Plan and provide advance behaviour support CHCICS404B: Week 3: Assess Problem Behaviour.

Plan and provide advance behaviour support

CHCICS404B:Week 3: Assess Problem Behaviour

Teacher Contact Details:

Teacher: Greg Egan

TAFE: GRANVILLE TAFEEmail: [email protected]

mailto:[email protected]

Class Ground Rules:

Class ground rules for the semester: Be respectful of each others opinions Confidentiality, what is discussed in class stays in class.Be supportive of each other to encourage learning. Cell phones off unless there is personal reason for it.No yelling in class.Listen to each others points of view. Be on time to class.

Agenda : Identify specific behavioural stimuli / function for data collection. Select most appropriate method of data collection for recording behaviour. Collect and summarise data relevant to individual behaviour. Observe and record type, frequency and triggers of behaviour likely to put the person and / or

others at risk of harm. Observe and record environmental context of behaviour likely to put the person and / or

others at risk of harm. Observe and record person’s emotional wellbeing in the context of behaviour likely to put the

person and / or others at risk of harm. Observe and record a person’s health status in the context of behaviour likely to put the

person and / or others at risk of harm. Observe and record person’s medication in the context in the context of behaviour likely to put

the person and / or others at risk of harm. Appropriately facilitate the involvement of others in the assessment process . Facilitate the process of functional and / or cognitive assessment for individuals.

Introduction:.

Behaviour assessment is the process of systematically gathering information which

clearly defines behaviours or issues identified in the whole of life context of your client.

Without conducting a functional behaviour assessment it is very easy to jump to

inaccurate conclusions about why a person is behaving in a certain way and this can

result in the selection of inappropriate strategies that will not address the person’s

needs or have a positive effect on the behaviour.

Introduction:.

Inappropriate strategies can often make the behaviour worse, lead to an

increase in the frequency, intensity and duration of the behaviour. This may

give rise to new behaviours creating more problems and risking harm to the

person and others involved.

Introduction:.

Behaviour serves a function or purpose for the person. Challenging behaviours are

maintained if the person is successful in altering their internal and external environment

through their behaviour. Staff need to identify specific behavioural stimuli / function for

data collection for recording behaviour, and collect and summarise data related to the

individual behaviour to understand what is causing the individual to act in a specific

manner. Understanding the motivation in the behaviour is a major factor in understanding

how to manage it.

Introduction:.

Behaviour assessment and analysis is therefore: Seeking to understand and define the behaviour to be changed and the

importance of it being changed. Evidence based, involving collecting data and summarising the patterns

and history of the identified behaviour. Seeking to understand the complexities of the support needs of the

client across environmental contexts. Seeking to understand the function of the behaviour for the client

across environmental contexts.

Topics 1 & 2 Identify specific behavioural stimuli / function for data collection, and most appropriate method of data collection for recording behaviour.

In looking at what are some of the functions of behaviour it’s also important to look at what motivates us in life , and a well known theorist on this topic was Abraham Maslow.

How is this theory relevant to understand behaviour?


Common functions of behaviour:

Now looking more specifically at people with disabilities common functions of behaviour of people with disabilities include such

things as:

Social attention:

A person may engage in a certain behaviour to gain some form of social attention or a reaction from other people. For example, a

child might engage in a behaviour to get other people to look at them, laugh at them, play with them, hug them or scold them.

Tangibles or activities:

Some behaviours occur so the person can obtain a tangible item or gain access to a desired activity. For example, someone might

scream and shout until their parents buy them a new toy (tangible item) or bring them to the zoo (activity).


Common functions of behaviour: (Continued)

Escape or avoidance:

Not all behaviours occur so the person can “obtain” something; many behaviours occur because the person wants to get away from something

or avoid something altogether . For example, a child might engage in aggressive behaviour so his teachers stop running academic tasks with him

or another child might engage in self-injury to avoid having to go outside to play with classmates.

Sensory stimulation:

The function of some behaviours do not rely on anything external to the person and instead are internally pleasing in some way – they are “self-

stimulating”. For example, a child might rock back and forth because it is enjoyable for them while another child might rub their knee to sooth

the pain after accidentally banging it off the corner of a table. In both cases, these children do not engage in either behaviour to obtain any

attention, any tangible items or to escape any demands placed on them.


Common functions of behaviour: (Continued)

Pursuit of power and control over one’s life:

Example: A client of mine with a mild intellectual disability, and mild autism sees his brother driving a car, and going out with

friends, having a job, and having freedom and independence. Because his parents do not allow him with same freedom he

becomes aggressive at home every time his parents refuse to allow him to do something at home.

Reduction of arousal and anxiety:

A client may masturbate because he/she is aroused and wants to release this feeling. A client may because anxious when in a

crowd of people so sits on ground and starts to hit themselves, or tries to pull you out of the situation.


What constitutes a behavioural episode or challenging behaviour?

It is important to know your clients and what constitutes normal behaviour, and a behavioural episode taking into account effects like their disability, mental health or medication they maybe on. Further staff should be

aware of all triggers to behaviours and history of behaviour, and consider current WHS issues within the workplace, and consider previous definitions of challenging behaviours.

ADHC Disability Services (2009) defined challenging behaviour as:

“Behaviour that is demonstrated by a person, which is of such intensity, frequency, or duration that the physical safety or emotional well-being of the person or others is placed at significant risk, or which limits the

person’s access to usual / ordinary settings, activities, services and experiences”.


Examples of Behavioural Assessment toolsPositive Behaviour Support uses assessments that look beyond the behaviour itself and more towards the social, emotional, cognitive and/or environmental

factors influencing the behaviour.

Applied behavioural analysishttp://www.youtube.com/watch?v=gbH_jpYlYewhttp://www.youtube.com/watch?v=hLAbiNZeQfc

Functional assessmentshttp://www.youtube.com/watch?v=Dj6HZGA6ANo

http://www.youtube.com/watch?v=gbH_jpYlYew


http://www.youtube.com/watch?v=hLAbiNZeQfc


http://www.youtube.com/watch?v=Dj6HZGA6ANo



Applied Behavioural Analysis (ABA):Definition:

In short Applied Behaviour analysis Therapy is a scientific approach to understanding behaviour And “shaping “that Behaviour.

It focuses on the principles of how behaviour works, and how learning takes place.

It looks at each behaviour to be taught and quantifies it, breaking it down into its component parts and begins teaching at the first step of a behaviour ( a behaviour being anything observable whether it is identifying colours to interacting with a peer, trying new foods, or sitting in a chair ) the field of

behaviour analysis applies many techniques for increasing meaningful and socially functional behaviours and extinguishing or lowering the frequency of maladaptive or interfering behaviours.


Functional Assessment:

A functional assessment offers a better understanding of the function or purpose behind behaviour. It contributes to a behaviour support plan by providing an understanding of why a person may engage in a particular behaviour and

identifying what support is required to address the person’s unmet needs. A functional assessment may ask the following types of questions:

• What is the behaviour of concern?• When and where does this behaviour occur?• What happens before and after the behaviour occurs?• How did the behaviour develop over time?• What is the person communicating with their behaviour?• How do other people view the behaviour?• What gaps in this person’s life does the behaviour suggest? For example, is it limited social interactions?• What positive support strategies might work to address the unmet needs?

Further Research:http://www.ped.state.nm.us/RtI/behavior/4.fba.11.28.pdfhttp://www.learningplace.com.au/deliver/content.asp?pid=47779

http://www.ped.state.nm.us/RtI/behavior/4.fba.11.28.pdf

http://www.ped.state.nm.us/RtI/behavior/4.fba.11.28.pdf

http://www.learningplace.com.au/deliver/content.asp?pid=47779

http://www.learningplace.com.au/deliver/content.asp?pid=47779


Intervention for challenging behaviour should aim to:

Improve the person’s behaviour in the home and in the community.

Enhance the caregivers capacity to support the person.

helping the person understand their daily life using clearer ways of communicating with them such as introducing a

picture schedule.

changing the environment to make where they live and work better for him or her (such as reducing high noise levels).

improving the person’s lifestyle so they have more interesting and enjoyable activities to keep them involved and

connected with their community, such as helping the person gain employment and supporting recreational or other

activities of interest.

changing the environment so the person is involved in meaningful and positive relationships with others.


The information about the function of behaviour and its maintaining variables leads to the design of a behaviour support plan.


When working with the families / carers of a client it is important for staff to consider the following:

Collaboration with carers The ecology of the family or residential system. (Eco Map) Strengthening and empowering carers. Identifying the positive aspects of the person. Stresses within the family or residential system.


Checklist for assessment of challenging behaviours:

Staff must consider: Staff should review:

Ensure safety of client and others. Psychiatric diagnosis. Environmental issues

Observe and describe behaviour. Communication difficulties Effect of psycho active substances

Collate relevant past history. Physical / medical cause eg: epilepsy.

Developmental stage

Historical diagnosis, and documentation.

What else is happening.

Historical observations and behavioural data.


Functional Understanding of behaviour involves:

A systematic collection of information / data on behaviours. Eg: Use of ABC charts, Interviews, observations etc.

Analysis of the available information:

Identify possible reasons (i.e. purpose, motivation, function, or goal) to explain why person engages in challenging behaviours.

Data collected for analysis should include such things as; the behaviour, conditions under which behaviour occurred, settings, triggers etc.


Identifying functions of behaviour should be record to:

Assist in development of behaviour intervention plan, or improve intervention. Remove or modify environmental conditions. Learn knew skills which render the challenging behaviour inefficient, ineffective, or obsolete.

The incident is often the most obvious data that is collected and attracts a lot of attention from staff. Though once the behaviour has been managed a more comprehensive understanding of the behaviour needs to draw this focus from the incident towards the function of the behaviour.


Having a deeper understanding of behaviour allows for:

Both staff and the service to understand the behaviour in the context of various environments and situations.

Allows for more targeted strategies to be developed. Allows staff to depersonalise the behaviour from

being either the clients fault or their fault and perhaps see the role of the events leading up to the behaviours.


In order to describe the client staff should ask themselves how the following features of the client add to their tendency to perform the behaviour:Physical characteristicsMental processesHealthLeisure and recreation.


In order to describe client’s background / personal history, staff should ask themselves about clients:Life experiences and how this has shaped the

client and their behaviours. Things such as placement history, family

stability, effects of life’s transitions.


In order to describe client’s skills staff should ask themselves:

How can I get a good picture of how the client operates in the environments that they are expected to function in?

What skills is the client missing, and how can I improve on these?

How good are the clients independent living skills? Level of communication skills. How well can the client access the community without

assistance.


Topography of the behaviour:

This refers to what the behaviour looks like. It focuses on observable characteristics of the challenging behaviour. General descriptions and labels such as “aggressive” and “hyperactive” are not useful on their own as they describe a class of behaviour and not individual behaviour.



Descriptions on behaviours should be specific and include such things as:

What the person does and / or says (sounds)How often the behaviour occurs, and when it

occurs, and under what circumstances. Where it occurs.



A precise description has following benefits:

It provides a common basis for discussion between those supporting the client.

Allows for better identification on things such as frequency of behaviours occurring.

Gives directions for when staff should implement behaviour support or incident prevention plans.

Allows staff to know which behaviours they are providing treatment for.


Cycle of the behaviour:

This refers to the onset and offset of the behaviour / incident, that is, defining the start and end of the incident.


Course of the behaviour:

This is the progression of the incident between the beginning and the onset. When gathering information at each of the stages, it is important to consider what would

either stop the incident or prevent further escalation.

This information is useful; however, it should not be included in the description of the course of he behaviour.



To determine the course of the behaviour it must be determined if:

The client goes through a series of behaviours in a usual sequence as opposed to a singular behaviour.

There is enough detail to complete an adequate picture of the behaviour.



The course includes the following stages:

1) Calm presentation – Behaviour when not engaged in challenging behaviour.

2) Escalation / build up – Increasing of behaviours. 3) Climax – Peak of the incident. 4) De-escalation – The client starts to calm down. 5) Recovery – Behaviour ends, and client is back to normal.


Strength of the behaviour:(Impact of behaviour)

In considering strength of behaviour staff must record the:

Frequency – How often. Severity – Impact on self, others, staff etc.

Duration – how long behaviour lasts.Latency – Length of time between trigger and behaviour.

Of the behaviour.


Strength of the behaviour:(Impact of behaviour)

Considering the strength / impact of behaviour is important because:

Helps staff consider priorities when allocating resources to change behaviour. Example: Does behaviour warrant immediate intervention?

The organisation may have limited resources and needs to consider what it can address at any one time.


History of Interventions:

In assessing challenging behaviours you also need to consider the past histories of interventions and ask yourself.

Was it successful or not? How comprehensive was the intervention? Was the intervention based on the behaviour / assessments? Was the intervention implemented adequately or consistency? Were carers and staff trained in interventions?


Methods of Data Collection in assessing challenging behaviours:

The method of collection will vary depending on behaviour being assessed, time and staff available for recording, and how often the

challenging behaviour occurs.


Methods of Data Collection in assessing challenging behaviours may include:

ABC Data collection charts

http://www.youtube.com/watch?v=c66KoeifoLI

(Given as handout in week 2 for assignment 1)

Using interviews, or video recorders, general observation.

Collection of incident reports.





ABC Data collection method:

Antecedent- the events, action, or circumstances that occur before a behaviour.

Behaviour- The behaviour.

Consequences- The action or response that follows the behaviour.


ABC Data collection ChartsAntecedent Behavior Consequence

Parent asks Joe to stop playing on the computer.

Joe screams, "NO!" and refuses to leave the computer.

Parent tells Joe to leave the computer again.

Parent tells Joe to leave the computer. Joe again refuses to leave. Parent starts counting to 10 as a warning to get off the computer.

Parent starts counting to 10 as a warning to get off the computer.

Joe does not move from the computer station.

Parent finishes counting to 10 and again warns him to get off the computer.

Parent finishes counting to 10 and again warns him to get off the computer.

Joe stays at the computer and refuses to leave.

Parent threatens that Joe lose computer privileges in the future.

Parent threatens that the Joe will lose computer privileges in the future.

Joe ignores and continues working on the computer.

The parent count to 10 again and again threatens future computer use.

The parent counts to 10 again and again threatens future computer use Joe ignores and continues computer use. The parent becomes angry and leaves the

room.


Methodology of Data collection:

Information should be collected over different days, settings and times.

Taken by different workers working with the client.

Why record information when no challenging behaviours occur?:

It may also be useful to record information on what is happening when the behaviours are not

occurring as this may give a idea on how to manage behaviours. This can often also be collected from

such things as communication books, general observation and interaction with the client. Maybe useful

to collection information on hourly behaviours of a client recording good and challenging behaviours.

Trainer Led Activity 1:

Q1. Identify specific behavioural stimuli / function data that might be

collected to assess client problem behaviour?

Q2. List some methods for data collection we have discussed or used in

your workplace?

Q3. Select a method of data collection you might use and why for

maybe your case study client for assignment 1?

Topic 3: Collect and Summarise Data related to individual behaviour

Data regarding individual behaviour should be collected and summarised so it can be used by the behaviour management team to develop a

behaviour management team.

Collect and summarise data related to individual behaviour Handout

(PG. 30 Trainers Manual)

Trainer Led Activity

Case Study: Jason is a 13 year old boy with an intellectual disability &

autism who becomes agitated and hits staff when he is unable to communicate his needs effectively.

Lets write a summary of the course of Jason’s behaviour. Be as creative, but also brief and realistic as possible.

(PG 26-27 Handout)(PG 31 Handout)

Topic 4: Observe and record type. Frequency and triggers of behaviour likely to put the person and / or others at risk of

harm.When working with clients with behaviour issues it is

important for staff to observe and record the type, frequency and triggers of behaviour likely to put the

person and / or others at risk of harm. These behaviours are often recorded in what we call

the ABC Charts which were handed out last week and also has been discussed in this lecture.

Also tally charts can be used. (https://iepq.education.illinois.edu/documents/Chart_35.pdf )

https://iepq.education.illinois.edu/documents/Chart_35.pdf



harm.Behaviour that is recorded as a concern by staff includes such behaviours:

Potential to harm self or others

Is disruptive to outside rules in the community. Example: Aggression.

Reduces quality of life

Lasts for excessively long time

Limits or delays access in the community

General non-compliance

Isolates a person and stops them engaging in normal behaviour.

Makes others feel uncomfortable or distresses.

Creates nuisance in public. Example: Harassing, begging

Interferes with persons learning.

Being extremely manipulative.

Self harm


harm.Self Harm for example:

Maybe occurring due to, relieve stress and tension, maybe a repetitive behaviour. The stimulus can be feelings of abandonment and rejection. There can be a fear of emotions

becoming overwhelming. This apprehensive is about getting out of control, causing feelings of depersonalisation and emotional numbness as feelings are shut off. Self harm can be a means

of feeling again. People who self harm may have a strong fear of rejection.

High risk groups include those with:Mental health clients

History of dysfunctional family.Survivors of abuse.

Those that use avoidance as a coping strategy.Angry, impulsive, anxious, and aggressive individuals.

People who feel out of control of their lives.


harm.Observing and recording behaviour:

Staff generally use ABC Forms and Tally Charts for recording behaviours

Comprehensive assessment requires obtaining accurate, reliable picture of what is happening. An understand of why a person engages in challenging

behaviour is enhanced by careful observation of the behaviour and the context in which it typically occurs.

Topic 5, 6 & 7: Observe and record; environmental context, person’s emotional wellbeing, person’s health status, and medication context likely

to put the person and / or others at risk of harm, and appropriately facilitate the involvement of others in the assessment process.

An environmental observation and record (review) aims to identify features of client’s environment that are particularly valued by the client as well as well as those features that are particularly difficult for the client and / or others, and require some change. The review can identify what action is required to improve the current lifestyle and environment regarding improving the way

the service is meeting the client’s individuals needs.

Findings in such reviews may highlight parts of the clients environment that have resulted in their reliance on challenging behaviours, or caused their

behaviours to occur. Example: Another client, way room is set up, lack of disability access.



Trainer Led Exercise:

What environmental triggers have you observed in your workplaces, that have been contributing factors to a clients behaviours and what were they?



Recording Emotional Wellbeing:

When observing and recording emotional wellbeing in the context of behaviour likely to put the person and / or others at risk of harm, staff should record the mood

or mental health status of the client. If the staff members does not have qualifications for a formal assessment of things such as depression, then staff

should record things such as sadness, anger, and where they occur in relation to behaviour.

Emotional wellbeing can be affected by many things such as environment, interaction with staff and peers, health, mental illness, staff having unrealistic

expectation of clients or vice versa, or inability to communicate needs.



Mental Illness:

Some studies suggest three concepts regarding the relationship between challenging behaviour and psychiatric illness:

1. Primary – Behaviour is direct result of illness, such as aggression when hearing voices, or paranoia.

2. Secondary – Response to symptom of illness, such as client screaming to a visual hallucination.

3. Consequential – Starts in primary, but is reinforced by others becoming a learned behaviour, such as becoming aggressive when see hallucinations, then

getting attention from it.



Health:

Illness and pain can also impact on behaviours that are normally out of character.

Though these behaviours can become a learnt behaviour if the client gets attention every time they pretend to be sick. Example: They may get more assistance in the

morning getting ready, or get out of going to a day program.

Medications can also impact on behaviour, and side effects should be taken into consideration when managing challenging behaviours, and in some cases the client

may need a medical review. So it is very important to record behaviours whilst off and on medications.

Topic 8 & 9: Facilitate the process of functional and / or cognitive assessment for individuals:

Functional Assessments:

Have discussed previously in this presentation, though there are several steps to completing a functional assessment for individuals including:

1. Collect information regarding conditions under which problem behaviour is observed and a more appropriate behaviour is required.

2. Development of testable (manipulable) hypothesis.3. Collect direct observational information.4. Develop implementation scripts.5. Collect information on effectiveness and efficiency of behaviour support plan and

redesign based on evaluation information. (Handout PG.43-44 Trainers Guide)

Topic 8 & 9: Facilitate the process of functional and / or cognitive assessment for individuals:

Cognitive Assessments:

Helps to identify a client’s strengths and difficulties in intellectual ability. Cognitive assessment can help to differentiate the developmental problems

experienced by some clients, so that appropriate intervention can be planned, and so that behaviour management plans take into account the

client’s cognitive abilities. Standardisation test and observation checklists are used in the assessment process.

Conclusion

In reviewing around general data collection to assist with the development of behaviour intervention plans, the tools, and methods are varied, and the reasons for behaviours are varied, and as such accurate data collection

around behaviours is essential to assist with behavioural intervention plans having any level of success.

FINISH

Handouts:• Positive Behaviour Support in DADHC Accommodation Services Curse

outline Version 4 2007. “Mistaken and alternative interpretation of behaviour table” PG.11

• Collect and summarise data related to individual behaviour. PG.30 Trainers Guide.

• Case study - Jason Handout Pg.31 Trainers Manual. Functional Assessment Template• http://www.pent.ca.gov/frm/functobserv.pdf

http://www.pent.ca.gov/frm/functobserv.pdf


REFERENCES (1):• Community Services & Health Industry Skills Council “CHC08 – Disability behaviour support

skill set learner resource suite.” • TAFE. 2009“ Community Services Training Notes and workbook; CHCICS404A Plan and

provide advance behaviour support” • http://www.businessballs.com/maslow.htm• http://www.educateautism.com/behavioural-principles/functions-of-behaviour.html• http://sybilmarie.hubpages.com/hub/-Lets-talk-Autism-APPLIED-BEHAVIORAL-ANALYISIS• Government of Western Australia . 2012 “Positive Behaviour Support Information for

Disability Sector Organisations” Disability Services Commission. • http://www.behavior-consultant.com/ABC%20-%202%20page%20form.pdf• http://www.youtube.com/watch?v=c66KoeifoLI• http://www.youtube.com/watch?v=gbH_jpYlYew• http://www.youtube.com/watch?v=hLAbiNZeQfc• http://www.youtube.com/watch?v=Dj6HZGA6ANo

http://www.businessballs.com/maslow.htm

http://www.educateautism.com/behavioural-principles/functions-of-behaviour.html

http://sybilmarie.hubpages.com/hub/-Lets-talk-Autism-APPLIED-BEHAVIORAL-ANALYISIS

http://www.behavior-consultant.com/ABC%20-%202%20page%20form.pdf





REFERENCES (2):• http://www.iidc.indiana.edu/?pageId=444• http://www.pent.ca.gov/frm/functobserv.pdf• https://iepq.education.illinois.edu/documents/Chart_35.pdf

http://www.iidc.indiana.edu/?pageId=444



Plan and provide advance behaviour support CHCICS404B: Week 3: Assess Problem Behaviour.

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