1 positive behavior support in community settings february 3, 2004 rachel freeman university of...

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Positive Behavior Support in Community

Settings February 3, 2004

Rachel FreemanUniversity of Kansas

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Positive Behavior Support

Positive behavior support is the integration of Valued outcomes Behavioral and biomedical science Validated procedures Systems change

In order to enhance quality of life and prevent problem behavior

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Characteristics of PBS

PBS plans can be short or more complicated

Many different intervention choices can result in same positive outcomes

Must fit the values, vision, and resources of those supporting the individual

PBS plans requires team collaboration Purpose is to increase quality of life and

build a team vision

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Why individuals Engage in Problem Behavior

If problem behavior is increasing look for events that reinforce it

Problem behavior increases when it is reinforced To obtain attention, access to people, events, or

activities To escape people, events or activities

Problem behavior influenced by physiological variables can occur to escape or obtain internal stimulation

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Common Functions Maintaining Problem Behavior

To escape from tasks, people, situations, or internal sensations

To obtain attention from staff, peers, or other individuals

To obtain access to preferred items or events To either escape or obtain internal sensations

due to physiological events

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First Steps in PBS Process

Medical check-up to ensure there isn’t a health problem or medical issue

Person-centered Planning Establish the team

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Person-centered Planning

Process for identifying ideal lifestyle Creates a vision for the team Focus on the positive Gathers important information for the

PBS plan Decreases the need for more intensive

interventions Priority and control is given to the

individual

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Functional Assessment

Identify why the person engages in problem behavior

Assess how to replace problem behavior with desirable behavior

Identify how to redesign the environment to prevent problem behavior

Link all interventions directly to information gathered in the functional assessment

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Routines, Settings and People Associated with the Occurrence and Nonoccurrence of Problem Behavior

Problem Behavior is Most Likely…

Before work Transitions Sitting next to his

friend John on the way to work

Problem Behavior is Less Likely…

Lunch Small groups Receiving high levels

of attention

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Developing a Hypothesis Statement

A Good Hypothesis Statement Includes the Following Components:

1. Setting Event

2. Antecedent

3. Problem Behavior

4. Consequences

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Setting Events

Environmental (noise levels, sitting next to a peer, late to work)

Social (fight during lunch, family crisis) Physiological (sickness, allergies, sleep

deprivation)

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Antecedent Events (Triggers)

Immediately precedes a problem behavior

Can be related to time of day, people, specific settings, the physical surrounding, or particular activities

Common examples include verbal demands, specific assignments, certain peers or individuals

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Consequences

An event that is presented contingent upon the occurrence of problem behavior

Common consequences include staff attention, the removal of a difficult task, or the presentation of something the person wants

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Hypothesis Statement

Setting Event Antecedent (Trigger)

Problem Behavior

Consequence

Change in work schedule

No attention from staff or peers

Pulls hair when someone is nearby

Immediate attention

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Activity

Complete the hypothesis statement activity in small groups or individually

Write down the setting events, antecedents, behaviors, and consequences described in each vignette

Answer sheet

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Types of Functional Assessment Strategies

Indirect assessment methodsDirect observationFunctional analysis

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Indirect Assessment

Interviewing the person, her parents, staff, and other individuals who know the person well

Record reviews Quality of life measures Checklists and rating scales

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Identify Routines

The behavior occurs “all the time” is not enough information

Select the most problematic situations and settings

Collect functional assessment information about specific routines

Observe these routines

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Defining a Problem Behavior

Avoid using a classification label (for example, ADHD, autism, etc)

Describe exactly what the behavior looks like Avoid using vague descriptions (temper tantrums

mean different things to different people)

Make sure the behavior is described in such a way that there is a clear beginning and ending

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Collecting Direct Observation Data

To help you develop an initial hypothesis To confirm that your hypothesis is

correct To create a baseline that can be used

later to evaluate the PBS plan

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Collect a Baseline of Problem Behavior

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Direct Observational Methods

Measure behavior by frequency, intensity, duration, or latency

Scatter plot “ABC” chart (documents observed

antecedents, behaviors, and consequences)

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Scatter Plot

ABC Chart

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Outcomes of a Functional Assessment

1. Describe the problem behavior

2. Identify the events, times, and situations that predict when problem behaviors both occur and do not occur

3. Identify the consequences that maintain a problem behavior

4. Develop a hypothesis

5. Confirm the hypothesis using direct observation

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Functional Analysis

A functional analysis involves observing behavior while systematically manipulating environmental events

A functional assessment includes functional analyses, indirect assessment, and direct observation

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Activity

In small groups, discuss an individual you currently support

Discuss what you think is maintaining an individual’s problem behavior

What type of information do you have to confirm this hypothesis?

What other evidence do you need?

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PBS Planning

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PBS Plans Must be a Good “Fit”

Values of team membersResources availableSkills and background of those

implementing the PBS planTraining identified as neededUse team based strategies to

identify interventions

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Team-based Brainstorming

Bring functional behavioral assessment information

Set up flip chart paper for writing down interventions

Set aside time to brainstorm each part of the hypothesis statement

Do not judge ideas during brainstorming Go back later as a team and pick

interventions

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Logically Linking the Functional Assessment to PBS Planning (Adapted from O’Neill, et al., 1997)


Problem Behavior

Consequence




Immediate attention

Setting Event

Interventions

Antecedent Interventions

Teach New Skills

Consequence

Interventions

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Logically Linking the Functional Assessment to PBS Planning (Adapted from O’Neill, et al., 1997)


Problem Behavior

Consequence




Immediate attention

Setting Event

Interventions


Teach New Skills

Consequence

Interventions Alert residential staff to changes at work Rehearse changes before work with his picture schedule

Temporarily increase attention on days when changes occur

Provide one on one staffing on days with schedule changes

Provide high levels of staff attention and structure activities that encourage interaction

Teach person to initiate a positive interaction with picture schedule

Reduce attention for hair pulls Reward person when he successfully completes time alone with no hair pulls

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Setting Event

Interventions


Teach New Skills

Consequence

Interventions

Alert residential staff to changes at work Rehearse changes before work with his schedule

Temporarily increase attention on days when changes occur

Provide one on one staffing on days with schedule changes

Provide high levels of staff attention and structure activities that encourage interaction

Teach person to initiate a positive interaction with picture schedule

Reduce attention for hair pulls Reward person when he successfully completes time alone with no hair pulls

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Examples of Setting Event Interventions

Minimize or eliminate the setting event Design interventions that are implemented

when setting events occur

--Neutralize the setting event

--Withhold or eliminate the antecedent

--Add more prompts for desirable behavior

--Increase the value of reinforcement for desirable behavior

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Avoid presentation of antecedent (verbal demand statements)

Modifying Tasks The way activity is completed Functional activities Compensate for skill deficits Initially providing extra support

Create high levels of predictability Offer choices

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Teaching New Skills

Identify a desirable behavior that will serve the same function as the problem behavior

This new behavior must be more efficient when compared to the problem behavior

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Consequence Interventions

Are important when teaching new skills (the goal is to make the problem behavior inefficient compared to new behaviors)

Withdraw or terminate reinforcement maintaining problem behavior (extinction)

Withdrawing or terminating reinforcement can result in an “extinction burst” (problem behavior may increase temporarily before decreasing)

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Examples of Consequence Interventions

Intervene early before problem behaviors increase in intensity (we often ignore early signs that are not as problematic and respond to serious problems)

Redirect person early in the chain of problem behaviors

Avoid engaging in coercive interactions

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Building a Positive Interaction Pattern

Rapport building strategies Provide 4 positive statements for every

demand or request Deliver reinforcement to persons

immediately when you observe them engaging in positive social behaviors

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Activity

Read this vignette and use the PBS planning tool

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PBS Planning Tool

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Cycle of Positive Behavior Support

PCP CurriculumFunctionalAssessment

Medical/Health

Hypotheses: Global and Specific

Multicomponent Interventions

Data Analysis and Evaluation

EffectiveIneffectiveGeneralization/Maintenance

Florida’s Positive Behavior Support Project-USF

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Effective PBS Plans

Identify the full set of problem behaviors Focus on routines Document the escalating pattern of problem

behavior from lowest to highest intensity List all behaviors and indicate which behaviors

are maintained by the same function Implement plan across all relevant settings and

times

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Features of a Written PBS Plan

Identifying information, reasons for the plan, person’s positive characteristics

Description of the problem behavior(s) Summary of the hypothesis statement General description of interventions and

specific strategies in more detail Crisis prevention plan (as necessary) Group commitment (obtain signatures)

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Implementing a PBS Plan

Provide a timeline for implementing each intervention

Document the agreed upon dates for meetings Identify the individuals responsible for

implementing each intervention Spread responsibilities among team members

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Implementation Plan Example

Activity Person Responsible Date of Completion

Functional AssessmentInterviews R. Freeman 11/14/00-

11/27Direct Observations T. Dolby 11/15/00

R. Freeman 11/16/00-11/17/00

Summary of Report R. Freeman 12/2/00Brainstorming Session All Team members 12/3/00PBS Plan DevelopmentDevelop materials B. Smith 12/11/00Schedule mentor sessions M. Brown 12/11/00Secure extra staff support L. Kinley 12/14/01Write scripts and R. Freeman 12/15/00Evaluation PlanMeetings for review of data All team members 1/14/01Collectors of data B. Smith OngoingSummarize data for meetings R. Freeman Ongoing(Adapted from Horner, Albin, Sprague, & Todd, 2000)

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Enlarged Implementation Plan

Activity Person Responsible Date of Completion

Functional Assessment

Interviews R. Freeman 11/14/00-11/27

Direct Observations T. Dolby 11/15/00R. Freeman 11/16/00-

11/17/00

Summary of Report R. Freeman 12/2/00

Brainstorming Session All members 12/3/00

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PBS Plan Development

Develop materials B. Smith 12/11/00

Mentor sessions M. Brown 12/11/00

Extra staff support L. Kinley 12/14/01

Write scripts R. Freeman 12/15/00

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Evaluation Plan

Review of data All members 1/14/01

Data collectors B. Smith Observe dinner

twice/week

Summarize data for R. Freeman Weekly

Meetings

(Adapted from Horner, Albin, Sprague, & Todd, 2000)

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Evaluating a PBS Plan

A PBS plan should result in… Decreases in problem behavior Increases in academic and social skills Positive lifestyle changes

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Collect a Baseline of Problem Behavior

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Examples of Evaluation Measures

Compare the frequency of problem behavior and appropriate behavior

Assess whether the person’s social skills have increased

Observe number of positive interactions that occur during key routines

Changes in the persons quality of life (access to new resources, new friendships)

Assess level of satisfaction with the PBS plan

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Useful Tools for PBS

Link to the Rehabilitation Research and Training Center on Positive Behavior Support Facilitator’s Guide:

http://www.fmhi.usf.edu/cfs/cfspubs/pbsguide/facilitatorguidepbs.htm

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For More Information

Kansas Institute for Positive Behavior Support (www.kipbs.lsi.ku.edu)

Kansas University Center for Developmental Disabilities - PBS Resources (http://www.uappbs.lsi.ku.edu)

Center on Positive Behavioral Interventions and Support(http://www.pbis.org)

Rehabilitation Research and Training Center on PBS (http://www.rrtcpbs.org)

1 positive behavior support in community settings february 3, 2004 rachel freeman university of...

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