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MASSACHUSETT S D EPART MENT OF D EVELOPMENTAL SERVI CES

JUNE 2 0 1 4

PAT R I C I A C R O N I N, P H . D . B A R B A R A P E E B L E S

VA L A R I E W H I T I N G , P H . D .

UNIVERSALPositive Behavioral Supports

Creating Healthy Responsive Environments1 Day Workshop

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Today—what you will learn

Understand that behavior tells us somethingUnderstand what PBS isLearn about basic Universal Support

strategiesUnderstand that PBS is a person-centered,

strengths-based approach to services and supports

Become familiar with terms used by teams when implementing PBS

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DDS’ Definition of PBS

Positive Behavioral Supports is a systemic, person-centered approach to understanding the reasons for behavior and applying evidence based practices for prevention, proactive intervention, teaching and responding to behavior, with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan.

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What PBS IS NOT….

http://youtu.be/YkFb-g7SAOk 

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Characteristics of PBS

Understand communicative/function of behaviorUnderstand that environment/context in which behavior

occurs is important—change environment--early recognition and intervention

Prevention rather than reaction to behaviorRange of interventions and strategies: change

environment, routine, expectations, task demands, teachStrengths-based, Person-Centered approach—holistic:

person’s wants, needs, dreams, preferencesVariety of interventions, including education,

habilitative, psychological. Evidence based strategies and reviewed (data, observation, adjusted as needed)

So, to review, PBS…..6

Focuses on preventing problems, rather than reacting to them (proactive)

Focuses on changing the environment, to change behavior and outcomes-easier to change environment than to change the person

Focuses on teaching skills aimed to replace the undesired behavior and/or learn prosocial and more effective behaviors

Person-centeredTargets self-regulation of behavior (not just behavior

change)Positive, capacity focused: strength-based

Source: Rehabilitative Research and Training Center. Learnet.org What are Positive Behavior Supports?

What is Behavior?

How can we tell if someone is behaving? Anything we say, do, think, feel is behavior.

Behavior happens all of the time—mostly good, neutral, sometimes we consider some behaviors to be problem behaviors.

Behavior happens for a reason—what’s the function of behavior? Behavior serves a purpose.

Behavior is communication. Listen to a person and their actions in different

ways—especially if people don’t use words to communicate

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This process is accomplished by determining, with the person, what is important TO them and by LISTENING in new ways to their behavior.

Behavior is communicative and is telling us

something. All behavior serves a purpose.

http://youtu.be/IP0SQIIErMg 

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Exercise: How do we listen to behavior?

How do we ‘listen’ to what people are telling us when they don’t use words, or even if they do?

► Talk about the different ways that people communicate information to each other, especially when they can’t use words to easily communicate?

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Exercise

Take a guess at what we think the person’s behavior means? Identify a person you work with and complete the following:

When the person does _____, we think it means ______, so we _______.

Discuss possible strategies that could be used with the person.

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PBS is a Strengths-Based, Person-Centered Approach

What contributes to a person’s well-being—across different settings in their lives?

► Control, perceived control►Preferences► Health► Reliable preferred routines► Growth► Relationships

3 Tiers of Support of PBS12

Begin to think about the 3 tiers of support:

Individualized

Targeted

Universal

Everyone gets it

Some need more

Only a few

need it all

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PBS Universal Supports

Provide environments that offer opportunities for healthy, happy lives

PBS systems and practices benefit everyoneDeveloped with individual’s preferences in

mind (routines, consistency, choice, praise, activities, etc.)

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PBS Universal Supports

Are always in place for everyone, ALL of the timeEnhance quality of lifeAll activities, plans, routines, learning opportunities

reflect individual’s preferences, needs, goalsSocially appropriate behavior taught, expected,

encouragedSensible expectations developed in all settingsIndividuals given choices and have lots of

opportunities to engage in preferred activitiesStaff are skilled, knowledgeable, caring-staff are

teachers

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Universal supports create physical and social environments that are positive and responsive.

ENVIRONMENT plays a BIG role in the well-being of a person.

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Check out DDSLearning.com website

http://ddslearning.com/dds-pbs-initiative/

Check out this website to learn more about PBS and Universal Supports…..

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Environmental Universal Supports

Create environments that are predictable and consistent with routines and preferences of person

Understand why people do what they do--Figure out what motivates people

Best guess about what we know from and about people

Listen to people in different waysBe flexible as we listen and implement

strategies

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Exercise

Think of a home, class, day program, or other group setting and identify some strategies you would use to create an environment that is predictable, safe and consistent with the preferences of the individuals in that setting and their learning new skills.

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Creating an Environment Supportive of and to the Person

What do we mean by an environment? ▷ physical set up ▷ structure, routines-positive, well

understood ▷ staff who interact with the people ▷ all the people in that setting ▷ broader environment ▷ similar past experiences in similar

settings

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Universal supports provide environments that are..

Pleasant to be inResponsive to needs, wants, preferences of

people living in themEnhance the quality of life of the person and

people so that people are successfulRoutines/schedules predictable, consistentSometimes need to change the environment,

get someone into a different environmentImportant to figure out what is important TO

a person

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Exercise

What could staff have done differently?

Name 3 things that a staff person could do in this situation.

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Create opportunities for someone to exert individual control

We like to feel that we are in control, of at least certain aspects of our lives—choice—person has preferred activities in their lives

When someone takes control of a situation, person may feel out of control—often becomes a power struggle

Is there a way to give the person more control? What does he/she want? Ask them.

Provide a short list of choices/suggestions (pictures?). What’s your big picture? Big goal? Don’t sweat the small stuff.

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Debbie’s Story

Read storyWhat could staff have done differently?

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Create a win-win environment by trying another way

What is the goal? Offer opportunity? Provide something important?

Health/safety risk?Is there another way to reach the goal?Daily opportunities for choice making throughout

daily lives in all settings—preferred activitiesIdentify multiple opportunities— “Find the good and

praise it.” Alex HaleyRule of 4: 4 positive statements to 1 negative

statementChange environment to decrease likelihood of

undesired behavior

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Redirect Behavior….ways to do this

Redirect behavior—often easier that confronting it

▷ Ignore undesired behaviors whenever possible if not a health/safety risk

▷ Use nonverbal gesture to direct…

▷ Always model acceptable way to deal with situation▷ Staff remain calm, in control, clearly state behavioral expectation

▷ Offer activity, engage in a behavior that is incompatible with undesired behavior

▷ Always try to redirect person to appropriate behavior/activity

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Create an atmosphere that allows a person time to think…

Many people with intellectual disabilities need some time to process what is asked of them.

Get someone to do something they want to do-like to do. Create an environment of YES.

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CHOICE: Offer Real Choices

Can you think of ways to specifically offer real choice that is based on desired preferences? Ways to enhance choice making:

► Schedule daily opportunities for people to make choice decisions throughout their daily routines in all settings

►Provide and plan as many choice-making opportunities as possible

► Doing so will help people learn, accommodates different learning styles, helps them finish tasks, increases positive behaviors

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People don’t like to be ordered around. They’d rather make choices on their own

Avoid power struggles and recognize if you are in one. Stop. Short break

If you stop, back up, consider your next action—break cycle. Other person can consider what’s really happening

Redirect behavior that is not pro-social

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Three questions for staff about choice

Why should I do it?When should I do it?How do I do it?

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Why should I do it?

Way of empowering a personPrevents power struggleMakes a person feel engaged and a part of the

decision making processIncrease prosocial behaviorPeople respond better to choicesImproved coping when having to do an undesired

taskDecreases conflicts, refusals, defiance, and

oppositionBuilds rapport

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When should I do it?

Offering a person choices should be a regular part of the day

When telling anyone to do something or giving a directiveWhen a person is reluctant to do somethingWhen a person is stuck on making a decisionWhen a person engages in a power struggle or is

argumentativeWhen a person is having a difficult timeWhen a person make excusesWhen students are reluctantWhen giving consequencesWhen giving rewards

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How do I do it?

Speak in calm, neutral toneProvide a person with two or more choices that you will

fully accept, for example, “you can either do your work sitting at your desk or sitting at the table”

Present the entire group or house with choices when assigning work, for example, “you can either do the mall or the grocery store, you choose”

Give choices when rewarding, for example, “John, do you want computer time or a fancy pen?”

Develop task completion picture boardProvide list of preferred activities to select fromOpportunities to make choices throughout daily routines

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Exercise—with a partner….

Discuss a person you know and how offering choices (additional choices) would affect their lives.

When during the day could you increase choice making or add opportunities to make choices?

Switch & share

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PRAISE: Help person succeed

Universal PBS supports create environments that let a person succeed—believe that it is possible, be positive

If in a difficult situation, begin with a choice that leads to successful behavior (want juice or water with your meds?)

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Create environment that lets someone know they had done a good job/something right--PRAISE

Identify opportunities to praise and encourage specific behaviors—do so consistently—encourage prosocial behaviors

Discover what motivates people and fill the person’s life up with enjoyable things to do

We respond better to positive than negative consequences.

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Three questions for staff about offering praise

Why should I do it?When should I do it?How do I do it?

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Why should I do it?

Some people need outward motivatorsIt helps keep people engagedProvides encouragementBoosts confidence, self-concept, and self-esteemIncreases buy-inBuilds rapport and trustIs upliftingIncreases persons’ desire and drive to please and succeedIncreases persons’ resilienceHelps embed an internal desire to try, succeed, and persistHelps people to push through difficulty, barriers, blocks, etc

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When should I do it?

Positive praise, according to research, should always be done with every person at a ratio of at least 4 positive praises to 1 criticism

When a person is stuck, frustrated, getting bogged down, etc

When a person exhibits good behavior, expectations, help others, show generosity, share, etc

When a person puts forth good effortWhen a person succeeds, overcomes, persists,

pushes through, achieves, etcWhen a person demonstrates positive behaviors

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When a person uses productive coping skills, problem solving skills, etc

When a person is independent, self-start, etcWhen a person looks down, needs encouragement, is

having issues, personal difficulties, peer conflict, etcWhen you want to increase a positive behaviorWhen you want to improve trust and rapport with

someoneWhen a person steps outside their comfort zone,

looks embarrassed, seems to feel stupid, takes a risk, etc

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How should I do it?

Praise, according to research, should be given in a ratio of at least 4 praises to 1 criticism

When a person display positive or productive behaviors, actions, skills, characteristics, etc, or appear to need some encouragement, etc, verbally praise the person and/or give them a high-five, pat on the back, clap, exclamation, cheer, hop, etc

Praise can be done either quietly or if the person is motivated by peer approval, in a group

Praise can be verbal or physical (like pat on the back, fist pump, head nod, hop, jump, etc)

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When delivering praise, use direct eye contact, positive demeanor, open body position, and get to the level of the person if possible

Make praises specific, personalized, and individualized

Repeat praises if the person seems unconvinced at the first stating of the praise

Restate praises in different ways to get the point across.

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Exercise

Get a partner, discuss a person you know and how praising them would affect their lives.

Switch.

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Creative a positive, proactive YES environment

Don’t just say NO and STOPThink of ways that a person can feel in

control of their life.—Andrew’s storyPREPARE—It doesn’t always workLearning new skills and having opportunity to

practice these skills, creates positive environment for someone to succeed

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Seven Actions: Things you can do right now..

1. Be sure that people know what you are asking them and what is expected in a given situation

2. Offer opportunities for choice – especially for those things that are important to someone

3. Tell people when they are doing a good job or doing something right

4. Ask someone to do something else if what they are doing is socially unacceptable

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5. Interact with people in a positive, proactive way – assume the best in them

6. Look for opportunities to teach someone more appropriate things to do, wherever you are

7. Create a positive, responsive environment so someone is offered opportunities to be successful

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Exercise

In a small group, list 3 actions that you can take to create a happy, responsive environment for the people you work with.

Discuss specifically what can happen on a big scale in your agency, house, etc., as well as what can happen to increase the quality of life for one person.

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Summary

Behavior IS communicationRelationships ARE importantWe need to listen in new ways to peopleWe need to be mindful of our own behavior and their

consequencesGive people meaningful choicesLet people know when they are doing something the

right wayCreate a positive, responsive environment which

increases the likelihood that someone will be happyThink of ways to say Yes, instead of No/StopAssume that people are able

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Remember….

PBS focuses on prevention, not reactionPBS is all about teaching people skills and

knowledge to improve their lives