Transcript Challenging Behavior in Natural Settings: PBS: What the

Challenging Behavior in
Natural Settings: PBS:
What the Research Says
Kathryn Hoover, Ph.D.
Radford University, Radford, VA
April 30, 2008
Introductions and Overview
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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 like—just
what can be seen, try not to interpret yet.
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What Children Need (and Seek)
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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!
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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?
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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)
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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
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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
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Attention, escape, tangible, sensory
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Just a few more Definitions
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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
FBA’s and implement Behavior Intervention Plans
(Tyrell, Horn & Freeman, 2006)
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OK, now let’s get to it!
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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)
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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, don’t 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 doesn’t work? FBA
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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
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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
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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
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Next Step: Gather Information & Hypothesis
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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)
 Antecedent—what happened before behavior
 Behavior (describe what you see)
 Consequence—what 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
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Also need to ask:
 How
does the child communicate? All behavior
communicates—is lack of appropriate communication
a major factor in the behavior?
 What predicts the behavior?
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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: complete—10 min.
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Step 3: Make a Plan
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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!)
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First, Look at the environment: what are the antecedents
(triggers) and can any of them be changed so the
behavior is reduced? Can you:
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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
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Helps promote self-determination, gives ‘control’—
prevents 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!
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Choices must be honored –don’t offer if not available
Who should ultimately control the child’s activities,
career, life when she is an adult? So teach now.
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Skills children need to be able to make
choices
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Be aware of the options (understand)
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They need to have favorites (preferences)
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Show them object, activity, or picture if they
understand pictures
Activities, events, people, objects
Be able to show you their choice
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Reach for it, point to it, gesture, name it
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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
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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
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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 others—this is a temporary stopgap
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Example: interrupt the behavior: “You may not ________
because _________” and physically walk the child to the quiet
area “You are _________ (label the emotion), let’s 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
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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
group—NOTE that at every step you will ask the
family if it will work for them—they will implement
AND Complete the Support Planning Chart
15 minutes
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Implementation and Program Evaluation
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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
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After implementation begins, evaluate the plan
Handout 4: Evaluation: You want to know:
1—How effective is the plan
 Is
the behavior happening less frequently?
 Is the child learning and using the replacement
behavior? Is the child more successful?
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2—Is 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!
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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 child’s behavior will change
Putting the effort into changing antecedents is
worth the effort—it may be all that is needed!
Remember, it is for the child’s future!
Please complete my evaluation before you
leave, thank you.
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