Role of Health Care Professionals in Team-based Problem Solving for Children with Chronic Behavioral Needs - PowerPoint PPT Presentation

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Role of Health Care Professionals in Team-based Problem Solving for Children with Chronic Behavioral Needs

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Role of Health Care Professionals in Team-based Problem Solving for Children with Chronic Behavioral Needs Rob Horner University of Oregon www.pbis.org – PowerPoint PPT presentation

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Title: Role of Health Care Professionals in Team-based Problem Solving for Children with Chronic Behavioral Needs


1
Role of Health Care Professionals in Team-based
Problem Solving for Children with Chronic
Behavioral Needs
  • Rob Horner
  • University of Oregon
  • www.pbis.org

2
Objectives
  • Define a team-based approach to designing
    behavior support with three key features.
  • Assessment Define a problem with precision
    before building a plan
  • Plan Design Build comprehensive plans that
    prevent, teach and reward positive behavior while
    minimizing reward of negative behavior.
  • Contextual Fit Make the elements of a plan
    fit the values, skills and resources of the
    performance context.

3
Major Changes in Behavior Support
  • Prevention
  • Teaching as the most effective approach
    (communication skills)
  • Environmental redesign, Antecedent Manipulations
  • Function-based support
  • Functional assessment (move from cookbook
    approach)
  • Separate crisis intervention from active
    support.
  • Comprehensive Interventions
  • Link Behavior Support to Lifestyle Outcomes
    (Values)
  • Multiple elements/components
  • Fit elements of behavior support to values,
    skills and resources.
  • Systems Change
  • Intervention at the whole-school level
  • Durable systems that nurture and sustain
    effective practices

4
Problem Behavior
  • Behavior is a function of

Physiology
Learning History
Current Context
5
A Context for PBS
  • Effective behavior support involves understanding
    Physiology and Learning History and changing the
    Current Context.
  • Behavior support is not the redesign of
    individuals
  • Pay as, or more, attention to what happens
    between problem behavior bouts as to what happens
    during instances of problem behavior. (Edward
    Carr)
  • Positive Behavior Support plans define changes in
    the behavior of those who will implement the
    plan.

6
Purposes of Behavior Support Plan
  • Define critical features of environments where
    the focus person will be successful.
  • Behavior support plans describe what we will do
    differently to establish these critical features.
  • Facilitate consistency across multiple
    implementers.
  • Provide professional accountability.

7
Identify Problem with Precision
  • What, Who, When, Where, Why and How Often

8
Identify Problem with Precision
Team-Initiated Problem Solving (TIPS II) Model
Make Summative Evaluation Decision
Identify Goal for Change
Collect and Use Data
Monitor Impact of Solution and Compare against
Goal
Identify Solution and Create Implementation
Plan with Contextual Fit
Implement Solution with High Integrity
Meeting Foundations
9
Defining a Problem with Precision
What is a problem?
A problem exists when there is a difference
between what you want and what you have.
10
Defining a Problem with Precision
  • A major error is to launch into problem solving
    BEFORE the problem has been defined with
    precision.
  • Typical pre-emptive solutions
  • What we did last year
  • What my cousin did with her son
  • What I can buy (or download) as a package on the
    internet
  • What I can buy as a training from an expert
  • Pre-emptive solutions
  • Often do not work
  • Usually are more expensive
  • Typically do not fit the context.

11
How Often
What

When


Where
Why
Who
Designing Effective Behavior Support
12
Start with Primary Problem Statements
Office discipline referrals for 3rd graders are
above national median for schools our size.
  • Look at the Big Picture. Then use data to refine
    the problem to a Precise Problem Statement.

Move to Precise Problem Statements
Referrals for physical aggression among third
grade students from 1130-1230 in the cafeteria
have increased to 3-4 per day. We believe that
physical aggression is rewarded by peer
attention.
13
Precise or Primary Statement?
Precise
Primary
What, Who, Where, When, Why, and How Often
Indicates a difference between what is happening
and what is desired.
14
Primary versus Precision Statements
  • Primary Statements
  • Too many referrals
  • September has more suspensions than last year
  • Gang behavior is increasing
  • The cafeteria is out of control
  • Student disrespect is out of control
  • Precision Statement
  • There are twice as many ODRs for aggression on
    the playground than last year. These are most
    likely to occur during first recess, with a large
    number of students, and the aggression is related
    to getting access to the new playground equipment.

15
Primary versus Precision Statements
  • Primary Statements
  • Derek screams at dinner
  • Emily bites her hand
  • James swears
  • Philip has ASD, and finds bright lights a
    problem. He will hid under furniture when lights
    are on.
  • Precision Statement
  • Elaine is 4 years old and refuses to go to bed
    about 4 nights per week. She cries and screams
    when put in bed until allowed to get up and play
    or get a story. She is effective at working
    herself into a physical state that makes sleep
    less likely, and she obtains a great deal of
    adult attention.

16
Precise or Primary Statement?
  • Darin uses inappropriate language with a high
    frequency in the presence of both adults and
    other children. This is creating a sense of
    disrespect and incivility in the school.
  • Tantrums in the van are creating unsafe travel.

Primary
Primary
17
Precise or Primary Statement?
  • James D. is hitting others in the cafeteria
    during lunch at least five times a week, and his
    hitting is maintained by peer attention.
  • Boys are engaging in sexual harassment.
  • Three 5th grade boys are name calling and
    touching girls inappropriately during recess in
    an apparent attempt to obtain attention. This is
    occurring at least 5 times a week.

Precise
Primary
Precise
18
Precise or Primary Statement?
  • Minor disrespect and disruption are occurring
    daily, increasing over time, and are most likely
    during the last 15 minutes of our block periods
    when students are engaged in independent seat
    work. This pattern is most common in 7th and 8th
    grades, involves many students, and appears to be
    maintained peer attention.
  • Danielle is 9 years old and refuses to follow
    parental requests to pick up toys, help with
    dishes, do homework. She will sulk and pout
    until we get frustrated and send her to her room.

Precise
Primary
19
Your Turn
  • Define a PRIMARY problem
  • Transform that description in to PRECISE problem
    statement.
  • Who
  • What
  • Where
  • When
  • Why
  • How Often

20
Comprehensive Behavior Support Pans
  • Focus first on prevention, teaching and rewards
  • Consider how to prevent problem behavior from
    being inadvertently rewarded.
  • Be clear about how to intervene with safety.
  • Avoid plans that only focus on consequences

21
Behavior Support Plan Elements
Prevent
Teach
Prompt
Reinforce
Extinguish or Withhold Reward
Correction
Safety
Data
Change the context to avoid the problem situation?
Teach what you want. Teach a socially acceptable
replacement.
Encourage opportunities for the desired behavior.
Reward for the desired behavior.
Prevent the problem behavior from being rewarded.
Use negative feedback if needed.
Add safety procedures if needed.
Define data to monitor implementation fidelity
and impact
22
Behavior Support Plan Elements
Prevent
Teach
Prompt
Reinforce
Extinguish or Withhold Reward
Correction
Safety
Data
Pre-correction
Play with me special toy to share
Pre-empt recruiting play
No extra reward needed peer attention very
effective (praise recruiting play)
Brief time out (no toy or peer) for any
aggression (verbal or physical) toward others
Practice the right way to recruit peer play
Increased supervision
Number of aggressions number of play initiations
23
Behavior Support Plan Elements
Rayette
Prevent
Teach
Prompt
Reinforce
Extinguish or Withhold Reward
Correction
Safety
Data
24
Behavior Support Plan Elements
Reading
Prevent
Teach
Prompt
Reinforce
Extinguish or Withhold Reward
Correction
Safety
Data
25
Contextual Fit
  • The elements of a behavior support plan should
    fit the values, skills and resources of the
    people who will implement and receive support.
  • One of the major reasons why behavior plans are
    NOT implemented is because of poor contextual fit.

Bennazi
26
Summary
  • Building effective behavior support involves
    designing contexts based on assessment,
    comprehensive planning , and attention to
    contextual fit
  • Assessment Who, What, Where, When, Why, How
    Often
  • Comprehensive Planning Prevent, Teach, Prompt,
    Reward, Extinction, Safety, Data
  • Contextual Fit Attention to values, skills and
    resources of those who implement and receive
    support.
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