Transcript BIS Orientation and Service Overview Presentation

Behavioural Intervention
Service – Hobb’s House
Orientation and Service Overview
“It’s a place like no other” - client, age 12
2007: Winner of the CYWHS Exceptional Teamwork and
Collaboration Award
Presentation Overview
• This presentation covers…
– A brief description of the Behavioural
Intervention Service (BIS)
– BIS referral criteria
– Common presenting features of BIS clients
– The Positive Behaviour Support Framework
– From referral onwards
– BIS Day program
– BIS Consultancy
A snapshot of BIS
• BIS is a state-wide, interagency partnership
between Child and Adolescent Mental Health
Service (CAMHS), Department and Education
and Children’s Services (DECS) & Families SA
(FSA)
• BIS provides an intensive day program &
consultancy service for young people with
significant mental health issues & long
standing, pervasive and persistent
behavioural problems
• BIS is staffed by a multidisciplinary team of
CAMHS clinicians & DECS teaching staff
– Psychologist, Mental Health Nurse, Speech
Pathologist, Social Worker, Occupational
Therapist, Psychiatrist, Teachers, SSO
Referral Criteria
• Aged 5-18 years old
• Mental health issues
– E.g. features of depression, anxiety, low selfesteem etc
• Previous intervention provided by more than
one agency or two or more programs with at
least one agency which were ineffective
– E.g. DECS programs, community CAMHS
interventions, private clinical therapy etc
• Persistent, pervasive (more than 1 setting) &
long standing behavioural problems
Features of BIS Clients
• Generally aged between 9-13 years old
• More than 80% of BIS clients are males
• 60% have Families SA involvement (including
living in foster care or community residential
units)
• Common life experiences often include…
– Exposure to domestic violence
– Abuse and/or neglect
– Family breakdown
– Rejection & abandonment
– Experiences of grief & loss
– Substance abuse within the family
– Other traumas (see Attachment, Trauma and Brain
Development Presentation)
Features of BIS clients
• Other common compounding issues include…
– Developmental disorders/delays
– Intellectual and/or physical disabilities
– Speech & language deficits
– Learning difficulties and learning gaps
– Systems issues
– Sensory and motor issues
– Limited experiences of success
– Poor social skills
– Poor play skills
– Poor sleep hygiene
Features of BIS clients
• Common emotional characteristics of BIS
clients…
– Insecure/disorganised attachment profile
(See Attachment Presentation for more information)
–
–
–
–
Display high levels of anger & aggression
Negative self-concept & low self-esteem
Have low tolerance for frustration
Few experiences of success & many
experiences of failure
– Display high levels of fear
– Emotionally ‘shut down’
Features of BIS Clients
• Common challenging behaviours exhibited by
BIS clients include…
– Aggression & violence (towards
other people or property)
– Obsessional or ritualistic behaviours
– Abusive/controlling interactions
– Sexualised behaviours
– Avoidance behaviours
– Risk taking behaviours
So how do we work with
such challenging young
people?
Positive Behaviour Support
• Positive Behaviour Support (PBS) provides the
theoretical underpinning of the educational &
therapeutic program at BIS.
• PBS is a non-punitive approach to behavioural
change that encompasses a broad range of systemic
and individualised strategies for achieving social and
learning outcomes while reducing challenging
behaviours
• PBS differs from traditional “reactive” methods of
behaviour management often used in schools.
• BIS clients are those young people who are least
responsive to these reactive behaviour management
practices
PBS – Functions of challenging
behaviours
• PBS assumes that all behaviour serves a specific
function for that person, no matter how
maladaptive or ineffective it appears to others
• Common functions of a young person’s challenging
behaviour
–
–
–
–
Avoid/escape a non-preferred person/activity
Obtain a preferred object/activity
Initiate or maintain a social contact
Express distress, emotion or sensory need
• Hypotheses and competing pathways plans are
developed to describe the function of a challenging
behaviour and then are tested or observed
• Hypothesis template
– When __(insert setting event)__ young person will
__(insert challenging behaviour)__ in order to
__(insert intended outcome/function)__.
PBS – Competing Pathways
It is hoped young
people will develop
new skills with new
reinforcers to replace
challenging behaviour
Setting
Events:
Being
in the
classroom
Triggers:
Being
asked to do
maths
In the short term an
acceptable alternative is
reinforced as it is ‘less
worse’ than the
challenging behaviour
Desired Behaviour:
Attempt maths tasks
Ask teacher for help
Maintaining
Consequence:
Experience of success
Positive relationship
with teacher
Challenging
Behaviour:
Maintaining
Consequence:
Yelling,
Swearing &
Threatening
Getting sent out
of room. And not
having to do
maths
Acceptable
Alterative:
Walk out of
classroom
Example Hypothesis: When asked to do a maths task Mike yells,
swears and threatens to harm the teacher in order to get sent
out of the classroom (thereby avoiding the maths task)
Positive Behaviour Support
•
PBS incorporates 2 key goals of intervention
1. Strategies with the specific purpose of diffusing
the immediate situation, maximise safety &
normalising the environment (reactive strategies
– use 10% of the time)
2. Strategies intended to decrease the likelihood of
future incidents & thereby facilitate long term
behavioural change (proactive strategies – use
90% of the time)
The best behaviour management occurs when
the challenging behaviour is not happening.
The best personal support occurs when the
challenging behaviour is present.
PBS – Proactive Strategies
• Proactive Strategies target modifications to the
environment or build skills in the young person
• Environmental
(changing the world to suit the young person)
– Modify physical characteristics of environment
– Modify planned timetable and activities
– Modify communication strategies/style used
• With the young person
(changing the young person to suit the world)
– Develop functionally equivalent skills
(acceptable alternatives to challenging
behaviours) & desired behaviours
– Coping & tolerance skills (build resilience)
– Build skills such as language, academic, sports,
social and play skills
PBS – Reactive Strategies
• Reactive strategies have a focus on
maintaining/restoring the safety of the young person
& those around them
• For each young person an incident management plan is
developed that identifies potential triggers, warning
signs, communication strategies, de-escalation
strategies & an exit plan
• Some examples of reactive strategies include…
– Removing other young people/staff from the area
– Removing dangerous objects
– Providing an easily accessible escape route & a safe place to
cool off
• This is not a time for teaching/learning new skills that
happens as a result of the proactive strategies when
the challenging behaviour is not occurring
• Following an incident relationships are repaired & the
young person can then be re-engaged with the
program
PBS Plan Template
wwwPOSITIVE BEHAVIOUR SUPPORT PLAN
Understanding Young Person
Strengths
Protective factors


Highlight particular interests
or strengths of the YP
People with whom the YP
has strong, positive
relationships.
Helping World to Suit Young Person
Environment
Strategies to manipulate physical
and social environment in order to:
- reduce triggers for challenging
behaviours
- enhance supportive relationships.
Taking into consideration:
 Informal & formal Assessment
 Existing environment(s) with
their unavoidable constraints
Be realistic and specific.
Set up an environment to foster and
repair relationships
Challenging Behaviours
May wish to list in order of priority
Collaborative decision making re
which behaviours are the current
focus of intervention
Refer to hypothesis development
Function of Behaviour
Please note that a hypothesis
describes the suggested triggers,
form and function of a challenging
behaviour.
List hypotheses that are currently
being tested by team
Communication
Strategies to assist people to adapt
their communication to suit the level
and emotional state of the YP.
Devised using information from a
variety of sources including:
 Speech and language
assessment
 Psychology assessment
 Observations
Timetable Tips
Contains strategies to help
organise YP’s day according to
what we know about his strengths
and needs.
Eg.
 YP has been observed to have
difficulty attending to structured
task before access. Psychologist
suggests…
 YP has positive relationship with
Home Group teacher – schedule
in routine contact
Helping Young Person to Suit World
Multi-Disciplinary Goals
This includes goals to address
skill deficits and build on existing
strengths.
Opportunity for adults to coordinate and prioritise their goals
These goals developed by the
collaborative team and aim to
increase young person’s
opportunities to develop skills
 Emotional regulation
 Leisure
 Social
 Academic
Focussed Behavioural Goal
Positive Reinforcement is essential
in helping YP shaping target
behaviours into more socially
acceptable and functionally
equivalent behaviours.
Reinforcement is given when
desired behaviours are performed,
not when challenging behaviours
occur.
Refer to hypotheses and
competing pathways to establish
appropriate replacement
behaviours and reinforcement
schedules.
How does a young person
get to BIS & what happens
when they get here?
Pathway to BIS
1. 1. A young person’s referral is coordinated by
Interagency Student Behaviour Managers
(DECS)
2. The appropriateness of the referral is
considered by the BIS Intake Panel made up
of CAMHS, DECS and FSA managers
3. If appropriate the young person is placed on
the waiting list (approximately 12 months) &
a series of recommendations and supports
are put in place to assist the young person
during this period
e.g. funding for increased SSO support at school
Pathway through BIS
1. Client is allocated a clinical and an educational key
worker from the BIS team
2. Information is compiled from a variety of sources
(family, other services, CAMHS file) and any
necessary assessments are conducted (e.g.
Functional Behavioural Assessment, psychology)
3. Hypothesis Development – Develop hypotheses
around the functions of challenging behaviours
4. PBS Planning – develop goals for the young person:
skill building, reinforcement strategies
5. Multi-disciplinary Team Intervention Planning – plan
interventions to address goals
6. Decide whether client would be best served by
attending the day program or by consultancy
service
7. Ongoing liaison with other systems supporting the
young person
The Day Program
• The day program (9:30am-3pm) has both an
educational & clinical focus.
• Young people spend a majority of the day in a
classroom environment with scheduled clinical
sessions throughout the week
• The day is highly structured with most activities
lasting only 15-30 minutes
• Young people participate in a number of group
activities such as gardening, bike riding, social
skills & art therapy
• The number and length of days attended by each
young person is determined in partnership with
the family & the enrolled school and depends on
the young person’s needs and goals.
Educational Program at BIS
• Each young person’s education at BIS is
modified to their individual academic level
• A key educational goal at BIS is to support
young people to re-engage with the
curriculum
• To increase young people’s capacity to
transition to a school setting & succeed in a
classroom environment
• To further develop literacy & numeracy skills
• To develop social & emotional competency in
a classroom setting
Example Timetable
Time
Activity
9:30
Organisation and
morning chat
9:45
Language theme –
Aboriginal studies
10:00
Reading and Art
10:15
10:30
10:45
11:00
11:30
11:45
12:15
12:45
1:00
1:30
1:45
2:00
3:00
Computer work
Spelling – THRASS work
Sharing success!
Recess
Relaxation
Maths
Time with clinician
Sharing success
LUNCH
Relaxation
Communication Folder
Time with clinician
HOME
Comment
Student’s rating
Goals of Clinical Intervention
•
•
•
•
•
•
•
•
•
Develop trusting relationships with adults
Develop safe personal boundaries
Change cognitive behavioral processes
Conflict resolution and negotiation skills
Provide experience of success and mastery
Appropriate self awareness and expression
Family work & systems education/support
Development a positive sense of self
Specific skills development e.g.
– Speech and language
– Emotional Regulation
– Play
• Social skills & peer relationship development
Consultancy Service
• A consultancy service is offered to young
people and families who…
– Live too far away to access the day program
(BIS is a state-wide service)
– Who are connected and engaging in their
enrolled school, but require additional support
• It includes assessment & the development of
a comprehensive PBS plan
• BIS staff engage, educate and train the
young person’s key supports to put in place
agreed interventions
• The role is flexible depending on the needs of
the young person & those who support them