1. Welcome!

2. Polk County PBS Academy
Introductions-weaknesses & re-frame into strengths

3. Training Objectives To learn what PBS is as both philosophy and tools
Learn the basics of how we set the tone for the environment-to help or hinder
Learn basic tools of PBS
Learn how to use data to drive decisions

4. What is PBS It is a philosophy and a set of tools
A way of thinking and doing
Positive behavior support offers a proactive process for
addressing behavioral challenges,
teaching adaptive skills, and
improving quality of life.
Tagline: It’s a philosophy & a set of tools. It’s two parts: a way of thinking and a way of doing.
Formal definition: Offers a proactive process for addressing behavioral challenges, teaching adaptive skills and improving quality of life.

5. Polk County PBS Mission & Values
We are an inter-agency coalition promoting positive support to enhance the quality of life for persons with disabilities.
We make decisions based on:
Dignity & respect
Long-term commitment
System consistency
Person-centered
Empowerment through training, support, & education
Reducing the need for right restrictions
Promoting full citizenship and the exercise of choice
The network is an interagency coalition…
How do we make decisions? We make decisions…
*dignity & respect (talk about later) *
*system consistency [across Polk County there’s a fundamental approach to how work with folks]
*training-PBS quarterly trainings, support thru agencies sharing successes & lessons learned—creating a community of providers not a provider community

6. Insert Agency MVV Slide
Insert MVV = Mission
Vision
Values

7. Insert Agency PBS Policy
How does something in an organization become incorporated into organizational culture? Strategic planning & policy/procedures.

8. Section One: Philosophy
Two parts to training: Philosophy & Set of Tools

9. Have participants identify roles
Have participants identify roles? How the world sees people with disabilities--
What do you think when you see this slide? These are the roles we categorize folks into and the labels we use to describe them. Roles are centered around the individual’s disability.
How you see me!

10. These roles help folks to lead a life… How I see myself & want to live-Don’t look at our disabilities, look at our ‘diversabilities’
Relationships bring meaning and value. [Speaker introduces themselves by roles, telling stories about a couple of roles]
Things of value lead to how I want to live.
Remember this picture. The rest of the philosophy and discussion of tools are to make this happen.
How I want to live!

11. Things of Value Universal Enhancement Strategies TARGET BEHAVIOR
Gardening
Dancing
Religion
Hiking
Pets
Sex
Music
Spontaneity
Work
Fishing
Day at the spa
Grilling out
Good Health
Dining out
Family
Vacationing
Volunteering
Exercising
Pomeranz/Recovery philosophy-get folks into roles-create things of value. Identify the life the people we support want and coach them into it.
If someone has nothing of value, what difference does it make if you take it away?
Movies
Voting
Having a will
Friends
Things
of Value
Positive rituals

12. GEM Good Enough for Me –Tom Pomerantz
Is the service you give the kind you would want to receive or have your son or daughter receive? If you were the guardian/parent, would it be ‘good enough for me?’

13. I have come to the frightening conclusion that I am the decisive element in my environment. It is my personal approach, which creates the climate. My daily mood makes the weather. I possess tremendous power to make a person’s life miserable or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is MY response that decides whether a crisis will be escalated or de-escalated and a person humanized or dehumanized. ( Adapted- Halm Ginott)
What’s MY role in coaching the person into a quality life?
The role of a helper is very important…how you coach people into things of value.
Types of coaching-yeller (why did you do this wrong) or supporter (how could you do it differently?)
??Insert coaching how tos?

14. We must provide an environment that is healthy enough for
Life
We must provide an environment that is healthy enough for
a life to happen.
Dan Berkowitz

15. ..requires the design of an environment that makes problem behaviors:
Effective Behavioral Support
..requires the design of an environment that makes problem behaviors:
Irrelevant
Ineffective
The person’s behavior is a barrier to making those things happen.
Plan A: the relationship
Plan B:
Irrelevant-does not affect how we live our day or our relationship
Ineffective-it doesn’t work to get what you want
Inefficient-too much energy to do
Inefficient

16. Does it Matter?! Prove It! Prove that: treating people with
dignity and respect
meeting unmet needs
bonding
decreases the frequency
and intensity of
challenging behavior.
Does it Matter?!
We believe problem behavior indicates an unmet needs
These things do matter-creating a positive relationship is the foundation

17. Respect – Fundamental to PBS
A personal quality that is non-contingent provided without judgment and given equally to all persons.
People should not have to earn your respect they should be the recipient of your respect without condition.
Dictionary definition??
Respect-it is something that you give not what you receive
Eg-flashlight on your head & doesn’t discrimate on who it shines on-it’s how we conduct ourselves
Don’t want to treat others how they treat you—won’t coach them into a life

18. Defining Characteristics of PBS
Person centered
Collaborative on-going process
Data-driven decision making
Prevention, positive, proactive strategies
Meaningful outcomes
*Nothing about me without me
*collaboration with rest of team
*get relationship in tact & need something more scientific to understand the person better& why the person is behaving that way in this situation-what are they getting out of it? The last thing you experience is the thing you remember the most: recentcy effect

19. IS NOT IS Simple Short term Just Decrease Behavior Reactive
Aversive (punish)
Observable Behavior
Experts Decide IS
Comprehensive
Long term
Teach Useful Skills
Proactive
Positive (reinforce)
Function
Involve Individual
??Bring strengths-based language?? What it is & what it isn’t?
The science (behavior management) & the value system/philosophy (PBS)—behavior management witht a conscious-
Compare behavior mgt to PBS
*simple-1 thing versus the bigger picture of the role of the person, how the behavior works for the person
*short vs long term-coaching the person into a life
*teach useful skills (break task down & teach)-social, adaptive behavior, work, etc… When system moved to Medicaid funding stream, taught until person reaches a level can’t learn anymore & then supported. Result was that we lost teaching and only focused on supporting. Medicaid also utilizes a medical model.
*proactive-if fix the unmet need upfront, don’t need the undesirable behavior
*Suppress behavior-punish…effective for short-term, not long-term-when you exercise cooersive/aversive strategy, can’t go back & you become the punisher, ie. erase the relationship-reference-Wacker-where consequence becomes ineffective & need to make the consequence more severe, Appelstein-if have the relationship, then correction becomes a way to support the person into a better life
*not just what the behavior is, but what function does the behavior serve?
*educate, teach, and put the supports in place so the individual can live their life

20. If an individual doesn’t know how to read, we teach.
If an individual doesn’t know how to swim, we teach.
If an individual doesn’t know how to multiply, we teach.
If an individual doesn’t know how to drive, we teach.
If an individual doesn’t know how to behave,
we…………………teach? punish?
Why can’t we finish the last sentence as automatically as we do the others?
Tom Herner (NASDE President, Counterpoint 1998, p.2)

21. Section 2: Tools How we get to a Life!

22. Four Steps to Designing an Effective Behavior Support Plan
Step One
Step Two
Step Three
Step Four
Gather Information
Develop a Hypothesis
Build a Support Plan
Evaluate effectiveness and modify support plan as needed
Framework
What-When-Why stage

23. Step 1: Gather Information
Person Centered Planning
Get to know the person.

24. Five Essential Goals of Person Centered Planning
Expressing preferences and making choices in everyday life
Gaining and maintaining satisfying relationships
Having opportunities to fulfill respected roles and live in dignity
Being present and participating in community life
Continuing to grow
Aborted developmental philosophy with waiver-end up doing for rather than coaching the person
Continue to grow-increase Qol?

25. Characteristics of Person-Centered Planning
Includes focuses on the individual
Respects the individual and their dreams and choices
Emphasizes strengths, abilities, and capacities
Strength based Training principles
Individualized supports
Empowers the consumer and team
Support behavioral excesses
Define empower??

26. Tools for Person-centered Planning
Insert organization planning tools
Person-centered planning is central to PBS

27. What is behavior? Anything a person says or does
90% of behavior is communication
Must be observable and measurable
Must meet the “dead man’s test”
*If a dead man can do it, it’s NOT behavior
People say, “having a behavior”-stigmatize a person—owe it to the person to talk about it with more clarity--

28. Behavior is method of: communication both verbally & physically of hopes, dreams, fears, anxieties, preferences, intentions and priorities Behavior is also a method to: cope with or respond to demands from others control and impulses, conform to generally accepted social conduct, and or influences of the environment Behavior is the result of complex neurological and sensory process.
Story-aggressive outbursts & wanted to discharge the individual, asked-have you ruled out any physical issues? Took the individual into the ER, individual had an impacted bowel, resolved & no more aggression-rule out somatic care issues first

29. He Had A Behavior
Of course he had a behavior! If he didn’t he’d be DEAD!
There is:
walking behavior talking behavior
sitting behavior standing behavior
smiling behavior eating behavior
Have you ever been outside when there wasn’t any weather?

30. Behavioral Definition
Definition of behavior needs to be clear, concise, and specific
A description of what you will see when the behavior occurs.
Written so that everyone can agree when the behavior occurs.
When you talk about behavior, use these rules……..

31. Specific Target Behaviors
Examples
high-pitched scream
Kicks chair over
Hits others/self
Completes tasks
Non-Examples
Poor impulse control
Angry, frustrated
Aggressive
Pay attention
Everything is a behavior-only focus on maladaptive behaviors…reframe into positive behaviors as well

32. To call someone lazy, uncooperative or stubborn is to admit we
Lack of Understanding
To call someone lazy, uncooperative or stubborn is to admit we
don’t understand them.
She’s just plain stubborn. She
refused to take her meds again!
If not understand, then barrier to relationship development. The behavior gets something they want, gets them out of something, or meets unmet need

33. Step 1: Gather Information
Functional Assessment

34. What is Functional Assessment
A functional assessment is a process for identifying clear, predictive relationships between events in a person’s environment and occurrences of a challenging behavior.
Not a data collection form
Not an event
Find a relationship between events & behavior to create a hypothesis
This is where we connect between the what of the behavior to the why of the behavior.

35. Why Conduct a Functional Assessment?
provides clear information
allows strategies to be based on the function(s) of challenging behavior
leads to more durable outcomes
reduces the need for reactive interventions and crisis plans
addresses the needs of an individual
increases quality of life

36. Find answers to the BIG Questions
Under what conditions do the challenging behaviors occur?
What are the outcomes?
Under what conditions do the challenging behaviors not occur
How’s that workin’ for ya? (Dr. Phil) !
Simulation exercise versus incident report versus simple example

37. A Functional Assessment Identifies Goals of Intervention
Defines specific target behaviors to increase and decrease
Pinpoints circumstances in which intervention will occur
Identifies desired lifestyle changes, such as
Participation in integrated activities
Enhanced independence and satisfaction
Expanded social networks
Work!!! 
Paul Berry story-coach person into a life-
The way you experience the world…what’s the valued role--as a MH consumer or a worker???

38. What are the basics?
Gather information about the challenging behavior through direct observation, interviews, record reviews and/or rating scales
Develop a hypothesis after analyzing the information regarding the variables that starts and maintains behavior
This takes time…direct observation, etc…

39. The ABC’s of a Functional Behavioral Assessment
Setting Event
the state a person is in, e.g., the person is tired, or hungry; a state that predisposes a person to behave in a certain way given a particular antecedent.
Antecedents
any stimulus which precedes a behavior occurrence
Behaviors
any observable act of an individual; the activity one performs in the presence of a particular stimulus
Consequences
the events which occurred following behavior
Consequences tend to be viewed as negative, but consequences can be positive, negative, or no value at all. If behavior happens again, then was positive as viewed by the person

40. Consequences are events that follow a behavior.
What are Consequences?
Consequences are events that follow a behavior.
Is a consequence positive or negative?

41. Results or Functions of Behavior
Get
Sensory
Attention
Tangible
Get
Away
????? Get or Get Away ???
Sensory
Attention
Tangible

42. Results or Functions of Behavior
Sensory
Escape
Attention
Tangible
Meet an unmet need
Sensory: It just feels good e.g., self stimulation
Escape: physical or psychological
Attention: attention may be defined as positive or negative but who makes that call?
Tangible: something one wants or needs
Met or Unmet need:

43. Why do people display challenging behaviors?
Biological/Medical Reasons:
Drugs/medicine
Seizure activity
Allergies/hormonal changes
To mask pain or discomfort
Self-Regulation
To maintain a level of arousal
Reaction to a change in sensory input
Medical example: DH example is person in snow storm with impacted bowel.
Self-regulation--FEAR

44. Reinforcement:
Internal-it feels good
External-to serve a purpose in one’s environment
Absence of Alternative Skill
Most behaviors have the goal to communicate
Messages are sent through behavior
Control is the key word

45. Alternative Behaviors
What is the best way to decrease a behavior that is a barrier to getting a life?
Find an alternative behavior that serves the same function or purpose – gets the same results.
Control is the key word! We try to control our environment—bring order to chaos

46. Agency Examples of ABC
Practice identifying ABCs specific to organization.
Mandt structure

47. Strengths-based slide?
Baskets A – B – C
Value of Life-Pomeranz

48. Competing Behavior Pathway
Desired
Behavior
Consequence
Setting Event
Antecedent
Problem
Behavior
Consequence
Alternative
Behavior

49. Acceptable Replacement
Desired Behavior
Typical
Consequences
Interact nicely; do what’s asked
Staff R+
Asked to do something
Problem Behavior
Setting Events
Triggering
Antecedents
Maintaining
Consequences
Scream,
Hit head
Approach by Staff
Staff move away; avoid request
Tired
Move to later?
[Animate the ppt boxes—walk staff thru, box by box]—Jeff’s breakouts with deliverable of sample behavior support plan / simulation
What was the problem behavior?
What happened right before that?
What happened immediately after?
What’s the state of the individual?
What’s the desired behavior? (utopia-perfect situation) & what would response be?—building compliance, not building a life
What’s an alternative behavior? (team decide-what’s close)-live with alternative behaviors & consequences-got out of doing the task
Acceptable Replacement
Behavior

50. Take what you can get; closest to what you want
Take what you can get; closest to what you want! Reinforce even small improvement or steps to reaching the objective

51. Step 2: Develop a Hypothesis

52. Your “best guess” about the function of challenging behavior
What is a hypothesis
Your “best guess” about the function of challenging behavior

53. Hypothesis Formula
When this occurs (what is the setting event/antecedent)….
The individual does (behavior)
To access or avoid (consequences or functions)
A setting event is the state a person is in, e.g., the person is tired, or hungry; a state that predisposes a person to behave in a certain way given a particular antecedent. Come up with own relevant examples of setting events.
An antecedent is the situation that immediately occurs before a behavior

54. A Sample Hypothesis When Sean…..
(setting event) did not get to sleep before 11 p.m. the previous evening or does not feel well,
(antecedent) is not engaged with others or when he’s engaged in activities for 15 minutes or longer
(behavior) he screams, slaps his face and pulls his hair
(Consequences/function) to gain access to staff attention

55. Linking Hypothesis Statement to Behavior Interventions
A hypothesis statement links behavior interventions to:
short-term prevention of problematic situations
Teaching alternative skills
Responses to challenging behaviors, including crisis management
Long-term prevention
Lifestyle changes

56. In any situation there are three things involved:
1 The Environment
2 The person
3 YOU
It cannot be guaranteed that you will be able to control the environment or the person served; however, you can control your own behavior.

57. What is a Behavior Support Plan
A written document that summarizes strategies that assist in preventing challenging behavior from occurring and helps the consumer learn new skills
The plan should:
develop and maintain skills
enhance opportunities for learning and self-fulfillment
Focus on positive rather than negative techniques

58. A support plan is not written in stone
A support plan is not written in stone. It was made to be changed as a person grows and changes.

59. Is the plan working? Are there improvements in challenging behavior?
Are there increases in skill development?
Are there improvements in quality of life?
Increased participation
Increases choice/decision making
Inclusion
Are there improvements in satisfaction?
Consumer and family
Staff and others
Are there improvements in health or well-being?

60. How do we collect this information?
Direct observation data
Incident reports
Interviews
Consumer
Parents
Service providers
Others
Informal anecdotal reports
Communication logs
Progress notes
Use this or agency inserts own

61. Remember, PBS is all about
Determining the function of challenging behavior and then:
Changing environments
Teaching new skills
Addressing quality of life issues
Changing our patterns of interaction

62. Review Training Objectives
To learn what PBS is as both philosophy and tools
Learn the basics of how we set the tone for the environment-to help or hinder
Learn basic tools of PBS
Learn how to use data to drive decisions
Quiz for knowledge/retention

63. Point of View
“When you change the way in which you see things-the things you see will change.”