Working Together to Resolve Behavior Challenges through ......1 3/11/2016 Working Together to...
Transcript of Working Together to Resolve Behavior Challenges through ......1 3/11/2016 Working Together to...
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Working Together
to Resolve Behavior
Challenges through
Positive Behavior
Support
Meme Hieneman, Ph.D., BCBA
APBS 2016, San Francisco
What is Positive Behavior
Support?
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Positive behavior support (PBS) is an approach to supporting individuals with behavioral challenges in complex community settings that combines the science of applied behavior analysis with principles from other disciplines (e.g., positive, ecological, and community psychology) to improve not only behavior, but quality of life.
PBS: Collaborative, Individualized
Problem Solving Process
1. Establish Goals
2. Conduct an FBA
– Gather Information
– Analyze Patterns
3. Develop a Plan
4. Implement Strategies
5. Monitor Outcomes
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What defines collaboration?
What does not?
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Tips for Collaboration
– Communicate
– Establish plans
– Stay focused
– Be flexible
– Respect limits
– Show appreciation
– Be accountable
– Document
– Be sympathetic
– Leave people out
– Work in isolation
– Expect perfection
– Drop the ball
– Ignore advice and
perspectives
– Blame/criticize
– Rely on memory
Do this… Not this…
Step 1: Establish Goals
– Broad goals for child, as well as family and
other support providers
– Specific behaviors of concern
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What do we want to change?
Domains of Quality of Life
Social Relationships
Self Advocacy
Health and Safety
Productive Activity
Community Participation
How do we identify goals?
– Ask child/family/support team
– Watch what the child currently does
– Compare behavior to same-aged peers
– Use person-centered planning process
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Warren: A Positive Vision
Now:
Highly structured activities in home and
community
1:1 supervision
Meltdowns when things go wrong
Perseverates on topics/issues
Social isolation
Gets off task and fails to do work
Go to friend’s house without parents
Establish regular homework routine
Try out activities (boy scouts, run club)
Have chores and get allowance
Independent self-care and clean up
Recognize and adapt to social cues
Engage in clubs and sports
Complete homework
Communicate with friends - sleepover
Coping skills to avoid meltdowns
Big Goals:
Multiple, high quality friendships
Physically active
College bound
Confident and comfortable
NO LIMITS
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“Try It” Activity 1___ years from now we would like our child to
_________.By this same time, we
would like to ________________.
Behaviors of Concern
– What you would like your child to say or do
(including do more often or better)?
– What behaviors would you like your child to stop
or decrease?
– Be objective, avoid assumptions
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What is “problem” behavior?
– Dangerous – endangers self or others
– Destructive – results in property damage
– Disruptive – interferes with activities
– Disturbing – causes social isolation
– Detrimental – delays development
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Is the behavior worthy of intervention?
Baseline
How often?
How long?
How intense?
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Date Frequency
3/21 llll lll3/22 lll
Date Start Stop Duration
3/21 3:16 4:03 47 min3/21 6:10 6:45 35 min
Date Intensity
3/21 0 1 2 3
3/22 0 1 2 3
Warren: Behaviors of Concern
– Completing tasks and activities
– Communicating needs and wants
– Hitting peers and siblings
– Crying and dropping to the floor
– Throwing or damaging materials
– Perseverating on topics (questions)
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“Try It” Activity 2Our child is unable to
______ and/or says or does _______, which interferes with achieving our goals.
(This occurs _____, and _____ would be acceptable).
Step 2: Conduct an “Informal FBA”(Functional Behavioral Assessment)
– Gather Information
– Ask: Interview others people
– Watch: Observe across situations
– Analyze Patterns
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Analyzing Patterns
Antecedent Behavior Consequences
What happensbefore behavior
What the child says or does
What happens after behavior
Who
What
Where
When
Positive behavior, as well as problem
behavior
Gets (e.g., items, attention)?
Avoids (e.g., demands)?
Setting Events: Circumstances (e.g., health, relationships, activity schedule) that affect the probability of behavior
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Warren: Patterns Affecting
Behavior
Antecedent Behavior ConsequencesUnstructured social situations (e.g., free time, sports, games, family events)
Repetitive comments or questions, crying,dropping, hitting
Avoids situations and social demands
Has difficulty completing tasks with precision –makes errors
Crying, throwing or destroying materials, refusing activities
Obtains assistance or task is modified or delayed
Setting Events: Unclear expectations related to social interactions or
tasks, physical discomfort (e.g., uncomfortable clothes), changes in routines or schedules (e.g., when parents were away, changes in caregivers)
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“Try It” Activity 3When ________ happens
our child says or does
_________, which results in
him or her getting/avoiding
____________(your best guess, for now)
Antecedent Behavior Consequence
Step 3: Develop a Plan (BIP)
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Being Proactive Teaching Management
Changing environment to prompt positive behavior and make problem behavior unnecessary
Teaching skills to replace the problem behavior or allow the individual be more successful
Responding to behavior to reinforce positive and not negative behavior
Modifying setting events and enhancing lifestyle to improve behavior
Supporting caregivers to implement interventions consistently
Proactive StrategiesIf the function of the behavior is…
Then proactive strategies should focus on…
Attention Increasing amount of attention providedLetting person know when attention is availableProviding independent activities when busyPrompting to request attention appropriately
Tangibles/activities Clarifying what items/activities are availableRemoving “off-limit” items from surroundingsOffering alternatives to items/activities deniedPrompting to request or negotiate alternatives
Escape/avoidance Modifying characteristics of settings or activitiesAllowing opportunities to choose what and whenShortening activities or providing periodic breaksReminding how to request break/stop correctly
Sensory stimulation Providing other, appropriate sensory stimulation(e.g., keeping engaged in desirable activities)Blocking access to inappropriate stimulationPrompting appropriate forms of stimulation
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Teaching StrategiesIf the contexts/functionof the behavior relates to
Teach skills such as…
Attention Replacement: Teach individual to request attention such as proximity, interaction, or physical contactDesired: Teach individual to wait or entertain him/herself
Tangibles/activities Replacement: Teach individual to request items or activities or initiate access on ownDesired: Teach individual to accept “no”, wait, or negotiate alternative item/activities
Escape/avoidance Replacement: Teach individual to say “no” or “later”, take breaks, or other ways to escapeDesired: Teach individual to remain on task or in the designated area
Sensory stimulation Replacement: Teach individual to obtain sensory input through alternative appropriate actionsDesired: Teach individual to tolerate boredom and appropriate time and place
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Management StrategiesIf the behavior occurs when Then consequences should focus on…
Attention is withdrawn Increase level and frequency of desired attention following positive behaviorMinimize attention (e.g., by ignoring, walking away) when problem behavior occurs
Tangibles/activities are withheld Provide access to tangibles/activities only following appropriate behavior (e.g., requests)Withhold tangible reinforcers after problem behavior (including “negotiation”)
Difficult or unpleasant activities are presented
Allow breaks, escape, changes in environment, or reductions in demands for appropriate behavior (e.g., participation)Withhold or delay escape for problem behavior
Sensory stimulation is unavailable
Allow access to items and activities that provide appropriate sensory stimulationBlock access to inappropriate events
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Changing Settings/Creating Supports
– Enlist other family members, educators, service
providers, friends, neighbors, and others
– Rearrange physical environment to make expectations
and limits amore evident
– Change activity schedule or nature of tasks required
(e.g., Premacking schedule)
– Support development/enhancement of relationships
– Enroll child in community or recreational activities
– Find ways to “fill the buckets” or regular caregivers
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Warren: Behavior Plan
Being Proactive Teaching Management
Written expectations and examplesSocial stories for complex interactionsPersonal spaceTraining for peersGradually increasing expectations
Requesting breaks, assistance, and/or explanationSelf-soothing (e.g., perspective-taking, breathing)Social/conversation skills
Responding quickly to communicationFeedback on social interactions (peer)Homework checklistChecking off workChoice of activities for completing work
Setting event strategies: Preparing schedule and environment in advance, anticipating challenges, group teaching and rewards
Supporting caregivers: Simple written plans, developing lists and examples, team meetings with feedback on progress
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“Try It” Activity 4: Brainstorm Ideas
Being Proactive Teaching Management
Setting event strategies:
Supporting caregivers:
Step 4: Implement Strategies
– Create an action plan
– What needs to occur?
– Who will complete it?
– When will it be done?
– Use strategies consistently
– Adjust as needed
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Ensuring Contextual Fit
Systems
Caregivers
Environment
Individual
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“Try It” Activity 5In order to put our plan in
place, ______ needs to be
accomplished by _____ by
______.
Step 5: Monitor Outcomes
– Reductions in behaviors of concern
– Increases in
– replacement behaviors
– skills needed for daily living
– Improvements in overall quality of life
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Frequency Record: Chores/WeekN
um
ber
of
tim
es h
ou
seh
old
cho
re o
n li
st is
co
mp
lete
d
20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20
19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19
18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18
17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17
16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16
15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15
14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14
13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13
12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12
11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11
10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10
9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9
8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8
7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7
6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6
5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5
4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3
2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2
1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Dat
es
CountingTimingRating
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Weeks:
Ch
alle
ngi
ng
Be
hav
ior
Number of Aggressive
Episodes
Average Duration
Average Severity 3 2 1 3 2 1 3 2 1
Po
siti
ve B
eh
avio
r
Routines Completed
Hygiene
Put away
Cooking
Exercise
Laundry
Chores
“Words” Used
Attend to me
May I _____
Stop/Later
3 = resulted in injury 2 = caused some level of discomfort 1 = made contact or attempt, no discomfort
Warren: Data From School
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Warren: Other Outcomes
– Competes successfully in triathlons, boy scouts, family
gatherings, and outings with friends
– On grade level and excelling in preferred subjects –
preparing to transition to a new school
– Able to discuss concerns and avoid “melt-downs” –
parents guide him through problems
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“Try It” Activity 6To objectively evaluate
progress for our child, we
will ______________ to
capture behavioral and
lifestyle changes.
Support for the Entire Family
(or Program/Classroom)
– Vision and expectations
– Physical organization
– Scheduling and routines
– Rewards for positive behavior
– Consistent consequences
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Physical Organization
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Scheduling and Routines
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Rewards and Consequences
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“Try It” Activity 7What might you be able to
do that would benefit your
entire family (or classroom/
program/agency) using the
principles of PBS?
In Summary,
we address behavior by…
– Understanding Patterns
– Becoming Proactive
– Teaching New Skills
– Responding Effectively
– Enhancing Lives
– Working Together
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Hieneman, Childs, & Sergay; 2006
Free Resources & References
– APBS Families Site: http://apbs.org/new_apbs/families.html
– Fox, L. & Duda, M. (No Date). Positive Behavior Support. Technical Assistance Center on Social Emotional Intervention for Young Children at www.challengingbehavior.org
– Hieneman, M., Nolan, M., Presely, J., et al. (1999). Facilitator’s Guide: Positive Behavior Support. RRTC-PBS, Child & Family Studies, USF at http://apbs.org/files/PBSwhole.pdf
– Janney, R., Black, J, & Ferlo, M. (1989). A problem-solving approach to challenging behaviors: Strategies for parents and educators of people with developmental disabilities and challenging behaviors. ERIC database. http://eric.ed.gov/?id=ED323734
– Parenting Special Needs Magazine articles http://parentingspecialneeds.com
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