Positive Behavior Support in Community Settings February 3, 2004

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Positive Behavior Support in Community Settings
February 3, 2004

• Rachel Freeman
• University of Kansas

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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

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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

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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

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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

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First Steps in PBS Process

• Medical check-up to ensure there isnt a health
  problem or medical issue
• Person-centered Planning
• Establish the team

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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

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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

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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

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Developing a Hypothesis Statement

• A Good Hypothesis Statement Includes the
  Following Components
• Setting Event
• Antecedent
• Problem Behavior
• Consequences

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Setting Events

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

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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

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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

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

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Types of Functional Assessment Strategies

• Indirect assessment methods
• Direct observation
• Functional analysis

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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

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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

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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

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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

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Collect a Baseline of Problem Behavior
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Direct Observational Methods

• Measure behavior by frequency, intensity,
  duration, or latency
• Scatter plot
• ABC chart (documents observed antecedents,
  behaviors, and consequences)

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Scatter Plot

• ABC Chart

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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

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Functional Analysis

• A functional analysis involves observing behavior
  while systematically manipulating environmental
  events
• A functional assessment includes functional
  analyses, indirect assessment, and direct
  observation

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Activity

• In small groups, discuss an individual you
  currently support
• Discuss what you think is maintaining an
  individuals problem behavior
• What type of information do you have to confirm
  this hypothesis?
• What other evidence do you need?

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PBS Planning
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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

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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

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Logically Linking the Functional Assessment to
PBS Planning (Adapted from ONeill, et al., 1997)
Setting Event Antecedent (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

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Logically Linking the Functional Assessment to
PBS Planning (Adapted from ONeill, et al., 1997)
Setting Event Antecedent (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
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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
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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

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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

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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

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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)

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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

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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

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Activity

• Read this vignette and use the PBS planning tool

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PBS Planning Tool
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Cycle of Positive Behavior Support
Medical/Health
Functional Assessment
PCP
Curriculum
Hypotheses Global and Specific
Multicomponent Interventions
Data Analysis and Evaluation
Generalization/ Maintenance
Effective
Ineffective
Floridas Positive Behavior Support Project-USF
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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

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Features of a Written PBS Plan

• Identifying information, reasons for the plan,
  persons 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)

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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

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Implementation Plan Example

• Activity Person Responsible Date of
  Completion
• Functional Assessment
• Interviews R. Freeman 11/14/00-11/27
• Direct Observations T. Dolby 11/15/00
• R. Freeman 11/16/00-11/17/00
• Summary of Report R. Freeman 12/2/00
• Brainstorming Session All Team members 12/3/00
• PBS Plan Development
• Develop materials B. Smith 12/11/00
• Schedule mentor sessions M. Brown 12/11/00
• Secure extra staff support L. Kinley 12/14/01
• Write scripts and R. Freeman 12/15/00
• Evaluation Plan
• Meetings for review of data All team
  members 1/14/01
• Collectors of data B. Smith Ongoing
• Summarize data for meetings R. Freeman Ongoing
• (Adapted from Horner, Albin, Sprague, Todd,
  2000)

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Enlarged Implementation Plan

• Activity Person Responsible Date of
  Completion
• Functional Assessment
• Interviews R. Freeman 11/14/00-11/27
• Direct Observations T. Dolby 11/15/00 R.
  Freeman 11/16/00-11/17/00
• Summary of Report R. Freeman 12/2/00
• Brainstorming Session All members 12/3/00

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Enlarged Implementation Plan

• PBS Plan Development
• Develop materials B. Smith 12/11/00
• Mentor sessions M. Brown 12/11/00
• Extra staff support L. Kinley 12/14/01
• Write scripts R. Freeman 12/15/00

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Enlarged Implementation Plan

• Evaluation Plan
• Review of data All members 1/14/01
• Data collectors B. Smith Observe dinner
• twice/week
• Summarize data for R. Freeman Weekly
• Meetings
• (Adapted from Horner, Albin, Sprague, Todd,
  2000)

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Evaluating a PBS Plan

• A PBS plan should result in
• Decreases in problem behavior
• Increases in academic and social skills
• Positive lifestyle changes

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Collect a Baseline of Problem Behavior
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Examples of Evaluation Measures

• Compare the frequency of problem behavior and
  appropriate behavior
• Assess whether the persons 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

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Useful Tools for PBS

• Link to the Rehabilitation Research and Training
  Center on Positive Behavior Support Facilitators
  Guide
• http//www.fmhi.usf.edu/cfs/cfspubs/pbsguide/facil
  itatorguidepbs.htm

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For More Information

• Kansas Institute for Positive Behavior Support
  (www.kipbs.lsi.ku.edu)
• Kansas University Center for Developmental
  Disabilities - PBS Resources (http//www.uappbs.ls
  i.ku.edu)
• Center on Positive Behavioral Interventions and
  Support(http//www.pbis.org)
• Rehabilitation Research and Training Center on
  PBS (http//www.rrtcpbs.org)