Thursday Targeted Training: From FBA to BSP/CIP Development Stacy L. Nonnemacher, Ph.D. January 31, 2012

Objectives Understand FBA from a Multiple Theoretical Perspective Be able to develop appropriate goals and objectives (as linked to the BSP information) Identify role in the participant’s team initially and ongoing

Reframing Functional Behavioral Assessments (FBA) A Different Way to Think About FBA

Steps to Complete FBA Step 1: Prioritize and Define Behavior Step 2: Indirect Data Collection Step 3: Direct Observation Step 4: Analysis of Information Next Step: Develop Behavior Support Plan/Crisis Intervention Plan

Misconceptions There is only one way to do an FBA FBA will not be an effective tool for people who have mental health issues In order to do a good FBA, only interviews and observations should be done You cannot determine function of behavior for people with internalizing behaviors

FBA IS… FBA IS NOT… A process Individualized Comprehensive Systematic An assessment tool Cookie cutter Standardized

Lets Reframe And Refocus

MISSION: HYPOTHESIS How do we get there? FBA is not a specific technique, rather it is a process that guides problem-solving and decision-making FBA should include multiple theoretical perspectives in determining function

FBA as a Process? The field has evolved into supporting people with challenging behavior under the philosophy of Positive Behavioral Supports which combines: Valued outcomes; Behavioral and Biomedical sciences; Validated procedures; and Systems change to enhance quality of life and reduce problem behaviors. (Association for Positive Behavior Support)

FBA as a Process? FBA should be considered the guiding process that is founded on understanding behavior and using the information collected to develop thoughtful, individualized supports.

Multiple Theoretical Perspective? Considering varied points of view within the micro system and macro system These theories or speculations can only be confirmed with data!

Put Into Practice

Sharon Sharon is diagnosed with ASD. She is 28 years old, lives with her parents and relies upon full support of her natural and paid network. Sharon has a seizure disorder, and also was in and out of residential treatment facilities as a student. After one particular stay, she came home with bruises and was very withdrawn. As an adult, Sharon is a participant in the Adult Autism Waiver. She has been involved in a day program that supports people with disabilities. Sharon has been supported by a behavioral specialist, in one form or another, since she was ten. Currently, her waiver team is encouraging her and her parents to consider more community based supports. An FBA is warranted with her increase in behaviors, particularly her propensity towards wanting to touch children.

What to do? There are medical concerns Has there been a current medical evaluation? There are behavioral concerns that impact other’s safety Do we know if she presents a current risk? There are undisclosed pieces of information from her past that are of concern What information about past experiences is important in understanding behaviors of concern? There is a need to understand the current behavior in the day program What does the behavior look like? When does it happen? Under what conditions does it happen? When does it NOT happen?

What to do? There are medical concerns Has there been a current medical evaluation? There are behavioral concerns that impact other’s safety Do we know if she presents a current risk? There are undisclosed pieces of information from her past that are of concern What information about past experiences is important in understanding behaviors of concern? There is a need to understand the current behavior in the day program What does the behavior look like? When does it happen? Under what conditions does it happen? When does it NOT happen? Using the FBA process of collecting information and data to answer these questions, we can develop hypotheses re: setting events, antecedents, and consequences that are all impacting behavior!

Once we identify what the questions are… We can do what we know FBA to do: Understand better what assessment tools will help answer the question Gain the perspectives of others Directly observe the behavior

Prioritization of Behaviors Important to identify, from BSS goals in the ISP and from information gathered from stakeholders, what behaviors should be observed and addressed through the BSP/CIP.

BSS Process FBA DESIRED BEHAVIORAL OUTCOME How do others respond? When does it NOT happen? With whom does it happen? When does this happen? HYPOTHESES What is the function? What exactly does the behavior look like? What are the problematic conditions? DESIRED BEHAVIORAL OUTCOME When will mastery of the desired behavior be achieved? What exactly does the desired behavior look like? When should the desired behavior occur?

Sharon Through the FBA process, we know… Sharon was physically and sexually abused by another resident at a facility that she lived in for a year Sharon’s desire to touch children is because she has limited social skills and learned to get other’s attention by hugging Sharon’s seizure medication was not effective and she was having petit mal seizures in addition to the grand mal, overt seizures Sharon’s behavior of aggressing towards others seems to happen only at home and the day program. Seemingly, it occurs to get out of undesired activities (e.g., group activities and chores).

FBA DESIRED BEHAVIORAL OUTCOME Through observations and/or staff collecting data, speaking with others who know Sharon well, and conducting other assessments… HYPOTHESES To obtain interaction with the child. She will try to hug or pick up the child When Sharon is around children and she wants to interact with them, DESIRED BEHAVIORAL OUTCOME Independently for 100% of the opportunities for one quarter She will greet the child maintaining personal space and not touch the child When Sharon is around children and wants to interact with them,

Considerations in Strategy Development Ensure you are addressing the function! Teach something that the participant may not have in their repertoire Link the Hypothesis and Desired Behavioral Outcome to the Strategies Analyze the situations that may be promoting the problem behavior Meaningful days are key to quality of life Communication should always be examined!!!

Misconceptions There is only one way to do an FBA FBA will not be an effective tool for people who have mental health issues In order to do a good FBA, only interviews and observations should be done You cannot determine function of behavior for people with internalizing behaviors

BAS encourages you to conduct an FBA in a systematic, holistic manner that truly attempts to understand all pieces of a person’s story.

FBA Is Only The Beginning

FBA drives next steps Develop BSP/CIP Getting the team on board Priorities Inaccuracies/New information or developments Appropriate services and needs Develop Goals and Objectives ALIGNED WITH THE BSP!!!!! Determine implementation of supports

Desired Behavioral Outcome Develop BSP/CIP Remember, BS is expected to complete the FBA and develop the BSP/CIP 60 days from service start date Hypothesis Condition Behavior Function Desired Behavioral Outcome Criteria Strategies Antecedent Replacement/Alternative Skills Consequence

Getting the team on board Once the FBA is completed, share the information with the team and get input on development of the BSP/CIP Develop methods of data collection and strategies that are doable Ensure that everyone understands HOW to implement the plan (initially and ongoing) Offer direct support not only to the participant, but the team, as well

Develop Goals and Objectives Julia will be more engaged in her home Objective: Rather than withdrawal from situations (i.e., leave the situation or refuse to interact), at mealtimes with her photo book on the table, when given a choice between two foods (e.g., carrots or peas), Julia will hand staff one photo to communicate her preference for 5/5 opportunities for 7 consecutive days.

Develop Goals and Objectives Sam will decrease his aggression towards others Objectives: When in an undesired situation (e.g., large family gatherings, around children), Sam will tell his mother or father, “I need to leave,” 80% of the time for 5 consecutive opportunities instead of hitting and scratching whomever is near. When at home and Sam becomes overwhelmed or anxious (e.g., with demands, with waiting), Sam will tell staff or family, “I need to leave,” (and take a walk ) for 4/5 consecutive opportunities instead of hitting and scratching whomever is near.

Consistency!!! IF the goals linked to BSS are appropriate, then the required objectives in the ISP should be the same as the Desired Behavioral Outcomes More than likely, the condition that is problematic and identified in the Hypothesis statement

Crisis Support “The Behavioral Specialist Services provider must have a Behavioral Specialist available for crisis intervention support 24-hours a day, 7 days a week. The Behavioral Specialist on call for crisis response and the Supports Coordinator must have access to the person’s crisis intervention plan.” All team members (incl. participant) should have a number to call in case of crisis If primary BS shares crisis responsibility, the substitute BS should have knowledge of participant to provide appropriate support

Logistics Need to notify team “offline” that the plans are in HCSIS Issues getting the BSP and/or CIP up in HCSIS (and saved)? First, contact the Help Desk and then contact the Provider Support Mailbox

Next ttt: february 7th: case study