The Expanding Vision of The Expanding Vision of Positive Behavior Support: Positive Behavior Support: Happiness, Helpfulness, Happiness, Helpfulness,

HopefulnessHopefulnessEdward G. Carr, PhD, BCBA, FAAMREdward G. Carr, PhD, BCBA, FAAMR

State University of New York at Stony BrookState University of New York at Stony Brook

Dr. Ted CarrDr. Ted CarrLeading ProfessorLeading ProfessorDept. of PsychologyDept. of PsychologyS.U.N.YS.U.N.YStony Brook, NY 11794-2500Stony Brook, NY 11794-2500Edward.Carr@sunysb.eduEdward.Carr@sunysb.eduwww.sunysb.edu/autismwww.sunysb.edu/autism

Accomplishments: Accomplishments: What We Have DoneWhat We Have Done

Journal of Positive Behavior InterventionsJournal of Positive Behavior InterventionsAssociation for Positive Behavior SupportAssociation for Positive Behavior SupportAnnual International Conference on PBSAnnual International Conference on PBSWebsite (Website (www.apbs.orgwww.apbs.org))Linkage to cognate organizations Linkage to cognate organizations

(e.g., the PBS SIG in ABA)(e.g., the PBS SIG in ABA)Impact on government funding priorities Impact on government funding priorities (e.g., multiple grants for PBS research)(e.g., multiple grants for PBS research)Codification of PBS in Federal law: IDEACodification of PBS in Federal law: IDEA

Unfinished Business: Unfinished Business: What We Need To DoWhat We Need To Do

Develop a conceptual framework, Develop a conceptual framework, grounded in relevant theory and data from grounded in relevant theory and data from multiple sciences, to guide our efforts in a multiple sciences, to guide our efforts in a systematic, prescriptive fashionsystematic, prescriptive fashion

Build infrastructure to ensure the future Build infrastructure to ensure the future viability of the PBS approach: preservice, viability of the PBS approach: preservice, inservice, organizational inservice, organizational change/reallocation of resourceschange/reallocation of resources

Unfinished Business: Unfinished Business: What We Need To DoWhat We Need To Do

Disseminate the PBS approach to new Disseminate the PBS approach to new venues and to new populations by venues and to new populations by developing relevant strategiesdeveloping relevant strategies

Articulate and promulgate a set of Articulate and promulgate a set of standards that accurately and concretely standards that accurately and concretely define the nature of PBS to ensure define the nature of PBS to ensure procedural integrity and quality controlprocedural integrity and quality control

Three ThemesThree Themes

Happiness: QOL as the central dependent Happiness: QOL as the central dependent variable in PBSvariable in PBS

Helpfulness: Systems change as the Helpfulness: Systems change as the central independent variable in PBScentral independent variable in PBS

Hopefulness: Facilitating the development Hopefulness: Facilitating the development of QOL and systems change by of QOL and systems change by incorporating knowledge from other incorporating knowledge from other sciencessciences

HappinessHappiness

Centrality of QOLCentrality of QOL

What can go right in a person’s life?What can go right in a person’s life?

vsvs

What are the forms of psychopathology that What are the forms of psychopathology that ruin a person’s life?ruin a person’s life?

Dimensions of Quality of LifeDimensions of Quality of Life

Material well-beingMaterial well-being

Health and safetyHealth and safety

Social well-beingSocial well-being

Emotional well-beingEmotional well-being

Leisure and recreationLeisure and recreation

AutonomyAutonomy

Material Well-BeingMaterial Well-Being

Adequate housingAdequate housing

Basic necessities (food, clothing)Basic necessities (food, clothing)

Sufficient incomeSufficient income

Availability of transportationAvailability of transportation

Amenities (toys, computers, valued Amenities (toys, computers, valued personal possessions)personal possessions)

Health and SafetyHealth and Safety

Adaptation to chronic illness and/or Adaptation to chronic illness and/or physical impairmentphysical impairment

Appropriate medicationAppropriate medication

Access to medical servicesAccess to medical services

Personal safety – home and communityPersonal safety – home and community

Health and wellnessHealth and wellness

Social Well-BeingSocial Well-Being

Social competence (interests and skills)Social competence (interests and skills)

Social networks (friends vs isolation)Social networks (friends vs isolation)

Community acceptance (social and ethnic Community acceptance (social and ethnic clubs, religious groups, hobby groups)clubs, religious groups, hobby groups)

Accessibility of desirable social contextsAccessibility of desirable social contexts

Emotional Well-BeingEmotional Well-Being

Close relationships (love, attachment, Close relationships (love, attachment, intimacy)intimacy)

Positive moodPositive mood

Emotional stabilityEmotional stability

Leisure and RecreationLeisure and Recreation

Social and solitary activities that generate Social and solitary activities that generate personal pleasure (hobbies, sports, personal pleasure (hobbies, sports, vacations, arts and entertainment, outdoor vacations, arts and entertainment, outdoor activities)activities)

AutonomyAutonomy

Being able to choose basic items: clothing, Being able to choose basic items: clothing, food, personal belongingsfood, personal belongingsBeing able to make major life choices: living Being able to make major life choices: living arrangements, social relationships, arrangements, social relationships, recreation and leisure, vocation, academic recreation and leisure, vocation, academic interests, religion and spiritual preferencesinterests, religion and spiritual preferencesSelf-sufficiency: achieving a level of Self-sufficiency: achieving a level of competence that reduces the level of competence that reduces the level of support required from others (e.g., self-care, support required from others (e.g., self-care, food preparation, safety in the community, food preparation, safety in the community, money management)money management)

Impediments to QOLImpediments to QOL

Problem behaviorProblem behavior

Skill deficitsSkill deficits

Dysfunctional systemsDysfunctional systems

The Problem With Problem The Problem With Problem BehaviorBehavior

Prevents full community integration Prevents full community integration (home/school/employment) (home/school/employment) Demoralizes family members Demoralizes family members (parents/siblings) and teachers(parents/siblings) and teachersIncreases likelihood of institutionalization Increases likelihood of institutionalization (loss of choice/dignity)(loss of choice/dignity)Rejection by others (social isolation/no Rejection by others (social isolation/no friends)friends)Damages self-esteem (shame/regret)Damages self-esteem (shame/regret)

SummarySummary: Destroys quality of life: Destroys quality of life

HelpfulnessHelpfulness

Support Support

vsvs

Cause and CureCause and Cure

Laboratory (Analog) Research Laboratory (Analog) Research as a Prelude to Effective as a Prelude to Effective

SupportSupport

Support: Maintenance and Support: Maintenance and SustainabilitySustainability

Linking Sustainability to Linking Sustainability to Systems Change: A ModelSystems Change: A Model

Elements of a Model for Systems Elements of a Model for Systems Change to Promote Sustainability Change to Promote Sustainability

of Effective Practicesof Effective Practices

VisionVision

SkillsSkills

IncentivesIncentives

ResourcesResources

Action planAction plan

Application of the Systems Change Application of the Systems Change ModelModel

Vision Vision e.g., goodness-of-fit; person-e.g., goodness-of-fit; person-centered planningcentered planning

SkillsSkills e.g., collaborative teaming and e.g., collaborative teaming and team trainingteam training

Incentives e.g., responsivity to social and Incentives e.g., responsivity to social and emotional needsemotional needs

ResourcesResources e.g., life arrangement and e.g., life arrangement and life coachinglife coaching

Action planAction plan e.g., group action planninge.g., group action planning

HopefulnessHopefulness

Extending PBS: Multiple Extending PBS: Multiple Populations and VenuesPopulations and Venues

PopulationsPopulations

Emotional and Emotional and behavior disordersbehavior disorders

Mental health / mental Mental health / mental illnessillness

Traumatic brain injuryTraumatic brain injury

Juvenile delinquencyJuvenile delinquency

Deaf / hard of hearingDeaf / hard of hearing

Conduct disorderConduct disorder

BulliesBullies

Literacy issuesLiteracy issues

Typical familiesTypical families

Fetal alcohol syndromeFetal alcohol syndrome

Alzheimer’s or dementiaAlzheimer’s or dementia

Sex offendersSex offenders

Extending PBS: Multiple Extending PBS: Multiple Populations and VenuesPopulations and Venues

VenuesVenues

Cross-cultural Cross-cultural settingssettings

Underserved Underserved communitiescommunities

Head start classesHead start classes

High schoolsHigh schools

Interagency coordinationInteragency coordination

Rural settingsRural settings

Normative work / living Normative work / living settingssettings

Medical / clinical settingsMedical / clinical settings

Note: Source of entries is from the first and Note: Source of entries is from the first and second conference agendas of the second conference agendas of the Association for Positive Behavior Support, Association for Positive Behavior Support, Orlando, FL (2003) and Tampa, FL (2005)Orlando, FL (2003) and Tampa, FL (2005)

Extending PBS: Linkage to Multiple Extending PBS: Linkage to Multiple Sciences and DisciplinesSciences and Disciplines

Organizational managementOrganizational management

Community / ecological psychologyCommunity / ecological psychology

Cultural psychologyCultural psychology

Biomedical sciencesBiomedical sciences

Positive psychologyPositive psychology

Organizational Management: Organizational Management: Systems Change ThemesSystems Change Themes

Models for effective service deliveryModels for effective service delivery

Models for effective trainingModels for effective training

Models for effective team buildingModels for effective team building

Models for building motivationModels for building motivation

Models for ensuring accountabilityModels for ensuring accountability

Models for data managementModels for data management

Community / Ecological Community / Ecological Psychology: Illustrative ExamplesPsychology: Illustrative Examples

A Focus on PreventionA Focus on PreventionIdentification and analysis of environmental Identification and analysis of environmental risk factorsrisk factors

Proactively addressing the issue of scarce Proactively addressing the issue of scarce resources (not enough time, money, resources (not enough time, money, personnel)personnel)

Preventive support plans that appeal to the Preventive support plans that appeal to the broader needs of settings and communitiesbroader needs of settings and communities

Community / Ecological Community / Ecological Psychology: Illustrative ExamplesPsychology: Illustrative Examples

Building Sources of Social SupportBuilding Sources of Social SupportSupport networks in the lifecycleSupport networks in the lifecycle

Self-help groupsSelf-help groups

EmpowermentEmpowermentNetworking Networking

Influencing policy formationInfluencing policy formation

Effectively competing for resourcesEffectively competing for resources

Building organizational coalitionsBuilding organizational coalitions

Cultural PsychologyCultural Psychology

Cultural relativism: conceptualizing Cultural relativism: conceptualizing problemsproblems

Cultural values: identifying acceptable Cultural values: identifying acceptable goalsgoals

Cross-cultural competence: customs, Cross-cultural competence: customs, rapport, cooperationrapport, cooperation

Biomedical Science: Some Biomedical Science: Some PossibilitiesPossibilities

Knowledge of brain function influences Knowledge of brain function influences how to build competencieshow to build competencies

Biological factors as setting events for Biological factors as setting events for problem behaviorproblem behavior

QOL and health psychology / behavioral QOL and health psychology / behavioral medicinemedicine

Positive Psychology: Our Greatest Positive Psychology: Our Greatest Scientific Ally?Scientific Ally?

““Positive psychology is an umbrella term for Positive psychology is an umbrella term for the study of positive emotions, positive the study of positive emotions, positive character traits, and enabling institutions character traits, and enabling institutions (Seligman et al., 2005)”(Seligman et al., 2005)”

Positive Psychology: Our Greatest Positive Psychology: Our Greatest Scientific Ally?Scientific Ally?

A strengths-based approachA strengths-based approachAddress behavior challenges by increasing Address behavior challenges by increasing competence competence Competence involves character building reflecting Competence involves character building reflecting six virtues: wisdom, courage, humanity, justice, six virtues: wisdom, courage, humanity, justice, temperance, and transcendencetemperance, and transcendenceImprove QOL by focusing on social and emotional Improve QOL by focusing on social and emotional well-beingwell-beingCreate institutions that enable positive affectCreate institutions that enable positive affectWidespread application across populations and Widespread application across populations and venuesvenues

We Are Not a Lonely Voice in We Are Not a Lonely Voice in the Wildernessthe Wilderness

We Are One of Many Voices in We Are One of Many Voices in a Chorusa Chorus