Transcript Behavior Support Planning ECN 4.4.13

BEHAVIOR SUPPORT
PLANNING
Mapping an Individual Behavior Support
Plan using the Pyramid
Model Practices
ECN Training
Thursday April 4th, 2013
Melissa Binkley & Beth Vorhaus
The Pyramid Model
Module
3
[Assessment-based
interventions result in
individualized behavior
support plans.]
Behavior
Is communicating…
Skill to be developed
Potential unmet need
A 6 month-old cries for long periods of
time unless held by his caregiver…
1. What is the ‘tip of the iceberg’ behavior?
2. What social-emotional skill is needing
support?
3. What might be going on for this child?
(possible unmet needs)
Old Way versus New Way
Old Way
New Way
• General intervention for all
• Intervention matched to
behavior challenges
• Intervention is reactive
• Focus on behavior reduction
• Quick fix
purpose of the behavior
• Intervention is proactive
• Focus on teaching new skills
• Long-term interventions
Behavior Support Plan
• Behavior Hypotheses- Purpose of the behavior;
your best guess about why the behavior occurs
• Prevention Strategies- Ways to make events and
interactions that trigger challenging behavior easier
for the child to manage
• Replacement Skills– New skills to teach throughout
the day to replace the challenging behavior
• Responses- What adults will do when the
challenging behavior occurs to ensure that the
challenging behavior is not maintained and the new
skill is learned
Behavior Hypothesis
Expands on the behavior equation and incorporates what
you have learned from the observations and interviews
Includes information about:
• Function of the behavior
• Triggers of the challenging behavior
• Description of the challenging behavior
• Responses that maintain the challenging behavior
HO: Hypothesis Statement
Data Collection
Collecting data about a child and the challenging behavior
helps us identify the form and understand the function.
Information that is collected to determine the function of a
behavior is called a “Functional Assessment”
• Literally, the assessment of the behavior’s function
Conducting a Functional Assessment
•
Observe the child in target
routines and settings
• Look for situations that predict
challenging behavior and
situations that predict
appropriate behavior.
• Interview persons most
familiar with the child
• Parents, Grandparents,
Teachers
• Review records
Behavior Support Plan
• Behavior Hypotheses- Purpose of the behavior, your
best guess about why the behavior occurs
• Prevention Strategies- Ways to make events and
interactions that trigger challenging behavior easier for
the child to manage
• Replacement Skills– New skills to teach throughout the
day to replace the challenging behavior
• Responses- What adults will do when the challenging
behavior occurs to ensure that the challenging behavior
is not maintained and the new skill is learned
Look at the Function of the Behavior
Ask yourself…
•
•
•
•
•
How can the environment be changed to
reduce the likelihood that challenging
behavior will occur?
What can be done to make challenging
behavior irrelevant?
What procedures can I select that fit in
the natural routines and structure of the
classroom or family?
How can I build on what works?
What can be done to help the child not
respond to the trigger or change the
trigger so it does not cause challenging
behavior?
Behavior Support Plan
• Behavior Hypotheses- Purpose of the behavior; your
best guess about why the behavior occurs
• Prevention Strategies- Ways to make events and
interactions that trigger challenging behavior easier for
the child to manage
• Replacement Skills– New skills to teach throughout the
day to replace the challenging behavior
• Responses- What adults will do when the challenging
behavior occurs to ensure that the challenging behavior
is not maintained and the new skill is learned
Teaching Replacement Skills
•
Replacement Skills are alternative behavior to
challenging behavior.
•
Replacement skills must be efficient and effective (i.e.,
work quickly for the child).
•
Make sure the reward for appropriate behavior is
consistent.
Competing Behavior Equation
Child yells,
kicks, throws.
Adult gives child
another turn.
Child asks for
one more turn.
Adult says “one
more turn, then
(siblings’s name)’s
turn” and gives turn.
Child told
sibling gets
a turn.
Functional Equivalence
•
Replacement skills should have
functional equivalence
‾
‾
•
Identify an acceptable way that the
child can deliver the same
message.
Make sure that the new response is
socially appropriate and will access
the child’s desired outcome.
Teach the child a skill that honors that
function of the behavior (e.g., if child
wants out of activity, teach child to
gesture “finished”).
Behavior Support Plan
• Behavior Hypotheses- Purpose of the behavior; your best
guess about why the behavior occurs
• Prevention Strategies- Ways to make events and interactions
that trigger challenging behavior easier for the child to manage
• Replacement Skills– New skills to teach throughout the day to
replace the challenging behavior
• Responses- What adults will do when the challenging behavior
occurs to ensure that the challenging behavior is not
maintained and the new skill is learned
Response to Challenging Behavior
• Respond in a way that will make challenging behavior
ineffective.
• Make sure rewards for appropriate behavior are equal to
or exceed rewards for challenging behavior.
Safety-Net Procedures
•
•
•
•
•
If a child is in danger of harming self or others, you must first
be concerned about safety.
You may hold a child or remove a child from the situation to
keep children safe.
Safety-net procedures may be planned for children who have
a history of dangerous outbursts.
Safety-net procedures only keep children safe; they do not
change behavior.
Safety-net procedures are appropriate only when there is also
a full behavior support plan or intention to develop a plan.
Developing an Individual Support Plan
1. Identify the basic equation (trigger, behavior,
maintaining consequence) of the challenging behavior.
2. Identify the function of the challenging behavior
3. Brainstorm Prevention Strategies
4. Brainstorm ideas about what Replacement Skills
should be taught to replace challenging behavior
5. Brainstorm ideas about how to Respond to challenging
behavior when it occurs.
6. Implement with Intentionality, then: Review, Edit,
Tweak, Reapply…
Keep in Mind:
Behavior Support Plans also…
•
Subscribe to Program Rules & Protocol
•
Outline clear steps in developing a plan to address the
behavior
•
Identify role/participants on the team (Parents/Family,
Teachers, Home Visitors, Assisting
Teachers/Paraprofessionals, Therapists, Administrative Staff,
Mental Health Consultant, Others…?)
•
Lay out how progress will be reviewed, how changes will be
made in the plan
•
Stipulate how decisions will be made about ending or
modifying the intervention protocol
Behavior Support Plan Development
Step One
• Identify the basic equation (trigger, behavior, maintaining
consequence) of the challenging behavior.
Trigger
Setting Events (if
applicable):
Handout 4 & 5
Behavior
Maintaining
Consequence
Behavior Support Plan Development
Step Two
• Identify the function of the challenging behavior.
Trigger
Behavior
Setting Events (if
applicable):
Function:
Maintaining
Consequence
Behavior Support Plan Development
Step Three
• Brainstorm Prevention Strategies
o Strategies to make routines or activities easier for the child
o Strategies to soften the triggers
Trigger
Behavior
Function:
Preventions
Maintaining
Consequence
Behavior Support Plan Development
Step Four
• Brainstorm ideas about what Replacement Skills should
be taught to replace challenging behavior.
o Think about what skills the child already has
o Think about what skills can use scaffolding
Trigger
Behavior
Function:
Preventions
New Skills
Maintaining
Consequence
Behavior Support Plan Development
Step Five
• Brainstorm ideas about how to Respond to challenging
behavior when it occurs.
o Consider current demands on teachers
o Keep responses easy to use/remember
Trigger
Behavior
Maintaining Consequence
Function:
Preventions
New Skills
New Responses
To Challenging Behavior:
To Use of New Skill:
Behavior Support Plan Development
Step Six
Intentional Implementation - Immediate:
• Review plan ideas; eliminate pieces that
don’t fit or are too difficult for team to do.
Emphasize that each column is necessary.
•
Create an Action Plan so that each team
member knows what, when, and how the
strategies will be implemented.
Intentional Implementation - Ongoing:
• Repeat process for other routines, settings,
or behavior functions.
•
Consult with a mental health professional if
the child is not responding and the
intensity, frequency, and duration of the
behavior is not improving.
Plan Development Tips:
•
Develop plan using plain language.
•
Develop action plan of who will produce what components needed
to implement the plan.
•
Make sure plan will fit with routines, activities, and values of family
and teaching staff. Design components that are easy to use, easy to
remember.
•
Plan must accommodate competing demands on teaching staff and
family.
•
Focus on ONE behavior at a time. Develop mini-plans for difficult
routines.
Activity 3-4
MICHAEL’S
CHALLENGING
BEHAVIOR
Case Study Example
Michael’s Challenging Behavior
Example 1:
Michael’s Challenging Behavior
Example 2:
Michael’s
Functional Assessment Interview
Key Points:
• Same pattern at home as at school
• Child not sleeping through the night
• Eats very quickly & takes food from others
• Limited in choices he gets to make at home
• Eating & Free Play are most frequent settings for challenging
behavior
• Set Offs: Mom talking on phone/attending to others
• Engaging in behavior leads to pay-off, “almost every time”
• Likes to: read w/adult, play alone with adult, play with cars &
bouncy balls
Behavior Support Plan Development
Step One
• Identify the basic equation (trigger, behavior, maintaining
consequence) of Michael’s challenging behavior.
Trigger
Group play:
outside play with
peers
Setting Events
(if Applicable):
Handout 4 & 5
Behavior
Maintaining
Consequence
Verbal Aggression
Peers give up toy/item
Physical Aggression
Peers leave area
Property Destruction
Adults intervene with
negative attention
Behavior Support Plan Development
Step Two
• Identify the function of Michael’s challenging behavior.
Trigger
Group play:
outside play with
peers
Setting Events
(if Applicable):
Behavior
Maintaining
Consequence
Verbal Aggression
Peers give up toy/item
Physical Aggression
Peers leave area
Property Destruction
Adults intervene with
negative attention
Function:
Obtain Toy/Attention
Michael’s Hypothesis Statement
Remember:
• Triggers of the challenging behavior
• Description of the challenging behavior
• Function of the behavior
• Responses that maintain the challenging behavior
In group play situations (outside play/centers),...
Michael uses verbal aggression (threats), physical aggression (hit,
push, kick, punch), and property destruction (throwing or banging
toys)…
to obtain toys and/or join play.
When this occurs, the peer relinquishes the desired toy and leaves the
play area and/or an adult intervenes and provides Michael with
excessive negative attention.
• Step 3: Preventions
o Pre-teach skills via scripted story.
o Use visual cards to help him remember lessons when in difficult
situation.
Trigger
Group play: outside
play with peers
Setting Events (if
Applicable):
Preventions
Pre-teach skills by role
playing via scripted story
Use visual cards to help
him remember lessons
when in difficult situation
Self-monitoring form to
work on new skills
Behavior
Verbal Aggression
Physical Aggression
Property Destruction
Function:
Obtain Toy/Attention
Replacement Skills
Maintaining Consequence
Peers give up toy/item
Peers leave area
Adults intervene with
negative attention
New Responses
• Step 4: Replacement Skills
o
Asking to play, Everyone can play with the toys, Flexibility, accepting
other’s ideas/space, Asking for teacher’s help, Self-monitoring form to
work on social goals.
Trigger
Group play: outside
play with peers
Behavior
Verbal Aggression
Physical Aggression
Property Destruction
Maintaining Consequence
Peers give up toy/item
Peers leave area
Setting Events (if
Applicable):
Function:
Obtain Toy/Attention
Adults intervene with
negative attention
Preventions
Replacement Skills
New Responses
Pre-teach skills by role
playing via scripted story
Use visual cards to help
him remember lessons
when in difficult situation
Self-monitoring form to
work on new skills
Asking to play
Everyone can play with
the toys
Asking for teacher’s help
• Step 5: New Responses
Immediately respond to his requests for help.
Intervene to prevent harm by providing attention/support to child who is
attacked.
o Provide certificate and acknowledge positive behavior at end of each
day for successfully achieving goals.
o
o
Trigger
Group play: outside play
with peers
Setting Events (if
Applicable):
Preventions
Pre-teach skills by role
playing via scripted story
Use visual cards to help him
remember lessons when in
difficult situation
Self-monitoring form to work
on new skills
Behavior
Verbal Aggression
Physical Aggression
Property Destruction
Function:
Obtain Toy/Attention
Replacement Skills
Asking to play
Everyone can play with
the toys
Asking for teacher’s help
Maintaining Consequence
Peers give up toy/item
Peers leave area
Adults intervene with negative
attention
New Responses
To Challenging Behavior:
Anticipate & cue to use new skill.
Intervene to prevent harm by providing
attention/support to child who is attacked
To Use of New Skill:
When asks, respond
Provide certificate/star and acknowledge
positive behavior. Fade certificate/star
Step 6: Intentional Implementation
Action Planning Form
Child Name: Michael
Program: Village Pre-K
Date: 10/11
Planning Objectives: Develop behavior support plan materials to
assist Tim at home and in preschool
Need
Action Steps
Person
Responsible Date
1. Develop scripted
story with 4
chapters:
• ask to play
• take turns
• go with the flow
• stop, think and
do
Write text.
Melissa, Beth
10/24
Insert pictures.
By 10/28
Print story.
By 10/28
Follow-up
Send story home
so they too can
read at home to
prepare for
school.
Action Planning Form (con’t.)
Need
Action Steps
Person
Responsible/
Date
Follow-up
2. Develop cue
cards for each
chapter in
story.
A. Create.
B. Print.
C. Laminate.
D. Punch hole
and attach to ring
Melissa by 10/24
Discuss via
phone 2 weeks
after use, or
earlier if
questions arise.
3. Develop self
monitoring goal
sheet:
• ask to play
• take turns
• go with the flow
• stop, think, and
do
Create and print
with one goal at a
time, add each
goal as he does
the prior goal(s).
Beth, Melissa
By 10/28
Send sample goal
sheet home and
discuss after 2
weeks of use.
Action Planning Form (con’t)
Need
Action Steps
Person
Responsible/ Date
Follow-up
4. Develop
certificate.
Create and
print many.
Beth
By 10/28
Send certificates
home as he
completes goals
(no comment
from parents if no
certificate comes
home).
Implementation
• Teach classroom staff/family/other adults – review strategies,
demonstrate or guide, provide reinforcement (not criticism).
• Make sure everyone on the team understands the plan.
• Design supports that help the adults remember the plan (posted
mini-plan, reminder signs, checklists).
• Be cautious about extinction bursts– offer support, availability.
• Ask for time, assure classroom staff/family that you are committed
to creating a plan that will work.
• Begin plan implementation when all pieces have been
developed (behavior support plan, materials, activity/routine
matrix, instructional procedures, and outcome monitoring
form).
Monitoring Outcomes
•
Helps determine the impact of the behavior support plan
(or lack of impact!)
•
Allows you to alter the plan as needed
•
Remember to KISS it!
Michael’s Playtime
4
Laughing,
stayed
Monday
3
Cooperated,
stayed briefly
Tuesday
2
Fussed, took
several turns
Wednesday Thursday
1
Cried, refused
to play
Friday
Saturday
4
4
4
4
4
4
3
3
3
3
3
3
2
2
2
2
2
2
1
1
1
1
1
1
Average Aggression
Child’s Name: __Michael____
Week of: ___4/1/13-4/5/13_________
Check the number of times the child is aggressive during the activity. Aggression
includes: hits, pinches, pulls hair, bites, kicks, & scratches.
Activity
Mon.
Tues.
Wed.
Thurs.
Fri.
Average
Arrival
___0 times
_x__1-5 times
__5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
__x_0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
Circle
___0 times
___1-5 times
__x_5-10 times
___10-15
___15-20
___+20
___0 times
__x_1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
__x_0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
__x_1-5 times
___5-10 times
___10-15
___15-20
___+20
Lunch
___0 times
___1-5 times
__x_5-10 times
___10-15
___15-20
___+20
___0 times
___1-5 times
__x_5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
__x_1-5 times
_x__5-10 times
___10-15
___15-20
___+20
Average
___0 times
___1-5 times
_x_5-10 times
___10-15
___15-20
___+20
___0 times
__x_1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
_x__0 times
___1-5 times
___5-10 times
___10-15
___15-20
___+20
___0 times
_x__1-5 times
___5-10 times
___10-15
___15-20
___+20
Child’s Transitions
Week of: _________________
Arrival
Circle
Nap
Clean-up
Monday
Tuesday
Wednesday
Thursday
Friday
0 1 2 3.
0 1 2 3.
0 1 2 3.
0 1 2 3.
0 1 2. 3
8
0 1 2 3.
8
0 1 2 3.
8
.
0 1 2 3
8
Other: Bus
Ride
0 1 2 3.
Average
Score
Average
Score
8
3
8
0 1 2 3.
8
0 1 2. 3
8
0 1 2. 3
8
.
0 1 2 3
8
Average
Score
2.2
8
0 1 2. 3
8
0 1. 2 3
8
0. 1 2 3
8
.
8
0 1 2 3
Average
Score
1.4
8
0 1 2. 3
8
. 2 3
0 1
8
0 1 2. 3
8
.0 1 2 3
8
0 1. 2 3
8
8
. 2 3
0 1
8
0. 1 2 3
8
0. 1 2 3
8
Average
Score
1.4
Average
Score
.8
Rate the problem behavior: 0 = no problems, 1 = whining, resisting, 2 = screaming,
falling on floor, 3 = screaming, hitting, other aggression
If Challenging Behavior Returns
• First
‾
‾
‾
Review plan and make sure it is being implemented as planned.
Review evaluation data to determine if the pattern is an extinction burst
(worse before it gets better).
Examine events to see if there are new triggers for behavior.
• Then
‾
‾
‾
‾
Restore support plan and implement with fidelity; or
Continue plan through extinction burst; or
Add components to plan to address new triggers; or
Conduct a new functional assessment and develop new support
strategies.
Example of Support Plan Checklist
Michael’s Support Plan Implementation
Implementation Items
In Place/Occurring?
Support providers enter into play activities and
teach Michael new play routines. Adults provide
support by scaffolding Michael’s interactions in play
routines outside and during centers.
Yes
Proof:
No
Sometimes
Adults assist Michael with turn-taking interactions
by moving into play activities and mediating his
social exchanges; and then scaffold the interaction.
Yes
Proof:
No
Sometimes
Yes
Proof:
No
Sometimes
Yes
Proof:
No
Sometimes
Adults facilitate the use of communication repair
strategies by Michael. (Michael may use
unintelligible mumbling or aggression if adults
fail to quickly interpret his message)
Pre-teach Michael through the use of a scripted
story the following skills: asking to play, everyone
can play (turn taking), being flexible and accepting
other’s ideas and space, and asking the teacher for
help.
Example of Support Plan Checklist
Michael’s Support Plan Implementation (cont.)
Michael uses a self-monitoring form to indicate if he
accomplished his social skills goals. One goal is
introduced at a time.
Yes
No
Sometimes
At the end of centers, a teacher helps Michael use the
form to record if he was successful in meeting his
goal(s) and then provides a certificate for Michael to take
home to celebrate the use of the new skill.
Yes
No
Sometimes
Michael receives positive statements about his use of
appropriate peer play behavior frequently throughout
the day in a natural fashion.
Yes
No
Sometimes
Example of Support Plan Checklist
Michael’s Support Plan Implementation (cont.)
When Michael has difficulty with initiating interaction with
his peers during play, anticipate the difficulty and cue him.
Yes
No
Sometimes
If Michael becomes angry, confused, and/or frustrated and
looks like he is about to use aggression, cue him to use the
“Turtle Technique” and help him through the steps.
Yes
No
Sometimes
If Michael using aggression, intervene to prevent harm by
providing attention/support to the child who is hurt and/or
upset.
Yes
No
Sometimes
Activity: Develop a Behavior Support Plan
(For identified child)
Write at least 3 “Observations.” (Use memory to develop
observation cards for this example only.)
Based on “Observations” determine the function of the behavior
and create Behavior Hypothesis.
Develop a Behavior Support Plan for one hypothesis statement.
1.
2.
3.
4.
5.
6.
I.
What Prevention Strategies could you put in place for target child?
II.
What Replacement Skills would you teach the target child?
III.
What New Responses would you develop for parents, teachers, other
adults in child’s life?
Create an Action Plan detailing who will create/implement what for
the child.
Create Monitoring Plan – Choose Data Tool & Develop Support
Plan Checklist
Be prepared to share your plan with the group.
Major Messages
1.
The behavior support plan includes four parts:
behavior hypotheses, prevention strategies,
replacement skills, and new responses.
•
•
Prevention strategies are used to soften the
triggers of challenging behavior.
Replacement skills (to replace challenging
behavior) are taught systematically and throughout
the day.
2.
Data collection needs to be easy to collect on
simple forms: “KISS” it (Keep It So Simple).
3.
Behavior support efforts are ongoing and
outcomes must be monitored.
Questions?
For More Information:
• http://teamtn.tnvoices.org
• http://csefel.vanderbilt.edu/resources/
strategies.html#toolsplans
• http://challengingbehavior.org/explore
/pbs/pbs.htm