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2 PROPRIETARY AND CONFIDENTIAL
THE SUCCESSFUL REPLICATION OF D-PBIS
ACROSS MULTIPLE CENTERS SERVING ADULTS WITH I/DDLeeann Haffner, MS – DPBIS Project Coordinator PA Adult ServicesMichelle Lipchock, DSW, LCSW Clinical Director, Devereux New JerseyMichelle Wonders, Psy.D – Clinical Director, Devereux Pocono
3 PROPRIETARY AND CONFIDENTIAL
PRESENTATION OBJECTIVES Participants will be able to define the components of D-
PBIS and describe the framework for implementation.
Participants will learn how the D-PBIS framework has been successfully implemented across multiple centers and how it can be adapted to fit individual programmatic needs.
Participants will be able to describe measures necessary to sustain D-PBIS in programs servicing adults with I/DD.
4 PROPRIETARY AND CONFIDENTIAL
DEVEREUX-POSITIVE BEHAVIOR INTERVENTIONS AND
SUPPORTS (D-PBIS I/DD)Scope The Devereux organization
operates in 13 states There are 8 Centers across
the United States serving I/DD Centers are located in (NY,
NJ, PA (2), MA, Florida, Texas, California)
Implementation Issues All centers are rolling out the D-
PBIS I/DD framework w/ modifications Coordination across/within
centers Focus on implementing with
fidelity Necessary to develop measures
that ensure sustainability
5 PROPRIETARY AND CONFIDENTIAL
3 TIERED APPROACH
~80% ? of Clients
~5%
~15%
TERTIARY PREVENTIONComprehensive FBAPositive Behavior Support PlansIncreased SupervisionIndividual and Family TherapyTrauma-Focused CBTModified PE
SECONDARY PREVENTIONCheck-in/Check outMentoringPeer supportGroup TherapySpecialized Group Skills Training
PRIMARY PREVENTIONBehavioral Assessment & ConsultationClear expectationsProactive FocusSkills TrainingData Based Decision MakingSelf-ManagementSafe and Positive EnvironmentLesson PlansCorrective InstructionStaff and Individual Acknowledgements
6 PROPRIETARY AND CONFIDENTIAL
Devereux Organizational FWPBIS Steering Committee
Meets quarterly
Center-based FWPBIS Leadership Team
Meets monthly
Self-ManagementGuided Self-Management
AcknowledgementsPerformance Based
Feedback
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
7 PROPRIETARY AND CONFIDENTIAL
Self-ManagementGuided Self-Management
AcknowledgementsPerformance Based
Feedback
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
SYSTEM-SELF MANAGEMENTSelf Monitoring –
Once lesson plans are written, models for self monitoring will be developedMust take into account various levels of intellectual disability and communication
8 PROPRIETARY AND CONFIDENTIAL
Self-ManagementGuided Self-Management
AcknowledgementsPerformance Based
Feedback
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
CORRECTIVE INSTRUCTIONStep 1: GET THE PERSON’S ATTENTIONStep 2 ACKNOWLEDGE THE PERSON’S EMOTIONStep 3 STATE THE SKILL THAT CAN BE PRACTICED IN THE MOMENTStep 4: PRACTICE THE SKILL Step 5: REVIEW AND PRAISE
9 PROPRIETARY AND CONFIDENTIAL
Self-ManagementGuided Self-Management
AcknowledgementsCorrective Instruction
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
ACKNOWLEDGEMENTS
Center-wide celebrationsChecklist of unit likes/Reinforcement Inventories Employee Appreciation Committee interfaceRewards packet for students and staff
10 PROPRIETARY AND CONFIDENTIAL
Self-ManagementGuided Self-Management
AcknowledgementsCorrective Instruction
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
LESSON PLANSScripts were revised to remove incorrect model of the skill or behaviorLesson Plans will be develop for two levels of learners:
Mild to Moderate level of disabilitySevere to Profound level of disability9 Essential Signs
11 PROPRIETARY AND CONFIDENTIAL
TEACHING MATRIX
12 PROPRIETARY AND CONFIDENTIAL
Self-ManagementGuided Self-Management
AcknowledgementsCorrective Instruction
Level of Safety
Teaching for Positive Learning
Teaching Matrix and Lesson
Plans
Program Components
LEVEL OF SAFETYUniversal List of Major and Minor Infractions was revised to include adult issues and concerns. Language was revised to positive and adults terminology and was expanded to include enhanced medical and wellness concernsTeach skills vs intervention
13 PROPRIETARY AND CONFIDENTIAL
REPLICATION OF D-PBIS
14 PROPRIETARY AND CONFIDENTIAL
OVERVIEW OF D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS
National Board of Directors
• 2012 mandate for all Devereux programs to implement PBIS• Goal to develop D-PBIS models (EBD, I-DD and Autism)• Balanced scorecard for all centers
D-PBIS Fidelity Advisory
Committee
• Creation of D-PBIS models• Assigned consultants to work with centers on specific
implementation of PBIS• Ensure fidelity of all implementing centers• Measuring progress the same manner—same data collection
across all centers
Center Leadership
Teams
• Team of center specific staff charged with D-PBIS Implementation including center leadership
• Meet once a month to review center implementation (fidelity, data analysis, and problem solving)
15 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS
The primary goal is to ensure implementation of D-PBIS with integrity and to ensure positive gains of staff and the individuals we serve. In partnership with corporate liaisons, the leadership team is
composed of representatives from various disciplines in the center. Provides oversight of implementation of D-PBIS across center. Ensures our D-PBIS implementation maintains a high degree of
fidelity through on-going data based decision making.
Center Leadership Team
16 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS
Monthly meetings are held to review and trend various data sets, create or alter permanent products for the programs and problem solve any issues or obstacles that may arise.
Charged with maintaining further implementation of D-PBIS programs across the center.
Consultation between Centers
Data collection is embedded in the Electronic Health Record
Center Leadership Team
17 PROPRIETARY AND CONFIDENTIAL
D-PBIS DATA ANALYSIS ACROSS IMPLEMENTING CENTERS
18 PROPRIETARY AND CONFIDENTIAL
D-PBIS DATA ANALYSIS ACROSS IMPLEMENTING CENTERS
19 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS
Individual
Direct Care Staff
Management and Clinical Staff
Leadership Team
Fidelity Committee
20 PROPRIETARY AND CONFIDENTIAL
HOW D-PBIS CAN BE ADAPTED TO FIT INDIVIDUAL PROGRAM NEEDS
Baseline data from observations of staff Active Engagement (materials and positive interactions) Preference assessments for individuals: motivators and
activities that are specific to each program Use of sign language (9 basic signs) Customized teaching matrix: expected behaviors for each
setting that D-PBIS is used: home, work and the community and the categories for expected behavior of the individual Lesson plans: instructional scripts to teach the individuals
appropriate prosocial behaviors: the instructional process uses an errorless learning approach to teach the skills to the individuals with a minimal amount of errors.
21 PROPRIETARY AND CONFIDENTIAL
SUSTAINABILITY OF D-PBIS
22 PROPRIETARY AND CONFIDENTIAL
SUSTAINABILITYWhy is it important?
Reduce challenging behavior Increase independence and use
of prosocial behavior Provide structure and
acknowledgments Increase/sustain satisfaction Improve quality of life How to Sustain
Develop a plan and build an infrastructure Monitor compliance Analyze data for fidelity Determine impact on outcomes
23 PROPRIETARY AND CONFIDENTIAL
TOOLS FOR SUSTAINABILITY Contingency Plan
Acknowledgements
D-PBIS Certification
Home Visit Spot Check
Satisfaction Surveys
Leadership Meeting and Compliance Data
Peer Mentoring
24 PROPRIETARY AND CONFIDENTIAL
CONTINGENCY PLAN Crucial for sustainability as there will always be staff
turnover, vacancies, and leaves of absence.
Ensures D-PBIS implementation, oversight, and consultation occurs when there is an open position in any role.
– Home visit spot check– Direct observation, data consultation, and performance
feedback schedule – Acknowledgement procedure
Monitors compliance of implementation through data analysis
25 PROPRIETARY AND CONFIDENTIAL
CONTINGENCY PLAN
26 PROPRIETARY AND CONFIDENTIAL
ACKNOWLEDGEMENTS When desired behaviors are observed, staff provide
individuals with acknowledgement cards, paired with verbal behavior specific praise.
Weekly or bi-weekly drawings for individuals and monthly drawings for staff to receive a prize (gift card, dinner, outing, DVD, etc.).
27 PROPRIETARY AND CONFIDENTIAL
D-PBIS CERTIFICATION Certified clinical staff are responsible for certifying supervisors
28 PROPRIETARY AND CONFIDENTIAL
HOME VISIT SPOT CHECK Completed once per month by clinical staff and operational
staff Information and Implementation scores analyzed to identify
trends
29 PROPRIETARY AND CONFIDENTIAL
SATISFACTION SURVEYS Completed by individuals, staff, and supervisors on a
quarterly basis
30 PROPRIETARY AND CONFIDENTIAL
SATISFACTION SURVEYS
31 PROPRIETARY AND CONFIDENTIAL
SATISFACTION SURVEYS
32 PROPRIETARY AND CONFIDENTIAL
LEADERSHIP AND COMPLIANCE Monthly leadership meetings held at each center Data compliance graphed and reviewed monthly by
clinical team and operations
33 PROPRIETARY AND CONFIDENTIAL
PEER MENTORINGAll D-PBIS certified supervisors are eligible to become a peer mentor for a supervisor rolling out their first D-PBIS program.
D-PBIS I/DD Peer Mentoring Teaching Procedure
1. Introduce the skill to be taught2. Give the rationale for using the skill3. State the steps of the skill4. Demonstrate the skill5. Have the trainee model the skill that was demonstrated6. Give the trainee feedback on their demonstration of the skill7. Have trainee demonstrate the skill with the individuals or staff8. Document on the checklist when the skill is performed correctly
34 PROPRIETARY AND CONFIDENTIAL
PEER MENTORING
Questions?Contact Information:
Michelle Wonders, Psy.Dmwonders@devereux.org
Leeann Haffner, MSlhaffner@devereux.org
Michelle Lipchock, DSW, LCSWmlipchoc@devereux.org
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