2. Polk County PBS Academy PBS 101

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

4. What is PBS It is a philosophy and a set of tools It is a philosophy and a set of tools A way of thinking and doing A way of thinking and doing Positive behavior support offers a proactive process for Positive behavior support 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 are an inter-agency coalition promoting positive support to enhance the quality of life for persons with disabilities. We make decisions based on: 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

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

7. Insert Agency PBS Policy

8. Section One: Philosophy

9. How you see me!

10. How I want to live!

11. Universal Enhancement Strategies Things of Value TARGET BEHAVIOR Spontaneity Positive rituals Dining out Exercising Day at the spa Dancing Sex Friends Voting Having a will Family Fishing Movies Vacationing Good Health Grilling out Music Volunteering Work Pets Hiking Religion Gardening

12. GEM G ood E nough for M e G ood E nough for M e –Tom Pomerantz

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)

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

15. Effective Behavioral Support..requires the design of an environment that makes problem behaviors:

16. 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?!

17. Respect – Fundamental to PBS A personal quality that is non- contingent provided without judgment and given equally to all persons. 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. People should not have to earn your respect they should be the recipient of your respect without condition.

18. Defining Characteristics of PBS Person centered Person centered Collaborative on-going process Collaborative on-going process Data-driven decision making Data-driven decision making Prevention, positive, proactive strategies Prevention, positive, proactive strategies Meaningful outcomes Meaningful outcomes

19. IS NOT Simple Simple Short term Short term Just Decrease Behavior Just Decrease Behavior Reactive Reactive Aversive (punish) Aversive (punish) Observable Behavior Observable Behavior Experts Decide Experts DecideIS Comprehensive Comprehensive Long term Long term Teach Useful Skills Teach Useful Skills Proactive Proactive Positive (reinforce) Positive (reinforce) Function Function Involve Individual Involve Individual

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

23. Step 1: Gather Information Step 1: Gather Information Person Centered Planning Person Centered Planning

24. Five Essential Goals of Person Centered Planning Expressing preferences and making choices in everyday life Expressing preferences and making choices in everyday life Gaining and maintaining satisfying relationships Gaining and maintaining satisfying relationships Having opportunities to fulfill respected roles and live in dignity Having opportunities to fulfill respected roles and live in dignity Being present and participating in community life Being present and participating in community life Continuing to grow Continuing to grow

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

26. Tools for Person-centered Planning Insert organization planning tools Insert organization planning tools

27. What is behavior? Anything a person says or does 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

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.

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

31. Specific Target Behaviors Examples high-pitched scream high-pitched scream Kicks chair over Kicks chair over Hits others/self Hits others/self Completes tasks Completes tasksNon-Examples Poor impulse control Poor impulse control Angry, frustrated Angry, frustrated Aggressive Aggressive Pay attention Pay attention

32. 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!

33. Step 1: Gather Information 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. 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

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

36. Find answers to the BIG Questions Under what conditions do the challenging behaviors occur? Under what conditions do the challenging behaviors occur? What are the outcomes? What are the outcomes? Under what conditions do the challenging behaviors not occur Under what conditions do the challenging behaviors not occur

37. A Functional Assessment Identifies Goals of Intervention Defines specific target behaviors to increase and decrease Defines specific target behaviors to increase and decrease Pinpoints circumstances in which intervention will occur Pinpoints circumstances in which intervention will occur Identifies desired lifestyle changes, such as Identifies desired lifestyle changes, such as –Participation in integrated activities –Enhanced independence and satisfaction –Expanded social networks –Work!!! –Work!!!

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

39. The ABC’s of a Functional Behavioral Assessment Setting Event 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 Antecedents any stimulus which precedes a behavior occurrence Behaviors Behaviors any observable act of an individual; the activity one performs in the presence of a particular stimulus Consequences Consequences the events which occurred following behavior

40. What are Consequences? Consequences are events that follow a behavior.

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

42. Results or Functions of Behavior Sensory Sensory Escape Escape Attention Attention Tangible Tangible Meet an unmet need Meet an unmet need

43. Why do people display challenging behaviors? Biological/Medical Reasons: Biological/Medical Reasons: Drugs/medicine Drugs/medicine Seizure activity Seizure activity Allergies/hormonal changes Allergies/hormonal changes To mask pain or discomfort To mask pain or discomfort Self-Regulation Self-Regulation To maintain a level of arousal To maintain a level of arousal Reaction to a change in sensory input Reaction to a change in sensory input

44. Reinforcement: Reinforcement: Internal-it feels good Internal-it feels good External-to serve a purpose in one’s environment External-to serve a purpose in one’s environment Absence of Alternative Skill Absence of Alternative Skill Most behaviors have the goal to communicate Most behaviors have the goal to communicate Messages are sent through behavior Messages are sent through behavior Control is the key word 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? 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. Find an alternative behavior that serves the same function or purpose – gets the same results.

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

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

48. Setting EventAntecedent Problem Behavior Desired Behavior Alternative Behavior Consequence Competing Behavior Pathway

49. Setting EventsTriggering Antecedents Maintaining Consequences Desired BehaviorTypical Consequences Problem Behavior Acceptable Replacement Behavior Scream, Hit head Approach by Staff Staff move away; avoid request Interact nicely; do what’s asked Staff R+ Asked to do something Tired

50. 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. 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)…. When this occurs (what is the setting event/antecedent)…. The individual does (behavior) The individual does (behavior) To access or avoid (consequences or functions) To access or avoid (consequences or functions)

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: 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 A written document that summarizes strategies that assist in preventing challenging behavior from occurring and helps the consumer learn new skills The plan should: 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. 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 improvements in challenging behavior? Are there increases in skill development? Are there increases in skill development? Are there improvements in quality of life? Are there improvements in quality of life? –Increased participation –Increases choice/decision making –Inclusion Are there improvements in satisfaction? Are there improvements in satisfaction? –Consumer and family –Staff and others Are there improvements in health or well- being? Are there improvements in health or well- being?

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

61. Remember, PBS is all about Determining the function of challenging behavior and then: 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 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 the basics of how we set the tone for the environment-to help or hinder Learn basic tools of PBS Learn basic tools of PBS Learn how to use data to drive decisions Learn how to use data to drive decisions

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