Transcript Document

PBS and Transition to
Adulthood
Vincent Winterling, Ed.D.
Statewide Director, Delaware Autism Program
Director, Vincent Winterling, Ed.D., LLC Consultants
Objectives
 Define and describe Positive Behavior Support (PBS)
 Define and describe the Lifestyle Planning Process
 Review essential elements of the FBA process
 Review essential elements of Behavior Intervention Plans
 Review (if time permits) why plans fail
Define and Describe Positive
Behavior Support
What is PBS?
 Applied science
 Use of educational methods
 Expand individual’s repertoire
 Systems change methods
 Redesign and individual’s living (or learning) environment
 Achieve quality of life
 Minimize problem behavior
PBS: Foundational Considerations
 Teach skills to increase likelihood of success in important
domains
 Teach, strengthen, expand positive behavior
 Utilize systems change to increase opportunities for the
display of positive behavior
PBS: Overarching Goals
 Assist individual’s lifestyle to evolve such that all in the
student’s world have experience of change
 Render problem behavior irrelevant, inefficient, and
ineffective by helping individual achieve goals in socially
appropriate manner.
Positive Behavior Support
 Differs from traditional approaches to behavior
support
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Function rather than form
Proactive rather than reactive
Functional Skills
Positive
Individualized
Long-term goals
Multi-component / comprehensive
PBS: Underlying Assumptions
 Challenging behaviors need to be understood within the
contexts in which they occur.
 Challenging behaviors serve a function or purpose for the
individual.
 Effective interventions are based on a understanding of the
individual, the social contexts in which they participate, and
the purpose/function of their challenging behavior.
 PBS emphasizes person-centered planning and values that
respect the dignity, preferences, diversity, and goals of each
individual.
PBS: Defining Characteristics
 PBS is assessment based. Interventions are directly linked
to environmental influences and hypotheses concerning the
function of challenging behavior.
 PBS plans are comprehensive, usually involving multiple
interventions.
 PBS is proactive, involving teaching alternative skills and
adapting the environment.
 PBS emphasizes carrying out assessment and intervention
practices in typical settings that are inclusive in order to
promote lifestyle enhancements.
PBS: Defining Charactertics
 PBS considers the values, beliefs, and goals of family
members in the assessment and treatment planning
process.
 PBS is sensitive to the resources available to families and
the constraints they face.
 PBS looks to build on the strengths of family members and
address areas of need.
 PBS has a broad view of success that includes (a)
increasing the use of alternative skills, decreasing the
incidence of challenging behaviors, and making
improvements in quality of life.
Define and Describe Lifestyle
Planning Process
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School Age (3 to 12 Years)
 Family Issues
 Educational Focus
 Adjusting to educational
 Communication
systems (IEPs; placement;
 Social Skills
support services)
 Play
 Developing advocacy skills
 Self-care
 Dealing with reactions from
 School-based and
peers groups and
Academics
community
 Domestic
 Locating community
 Community
resources
 Maintaining a healthy
family process
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Adolescence (13 to 17 Years)
 Family Issues
 Addressing emerging
sexuality
 Dealing with peer rejection
and isolation
 Addressing more serious
behavioral issues
 Estate/Trust planning
 Redefining parental roles
and expectations
 Learning about post-21
services
 Educational Focus
 Vocational
 Domestic
 Self-care
 Community
 Communication
 Social Skills
 Recreation
 Functional Academics
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Launching (17 to 21 Years)
 Family Issues
 Adjusting emotionally to
having an adult
son/daughter with special
needs
 Residential issues
 Financial and guardianship
planning
 Developing advocacy skills
for adults
 Educational Focus
 Vocational
 Domestic
 Self-care
 Community
 Communication
 Social Skills
 Recreation
 Functional Academics
Transition Planning
 Carefully planned process
 Initiated by any team member
 To establish a plan for either additional training or
employment
 At least 3-5 years prior to the transition target date
 Must involve the majority of IDT members and an
employer or service providers, as needed
Transition Planning Best Practices:
Needs of Individuals with
Disabilities
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Transition planning must be comprehensive to meet the
individual’s total life needs.
 Criterion of Ultimate Functioning (historical)
 Quality of Life
Case Conceptualization:
Treatment Considerations
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What are the goals we should be pursuing for our group of
learners?
How much of what we do could be considered current
within the field of special education and ABA?
With respect to Behavior Intervention Planning should we
be positively focused, assessment driven, and governed by
EBP?
How much of what we do could be labeled as Positive
Behavior Support?
 If we can’t be more exclusively positive what barriers prevent
it?
Case Conceptualization: What are
the priorities?
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What are the priorities for the Support Plan?
Who determines them?
What is the process for that determination?
What is a reasonable (i.e., balanced) program of skill
enhancement and behavior intervention?
 How is that determination made?
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Are there children for whom our model is ineffective?
 How do we make that determination?
 How do we resolve that?
 Do we track them in any way?
Case Conceptualization:
Assessment
 What is our assessment protocol?
 For whom is it provided? When?
 How do we link the findings of assessment to an active plan
of skill enhancement (i.e., teaching) to behavior intervention?
 How is it used specifically for program planning?
 Is it proceduralized? And / or systematized in any way?
Case Conceptualization:
Treatment Considerations
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How much of what we do includes providing either negative
consequences / coercion / punishment to the children /
youth in our care?
To what extent does the professional literature guide
intervention planning / implementation for our students?
Do we follow any specific guidelines?
 Should we have guidelines for practice within our
system?
How much does the analysis of the results of formative data
collection processes impact on our intervention process?
 Is there a system level process for managing these
data?
Case Conceptualization: Additional
Treatment Considerations
 Context for intervention – positive, organized milieu (e.g.,
classroom management)?
 Presence of supervision, monitoring, and quality
management systems
 Orientation to collaborative teaming
 Mediator analysis
Lifestyle Interventions
 Considerations (Turnbull & Turnbull, 1996):
 Interdependence
 Inclusion
 Contribution
Lifestyle Interventions
 Long-range outcomes (Risley, 1996):
 How is the person doing overall over time?
 Is she or he happy, satisfied, and safe?
 Does the person have a stable home and family
and friends on which to base her or his life and
future, and after whom to model her or his ways?
 Is she or he practicing independence,
productivity, and integration?
 Is the person continuing to develop new
interests, new friends, and new skills?
Lifestyle Intervention Components
(Hedeen, Ayers, Meyer & Waite, 1996)
 Relationships with others
 Ecological factors and setting variables
 Communication and understanding
 Activity preferences
 Meaningful curriculum
 Choice and self-determination
 User-friendly evaluation strategies
Best Practices
 Focus Upon Quality of Life Indicators
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Choices and control
Opportunities to participate in preferred activities
Community inclusion
Peer relationships
Relationships with family members
Increased independence across settings
Expressive and receptive communication
Are they happy most of the time?
Person-Centered
Planning
The Philosophy
 Person-Centered Planning is build on a philosophy that does
the following
 Takes a capacity-based perspective of the individual
 Uses natural resources to fulfill a vision
 Builds a circle of support for the individual that includes friends,
family and service providers
What is Person-Centered
Planning?
 Person-Centered Planning allows a diverse group of people
who share a common goal or need to align their”
 Vision, Purposes and goals
 Understanding of the focus person’s past, present and
future; and
 Actions for change, mutual support, personal and team
development, and learning.
 Person-Centered Planning is a planning process
 But PCP can also be seen as an assessment tool in that it
evaluates where the person has been, what their
environment is like now, and where they would like to go in
the future.
What is Person-Centered
Planning?
 PCP can also be an intervention.
 PCP has the potential to create and build a strong and
effective team dedicated to supporting the individual with
problem behavior, and well as each other.
What Person-Centered Planning is
NOT:
 An easy, one-shot process
 The answer to all problems
 The replacement for an IEP
 A quick fix solution to complex human and/or organizational
problems
 Something to be done and forgotten
 A guarantee
5 Essential Goals of PCP
 Being present and participating in community (school) life
 Gaining and maintaining satisfying relationships
 Expressing preferences and making choices in everyday life
 Having opportunities to fulfill respected roles and live in
dignity
 Continuing to develop personal competencies
Different Approaches
Different Approaches
A Sample Person-Centered Plan
 Britney
Sample MAP Pages
Sample Relationship Map
Relationship maps are used to find out who is currently
involved with the focus person's life and in what capacity. By
mapping relationships in this way, it allows conscious changes
and developments to be planned and made to the benefit of the
focus person
Sample PATH - Planning Alternative Tomorrows
with Hope
Using the focus person's dreams as a starting point, a PATH is used to help plan the
steps necessary to achieve those dreams and aspirations. The PATH helps to make
clear who's help is needed, how to go back enrolling appropriate assistance, who
will help with what, the first steps to be taken, 6 monthly goals, and so on.
Sample page from an
Independent Living proposal
Sample pages from a kitchen
guide/cookbook
Essential FBA Components
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Design and Delivery of PBS Plans
 Step 1:
 Step 2:
 Step 3:
 Step 4:
 Step 5:
Conduct an FBA
Develop a hypothesis statement
Design PBS plan
Evaluate plan effectiveness
Modify plan as needed
Steps for Conducting a Functional
Assessment and Developing a BIP
Identify and operationally define target
behavior
Purpose: To identify (and prioritize
behaviors that interfere with learning,
productivity, and general well-being
and agree on exact topography
Strategies: Group consensus
FBA: Pre-intervention Assessment
 Identify contextual variables that evolve and maintain
adaptive behavior.
 Identify functional relations that maintain challenging
behaviors (environment and challenging behaviors), both
proximal and distal.
Steps for Conducting a Functional
Assessment and Developing a BIP
Assess the student’s behavior
Purpose: To identify activities and events
associated with occurrences and
nonoccurrences of the problem behavior
Strategies: Questionnaires, checklists,
conversations, structured interviews,
direct observations
Understanding the Individual with
Problem Behavior
 Gather Broad Information
 Individuals strengths and skill limitations (communication,
social skills, self-help skills, play, recreation and leisure).
 Daily Routines and Activities
 Preferences and Goals for the Future
 Medical/Health related Issues
 Quality of Life Considerations: (opportunities for choice,
exercising control, experiencing social relationships,
participating in inclusive settings)
Understanding the Individual with
Problem Behavior
 Gather Specific Information
 When is the individual most and least likely to engage in
challenging behaviors?
 What specific events appear to be contributing to the
challenging behavior?
 What functions do the challenging behavior serve for the
individual (i.e., what are they communicating)?
Steps for Conducting a Functional
Assessment and Developing a BIP
 Develop hypotheses
 Purpose: To formulate data-based (based on assessment
information) hypotheses about why behavior occurs
 Strategies: Review all assessment information; Develop
hypothesis statements that identify variables that can be
manipulated to formulate an intervention
Developing Hypotheses
 Strategy:
 Review assessment information
 Develop hypotheses statements about why behavior is occurring
Steps for Conducting a Functional
Assessment and Developing a BIP
Assess the accuracy of the
hypotheses (optional step)
Purpose: To evaluate whether
hypotheses are accurate prior to
formulating an intervention
Strategies: Brief reversals
Summary Statements
 Purpose: to offer and explanation of the problem behavior in
terms of antecedent and setting events and possible function
Content of Summary Statements
 Description of antecedent and/or setting events
 Description of problem behavior
 Identification of presumed function
Examples of Summary Statements
 When Amy is given difficult work (antecedent) she
engages in property destruction (behavior) to escape
the task (function).
 When Rob has a cold (setting event) and is asked to
perform a difficult task (antecedent) he engages in selfinjury (behavior) to escape the task (function).
 When Sally is left alone without anything to do
(antecedent) she engages in hand mouthing (behavior)
to gain sensory stimulation (function).
 When Tommy is in large groups (antecedent) he
engages in aggression (behavior) to obtain attention
(function)
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All Behavior
Serves a Purpose or
“Function”
Behavior
Gain Access to a
Desirable
Stimulus or Event
Escape/Avoid
an Undesirable
Stimulus or Event
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Escape or Avoid...
Non-Preferred
Object or Activity
(Task)
Social
Interaction
Adults
Peers
Sensory
Stimulation
Steps for Conducting a Functional
Assessment and Developing a BIP
Design an intervention/support
plan
Purpose: To formulate an intervention
that is directly linked to the hypotheses
Strategies: Consider contextual fit
Steps for Conducting a Functional
Assessment and Developing a BIP
Collect data on effectiveness of
intervention/support plan
Purpose: To assure plan effectively
reduces problem behavior and increases
desirable behavior
Strategies: Direct observation; Review
permanent products, natural documents
Essential Plan Components
Developing Behavior Intervention
Plans
 Based on hypotheses established in the assessment
process.
 Person Centered in that goals and intervention strategies
preserve the individuals’ dignity, and reflect their preferences.
 Individualized to reflect a good fit between the person’s
needs and corresponding intervention strategies.
Best Practices
 Among other components, the written PBSP contains
a description of antecedent modifications, functionally
equivalent alternative responses (and teaching
strategies), differential reinforcement systems, and
consequences designed to eliminate or minimize
reinforcement after undesirable responses
 Objective data is used to determine program
effectiveness and to guide modifications in the PBSP
Outline of a Behavior Support Plan
 Set Up (description, strengths, vision)
 Assessment
 Operational Descriptions, Routines, FA Hypotheses
 Foundations (if needed)
 Prevention
 Teaching/Education
 Consequence Procedures
 Minimize reward for problem behavior
 Ensure regular, clear reward for positive behavior
 Punishers (if needed)
 Define safety/emergency procedures (if needed)
 Evaluation and Monitoring for Improvement
 Steps for implementation
Why Should a Support Plan be
Multicomponent?
 Many variables usually influence whether problem behavior
will occur; therefore effective support most often involves
manipulation of several of these variables
 Long-term reduction in problem behavior usually requires
intervention in several areas
Best Practices
 Comprehensive Staff Training and Support
 Pre-service and in-service training and workshops
 Performance checklists
 Ongoing supervisory feedback and support (structured classroom
observations, supervision meetings, and so on)
 Weekly classroom team meetings
Best Practices
 Family Inclusion and Support
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Participate fully in planning
Updated routinely on child’s progress
Frequent opportunities to communicate with staff
Access to informational seminars and training on interventions
and strategies
 Futures planning
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Common Elements of Good Interventions
 A comprehensive assessment of skills is completed
 Targeted skills are meaningful to the student and will facilitate
independence
 Lessons are designed to enhance student motivation
 Spontaneity is taught early on
 Communication training occurs across environments and across
the student day
 Communicative responses that are taught can be understood by
all members of the community
Change Behavior Successfully
 Prioritize and work with only 1 or 2 behaviors at a time
 Require only gradual improvement in behavior
 Use procedures that are easily implemented and inexpensive
(to the extent possible)
 Use immediate consequences whenever possible
Change Behavior Successfully
 Teach the behaviors you want to see the individuals exhibit
 Use and fade prompts to increase the likelihood of
appropriate behavior
 Pair social reinforcers with tangible or activity reinforcers
 Thoroughly organize and precisely introduce the program to
the individual
Steps for Changing Behavior
 Decide on which behavior to change
 Operationally define the behavior
 Collect data for a baseline on the behavior
 Intervene on the behavior
 Graph and evaluate the ongoing process
 Revise the program if needed
Interventionists To-do List
 Consider the use of program-wide rules
 Limit to no more than 5 sspecific, observable, and
positively stated
 Post rules in prominent places
 Develop a plan for providing frequent positive feedback for
following rules and routines.
 Develop consequences for common rule infractions
(consequence should fit the violation and be as mild as
possible)
 Develop an attention signal
 Design routines for most common procedures in the
setting
Interventionists To-do List
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Analyze the physical setting and modify if needed and
possible
Develop lessons and provide regular review of rules and
routines
Design activities to maximize engagement in meaningful
tasks
Set and plan to achieve goals to improve instructional
delivery
Things to Remember!
 Let the data drive your hypothesis development
 Individuals may engage in problem behavior for a variety of
reasons
 A single problem behavior may serve more than one function
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PBSP
 Components of a PBSP
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Antecedent Strategies
Functional Equivalence Training
Differential Reinforcement
Consequence Strategies
Evaluation and Modification
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Characteristics of PBSP
 Based on assessment results and hypothesis driven
 Emphasizes skill building
 Comprehensive, usually involving multiple intervention
components
 Focus on long-term solutions, not quick fixes
 Team approach
 Function rather than form
Categories of Intervention
Establishing
Operations
Ameliorate
Eliminate
Immediately
Before
Behavior
Relative to
Function
Antecedent
Manipulations
General Skills
Training
Equivalence
Training
Self-Regulation
Training
After
Behavior
Instructional
Consequence
Reduction
Oriented
Consequence
What are Antecedent
Interventions?
 Environmental modifications that are made to reduce the
likelihood that problem behavior will occur
 Antecedent interventions are arranged before the problem
behavior occurs
What are Antecedent
Interventions?
 Environmental modifications that are made to reduce the
likelihood that problem behavior will occur
 Antecedent interventions are arranged before the problem
behavior occurs
Replacement Behavior
 Behavior that serves the same function as the problem
behavior but is socially appropriate
How Can We Assure Appropriate Behavior
Will Replace Problem Behavior?
Make it effective:
 Reinforcement should always be
provided at first
Make it efficient:
 Response should be less effortful than
problem behavior
 Reinforcement should occur
frequently and quickly
Rationale for Alternative Skills
Instruction
 Individuals do not have the general skills to cope with
everyday demands; therefore, problem behaviors occur
Categories of Alternative Skills
 General skills
 Self-management skills
 Coping and tolerance skills
Purpose of Consequences
 To teach alternative responses to problematic situations
 To respond to problem behavior in a way that is least likely to
reinforce it
Consequence Approaches
Feedback
Problem Solving
Response Cost
Time Out
Restitution
Extinction (Ignore)
Natural Consequences
Advantages/Disadvantages
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PUTTING IT ALL TOGETHER
 Design intervention that
Look at behaviors,
teaches child more
assess, identify function
acceptable behaviors
Why Plans Fail
Failure is not an
option…
(but does happen)
Failure is not inescapable BUT its
impact can be minimized
 You cannot strive to serve the most challenging students
and escape failure
 Failure per se is less of a problem than the refusal to
acknowledge and act upon it
 At every Devereux Center, at any given time, every
 Psychologist and school has a failed BMP
 The center has a student whose failed BMP
leaves someone open to injury or other risk
management issue.
Why are plans for high risk
students more likely to fail?
 Behaviors can result from a broad range of biopsychosocial
factors and / or skill deficits
Student’s cognitive / skill level
Variable mood / affect
Psychiatric issues
Abuse / victimization history
May have more limited range of education / interests / positive
influences
 Poor case conceptualization / training / implementation of plan
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What did we miss?
 Plan is not proactive
 We missed something in the data?
 Staff not trained sufficiently to implement plan successfully
 Plan is not positive
 Plan does not teach new skills (new skills take time to learn)
 Plan was not given sufficient time to work
 Plan contains unintended aversives that cause behavior
deterioration
 Team is not a team