1. 1 Positive Behavior Support in Community Settings February 3, 2004 Rachel Freeman University of Kansas

2. 2 Positive Behavior Support  Positive behavior support is the integration of Valued outcomes Behavioral and biomedical science Validated procedures Systems change In order to enhance quality of life and prevent problem behavior

3. 3 Characteristics of PBS  PBS plans can be short or more complicated  Many different intervention choices can result in same positive outcomes  Must fit the values, vision, and resources of those supporting the individual  PBS plans requires team collaboration  Purpose is to increase quality of life and build a team vision

4. 4 Why individuals Engage in Problem Behavior  If problem behavior is increasing look for events that reinforce it  Problem behavior increases when it is reinforced To obtain attention, access to people, events, or activities To escape people, events or activities  Problem behavior influenced by physiological variables can occur to escape or obtain internal stimulation

5. 5 Common Functions Maintaining Problem Behavior  To escape from tasks, people, situations, or internal sensations  To obtain attention from staff, peers, or other individuals  To obtain access to preferred items or events  To either escape or obtain internal sensations due to physiological events

6. 6 First Steps in PBS Process  Medical check-up to ensure there isn’t a health problem or medical issue  Person-centered Planning  Establish the team

7. 7 Person-centered Planning  Process for identifying ideal lifestyle  Creates a vision for the team  Focus on the positive  Gathers important information for the PBS plan  Decreases the need for more intensive interventions  Priority and control is given to the individual

8. 8 Functional Assessment  Identify why the person engages in problem behavior  Assess how to replace problem behavior with desirable behavior  Identify how to redesign the environment to prevent problem behavior  Link all interventions directly to information gathered in the functional assessment

9. 9 Routines, Settings and People Associated with the Occurrence and Nonoccurrence of Problem Behavior Problem Behavior is Most Likely…  Before work  Transitions  Sitting next to his friend John on the way to work Problem Behavior is Less Likely…  Lunch  Small groups  Receiving high levels of attention

10. 10 Developing a Hypothesis Statement A Good Hypothesis Statement Includes the Following Components: 1. Setting Event 2. Antecedent 3. Problem Behavior 4. Consequences

11. 11 Setting Events  Environmental (noise levels, sitting next to a peer, late to work)  Social (fight during lunch, family crisis)  Physiological (sickness, allergies, sleep deprivation)

12. 12 Antecedent Events (Triggers)  Immediately precedes a problem behavior  Can be related to time of day, people, specific settings, the physical surrounding, or particular activities  Common examples include verbal demands, specific assignments, certain peers or individuals

13. 13 Consequences  An event that is presented contingent upon the occurrence of problem behavior  Common consequences include staff attention, the removal of a difficult task, or the presentation of something the person wants

14. 14 Hypothesis Statement Setting EventAntecedent (Trigger) Problem Behavior Consequence Change in work schedule No attention from staff or peers Pulls hair when someone is nearby Immediate attention

15. 15 Activity  Complete the hypothesis statement activity in small groups or individually  Write down the setting events, antecedents, behaviors, and consequences described in each vignette  Answer sheet Answer sheet

16. 16 Types of Functional Assessment Strategies  Indirect assessment methods  Direct observation  Functional analysis

17. 17 Indirect Assessment  Interviewing the person, her parents, staff, and other individuals who know the person well  Record reviews  Quality of life measures  Checklists and rating scales

18. 18 Identify Routines  The behavior occurs “all the time” is not enough information  Select the most problematic situations and settings  Collect functional assessment information about specific routines  Observe these routines

19. 19 Defining a Problem Behavior  Avoid using a classification label (for example, ADHD, autism, etc)  Describe exactly what the behavior looks like  Avoid using vague descriptions (temper tantrums mean different things to different people)  Make sure the behavior is described in such a way that there is a clear beginning and ending

20. 20 Collecting Direct Observation Data  To help you develop an initial hypothesis  To confirm that your hypothesis is correct  To create a baseline that can be used later to evaluate the PBS plan

21. 21 Collect a Baseline of Problem Behavior

22. 22 Direct Observational Methods  Measure behavior by frequency, intensity, duration, or latency  Scatter plot  “ABC” chart (documents observed antecedents, behaviors, and consequences)

23. 23 Scatter Plot ABC Chart

24. 24 Outcomes of a Functional Assessment 1. Describe the problem behavior 2. Identify the events, times, and situations that predict when problem behaviors both occur and do not occur 3. Identify the consequences that maintain a problem behavior 4. Develop a hypothesis 5. Confirm the hypothesis using direct observation

25. 25 Functional Analysis  A functional analysis involves observing behavior while systematically manipulating environmental events  A functional assessment includes functional analyses, indirect assessment, and direct observation

26. 26 Activity  In small groups, discuss an individual you currently support  Discuss what you think is maintaining an individual’s problem behavior  What type of information do you have to confirm this hypothesis?  What other evidence do you need?

27. 27 PBS Planning

28. 28 PBS Plans Must be a Good “Fit”  Values of team members  Resources available  Skills and background of those implementing the PBS plan  Training identified as needed  Use team based strategies to identify interventions

29. 29 Team-based Brainstorming  Bring functional behavioral assessment information  Set up flip chart paper for writing down interventions  Set aside time to brainstorm each part of the hypothesis statement  Do not judge ideas during brainstorming  Go back later as a team and pick interventions

30. 30 Logically Linking the Functional Assessment to PBS Planning (Adapted from O’Neill, et al., 1997) Setting EventAntecedent (Trigger) Problem Behavior Consequence Change in work schedule No attention from staff or peers Pulls hair when someone is nearby Immediate attention Setting Event Interventions Antecedent Interventions Teach New Skills Consequence Interventions

31. 31 Logically Linking the Functional Assessment to PBS Planning (Adapted from O’Neill, et al., 1997) Setting EventAntecedent (Trigger) Problem Behavior Consequence Change in work schedule No attention from staff or peers Pulls hair when someone is nearby Immediate attention Setting Event Interventions Antecedent Interventions Teach New Skills Consequence Interventions  Alert residential staff to changes at work  Rehearse changes before work with his picture schedule Temporarily increase attention on days when changes occur Provide one on one staffing on days with schedule changes  Provide high levels of staff attention and structure activities that encourage interaction  Teach person to initiate a positive interaction with picture schedule  Reduce attention for hair pulls  Reward person when he successfully completes time alone with no hair pulls

32. 32 Setting Event Interventions Antecedent Interventions Teach New Skills Consequence Interventions  Alert residential staff to changes at work  Rehearse changes before work with his schedule Temporarily increase attention on days when changes occur Provide one on one staffing on days with schedule changes  Provide high levels of staff attention and structure activities that encourage interaction  Teach person to initiate a positive interaction with picture schedule  Reduce attention for hair pulls  Reward person when he successfully completes time alone with no hair pulls

33. 33 Examples of Setting Event Interventions  Minimize or eliminate the setting event  Design interventions that are implemented when setting events occur --Neutralize the setting event --Withhold or eliminate the antecedent --Add more prompts for desirable behavior --Increase the value of reinforcement for desirable behavior

34. 34 Antecedent Interventions  Avoid presentation of antecedent (verbal demand statements)  Modifying Tasks The way activity is completed Functional activities Compensate for skill deficits Initially providing extra support  Create high levels of predictability  Offer choices

35. 35 Teaching New Skills  Identify a desirable behavior that will serve the same function as the problem behavior  This new behavior must be more efficient when compared to the problem behavior

36. 36 Consequence Interventions  Are important when teaching new skills (the goal is to make the problem behavior inefficient compared to new behaviors)  Withdraw or terminate reinforcement maintaining problem behavior (extinction)  Withdrawing or terminating reinforcement can result in an “extinction burst” (problem behavior may increase temporarily before decreasing)

37. 37 Examples of Consequence Interventions  Intervene early before problem behaviors increase in intensity (we often ignore early signs that are not as problematic and respond to serious problems)  Redirect person early in the chain of problem behaviors  Avoid engaging in coercive interactions

38. 38 Building a Positive Interaction Pattern  Rapport building strategies  Provide 4 positive statements for every demand or request  Deliver reinforcement to persons immediately when you observe them engaging in positive social behaviors

39. 39 Activity Read this vignette and use the PBS planning tool

40. 40 PBS Planning Tool

41. 41 Cycle of Positive Behavior Support PCP Curriculum Functional Assessment Medical/ Health Hypotheses: Global and Specific Multicomponent Interventions Data Analysis and Evaluation EffectiveIneffective Generalization/ Maintenance Florida’s Positive Behavior Support Project-USF

42. 42 Effective PBS Plans  Identify the full set of problem behaviors  Focus on routines  Document the escalating pattern of problem behavior from lowest to highest intensity  List all behaviors and indicate which behaviors are maintained by the same function  Implement plan across all relevant settings and times

43. 43 Features of a Written PBS Plan  Identifying information, reasons for the plan, person’s positive characteristics  Description of the problem behavior(s)  Summary of the hypothesis statement  General description of interventions and specific strategies in more detail  Crisis prevention plan (as necessary)  Group commitment (obtain signatures)

44. 44 Implementing a PBS Plan  Provide a timeline for implementing each intervention  Document the agreed upon dates for meetings  Identify the individuals responsible for implementing each intervention  Spread responsibilities among team members

45. 45 Implementation Plan Example ActivityPerson ResponsibleDate of Completion Functional Assessment InterviewsR. Freeman11/14/00-11/27 Direct ObservationsT. Dolby11/15/00 R. Freeman11/16/00-11/17/00 Summary of ReportR. Freeman12/2/00 Brainstorming SessionAll Team members12/3/00 PBS Plan Development Develop materialsB. Smith12/11/00 Schedule mentor sessionsM. Brown12/11/00 Secure extra staff supportL. Kinley12/14/01 Write scripts and R. Freeman12/15/00 Evaluation Plan Meetings for review of dataAll team members1/14/01 Collectors of data B. Smith Ongoing Summarize data for meetingsR. FreemanOngoing (Adapted from Horner, Albin, Sprague, & Todd, 2000)

46. 46 Enlarged Implementation Plan ActivityPerson ResponsibleDate of Completion Functional Assessment InterviewsR. Freeman11/14/00-11/27 Direct ObservationsT. Dolby11/15/00 R. Freeman11/16/00-11/17/00 Summary of ReportR. Freeman12/2/00 Brainstorming SessionAll members12/3/00

47. 47 Enlarged Implementation Plan PBS Plan Development Develop materialsB. Smith12/11/00 Mentor sessionsM. Brown12/11/00 Extra staff supportL. Kinley12/14/01 Write scripts R. Freeman12/15/00

48. 48 Enlarged Implementation Plan Evaluation Plan Review of dataAll members1/14/01 Data collectors B. Smith Observe dinner twice/week Summarize data for R. Freeman Weekly Meetings (Adapted from Horner, Albin, Sprague, & Todd, 2000)

49. 49 Evaluating a PBS Plan A PBS plan should result in…  Decreases in problem behavior  Increases in academic and social skills  Positive lifestyle changes

50. 50 Collect a Baseline of Problem Behavior

51. 51 Examples of Evaluation Measures  Compare the frequency of problem behavior and appropriate behavior  Assess whether the person’s social skills have increased  Observe number of positive interactions that occur during key routines  Changes in the persons quality of life (access to new resources, new friendships)  Assess level of satisfaction with the PBS plan

52. 52 Useful Tools for PBS  Link to the Rehabilitation Research and Training Center on Positive Behavior Support Facilitator’s Guide: http://www.fmhi.usf.edu/cfs/cfspubs/pbsgui de/facilitatorguidepbs.htm

53. 53 For More Information  Kansas Institute for Positive Behavior Support (www.kipbs.lsi.ku.edu)www.kipbs.lsi.ku.edu  Kansas University Center for Developmental Disabilities - PBS Resources (http://www.uappbs.lsi.ku.edu)http://www.uappbs.lsi.ku.edu  Center on Positive Behavioral Interventions and Support (http://www.pbis.org)http://www.pbis.org  Rehabilitation Research and Training Center on PBS (http://www.rrtcpbs.org)http://www.rrtcpbs.org