Positive Behavior Support: What It Is, and How it Can be Helpful in Schools, Homes and other Settings David A. Rotholz, Ph.D., BCBA-D Center for Disability Resources University of South Carolina Nurturing Developing Minds Conference Greenville, SC Feb. 2016

Purpose of This Session  Learn about Positive Behavior Support (PBS)  How it is different from behavior management or behavior modification  Consider what to ask for when needing behavioral assistance

Activity 1  Please take a minute to write your answer to this question:  What is the most effective strategy or intervention you have seen to address problem behavior of a child (or adult) with a developmental disability?

How is Positive Behavior Support Different from Behavior Modification/Management? Let’s look at the two approaches Behavior Modification/Management Positive Behavior Support Was the best we had 30 years ago and was helpful in ways that were appropriate at the time Builds upon the successes of behavior modification, AND has important changes and additions based on decades of evidence & experience

Behavior Management  Too often the focus of behavioral intervention is on the problem behavior and is a punitive consequence  Expectation that the solution for a particular form of problem behavior will be the same across people  Does not focus on the function of the behavior  Often fails to accomplish goal and misses opportunity to teach new skills.

What is Positive Behavior Support? It is not what some older professionals learned 20+ years ago... I know, I am one... It is not something you do to people It is not a piece of paper or a curriculum It is an effective way to help children, youth and adults, in our case those with a developmental disability, use more appropriate means to reach a desired outcome

PBS  Originally introduced by Horner, et al, (1990).  Described as “a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person’s environment” (Association for Positive Behavior Support, 2011, ro.aspx). ro.aspx 7

“One of the central messages of PBS is that, in providing support, we should focus our efforts on fixing problem contexts and not problem behavior” Carr, et al David A. Rotholz, Ph.D.

Positive Behavior Support PBS includes: the evidence-based approach of applied behavior analysis And a more clearly described and current values base And improved focus on increasing quality of life and decreasing problem behavior by teaching new skills and making changes in a person’s environment David A. Rotholz, Ph.D.

Positive Behavior Support Focus is more on the person than the behavior Includes functional assessment of behavior Changing environmental & curricular variables with special emphasis on prevention/antecedents Includes teaching new skills & adaptive behavior (replacement behavior) Includes Person-Centered Planning

Values Assumed with Positive Behavior Support (Quoted from O’Neil et al., 1997) People do not engage in problem behaviors because they have an intellectual disability (formerly known as mental retardation) or other developmental disabilities. They engage in patterns of behavior that have worked for them.

FBA  People exhibit behavior for a reason and functional assessment is a process to understand what the behavior does for the person (the function)  Exception of properly diagnosed psychiatric disorder  This will tell us what the person likely gets or gets away from  “It is a systematic process for gathering information in order to determine the relationships between a person’s problem behavior and aspects of their environment”  (RRTC on PBS) 12

More on Values PBS is not just about behavior support plans It is about skill building, social interactions, accessing natural reinforcers, spending time in meaningful, appropriate activities and a satisfying life. David A. Rotholz, Ph.D.

Evidence Based Practices In our field, as in many others, only practices with an evidence based should be used. The science that is the foundation for PBS has an evidence base going back over 50 years. ABA interventions have been documented to effectively address a wide variety of important issues.

Misconception We provide lots of positive reinforcement and routinely conduct functional assessments. Therefore we are doing positive behavior supports. David A. Rotholz, Ph.D.

Saying ≠ Doing David A. Rotholz, Ph.D.

The Role of Teaching and Skill Development in PBS A key component of effective PBS is to replace the problem behavior with an appropriate alternative skill or behavior. This often involves teaching a new skill David A. Rotholz, Ph.D.

Teaching New Skills  Needs to be an included focus of any behavior support plan, especially those with restrictive interventions  Not sufficient to pass this off to other professionals  Skills should be replacement behavior 18

Teaching/Training Needs a well-designed plan Needs effective: Instruction Prompting Error Correction David A. Rotholz, Ph.D.

Teaching Skills Checklist Staff ________________ Observer ______________ Date ________ Consumer and Skill Being Taught_______________________________________ 1. Were all steps trained in order? ____ Yes ____No ____NA 2. Were all prompts appropriate? ____Yes ____No ____NA 3. Were all positive consequences provided correctly? ____Yes ____No 4. Were all error corrections done correctly? ____Yes ____No ____NA Data Summary # yes # yes + # no X 100% = _______% Did the staff member score at least 75% on this checklist? ___Yes ___ No

Replacement Behavior This is the skill that will be taught and/or reinforced to make the problem behavior irrelevant. It needs to be functionally equivalent to the problem behavior. Functional equivalence is a BIG DEAL David A. Rotholz, Ph.D.

Replacement Behavior  Not the same as just listing a desired behavior that you want to occur instead of the problem behavior.  This is the skill that will be taught and/or reinforced to make the problem behavior irrelevant.  It must serve the same function or it will not work FBA  The psychologist or behavior analyst is supposed to know how to do this... 22

Bill’s Competing Behavior Model Antecedent/Predictor - Antagonized by peer(s) Problem Behavior - Physical aggression Maintaining Consequence - Escape to quiet environment Setting Event - Bad van ride This is what is happening now

Bill’s Competing Behavior Model Antecedent/Predictor - Antagonized by peer(s) Problem Behavior - Physical aggression Desired Behavior - Ignore antagonizing peer(s) Intended Maintaining Consequence Staff praise Choice of reinforcer from menu Maintaining Consequence - Escape to quiet environment Setting Event - Bad van ride This is what is often attempted

Bill’s Competing Behavior Model Replacement Behavior -Ask for “break” Antecedent/Predictor -Antagonized by peer(s) Problem Behavior -Physical aggression Maintaining Consequence - Escape to quiet environment Setting Event -Bad van ride This includes replacement behavior Desired Behavior -Ignore antagonizing consumer(s) Intended Maintaining Consequence -Choice of reinforcer from menu

Functional Skills These are skills that someone would have to help the person with if they could not do it for themselves. Skills that help people to function in the places where they live, work, and play are functional skills. Examples: Fine motor skills -- clothespins vs.. coins “Simulated work” - why? Remember “pegboards”, “zipper boards”? David A. Rotholz, Ph.D.

Challenges  Lack of appropriate credential  ABA (BCBA © ) is necessary but not sufficient  Has the behavioral part but does not require, assess, or insure PBS part.  BCBA does not assure experience to work w/DD or severe behavior problems  Psychology license is not relevant, leaving aside legal requirements in some states. Most psychologists are not trained in ABA or PBS  No current credential solves issues 28

How to Find the Right Behavioral Resource  Ask them what they do for a person with “x” problem behavior.  If their answer does not include mention of addressing why the problem occurs, go elsewhere for help.  Be sure they have a process for learning what contributes to and reinforces the problem behavior.

30 Thank You Questions?