1. Pam Treadway, M.Ed. Clinical Consultant Bureau of Autism Services
Thursday Afternoon Adult Autism Waiver Provider Training: Behavior Support and Crisis Intervention Plans
Pam Treadway, M.Ed.
Clinical Consultant
Bureau of Autism Services

2. Agenda Review/Expectations of FBA Sample FBA Report
Linking to BSP/CIP screens in HCSIS
Evaluating BSP Outcomes Examples

3. Review of Functional Behavioral Assessment

4. What is a Functional Behavioral Assessment?
An FBA is a systematic approach to understand WHY a person engages in challenging behaviors.
Can address negative behaviors (e.g. social issues, withdrawal) or more severe overt behaviors (e.g. physical aggression).

5. 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

6. Step 1: Prioritize and Define Behavior
Destructive
Safety concern with self, property, or others
SIB, Physical Aggression
Disruptive
Interfere with one’s inclusion, acceptance, and overall quality of life
Verbal Aggression, Self-stimulatory behaviors
Disturbing
Behaviors that are annoying to others
Twirling hair, water play

7. Step 2: Indirect Data Collection
Interview people who know the participant well (e.g. family members, friends, staff members, previous staff members) using interview forms, rating scales, questionnaires, etc.
Broad/Background Information
Detailed description of the behaviors
Antecedents
Perceived function
Consequences received after behavior occurs

8. Step 3: Direct Observation
Observe participant in natural settings where behaviors occur
Validate and clarify statements from indirect data
Many data collection forms to choose from (see Appendix B of BS Manual)
Consider Duration, Latency, and Intensity, and NOT just Frequency

9. Step 4: Analysis of Information
Analyze data to compare patterns and consistencies
Represented in graphic form (bar graphs)
A hypothesis statement should emerge from the graph
**The hypothesis statement is the bridge between the FBA and the BSP.**

10. Step 4: Analysis of Information: Hypothesis Statement
Developed to illustrate the FUNCTION of the behavior
Clearly identifies the antecedents, behavior of concern (written clearly in observable and measurable terms), and perceived function
Example: When asked to complete a household chore (e.g. wash dishes, laundry), Ryan will scream “Get away from me” and kick an object within close proximity in order to escape or avoid the request.
* This is expected in the BSP in HCSIS

11. Expectation of FBA Evidence of: Indirect data collection
Rating scales
Motivation Assessment Scale
Functional Assessment Interview Form
Direct data collection
Raw frequency, duration, latency, etc. data
Analysis of Information
Graphs and hypothesis statement(s)
**The Behavioral Specialist will have 60 days from authorization of Behavioral Specialist Services to complete the FBA, BSP, and Crisis Intervention Plan (CIP). **

12. FBA Report

13. FBA Report AAW does not require a formal FBA report
AAW monitors for evidence that an FBA was conducted
Evidence of FBA reviewed in previous slide
Sample FBA Report format requested by many BS

14. Suggested FBA Report Components - Overview
I. Behavior(s) of Concern
II. Data Collection Process
A. Indirect Direct Collection
Record Review
Interview Information
Historical perspective
Perceived functions
Primary problematic situations
Interventions tried and their success

15. Suggested FBA Report Components - Overview
Rating Scales/Questionnaires (e.g., Motivation Assessment Scale)
Summarize findings
Behaviors of Concern: What was the primary function based on results?
Anecdotal Information

16. FBA Report - Overview B. Direct Data Collection
Information detailed by setting (e.g., home, day program, school):
How was data collected?
Who collected the data?
Dates of data collection
Insert graphs
Summarize data

17. FBA Report - Overview III. Hypothesis Statement(s)
Example: When Robert lacks sleep, is not engaged in an activity and/or is trying to communicate a desire or need, he will engage in behaviors that are hurtful to self and/or hurtful to others (see definitions above) in an effort to obtain either a preferred activity or object or escape an undesired activity.

18. FBA Report - Strategy Recommendations
Preventative or Proactive
Replacement/Needed Skills
Responsive
Lifestyle

19. Strategy Recommendations
Each component should contain multiple recommendations
Meet with team to review recommendations
Encourage team to “select” strategies from each section
Incorporate “selections” in the BSP

20. Sample FBA Report
View completed FBA Report

21. Translating FBA Report Findings to HCSIS

22. Translating FBA Report Findings to HCSIS
Points to Consider/Remember:
Multiple Desired Behavioral Outcomes can be added to BSP
Can add more than one Desired Behavioral Outcome linked to a Hypothesis Statement (just repeat the Hypothesis)
decrease a behavior, and
increase another, appropriate or alternative/replacement behavior)

23. Translating FBA Report Findings to HCSIS
Clear intention of Desired Behavioral Outcome
Desired Behavioral Outcomes should be submitted to the SC as objectives for a behavioral goal
What behaviors are identified on the SIBR Maladaptive Index and within the ISP?

24. Raul FBA DESIRED BEHAVIORAL OUTCOME
When Robert lacks sleep, is not engaged in an activity and/or is trying to communicate a desire or need, he will engage in behaviors that are hurtful to self and/or hurtful to others in an effort to obtain either a preferred activity or object or escape an undesired activity.
HYPOTHESES
Condition: When Robert lacks sleep, is not engaged in an activity and/or is trying to communicate a desire or need
Behavior: he will engage in behaviors that are hurtful to self and/or hurtful to others
Function: in an effort to obtain either a preferred activity or object or escape an undesired activity.
DESIRED BEHAVIORAL OUTCOME
Condition: When Robert has completed an activity or wants to change activities,
Behavior: he will hand his mother/staff a picture of what he would like to do next
Criteria: with 90% independence for one calendar month

25. Hypothesis and Behavioral Outcome Screen in HCSIS

26. Translating FBA Report Findings to HCSIS
Strategies Screen in HCSIS
Antecedents
Alternative/Replacement
Consequence
Linked directly to Strategy Recommendations in FBA Report
Preventative/Proactive, Replacement/Needed Skills, Responsive

27. Translating FBA Report Findings to HCSIS
Examples:
Antecedent: Find a time and place that is not in direct presence of Robert to share PERTINENT information.
Alternative/Replacement: Teach Robert to use a “break card” to effectively communicate when he wants to leave the area or take a break from an activity
Consequence: Leave the immediate area when Robert begins to attempt to strike, grab, or bite. If necessary use blocking pads to deflect hits and attempts to bite

28. Strategies Screen in HCSIS

29. Crisis Intervention Plan
Consider other information obtained during FBA
What precursors were identified?
Do behaviors occur in a chain?
What was identified as effective in de- escalating behavior in past?

30. Crisis Intervention Plan Screen

31. Wrapping it Up: Examples

32. Wrapping it Up: What do you think?
Hypothesis
Desired Behavioral Outcome
Condition: When presented with non-preferred activities, transitions or novel situations or people
Behavior: Joe will become physically aggressive towards support staff attempting to hit, kick, scratch and bite.
Function: As he has extremely limited communication skills
Condition: Gradual introduction of any new activity, Presetting for all transitions, Frequent sensory input scheduled throughout his day, consistent predictable schedule with familiar support staff, instruction in the use of alternative communication system
Behavior: Joe will demonstrate a decrease in frequency of physical aggression
Condition: will demonstrate a reduction in frequency of attempts at physical aggression to one or less times per month.

33. Wrapping it Up: What do you think?
Hypothesis
Desired Behavioral Outcome
Condition: When people challenge Judy’s views, interrupt her, don’t give into her demands, or correct her
Behavior: Judy will argue, yell, hit things, and threaten to hit others
Function: escape person (get others to leave her alone)
Condition: social skill development, coping skill development
Behavior: Judy will utilize positive coping skills when provoked by others
Condition: frequency data

34. Next Week: Thursday Afternoon Adult Autism Waiver Provider Training: TBA