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Positive Behaviour Support – An Irish Context
Gillian Martin The Callan Institute for Positive Behaviour Support, St. John of God Hospitaller Services Dublin, Ireland
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Introduction A History of The Callan Institute
Positive Behaviour Support Model: Multi Element Behaviour Support Particular Case Training Maintenance of Positive Behaviour Support in Services Future Directions
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1. A HISTORY OF THE CALLAN INSTITUTE
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History of The Callan Institute
1994 Audit Compassion, Care & Respect Positive Behaviour Support
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What We Do…. Promote the use of effective, non-aversive methods for working with individuals who have challenging behaviours so that they can enjoy community participation with satisfaction, dignity and respect. Services include Behaviour Support Plans, Positive Futures Planning, Systematic Instruction, Crisis Intervention and Periodic Service Review.
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provides these services through individual consultation, staff training and regular support to staff who implement Behaviour Support Plans within the Order’s services.
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Hospitaller Order of St John of God
Residential services Group homes Day centres Special schools Adult training & Work enterprises = 3,000 people Dundalk Drumcar Drogheda Belfast Celbridge Dublin Islandbridge Dun Laoghaire Tralee Bray
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Location of Services
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St. John Of God Services: 2,943 people with an Intellectual Ddisability
Approx 840 with behaviour that limits their access to community facilities Approx 450 people with very severe challenging behaviours (tissue damage in the last 3 months)
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Examples of SJOG Services
Job Coaching / Employment Residential Placement Mental Health / Dual Diagnosis Services Day Services Respite Services Schools (early intervention and secondary) Outreach Services
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Staff Demographics No of Staff employed in Intellectual Disability Services = 1661 Includes Employment Specialists Nursing Staff Clinical Staff Social Care Staff Teachers, Classroom Assistants & SNA’s
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2. POSITIVE BEHAVIOUR SUPPORT MODEL: MULTI ELEMENT BEHAVIOUR SUPPORT
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Multi-element Behavioural support
Assessment & Functional Analysis Proactive Strategies Reactive Strategies Environmental Accommodations Setting Interactions Activities Choice Variety Skills Teaching General skills Functionally equivalent skills Functionally related skills Coping & tolerance skills Direct Intervention Reward no behaviour Reward low rates of behaviour Reward alternatives Co-operation training Satiation Ignore Redirect Feedback Instruction Facilitate Stimulus Change Active Listening Crisis Intervention Support system Outcomes Speed & degree of effects Generalisation Maintenance Side effects Quality of life
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Assessment & Functional Analysis: Looking for clues
Consequences Antecedents Environment Communication Skills Experiences
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Environmental accommodations
Proactive Strategies Reactive Strategies Environmental Accommodations Setting Interactions Activities Choice Variety Skills Teaching General skills Functionally equivalent skills Functionally related skills Coping & Tolerance skills Direct Intervention Reward no behaviour Reward low rates of behaviour Co-operation Satiation Ignore Redirect Feedback Instruction Facilitate Stimulus Change Active Listening Crisis Intervention Programmatic Interpersonal Physical
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Robert Escape Picture Schedule Redirect Sequencing Wait Freebies Relax
I’m confused! What’s happening next? Too noisy! I can’t wait! Environmental changes Reactive Strategies Escape Schedule Wait Relax Picture Sequencing Freebies Walks Don't say wait Redirect
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Make Activities More Predictable / Concrete
8am 9am am 1pm 2pm 3pm 4pm 4.30pm pm 6pm pm 10pm
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Making Information Clear
Mon Tues Wed Thurs Fri Kate Kate Kate Sue Sue Jim Jim Sue Jim ? Ann Carl Ann Carl Carl
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Skills teaching Skills teaching General skills
Proactive Strategies Reactive Strategies Environmental Accommodations Setting Interactions Activities Choice Variety Skills teaching General skills Functionally equivalent skills Functionally related skills Coping & Tolerance skills Direct Intervention Reward no behaviour Reward low rates of behaviour Co-operation Satiation Ignore Redirect Feedback Instruction Stimulus Change Active Listening Crisis Intervention General skills training Functionally equivalent skills Functionally related skills Tolerance and coping skills
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“It’s Too Noisy!”
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Escape – “What would you like to do instead?”
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Systematic Instruction
(Example: Min the mooche) Teacher says something Teacher helps me so that I get it right I respond (I hope so) Am I correct? If I’m not If I am Something good happens every time Something not so good happens every time (Wow!) (Boo!) (and maybe start over again) Then we take a rest...
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Connor
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DIRECT INTERVENTIONS Direct Intervention Reward no behaviour
Proactive Strategies Reactive Strategies Ecological Strategies Setting Interactions Activities Choice Variety Positive Programming General skills Functionally equivalent skills Functionally related skills Coping & Tolerance skills Direct Intervention Reward no behaviour Reward lower rates Reward alternatives Antecedent control Co-operation Satiation Ignore Redirect Feedback Instruction Stimulus Change Active Listening Crisis Intervention
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Antecedent Control Stimulus control
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REACTIVE STRATEGIES Ignore Redirect Feedback Instruction Facilitate
Proactive Strategies Reactive Strategies Ecological Strategies Setting Interactions Activities Choice Variety Positive Programming General skills Functionally equivalent skills Functionally related skills Coping & Tolerance skills Direct Intervention Reward no behaviour Reward lower rate Antecedent control Co-operation Satiation Ignore Redirect Feedback Instruction Facilitate Stimulus Change Active Listening Crisis Intervention
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Chris
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3. PARTICULAR CASE TRAINING
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Multi-Element Behavioural Support:
A Short Course
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Course Structure 9 month programme (64 hrs Contact; at least 100 hrs assignment & additional reading) Competency based Accredited with Dublin Institute of Technology (since 2001) CPD’s from Psychological Society of Ireland (2004)
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Course Outline Module 1 (3 days) Assessment Module 2 (1 day)
Functional Analysis Module 3 (1 day) Behaviour Support Plan Module 4 (1 day) ¼ Report & Periodic Service Review Module 5 (1 day) ¼ Report & Video Module 6 (1 day) Final Portfolio
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UNIQUE FEATURES OF THE TRAINING
Practitioner Model of Training Tuition On the job performance Person Centred Values Multi-Element Behaviour Support Plan
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COURSE DOCUMENTS Lecture workbook Assignment Workbooks
Post-tests Competency based assignments/ references Technical support materials Text books /Articles Tutor/Mentor Support A reading list
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OUTCOMES OF TRAINING Service User Outcome Participant Outcome
Organisational Outcome (Kirkpatrick, 1996)
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Eddie
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Behavioural Outcomes
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Participant Satisfaction
96% of students rate the course as ‘very interesting’ (on a scale of 1-7) 94% of students rate the course as ‘very relevant’ (on a scale of 1-7)
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Participant Knowledge
100% achieve a pass of 85% 97% receive distinction/merit DIT Accreditation at Masters Level
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Participant Competencies
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Participant on-the-job performance
Clinical Effectiveness Social Validity Personal Validity
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Organisational Outcomes
Trained practitioners Access & speed of response Culture of Positive Behaviour Support Supervisory/management Policy & Procedures Accredited Training Body
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4. MAINTENANCE OF BEHAVIOUR SUPPORT IN SERVICES
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Audit Results 2002
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Periodic Service Review
Quality Assurance Tool to measure ongoing implementation of behaviour support services Scored on a percentage basis
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Behaviour Specialists
The Role of the Behaviour Specialist Training Behaviour Support Case Work Management of Behaviour Support Services Behaviour Specialists Forum
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On-Going Training Refresher Workshops Key Worker Workshops
Supervisors Workshops Introductory Workshops (1, 2 or 3 days) Micro Training Sessions (e.g. ASD, Dementia, NVCI, Skills Teaching)
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Top Down Commitment Accountability – Regular Review
Use of Incident Reports Training for and Support from Director and Management Clinical staff trained & committed to Positive Behaviour Supports Streamlining PBS systems into existing systems
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Bottom Up Commitment Full participation of service users
Train a critical mass of front line staff Taking ownership of behaviour support Ongoing Data Collection Team Communication Involvement of Circle of Support
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Status of Behaviour Support Plans 2002
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5. FUTURE DIRECTIONS
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MODES OF LEARNING Approval of Prior Learning- APL Team Learning- TL
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FUTURE DEVELOPMENTS Continuing Professional Development (CPD) Credits
Academic / Case work Modules Train The Facilitator Course Post Graduate Course in Positive Behaviour Support
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Future Directions Behaviour Analyst Certification Board
Division of Behaviour Analysis within the Psychological Society Of Ireland Partnership with Academic Institutions – Dublin Institute of Technology Limerick Institute of Technology Open Training College
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FUTURE DEVELOPMENTS Mediator Measuring Tool
Organisational Analysis to enhance staff training, management practice and strategic planning for people with challenging behaviour. Establishing Organisational Readiness for Positive Behaviour Supports
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Research Team Organisational Factors relating to PBS
Training Evaluation Validity / Reliability of Assessment Tools Effectiveness of PBS Individual Outcomes
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Working with other systems
Personal Outcomes Measures to be conducted in conjunction with behaviour supports. Sharing goals with Individualised Education Plans
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Human Rights Based Approaches
Awareness & Identification of Human Rights Issues Assessment of Behaviour Support Plans for Human Rights Infringements Establishment of organisational structures to address Human Rights Issues
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for Positive Behaviour Support,
The Callan Institute for Positive Behaviour Support, St. John of God Hospitaller Services Crinken House, Crinken Lane Shankill, Co. Dublin Ireland Tel: +353 (01) /
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