Culturally Responsive PBS with Families of Diverse Cultural

Culturally Responsive PBS with Families of Diverse Cultural and Linguistic Backgrounds Joseph M. Lucyshyn, Christy Cheremshynski, Cathryn Schroeder, & Ishu Ishiyama, University of British Columbia Deborah Olson, University of Oregon Making Connections Conference Richmond, B. C. November 5, 2013

The Need for Culturally Responsive PBS Services � Research over past 16 years has documented the effectiveness of PBS with families of children with developmental disabilities and problem behavior � Vaughn, Clarke, & Dunlap, 1997; Koegel, Steibel, & Koegel, 1998; Clarke, Dunlap, & Vaughn, 1999; Buschbacher, Fox, & Clarke, 2004; Lucyshyn et al. , 2007; Duda, Clarke, Fox, & Dunlap, 2008 � � Little of this research has been conducted with families of diverse cultural and linguistic backgrounds � Vaughn, Wilson, & Dunlap, 2002; Wang, Mc. Cart & Turnbull, 2007; Binnendyk & Lucyshyn, 2009 � Growing diversity in the U. S. and Canada creates a need for culturally appropriate PBS services. Visible minorities account for 79% of recent population growth in United State and 83% of population growth in Canada � Bernstein, 2006; Statistics Canada, 2008

Culture �Culture can have a profound effect on the interactions between families and service providers. �Families raising a child with disability may be influenced by cultural views on: � Child rearing practices � Disability � Family roles and structure � Communication styles within and outside the family �A failure to recognize cultural differences can make collaboration and service delivery difficult when providing support to parents (Lynch & Hanson, 1998).

Cross-Cultural Competence Educators and mental health professionals agree that to establish culturally appropriate services, cross-cultural competence is necessary. � � Sue et al. , 2009; Lynch & Hanson, 2011 Cross Cultural Competence (Cross et al. , 1989) � � “A set of congruent behaviors, attitudes, and policies that come together and enables a system, agency, or professional to work effectively in a cross-cultural situation. ”

Cross-Cultural Competence � Lynch and Hanson (2011) described three elements in the development of cross cultural competence: Awareness of one’s own culture and heritage 2. Knowledge specific to the target family’s culture 3. Ability to apply cultural knowledge and develop skills necessary to work with the family 1.

Developing Culturally Responsive PBS Plans �Chen, Downing, & Peckham-Hardin (2002) developed a cultural assessment tool to assist in the design of culturally appropriate PBS plans �Three sections: � Planning for interactions with family � Gaining culturally relevant information � Self-evaluating interactions with family members with aim of developing culturally-responsive partnership

Questions to Guide Culturally Responsive PBS (Chen et al. , 2002)

Questions to Guide Culturally Responsive PBS (Chen et al. , 2002)

Questions to Guide Culturally Responsive PBS (Chen et al. , 2002)

Need for Research on Culturally Responsive PBS �PBS uniquely suited as a scientific discipline to empirically develop culturally responsive PBS services (Carr et al. , 2002) � Ecological validity � Flexibility in regard to scientific practice � Multiple theoretical perspectives �Combining quantitative and qualitative research methods provides a promising way to study and develop culturally responsive PBS � Single case design methods to evaluate effects � Qualitative methods to understand cultural aspects of family life and the perspective of interventionists and parents involved in PBS services

Three Studies in Culturally Responsive, Family Centered PBS

Studies in Culturally Responsive PBS �Cheremshynski, Lucyshyn, & Olson (in press) � Japanese family � 5 year old boy with autism �Lucyshyn et al. (in preparation) � Taiwanese family � 8 year old girl with moderate intellectual disability �Schroeder et al. (in progress) � Taiwanese family � 5 year old girl with autism

Independent Variable: Culturally. Responsive, Family-Centered PBS Approach �Build collaborative partnership �Conduct comprehensive assessment � Functional assessment � Family ecology assessment � Cultural assessment (2 studies) �Design PBS Plan for target family routine(s) �Identify and provide family-centered supports �Provide implementation support � Initial training and support � Maintenance support �Follow-up evaluation and support as needed

Dependent Measures �Percentage of intervals of problem behavior �Percentage of routine steps completed �Latency in minutes to termination of routine due to problem behavior or to successful completion of routine �Social validity �Contextual fit

Research Designs �Withdrawal design (1 study) � A-B-C �Multiple baseline design across two routines (2 studies) � Three phases: Baseline; Intervention; and Follow-up �Qualitative case study design (2 studies) � Semi-structured interview on family culture (family assessment from cultural assessment tool) � Interventionist journal � Review of coding categories by qualitative researcher � Member checks

Implementation of a Culturally Appropriate PBS Plan by a Japanese Mother of a Boy with Autism Christy Cheremshynski & Joseph M. Lucyshyn University of British Columbia Deborah Olson University of Oregon

Kenji and Family � 5 year old boy with autism � Healthy and active � Enjoys outdoor activities � Non-verbal; uses Picture Exchange System �Family from Japan – immigrated 10 years before � Mother – homemaker � Father – sushi chef � Older sister �Problem behaviors � Non-compliance, physical resistance, whining, crying, leaving assigned area, taking off clothing �Target routine � Dinner time with mother and sister

PBS Plan for Kenji Preventive Strategies Teaching Strategies � Limit amount of food that � Use proactive task Kenji eats one hour before dinner � Provide Ken with advanced warning � Use visual strategies to increase predictability of routine steps and expectations (e. g. , picture sequence, visual contingency) � Use positive contingency statements prompts to teach Kenji dinner time behavior and skills Consequence Strategies • Give praise , physical � Teach Ken to use picture symbols and sign language to request more food or to inform parent he is “all done. ” � Teach Ken to keep his favorite things in a designated area. • • • attention, and preferred foods contingent on desired behaviour (e. g. , sitting in chair at table, using utensils, keeping clothing on) Give preferred activity (T. V. ) contingent on finishing meal. For minor problem behaviour, actively ignore and redirect For major problem behaviour, remove objects, wait until calm, redirect back to table

Cultural Fit Considerations �Cultural assessment offered 3 points of enhancement to the PBS plan � Incorporate both English and Japanese languages into dinner routine � Teach table manners similar to those taught to children in Japan � Adapt positive reinforcement strategies so that they are culturally comfortable to mother �Physical affection �Small tangible rewards

Problem Behavior

Routine Steps Completed and Latency in Minutes

Contextual Fit Rating Treatment Integrity � 4. 7 �Percentage of intervals (1 = poor fit; 5 = good fit) � Comments: � “When I was little the whole family ate together, Now I’m glad he joins in. It is nice. ” � At first I thought it was going to be hard, but it became a natural thing. It was easier that I thought, so I can continue to do it. ” of: � accurate use: 67% � inaccurate use: 4. 7% � nonoccurence: 27. 9% �Percentage of accurate use across all attempts: � 93. 5%

Qualitative Findings �Building and maintaining rapport informed by cultural knowledge � Understanding and working through communication barriers � Adapting communication and teaching style �Obtaining guidance from a cultural interpreter � Reading literature on Japanese culture � Decoding Japanese cultural rules � Learning common Japanese phrases �Recognizing and accommodating a cross cultural belief system � Incorporating elements reflecting both cultures into plan

Transforming Coercive Processes in Family Routines with a Taiwanese Family of a Child with a Moderate Intellectual Disability Joseph M. Lucyshyn, Christy Cheremshynski & Lynn Miller University of British Columbia

Amanda and Family �Girl 8 – 12 years old with moderate intellectual disability �Family from Taiwan � Mother – homemaker human relations � Father – money trader liaison for new immigrants �Problem behavior � Non-compliance/defiance, negative vocalizations (e. g. , whining, yelling, crying), physical aggression, disruptive & destructive behavior, �Routines � Parent preparing supper/child free-time � Bedtime

PBS Plan for Amanda Preventive Strategies � Use social stories to help Amanda understand steps and expectations of target routines � Use visual contingencies to encourage Amanda to engage in desired behaviour � Use a timer to help Amanda predict when parental attention will be given � Offer choices Teaching Strategies � Use errorless teaching Consequence Strategies • strategies (i. e. , proactive assistance to ensure success). � Teach Amanda to be independent by informing her of the value of independence and by gradually fading your assistance and presence • • � Teach Amanda to use appropriate language to communicate her wants and needs (e. g. , ask nicely for attention or help). • Give praise and rewards contingent on desired behaviour (e. g. , playing nicely, remaining occupied while parent is busy, complying to requests) Honour requests for attention or help For minor problem behaviour, actively ignore and redirect to positive behaviour For major problem behaviour, remove yourself for 1 minute, then redirect

Cultural Fit Considerations when Supporting this Taiwanese Family �Begin intervention with mother �Go family’s pace (slow but steady) �Build on family cultural strength: Buddhist belief system � Mother participated in teaching father to implement PBS strategies with Amanda

Multiple Baseline Results for Problem Behavior and Steps Completed

Social Validity and Contextual Fit (1 = unacceptable or poor fit; 5 = acceptable or good fit) �Social Validity �Goodness of Fit � 10 measures � 11 measures (2007 -10) � 5. 0 Average � Range 5. 0 -5. 0 (2006 -10) � 4. 7 Average � Range 3. 7 – 4. 9

Family 12: Experiences and Perspectives

Culturally Responsive, Family. Centered PBS with a Taiwanese Family of a Child with Autism Cathryn Schroeder & Joseph M. Lucyshyn, & Ishu Ishiyama University of British Columbia Deborah Olson University of Oregon Daisy Wang Autism Spectrum Therapies

Mia and Family � 4 -5 year old girl with autism � Bright and energetic, � Affectionate � Can speak but tends to use one-word phrases �Family from Taiwan � Mother – homemaker � Father – engineer � Primary language at home Mandarin �Problem behavior � Non-compliance/defiance, negative vocalizations (e. g. , whining, crying screaming), elopement, low intensity physical aggression and self-injurious behavior �Routines � Dinner with family � Cooperative play with older brother (table games)

PBS Plan for Mia in Dinner Routine Preventive Strategies � Prepare an age- Teaching Strategies � Interventionist does 1: 1 intensive training until Mia is able to eat an age Provide advanced appropriate sized bowl of warning rice, vegetables, and meats � Use stimulus and response Use visual supports fading for meal size, food (e. g. , visual schedule, piece size, and types of visual contingency map, food “take a break” card) � Use errorless teaching Use positive strategies (i. e. , proactive promoting to ensure contingency statements success). Use safety signals � Teach Mia to use Provide non-contingent appropriate language to attention during dinner ask for a break. Consequence Strategies • appropriate meal size � � � (i. e. , conversation) • • • Give praise and tangible reward contingent on desired behavior (e. g. , sitting in chair, eating food served, eating at a faster pace) Provide a 2 -minute break contingent on asking. For minor problem behavior, actively ignore and redirect to task For major problem behavior, block harmful behaviors, minimize attention, wait until Mia calms down, redirect back to task

Contextual and Cultural Fit Considerations Contextual Fit Cultural Fit � Establish equity between � Ensure that plan supports siblings � Teach parents problem solving skills to minimize spousal conflict � Build on parents’ value of being loving and affectionate with children parents’ core cultural value of nurturing happiness, politeness and respect � Provide a translator and translate documents for mother into Mandarin � Begin intervention with father � Refrain from putting mother in position of having to use escape extinction before she is intellectually and emotionally ready

Problem Behavior and Steps Completed

Treatment Integrity �Percentage of intervals of accurate use: 83. 5% �Percentage of intervals of inaccurate use: 5. 0% �Percentage of intervals non-occurrence: 11. 4%

Contextual and Cultural Fit Ratings �Father – 4. 6 �Mother – 4. 8 �Comments: � “Our main goal was for Mia to sit and eat dinner. Now she does that. So our priority was met” (mother) � “We will use all of the strategies for the rest of our life” (father)

Parent Reported Collateral Effects �Generalization to other meal routines and foods �Generalization of cooperative play �Generalization of PBS strategies to non-related routines

Qualitative Findings 1. Partnership with a translator �Understanding need for a translator, �Development of strong relationship between translator and family �Importance of interventionist maintaining therapeutic alliance with family in context of translation work. 2. Development of a therapeutic alliance �Cultivating ingredients for a strong alliance Trust, respect, hope, gratitude, compassion, open communication �Maintaining parent-professional equality �Family member assuming role of cultural liaison

Qualitative Findings 3. Understanding and accepting shared and divergent cultural perspectives �Understanding the family’s Taiwanese culture and how it changed over time �Identifying cultural and linguistic similarities and differences �Maintaining intent to be culturally responsive 4. Identifying and rectifying errors and barriers �Maintaining a beginner’s mind �Persevering to gain deeper levels of knowledge �Utilizing knowledge to prevent or correct errors/barriers

Qualitative Findings 5. Continually reflecting on, developing knowledge of, and taking steps toward cultural competence � Maintaining intent to be culturally responsive � Posing and answering questions about being culturally responsive

Eight Culturally Responsive Practices Build and maintain rapport informed by cultural knowledge 2. Obtain guidance from a cultural interpreter 3. Partner with a translator 4. Develop a therapeutic alliance 5. Understand accept shared and divergent cultural perspectives 6. Recognize and accommodate a cross cultural belief system 7. Identify and rectify errors and barriers 8. Continually reflect on, develop knowledge of, and take steps toward cultural competence 1.

Implications for Practice 1. Value of using a cultural assessment tool � Essential in building an understanding of the family’s culture � Provided guidance for developing cultural competence � Prompted cultural self-reflection 2. Advantages of including evaluations of contextual and cultural fit � Vital in determining the extent to which service provision proceeded in a manner that was responsive to the culture and ecology of the family � Eight themes may serve as preliminary guide to interventionists

Limitations �Lack of experimental control in 2 of 3 studies �Only one study with extended follow-up data �Time intensive nature of intervention in 2 studies (Amanda and Mia) �Potential biases in qualitative findings �Limited external validity

Future Research 1. Replication and extension of culturally responsive PBS research �New populations �Different family structures 2. Identification of most effective and efficient culturally responsive practices �In context of family-centered PBS 3. Investigation into the extent to which culturally responsive practices contribute to positive outcomes �Beyond contributions of family-centered PBS practices

ありがとう! Xie xie! Thank you!