1. Implementing Behavioral Support Part III
Amy Alford, M.E.d.
Clinical Consultant
Bureau of Autism Services
Amy begins

2. Agenda Review John’s BSP/CIP
Direct/Consultative Roles and Responsibilities
Implementation of the BSP/CIP for John
Within natural environments/supports
Across existing services  

3. BSP/CIP Review- John

4. 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

5. 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.

6. 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.

7. 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.

8. Desired Behavioral Outcomes

9. Raul FBA HYPOTHESES DESIRED BEHAVIORAL OUTCOME
Through observations and/interviews with those who know John well we know….
Hypo #1
HYPOTHESES
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.
DESIRED BEHAVIORAL OUTCOME
Behavior: John will utilize a coping strategy to verbalize his displeasure in the situation
Criteria: with no prompts for 90% of the opportunities for one quarter.

10. Raul FBA HYPOTHESES DESIRED BEHAVIORAL OUTCOME
Through observations and/interviews with those who know John well we know….
Hypo #2
HYPOTHESES
Condition: At the bowling alley when prompted by CI staff “15 mins. 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…) and hit self on the head with fist,
Function: in order to remain at the alley for a longer amount of time.
DESIRED BEHAVIORAL OUTCOME
Behavior: John will use his breathing and strategy of, “oh well, I’ll be back again soon” and start to pack up
Criteria: with no more than one verbal prompt for 90% of the opportunities for one quarter.

11. Review of John’s Behavior Support Plan
HYPOTHESIS AND DESIRED BEHAVIORAL OUTCOME for John
Antecedent Strategies
Replacement/Alternative Skills Strategies
Consequence Strategies
-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
-Increase preferred items- more bowling, more RC car folks- club?
-Encourage music in background
-Alternate preferred and non-preferred
Teach him to:
-ask- how much do I have to do?
-to check white board
-to ask for a break
-to look at calendar for next op to see preferred activity
-to put on music
-Teach others to respond to his RC car interest
-Practice role play how to voice disappointment-
-Use sibling
-Social skills-Teach polite and rude- think language in public!
-Use video examples
-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!
-After John finishes chore immediately go to reinforcer activity- cars, look at books, or more music.
-If John starts to hit his head block the hits as you must keep him safe. Speak in a quiet, calm voice.
Review of John’s Behavior Support Plan

12. 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 brother

13. Review of John’s Crisis Intervention Plan

14. Crisis Intervention Plan for John
Before
During
After
-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.
-Speak calmly
-Use 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,
-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

15. Next Steps The FBA is complete; BSP/CIP are written
Enter BSP/CIP into HCSIS
Submit Desired Behavioral Outcomes as Objectives to SC
Behavior Specialist is now required to train all team members
This process will look differently for each participant due to:
Services
Behaviors of Concern
Individual Participant Dynamics

16. Direct and Consultative Roles and Responsibilities

17. Roles and Responsibilities- Direct Services
Train the participant and team members (family, friends, waiver providers, and other support persons)
Purpose, objectives, methods, and documentation of the BSP or revisions of the plan with the participant present.
Train at least with Participant and Family initially
All providers must be trained face-to-face at some point
CIP components should also be included within initial training
(BSS description in Adult Autism Waiver)

18. Roles and Responsibilities Consultative Services
Train the participant and team members (family, friends, waiver providers, and other support persons)
Train to the purpose, objectives, methods, and documentation of the BSP or revisions of the plan without the participant present
Monitor and analyze data to report on progress of goals monthly and quarterly
Re-train members of the team if revisions are made or new FBA is complete
Report quarterly progress to Supports Coordinator
(BSS description in Adult Autism Waiver)

19. Guidelines for Training all Team Members
All service providers and family members must be trained in face-to-face setting
Initial team meeting must be with participant and family, at minimum
A team meeting must be conducted following completion of BSP/CIP.
Reach out to service providers to find most convenient time to provide this training

20. What would a team meeting look like for John?
Who might be present:
John
John’s parents SC
CI staff (preferably someone who works directly with John)
Day program staff (preferably someone who works directly with John)
Behavior Specialist
Not everyone may be available- consider this!

21. What would a team meeting look like for John?
Possible structure of meeting
Review FBA (show the Graphs!)
Explain hypothesis statements
Share Desired Behavioral Outcomes
Review components of BSP/CIP
Discuss any changes or updates to the ISP, as well as changes to services or weekly schedule
Explain next steps
**Ask for INPUT from team. Remember these are NOT final documents

22. Next steps for AFTER the meeting
Behavior specialist will show HOW to prompt John to use a strategy when upset
Teach in the settings John will use strategy, when possible
Behavior Specialist will explicitly show parents and staff to collect data
Modify materials and teaching plans- simple terms
Don’t forget to teach John!
This may occur in natural setting (think: incidental teaching) OR separate time at home, when other services are not occurring.

23. Important! Allow extra time for questions and clarification
Provide feedback where necessary
Explain change is gradual
Be readily available (phone or in-person) to family and service providers, especially at the beginning
Keep ENTIRE team in-the-loop about any changes in bx or support plan

24. Sample teaching plan when bowling
Before exiting car in parking lot,
Quickly review expectations with John (use appropriate language, please/thank you, etc…)
Remind John of strategies he can use if upset (deep breaths, take short walk, talk to someone)
Also remind John of reinforcer he can access if he uses strategies appropriately
Help John set alarm on watch for “15 minutes” until it is time to leave

25. Sample teaching plan when bowling
Once inside
Remind John after he has his bowling ball and shoes, staff/parents will sit at nearby table so he can interact with members of bowling league
E.g. “If you need me, I will be sitting at this table. You can ask teammates for help as well.”
Observe for any changes in behaviors or signs of frustration (closer proximity to John if needed)
Offer positive praise when strategies are used (age appropriate and without bringing extra attention)

26. Sample teaching plan when bowling
After bowling has ended (and back in car)
When John transitions without challenging bx’s:
Praise for using strategies (be specific!)
Allow John to access preferred reinforcer (as previously determined)
When John has difficulty transitioning:
Define what bx’s suggest “difficult transition”- be consistent!
Remind him of expectations when in the community
Allow extra time to practice strategies, if possible
Remind him he will have another chance to practice next time he goes bowling.

27. Let’s talk more about John…

28. What actually happened at John’s initial meeting?
BS, Parents, John, and CI staff were present. Day program called into mtg.
BS sent docs to everyone 3 days BEFORE the meeting began
Parents felt overwhelmed with implementing these strategies all at once at home
Team discussed ways to prioritize and focus on one thing at a time- consistently across settings

29. John’s initial team meeting
Team realized John was bored at day program and began exploring possible job services.
Gradually re-structured his week
Faded day program to 2 days per week, 4 hours per day (in the morning)
Increased CI hours
Job Assessment and Job Finding were added and found John enjoyed working with his hands and being outside. He worked best when minimal people were present.
Dad’s lumberyard was only volunteer. John wanted paid employment

30. How did everything else come together for John?
John’s brother’s friend is a landscaper and expressed a need for someone to help him with projects in the community.
1-2 afternoons a week, weather was a factor
After about 2 months, work thinned, team had to explore other job options
John began working at Lowe’s with SE
Gradually increased from 5 to 15 hours per week
Alternated between gardening section and lumber section

31. What happened with CI?
John joined the bowling league, 2 times per week (afternoon with CI, evening with Dad)
Coping skills were taught. Bx’s decreased
Staff supports have significantly faded to other members of bowling team
Instead of focusing on actual cooking, explored grocery shopping, meal planning, and budgeting
Will re-visit cooking in 6 months

32. Support at Home
Whiteboard contained weekly and daily schedules- easily accessible
Chores were spread evenly across the week
New chores slowly introduced
John goes on Skype with his brother once per week
John continues to play with RC cars with Dad, but also with a neighbor up the street

33. Monitoring Progress

34. Means of Monitoring/Evaluating
Should capture the BEST way to show a decrease in the problem and/or increase in the appropriate behavior.
Should be part of the function/replacement link.
If you are looking to decrease inappropriate comments be clear what these may be as this varies according to participant’s age, culture and setting.

35. Monthly Data Collection
No required form, but must be reported to the SC
Service Providers may be collecting data
MEANS OF MONITORING: Progress/Update
Data will be used to complete Quarterly Review Form
Complete new FBA for new behaviors
Change components of BSP/CIP as needed
Any changes require re-training family and providers

36. Quarterly Review Form
Documents participant’s progress towards objectives
Submitted quarterly to the SC based upon Eligibility/Plan Effective Date
SC will enter into HCSIS
Comment upon “New Concerns”
Sample Quarterly Report can be found in VTC

37. Sample Data Collection Sheet- John
Date
Coping Strategy
Cursing/ Inappt. Statements
Hitting Self
Comments
Day 4
III I
Day 5 II
Day 6
IIII
Day 7
Bx began as soon as bowling started
Day 8
IIII II
Strategies used independently

39. What to walk away with…
Individualize documents, teaching strategies, etc…
Include the participant in discussions, where appropriate
Think: age appropriate, respectful
Inform team of ANY changes re: bx support
Frequently analyze data (monthly, quarterly, yearly- at minimum)- Graphs are powerful!
Ask questions, ask for clarification

40. Next Week Thursday, Feb. 24th 1 – 2pm BSS Provider Training:
Appropriate and Creative Supports/Services
Review AAW's values of supporting participants to become more independent and live, work and play in
least restrictive environments.