Challenging Behavior in Natural Settings: PBS: What the Research Says


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Challenging Behavior in Natural Settings PBS
What the Research Says

• Kathryn Hoover Ph.D.
• Radford University Radford VA
• April 30 2008

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Introductions and Overview

• First who I am
• Next who are you
• Overview
• Rationale for addressing challenging behavior
• Discussion/Definition of terms found in the
  research
• Research based steps to Positive Behavior Support
  with group work to practice each step in the
  process
• I hope one of you will provide us with a case
  study so we can apply these strategies to real
  life situations. Please remember to respect the
  confidentiality of the child and family (no
  identifying information) and to describe
  objectively what the behavior looks likejust
  what can be seen try not to interpret yet.

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What Children Need (and Seek)

• Children need to be able to predict and control
  as much as they can in their world
• How do infants control parent behavior (when
  hungry tired dirty diaper frightened
  etc.what do they do And what do parents do).
  Children become adults.
• Did you make your own decision to come to this
  workshop How important is the control of your
  life to you It is important to children too!
• To be predictable the environment needs to be
  consistent and provide structure and choices
  within limits
• Research shows that teachers respond more
  predictably to challenging behavior than
  appropriate (Jolivette Stichter McCormick
  2002 Nielsen McEvoy 2004)given that how do
  you think a child who needs predictability is
  more likely to act if they need predictability
  appropriately or

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Why is it important to address challenging
behavior

• What children risk if they take challenging
  behaviors to day care preschool school
• Rejection by peers (and by programs!)
• Negative interactions (relationships) with
  teachers sets children up for negative
  relationships in future
• Probable negative impact on family and family
  relationships (for all members)
• Risk of later substance abuse delinquency
  unemployment etc. (Powell Fixsen Dunlap Smith
  Fox 2007)
• What can we do
• Positive Behavior Supports in all environments
  (focus time and attention on prevention of
  challenging behavior how to do it) (Boulware
  Schwartz McBride 1999).

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First Some Definitions

• PBS Terminology Handout
• Terms you will hear as we discuss PBS and FBA
• PBS Positive Behavior Support/s
• FBA (Functional Behavior Assessment)
• Challenging Behavior (why not misbehavior)
• Environment (includes surroundings people
  things)
• Antecedent events or triggers
• Consequences
• Positive Reinforcement (reinforcers)
• Punishment
• Function of a Behavior
• Attention escape tangible sensory

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Just a few more Definitions

• Replacement Behavior (communication included)
• Altering antecedents (environment)
• Family-Centered Intervention COLLABORATION
• Contextual fit any plan to address challenging
  behavior must fit into the needs of the child AND
  the family and the abilities and comfort in
  implementing the plan of family members and fit
  into the routines and daily work of the family
• Shared decision-making and responsibility
• Why is this crucial
• Research shows that families can learn to conduct
  FBAs and implement Behavior Intervention Plans
  (Tyrell Horn Freeman 2006)

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OK now lets get to it!

• Prevention of Challenging Behavior at Home or in
  a Program (child care classroom)
• Focus on Teaching Social Skills to Prevent
  Problem Behavior
• First identify the social behaviors that you
  want the child to learn (communication is a
  social behavior)
• Then Teach those behaviors all adults use the
  same language We say please when we want (a
  toy)
• Respond consistently to appropriate prosocial
  behavior give the child feedback so she knows
  how she is doing (remember if we are only
  consistent when we punish they will seek
  punishment when they need predictability)

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Instruction in Discipline

• First set up a few simple rules (pick your
  battles) state what the child is to do (not what
  she is to not do)
• Example Toys are for playing Hands stay on
  your own body Feet stay on the floor Walking
  feet in the hall
• Next decide how you will respond to the child
  when a rule is broken (natural fit not
  punishment for children under 18 months-2 years
  do-able and all commit to do it)
• TEACH the desired behavior dont just expect the
  child to learn it without instruction
• Then ALWAYS respond as planned when a child
  breaks a rule (act do not react not in anger)
  explain why the consequence is being delivered
  and how to avoid in future If you throw a toy
  the toy is gone for now. Are you all done Then
  show (or tell) me all done.

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What if it doesnt work FBA

• Basic Steps of FBA (based on Boulware et al.
  1999)
• Identify the problem (define the behavior)
• Gather information observations checklists
  interviews
• Brainstorm possible functions and possible
  solutions
• Make a plan
• Implement the plan
• Evaluate the results
• Steps of FBA Handout 1
• Does anyone have a situation you would like to
  share with the group Then you will do this as
  small groups for another child real life or case
  study

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Steps of FBA Identify the Problem

• Identify the Problem
• With family decide what the problem is
  sometimes clear (aggression) sometimes not clear
  (tantrums at unpredictable times
  transitions/change or No etc.)
• Helps to identify when it occurs with whom and
  what it looks like (tantrum what does it mean)
• Very important also to know when the behavior
  DOES NOT occur!
• So with our case study
• What is the problem What does it look like
• When does it occur With whom (with what)
• When does it NOT occur
• Now with your handout 1 get in groups and do as
  small group (10 minutes)

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Next Step Gather Information Hypothesis

• Gather Information
• Interviews (formal or informal) with family
  other care givers (bus driver etc. for school
  setting)
• Motivational Assessment Scale MAS (handout is
  old version) several who interact with child
  complete
• Observation ABC chart (handout)
• Antecedentwhat happened before behavior
• Behavior (describe what you see)
• Consequencewhat happened after which is
  probably reinforcing the behavior to keep it
  effective
• The Consequence often then becomes the Antecedent
  for the next cycle of ABC

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Gathering Information and Hypothesis

• Also need to ask
• How does the child communicate All behavior
  communicatesis lack of appropriate communication
  a major factor in the behavior
• What predicts the behavior
• Hypothesis
• When _________ happens (antecedent) the
• child ________________ (behavior) in order to
• get ________________(consequence) therefore the
• function of the behavior is _________________.
• For our case study child can we hypothesize
• So now with FBA Handout 2 complete10 min.

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Step 3 Make a Plan

• The Purposes of the Plan are
• A. Prevent the challenging behavior
• B. Help the child be successful in the situation
  
• C. TEACH a REPLACEMENT (appropriate) behavior
  which will serve the same function (achieve same
  goal) and
• D. what will you do if the behavior still occurs
  (sometimes called crisis intervention plan)

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A) Prevent the Behavior (most important!)

• First Look at the environment what are the
  antecedents (triggers) and can any of them be
  changed so the behavior is reduced Can you
• Change the room arrangement amount of materials
  location
• Adapt the schedule (are you rushing the child
  when he needs more time for an activity Do you
  plan nap time after outside)
• Modify activities or tasks is it too hard Too
  easy Boring
• Provide cues for the child transition cues
  verbal visual model
• Ignore inappropriate behavior if not harmful or
  destructive
• Redirect or distract the child
• Remind child/ren of the rules teach/review the
  rules before situation point out appropriate
  behavior (target behavior)
• Give choices a very effective preventative
  strategy (McCormick Jolivette Ridgeley 2003)

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Prevent Offering Choices

• Helps promote self-determination gives
  controlprevents or resolves a lot of power
  struggles!
• Opportunities can you give a child to make a
  choice
• 1) Order of tasks materials (which
  color)
• 2) Where to do it (living or kitchen)
• 3) Person to go/do with
• 4) Partner (peer)
• 5) Which activity afterwards
• 6) When to take a break
• 7) When to end and do something else
• Do this or go to time out is NOT giving
  choices!
• Choices must be honored dont offer if not
  available
• Who should ultimately control the childs
  activities career life when she is an adult So
  teach now.

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Skills children need to be able to make choices

• Be aware of the options (understand)
• Show them object activity or picture if they
  understand pictures
• They need to have favorites (preferences)
• Activities events people objects
• Be able to show you their choice
• Reach for it point to it gesture name it
• Be able to make a choice when offered options
• Be able to engage in the choice (play with it)
• You can teach any of the above

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Choices

• Young children need choices within the activity
  or right before the next activity
• For example the child does not like his bath
  Joey do you want Daddy or Mommy to give you a
  bath today (only if both are available)
• Or a child does not like to come in from
  outside so a few minutes before it is time to go
  inside ask Carrie do you want to watch your
  movie or help me with dinner when we go inside
• The adult controls the choices but give the
  child control over which to choose and honors
  the choice.

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B C Help the Child be Successful Teach

• Prevention is a major part of success for the
  child
• Teach a Replacement Behavior is the next most
  important part of the Plan
• First identify what behavior will achieve the
  same goal (perform the same FUNCTION)
• Then decide how best to TEACH the child that
  behavior
• Is it a need to ask for a break Understand the
  schedule or order of the day Have control over
  some part of the task (choices) Need more
  sensory input
• Tell the child what she can do show her what to
  do and practice (role play) what she can do
  (when she is calm and teachable)
• Include exactly what to say to the child in the
  plan

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D. Crisis Management Plan

• What will you do if you try all of these things
  (or until the plan has been developed and is in
  place) when the behavior occurs
• Needs to be respectful of the child feelings
  needs age appropriate not punishment but
  consequences to protect the child and othersthis
  is a temporary stopgap
• Example interrupt the behavior You may not
  ________ because _________ and physically walk
  the child to the quiet area You are _________
  (label the emotion) lets go to the quiet area
  until you are calm (define your voice is quiet
  or your feet are quiet) then we will talk. If
  child can be left leave if not stay and provide
  gentle physical support not punishment just
  help to be calm while protecting yourself) then
  come back (or when calm) praise for regaining
  calm and redirect or calmly review rules
  encourage to try again etc.

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Prevent Teach Crisis Management

• So with our case study child what might we do to
  prevent the behavior
• What behavior might we teach him or her
• How
• What can we do if it occurs before learning takes
  place (Crisis Management Plan)
• With Handout 3 answer these questions in your
  groupNOTE that at every step you will ask the
  family if it will work for themthey will
  implement
• AND Complete the Support Planning Chart
• 15 minutes

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Implementation and Program Evaluation

• Now with the plan developed it is time to
  prepare to implement the plan
• First all those who will implement (family
  child caregivers teachers therapists etc.)
  need to be comfortable and feel they can do it!
• May need support to change the environment
  change the way they talk to the child etc.
• Decide how it will fit into the routines of life
• May want to practice role play child parent or
  teacher and let them practice the plan
• Role play crisis intervention implementation

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Evaluating the Plan

• After implementation begins evaluate the plan
• Handout 4 Evaluation You want to know
• 1How effective is the plan
• Is the behavior happening less frequently
• Is the child learning and using the replacement
  behavior Is the child more successful
• 2Is the problem solved to the satisfaction of
  the family (and teacher if appropriate)
• Is the behavior decreased enough Does the
  intervention fit with daily life activities in
  the family (classroom) etc.
• If not go back to brainstorming create another
  plan

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Positive Behavior Support Works!

• Remember challenging behaviors have been
  developed over time and it will take time and
  work to re-teach the child appropriate behavior
• The adults must change their behavior first
  (ignore redirect change antecedents teach
  etc.) before the childs behavior will change
• Putting the effort into changing antecedents is
  worth the effortit may be all that is needed!
• Remember it is for the childs future!
• Please complete my evaluation before you leave
  thank you.