Bob Putnam, Ph.D., LABA, BCBA-D Improving Behavior Support and Quality of Life: The Department of Development Services’ PBS Initiative Janet George, Ed.D., Ass’t Commissioner for Children's Services & Policy &Planning, DDS & Bob Putnam, Ph.D., LABA, BCBA-D May Institute

Behavior support practices Department of Developmental Services: Positive Behavior Support Initiative DDS is moving to remove old Behavior Modification regulations (last approved in 1988* with changes in 2011 and 2013) and replace with Positive Behavior Support regulations that focus on improving Quality of life Behavior support practices

DDS PBS Definition A systematic, person centered approach to understanding 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 quality of life across the life span. PBS is not a specific “model” but a framework of effective practices, interventions, and system change strategies that have empirical support and individually have been demonstrated to be effective. http://ddslearning.com/dds-pbs-initiative

Improving Behavior Support & QOL: DDS’ PBS Initiative – GOALS Agency understands PBS as a systems approach to helping individuals with habilitation and behavior. Agency understands that PBS affects all individuals they support not just those with challenging behavior Agency has well functioning Leadership Team (key to PBS success)     {re 2’nd bullet: ALSO NOTE - PBS WILL BE A FIT FOR DDS’ NEW POPULATIONS} and across all age groups

Improving Behavior Support & QOL: DDS’ PBS Initiative – GOALS (cont.) Agency has tiered model of support and prevention and there is an emphasis within Agency on Universal supports Agency understands and embraces the “Four 4 integrated elements” framework of PBS (D,P,S,O) Agency has qualified clinicians sufficient to do the clinical work AND those clinicians are well integrated into the Agency.     Recall, the four elements = Use of key objective data for decision making Systems that support staff to do their best work (e.g. systems addressing staff supervision, training, & recognition) Evidence based practices (put in place by qualified clinicians); and, Agency is pursuing outcomes related to QOL (vs. e.g., simple count of # of problem behaviors) [[re: 3’rd bullet: E.g., clinicians supported to consider more than “behavior plans” (environmental changes)]]

Improving Behavior Support & QOL: DDS’ PBS Initiative – GOALS (cont.) Agencies will make use of the PBS resources available: Staff Training: from DDS & vendors On-line info - PBIS.org http://ddslearning.com/dds-pbs-initiative DDS put on line on-line classes, copyrighted articles, FAQs, as well as DDS papers giving guidance to the field e.g. “Informational Bulletin On Positive Behavioral Supports” Other supports e.g., May Center’s offer to help with data management strategies; PBS Training materials available commercially; Consultation available from private clinicians (DDS supported PBS consultation)

Division of Developmental Services http://ddslearning.com/dds-pbs-initiative

Improving Behavior Support & QOL: DDS’ PBS Initiative – LESSONS BEING LEARNED What have we heard? Use data already being collected Gradual implementation (not all at once) It takes time to make the changes And, … a few thoughts on what we’ve heard at the hearings as well as written testimony Janet takes over after this slide

Improving Behavior Support & QOL: DDS’ PBS Initiative - Status of Revision of Regulations Under Review Current Regulations in effect Encourage Providers to Use PBS DDS has published draft regulations (June, 2016) Public hearing and written testimony provided to DSS (August, 2016) Key Themes and Components Alignment with Community Rule, Person Centered Planning Quality Improvement and Enhancement Refer to Guidance Materials and Key Components on ddslearng.com      Simplification and Ease of Readability Clarity of definitions

Improving Behavior Support & QOL: DDS’ PBS Initiative – (cont.) Centrality of Leadership Team Critical for success Need full complement of staff DDS has laid out Develops metrics Uses data to make changes Develops PBS Action Plan Takes holistic view of agency work -sharing Determines number and type of PBS Tiers Insures quality

Improving Behavior Support & QOL: DDS’ PBS Initiative Emphasis on Quality Improvement and Enhancement Leadership Role in Quality Monitoring Peer Consultation Treatment integrity across Tiers Qualified Clinicians Role of DDS Human Rights Updated guidance material to align with changes in the future

Emphasis on Universal Tier Creating culture Suggested interventions in Guidance Material Providers can be engaged in this now Attention to physical environments and populations served

Other Changes in the Works Programs certified Restraints available Holds are typically restraints Addition of Emergency Individual Protocol Consolidation of State Operated Restraint programs underway Emergency restraint use

Improving Behavior Support and QOL: Relationship to ISP Behavior Assessment vs. FBA Sequencing of Reviews Survey and Certification Technical Assistance Available

PBS Conclusion Encourage providers to create Action Plan Take advantage of Consultation offered Encourage use of Guidance Forms, not required, but elements key Position agency for when regulations are promulgated Current regulations in effect