October 21, 2009

Shannon Dorsey, Ph.D.University of Washington, School of Medicine

Division of Public Behavioral Health and Justice Policy

Behavior Management:

Skills you can Use…TOMORROW

Goals for Today

How to define the problem and its positive opposite

Strategies to increase positive behaviorStrategies to decrease unwanted behaviorConsidering the nuanced aspects of attention

Strategies to teach the above strategies

Basically, a lot of strategies. The end.

2

Behavior Management Strategies

Basics from the range of evidence-based parenting programs Parent-child Interaction Therapy Incredible Years Triple P Helping the Noncompliant Child

Not teaching an intervention model but techniques from the underlying principles Makes sense that all have so much in common, all

derived from the Hanf model

Who you Work With…

Common across all behavioral interventions: the Caregiver is your main partner

If the caregiver isn’t engaged in the work—behavioral change won’t happen

For foster parents, you have a second partner, the caseworker

Skill Number 1: Defining the Problem

And…it’s Opposite

First Things First: Define the Problem Behavior

We can’t fix what we don’t know REALLY, REALLY well.

Make it behavioralWhat does it look like? What does it sound like?

ExamplesWhat are some examples of behavioral

problems?What are some examples of loosey goosey

somethings or others?

The Difference Between the Two

Behavioral ProblemsNot listening to directionsDestroying propertyTouching a sibling’s private partsHitting other kids and adultsHaving temper tantrums

Loosey Goosey SomethingsBad attitudeBeing disrespectfulActing suspiciousActing immature

First Things First: Define the Problem Behavior

What would the opposite of the problem be?Make it behavioralWhat would it look like? What would it sound

like?

Not listening to directionsDestroying propertyTouching a sibling’s private partsHitting other kids and adultsHaving temper tantrums

First Things First: Define the Problem Behavior

Get the Specifics of the Behavioral Problem: How frequently does it happen? For how long has it been happening? How intense is the behavior?

KEY: Your plan will look very different, depending on these factors

If you don’t know, worth taking the time to find out Tracking

Examples of Differences in Freq., Duration, and Intensity

Stealing change from an unlocked car one time vs. a 1-year history of stealing jewelry and wallets

Tantrums once a week vs. 2-3 times a daySexualized behavior: covert masturbation vs.

overt masturbation and touching a siblingFiresetting: happened once, inappropriate

access to matches for a 9 y.o. vs. intentional fire setting over a year by a 14 y.o.

Skill Number 2: Learn all you can about what surrounds the behavior

What’s the context than maintains the problem? Where can we

intervene?

Learn all that you can about it

Functional Behavioral Analysis

Basically… What happened right before the problem behavior? Then what happened? What did you do? What did he do? Then what did you do? And what did he do? And after that, what happened, what did you do? Tell me another time it happened. (repeat)

Great Functional Behavior Analysis Resource

All behaviors serve a function

Can take some time to understand the function, and how the behavior is maintained

What are people’s responses to the child’s behavior?

How can the responses be modified so the inapprop. behavior doesn’t “payoff?”

What are we looking for?

Behavior

Consequences

Antecedents

What happens right before the behavior, what happens right after?

Group Exercise

What do you know so far?

Skill Number 3: Focus on Increasing the Positive Opposite

Using reinforcement and attention to increase the absence of the

problem

Reinforcement

You have the positive opposite defined; What are your options for increasing the positive opposite?

All evidence-based parenting programs start with positives first

Many times, a focus on improving the relationship and praise and rewards first

Praise Labeled and Specific

Rewards Creativity in Rewards

Praise

Label the positive behaviorGive it RIGHT AFTER the behavior is displayedNo handshake-slap praise undoing

“you did a great job cleaning up your dishes after dinner, why can’t you do that every night?”

Key is how you TEACH it and how you USE it Not just “yeah yeah we all use praise” Specific focus on the positive opposite: Praise as a tool Model Role Play Homework (Praise for each time you see it over the next

week) Follow up

Rewards

What are free or low cost rewards? What are creative, out of the box rewards that are

motivating? Ice cream for breakfast example

Can rewards be things that kids receive already, but now are earned? This can be challenging—make sure doesn’t turn into

privilege removal, b/c then it isn’t a rewardCan tokens be used?How often do rewards need to be given?

Depends on frequency, duration and intensity (Skill #1) Depends on age

Rewards

When the positive opposite is the absence of the problem behavior, and not so much actively doing something else….what’s the interval for the reward? Depends on frequency, duration and intensity (skill #1)

AND what you know about the problem behavior (skill #2)

Does the child need to have completely DO the positive opposite, or just make steps towards it? Depends on frequency, duration and intensity (skill #1)

Rewards: Shaping Behavior

Does the behavior have a few parts? Can you reward steps toward the appropriate

behavior, parts of the desired behavior?

How do you present a rewards plan? Off Road Parenting Example

What do you notice about how it is introduced?

Skill Number 4: Using Selective Attention to your Advantage

Only Works once Praise and Rewards are in Place

The Power of Attention

Ignoring

Eye contactFacial expressionBody language (including blushing!)

In many cases, the ignorer needs to occupy themselves in another activity Home-related task Shift attention to another child

Ignoring STOPS as soon as the child moves toward the positive opposite behavior

Skill 5: Consequences

When Rewards and Selective Attention Aren’t Enough

Consequences

Vary based on ageTime outPrivilege removalWork chores

Younger the child, apply as soon as possible after the problem behavior

Spending less time here, b/c if we do the others well, less need for consequences

Skill #6: How to Teach Skills

This is just as, or more, important as the other skills

UP and OUT of your Chair

Talking about how to deal with difficult behaviors or do something new doesn’t tend to lead to success or make people feel capable

Peanut Butter & Jelly Example

Practicing: UP and OUT of your Chair

Talking about how to deal with difficult behaviors or do something new doesn’t tend to lead to success or make people feel capable

Steps Model: You demonstrate the new skill, have

caregiver realistically play the child/adolescentDiscussPractice: Now you play the childTalk about homework and planProblem solve loopholes (if appropriate)

Practicing: UP and OUT of your Chair (cont.)

Can do a 2-takes practice to get buy in, if you think the caregiver is escalating the child

Take 1: Parent engages in power struggle, accidentally reinforces

Take 2: Parent does NOT engage in the power struggle, watches the role of attention

You play the parent, have ACTUAL parent, who is playing the child, give you feedback

Bringing it all Together

Case Application

What we want to avoid….(the problem behavior!)

The Positive Opposite!

What family, child do you have in mind? What can do you from Skills 1 & 2 in the next

week?

What would be your next step, for Skill 3?

Questions? Thank you.

dorsey2@u.washington.edu