collection of information and selection of all interventions used.

2

Plan identifies and defines functionally equivalent replacement behaviors or alternative behaviors for all targeted challenging behaviors.

No functionally equivalent replacement behaviors or alternative behaviors are identified and defined.

Functionally equivalent replacement behaviors or alternative behaviors are not identified or defined for all challenging behaviors.

Plan identifies and defines all functionally equivalent replacement behaviors or alternative behaviors for all targeted challenging behaviors.

3

Plan identifies the method and timeline for team review of data and progress.

No plan for team review is identified.

Plan for team review of data and progress is identified but there is no timeline or it is more six months before team review.

Plan identifies the method and timeline for team review of data and progress on an ongoing basis (at least quarterly).

4

The plan describes methods for providing opportunities for choice and social interaction.

No intervention in the plan addresses these areas.

Interventions do not adequately address opportunities for choice or social interaction.

Interventions for choice and social interaction are clearly addressed.

5

The plan describes setting event and antecedent intervention based on the targeted challenging behaviors.

No setting event or antecedent interventions are included.

Setting event and/or antecedent interventions are included but are not clearly described or based on the targeted challenging behaviors.

Setting event and antecedent interventions are clearly described and based on the targeted challenging behaviors.

6

Positive consequence interventions include an explanation of how they relate to the perceived function stated in the hypothesis.

Positive interventions do not address the perceived function in the hypothesis statements.

Positive interventions do not relate or relate incorrectly to the perceived function in the hypothesis statement.

Each positive intervention specifically states how it related to the perceived function in the hypothesis statement.

7

Safety/emergency procedures for what to do if/when crisis occurs is addressed.

There is no crisis plan noted and the severity of the behavior warrants one.

There is a crisis plan noted but the description is incomplete or it is inappropriate given the severity of the behavior.

There is a specific crisis intervention plan described and the components are appropriate given the severity of the behavior. If safety/emergency procedures are not necessary, it is so stated.

8

Measurement method of each targeted challenging behavior and what data will be gathered for the intervention effectiveness assessment are described (including replacement behaviors once dated are collected on them).

There is no description of how any targeted challenging behavior will be measured nor is there mention of data collection of any kind to assess intervention effectiveness.

Mention is made that data will be collected on the targeted challenging behavior but there is not concrete description of the data collection method that will be used, or there is not a description for each of the challenging behaviors targeted, or it is unclear which data collected will be used for intervention effectiveness assessment, or it is unclear how this data will be collected.

The data collection method for each targeted challenging behavior is described and exactly what data is collected, to assess intervention effectiveness is stated.

9

Process for monitoring the intervention plan is described and includes, at a minimum, the timeline for meetings, what needs to be completed, when it must be done and by whom (responsibilities).

There is no indication that the plan will be monitored at all.

A process for monitoring is included but not clearly defined and/or does not included clear timelines and responsibilities.

There is a specific process described for the team to meet and for specific individuals to monitor the plan. The plan identifies that implementation data will be analyzed and shared with the team, at least monthly, as well as discussed in team meetings at least every three months.

10

Selecting effective reinforcers and/or maximizing positive reinforcement for desired behavior is included.

The plan does not include a description of positive reinforcement to be used.

The intervention(s) includes appositive reinforcement component but does not describe how to implement the intervention(s) e.g. praise desired behavior.

The intervention(s) includes specific positive reinforcement for desirable behavior and describes how/when the reinforcer will be used.

11

At minimum one intervention relates specifically to increasing quality of life based on the Quality of Life Assessment.

There are no quality of life interventions.

Quality of life interventions do not directly relate to the Quality of Life Assessment or the person’s dream.

An intervention that directly relates to improving the person’s quality of life as identified in a quality of life assessment, is clearly explained.

12

At least one intervention supports minimizing reinforcement for challenging behavior.

There is no intervention to minimize reinforcement for challenging behavior.

Intervention includes decreasing reinforcement of target challenging behavior but does not describe specifically how to implement.

Intervention describes specifically how to tope of minimize reinforcement of challenging behaviors.

13

The plan includes how each intervention will be implemented and step-by-step directions that include the sequence of actions for implementation.

The plan does not include the sequence of interventions or step-by-step directions that include the sequence of actions for implementation.

The plan includes the sequence for interventions and directions for implementation, however either the plan is unclear or it is impossible to follow.

All interventions in the plan are clearly described, logical, and presented sequentially.

14

Plans for staff training, generalization of skills, and dealing with life changes are included to sustain success.

There is no mention of staff training, generalization of skills or dealing with life changes.

Plan identifies staff training, generalization of skills or dealing with life changes, but not all three areas.

Plan specifically addresses the need for staff training, generalization of new skills, and strategies to sustain success.

15

The plan is clear, well-organized, and grammatically correct, which permits the reader to follow the plan.

Serious organizational or grammatical issues interfere with the read3er’s ability to follow the plan.

The plan has organizational or grammatical issues, however, the issues don’t interfere with the reader’s ability to follow the plan.

The plan is well-organized and grammatically correct with only minimal spelling, grammar or punctuation errors.

A score of at least 28 out of 30 is required to be considered a complete PBSP.

Total Score

Reviewer comments:



32


Recommendation Forms

Two recommendations from individuals familiar with your work in PBS

· Focus Person Reference Form

· Family Member Reference Form

· Professional Form (Team Member, Colleague or Supervisor)

*NOTE: Send the appropriate forms to each party with a self-addressed stamped envelope included. Instruct each person to complete the form, seal it in the envelope, sign their name across the seal of the envelope and return the form to the applicant. The applicant is to put the sealed envelopes with the forms in portfolio.

See forms to be completed on following pages

Positive Behavior Support Professional Recommendation Form

Candidate:____________________________________

Family Version

The individual listed above is applying for Endorsement as a Positive Behavior Support Professional. This form is designed to help you give us feedback on your experiences working with this individual in providing

Positive Behavior Support. Please answer the following questions and mail the completed form back in the self-addressed stamped envelope provided. Your completed form will help us decide if this person meets the criteria to become endorsed as a Positive Behavior Support Professional. Thank you for your time!

Please use the following scale to rate your response: circle the item

YES = you agree with the statement PARTIAL= you agree somewhat

NO = you do not agree N/A = is not applicable for my situation

1.

We felt that we were included (or asked to be included) in all meetings.

YESPARTIAL

NON/A

2.

We felt we were treated with dignity and respect.

YESPARTIAL

NON/A

3.

We felt our team listened to us.

YESPARTIAL

NON/A

4.

This person found out what my family member’s hopes and dreams are for life.

YESPARTIAL

NON/A

5.

This person asked us questions during our meetings.

YESPARTIAL

NON/A

6.

My family member's rights were respected by this person throughout the process.

YESPARTIAL

NON/A

7.

A goal of my family member’s behavior and person-centered plan has been to be as independent as possible.

YESPARTIAL

NON/A

8.

We feel that my family member’s life has been better since working with this person.

YESPARTIAL

NON/A

9.

We feel we have learned ways to provide Positive Behavior Support from working with this person.

YESPARTIAL

NON/A

10.

We would recommend this person to provide Positive Behavior Support services to others.

YESPARTIAL

NON/A

Additional Comments:

Name of Person Completing the Form: ____________________________________________________

Address:____________________________________________________________________________

Phone:________________________________________


Signature:______________________________________


Candidate:_____________________________

Focus Person Version

The individual listed above is applying for Endorsement as a Positive Behavior Support Professional. This form is designed to help you give us feedback on your experiences working with this individual in providing

Positive Behavior Support. Please answer the following questions and mail the completed form back in the self-addressed stamped envelope provided. Your completed form will help us decide if this person meets the criteria to become endorsed as a Positive Behavior Support Professional. Thank you for your time!


YES = you agree with the statementPARTIAL= you agree somewhat


1.

I felt that I was included (or given the option to be included) in all meetings.

YESPARTIAL NON/A

2.

I felt like I was treated with dignity and respect.

YESPARTIAL NON/A

3.

I felt my team listened to me.

YESPARTIAL NON/A

4.

This person found out what my hopes and dreams are for my life.

YESPARTIAL NON/A

5.

This person asked me questions during our meetings.

YESPARTIAL NON/A

6.

I feel that my rights have been respected in this Positive Behavior Support or Person-Centered Plan process.

YESPARTIAL NON/A

7.

A goal of my Positive Behavior Support or Person-Centered Plan has been for me to be as independent as possible.

YESPARTIAL NON/A

8.

I feel that my life has been better since working with this person.

YESPARTIAL NON/A

9.

As a result of working with this person, I have learned better ways to handle things.

YESPARTIAL NON/A

10.

I would recommend this person to provide Positive Behavior Support services to others.

YESPARTIAL NON/A



Address:____________________________________________________________________________

Phone:___________________________________

Signature:______________________________________


Candidate:___________________________

Professional Version

The individual listed above is applying for Endorsement as a Positive Behavior Support Professional. This form is designed to help you give us feedback on your knowledge of this individual and their ability to provide

Positive Behavior Support services. Please answer the following questions and mail the completed form back in the self-addressed stamped envelope provided. This form, in conjunction with other documents, will be

reviewed by an Endorsement Board to determine if the candidate listed above has met the criteria to become endorsed as a Positive Behavior Support Facilitator. Thank you for your time!


YES = you agree with the statementPARTIAL= you agree somewhat


1.

This candidate identifies the strengths of individuals

YESPARTIAL

NON/A

2.

This candidate demonstrates respect in working with individuals.

YESPARTIAL

NON/A

3.

This candidate has demonstrated knowledge of the key concepts of Positive Behavior Support.

YESPARTIAL

NON/A

4.

The candidate understands the importance of collaboration and makes efforts to include all team members in the PBS process.

YESPARTIAL

NON/A

5.

This candidate responds to others in a timely manner.

YESPARTIAL

NON/A

6.

This candidate has been effective in helping others learn more about Positive Behavior Support.

YESPARTIAL

NON/A

7.

This candidate has skills in conducting a Functional Behavior Assessment.

YESPARTIAL

NON/A

8.

This candidate has skills facilitating, developing and implementing a Positive Behavior Support plan.

YESPARTIAL

NON/A

9.

This candidate facilitates data-based decision making.

YESPARTIAL

NON/A

10.

This candidate focuses on quality of life improvements

YESPARTIAL NON/A

11.

This candidate is responsible in their professional conduct and is a good role model.

YESPARTIAL NON/A

12.

I would recommend this person to provide Positive Behavior Support services to others.

YESPARTIAL NON/A




Address:____________________________________________________________________________

Phone:__________________ I am familiar with the applicant as a (check one) PBS Professional Colleague Team Member Supervisor or Other (please list)___________________

Signature:______________________________________


Other Items

(i.e. examples of PBS or PCP work or training)

Contents of Portfolio Packet - West Virginia Association for ... · Web view2016/12/02 · WVAPBS...

Documents

Transcript of Contents of Portfolio Packet - West Virginia Association for ... · Web view2016/12/02 · WVAPBS...