1. 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

2. 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

3. 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.

4. 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

5. 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)]]

6. 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
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)

7. Division of Developmental Services

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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