1. Implementing Behavioral Support Part II
Claire Choutka, M.E.d., BCBA
Clinical Director
Bureau of Autism Services
Amy begins

2. Agenda Remember John? Desired Behavioral Outcomes
Summary from last week
FBA results
Desired Behavioral Outcomes
Brief review of BSP/CIP components
Developing the BSP/CIP for John

3. Roles and Responsibilities Initial Behavior Support Plan Development
Develop working relationship with participant and family
Review SIB-R Assessment (specifically, Maladaptive Behavior Index)
Path in HCSIS: Individual > Evaluation >Assessment Switchboard
Review ISP developed by SC
Conduct FBA within 60 days of beginning services
This include the development of the BSP/CIP
Face-to-face
SC will also have a copy
Know and Do, Psychosocial, and Social/Emotional will be important

4. Remember John?
Mention you are going to introduce John as a potential participant in AAW. All information is fictional, but we will walk through how to complete the FBA for John.

5. Case Study – John 24-years-old, lives with his mother and father.
Younger brother has been away at college but comes home on holidays and summers.
Weekly Schedule:
Mon, Tues, and Wed- attends day program on supervised mobile work crew, 6 hours per day.
Thurs-CI services, 12:30-4:30 and Fri 12:30-2:30, learning to cook healthy meals, increase his communication skills and exploring activities in the community.
Fri- CI services, 2:30-4:30- Bowling
2 Saturdays a month- works at family lumberyard, stacking planks of wood

6. What does John do at home?
works with his battery, remote operated car collection with his dad.
enjoys doing outside work including raking leaves, shoveling snow, and helping his dad hang up Christmas lights.
clears the table and brings the dirty dishes over to this mother who then loads them into the dishwasher.
Watches brother and friends play video games on occasion.

7. John’s challenging behaviors
Home
Community
Day Program
-Refusing to clear the table
-leaving dinner table and staying in room all night
-hits head on wall, table, or with closed fist
-refuses to run errands with Mom
-curses loudly or yells inappropriate verbalizations at Dad
-Curses loudly or yells inappropriate verbalizations when in church, mall, bowling alley
-refuses to work on meal prep skills
-hits head on wall or with closed fist
-Curses loudly or yells inappropriate verbalizations at co-workers and quality of work performed
-leaves area and spends significant amounts of time in men’s room

8. What we learned from John’s interviews
Home
When his brother was home, Mom never asked John to help clear the table.
Also, Mom would allow John to stay at home with his brother while she ran errands. Now, he has to go with her.
Behaviors began immediately after his brother went back to college
It is harder for Mom to wake him up in the mornings, especially Mon, Tues, and Wed.
Dad has been working late, minimal time to play with RC cars

9. What we learned from John’s interviews
Day Program
He has been attending for 4 years, going from 2 days a week to 3 days a week about 6 months ago
Three new participants recently began at program and have consumed a lot of attention from staff.
Most of his behaviors occur within the last 2 hours of each day

10. What we learned from John’s interviews
Community Inclusion
There have been 3 snow days since Christmas and bowling has been cancelled.
John will be unable to join a bowling league until March.
Behaviors only occur during the last 15 minutes of bowling (when staff tells him it is almost time to go)
A different staff member has been working with John because of maternity leave for 3 weeks. Meal prep refusals have increased.

11. What John told us
He liked seeing his brother and his brother’s friends- They were funny.
He doesn’t like the new people at his day program.
He misses his former CI staff.
He wants to go bowling everyday and join the league now.
He does not like to run errands with Mom.
He wants Dad to be home more often.

15. Hypothesis Statement – John
- Condition: On days when bowling gets cancelled (or schedule changes) and John is prompted by his mother to help with chores/tasks around the house (e.g. emptying the dishwasher),
- Behavior: John will yell obscenities as he leaves the room and hit self in the head with his fist, on the desk, or on the wall,
Function: in order to escape the request.

16. Hypothesis Statement – John
- Condition: At the bowling alley, when prompted by CI staff, “15 minutes until we have to leave,”
- Behavior: John will begin yelling at other people in the bowling alley (e.g. “Get out of my lane,” “It’s my turn,” “Don’t talk to me”) and hit self on head with his fist
- Function: in order to remain at the bowling alley for a longer amount of time.

17. Hypothesis Statement – John
Condition: When at his day program, with more than 4 people
and asked to help someone complete a last minute activity,
- Behavior: John will yell obscenities or tell them to “hurry up already”
- Function: in order to get out of finishing the project and go home early.

18. Now that we know the functions of John’s challenging behaviors, a Behavior Support Plan (BSP) and Crisis Intervention Plan (CIP) should be developed

19. Desired Behavioral Outcomes

20. Desired Behavioral Outcomes
Should be linked to the FBA and hypothesis statements
Be specific when asked to write behavior (operational definition)
One hypothesis may be linked to two or more Desired Behavioral Outcomes
you may want to decrease a behavior, and
increase another, appropriate or alternative/replacement behavior)

21. FBA Raul DESIRED BEHAVIORAL OUTCOME
Through observations and/interviews with those who know John well we know….
Hypo #1
HYPOTHESES
On days when bowling gets cancelled (or schedule changes) and John is prompted by his mother to help with chores/tasks around the house (e.g. emptying the dishwasher),John will yell obscenities as he leaves the room and hit self in the head with his fist, on the desk, or on the wall, in order to escape the request.
DESIRED BEHAVIORAL OUTCOME
With no prompts for 90% of the opportunities for one quarter.
On days when bowling gets cancelled (or schedule changes) and John is prompted by his mother to help with chores/tasks around the house (e.g. emptying the dishwasher),John will with 1 reminder to 1. take a deep breath and shown a calendar when will he do the cxled thing, shown how much he has to do on a chore board, he can start his preferred music to play and then verbalize his displeasure in the situation
Raul

22. FBA Raul DESIRED BEHAVIORAL OUTCOME
Through observations and/interviews with those who know John well we know….
Hypo #2
HYPOTHESES
At the bowling alley when prompted by CI staff “15 mins. Until we have to leave” John will begin yelling at other people in the bowling alley (e.g. get out of my lane, it’s my turn…) and hit self on the head with fist, in order to remain at the alley for a longer amt. of time.
DESIRED BEHAVIORAL OUTCOME
At the bowling alley when prompted by CI staff “15 mins. Until we have to leave” with no more than one verbal prompt John will use his breathing and strategy of, “oh well, I’ll be back again soon” and start to pack up for 90% of the opportunities for one quarter.
Raul

23. Review of Behavior Support Plan

24. Components of BSP Antecedent Interventions
Replacement or Alternative Skills Instruction
Consequence Interventions
Lifestyle Interventions and Long-term Supports

25. Multi-Component Intervention Plan
Antecedent/
Setting Event
Interventions
Alternative
Skills
Instruction
Consequence
Interventions for
Problem
Behavior
Alternative Skills
Lifestyle
Interventions/
Long-term
Supports
-Modify OR
Eliminate
stressors
-Introduce
positive
elements
-Communication
skills
-Self-monitoring
-Coping/tolerance
-General-life skills
-Social Skills
-Reduce outcomes
-Provide instructive feedback
-Develop crisis
management
plan
-Make lifestyle
changes to
increase
quality of life
-Strategies to
sustain
support
Lifestyle Interventions are not necessarily captured in HCSIS, but should be carefully considered to drive goals and services when addressing the challenging behaviors.

26. Antecedent Examples only- not exhaustive list
Help to eliminate the fast triggers that cause challenging behaviors to occur
Examples:
Give participant choice
Alternate preferred and non-preferred activities
Preview activities to prepare for changes
Offer frequent breaks
Modify task lengths
Involve participant in daily planning
Reminders of coping strategies
Use visuals
Picture schedule or written schedule= preferred, non-preferred, preferred

27. Antecedent Interventions for John
White board to explain chores
Reminders of breathing
Reminders that he can take a break
Calendar to review preferred events
Timer/watch
Reminders of polite and rude
Reminders of coping strategies
Choice

28. And more…
Increase preferred items- more bowling, more RC car folks- club?
Encourage music in background
Alternate preferred and non-preferred
Calendar

29. Replacement or Alternative Skills Instruction
These skills must be as effective, efficient, and relevant as the function of the challenging behavior.
Categories of skills that should be considered:
Communication skills
Self-monitoring skills
Teach coping skills
General life skills
Social Skills
Give examples of each

30. Replacement Behaviors to teach John
Teach him to ask- how much do I have to do?
Teach him to check white board
Teach him to ask for a break
Teach him to look at calendar for next op to see preferred activity
Teach him to put on music
Teach others to respond to his RC car interest

31. Replacement behaviors Teach- skill instruction
Practice role play how to voice disappointment- use sibling
Social skills-Teach polite and rude- think language in public!
Use video examples

32. Consequence Interventions
Address the way others react to a behavior
Consequences Interventions address the following:
Strategies that reinforce the replacement behaviors
Strategies to decrease challenging behaviors
Should specify what happens of the person performs the undesired behavior- how should staff proceed?

33. Considerations for consequence strategies
Will it decrease problem bx?
Can you do it across settings?
Does it have good contextual fit?- values of team?
Match to cognitive understand of person?

34. Consequence Interventions for John
If John starts to hit his head block the hits as you must keep him safe. Speak in a quiet, calm voice.
After John finishes chore immediately go to reinforcer activity- cars, look at books, or more music.
Verbally praise John- in an age appropriate way for using the new skills.
Help explain to him the items on the white board chore chart when he goes to it.
Redirect language- appropriate words!

35. Lifestyle Interventions
Not required to include in HCSIS, but still important!
Consider the participant’s lifestyle and quality of life:
Choice
Community Inclusion
Relationships
Valued Roles
General Health and Well-Being

36. Lifestyle Interventions for John
Think about day activities
Different job/volunteer stuff
RC car club- dad can’t always be there
RC magazines, chat rooms
Schedule time with bro

37. Review of Crisis Intervention Plan

38. CIP The primary purpose of a crisis intervention plan is to:
Identify potential for de-escalation
Ensure safety of all persons and property
Inform future support
NEVER A TIME TO TEACH!!!

39. Crisis Intervention Plan Screen

40. CIP for John- Before use all the antecedent strategies,
use visuals, have these with you,
know that when he leaves room, when he starts clenching fists, talking to self, remind him to start the breathing,
try to get him into more private area.

41. CIP for John- During Speak calmly Short phrases Use visuals
Block head banging
Insure safety- not a teaching moment
Clear extra folks
Staff notify other staff via cell phone- walkie-talkie, etc.
Bx that crisis has ended?- breathing normal, no attempts to hit, sitting not pacing,

42. CIP for John- After Return to previous setting if possible
Modify task- gather things
Follow-up with team
Encourage him to apologize to others
Review with John for next time what to do
Talk about things that went right
Can occur later not right after
Document

43. Implementing Behavioral Support – Part III
Next Week
Thursday, Feb. 17th – 2pm
BSS Provider Training:
Implementing Behavioral Support – Part III
Use case study to discuss considerations in implementation of BSP/CIP through natural environments/supports and existing services