Positive Behavior Supports Changing Behavior through a Person
Positive Behavior Supports: Changing Behavior through a Person. Centered, Individualized Approach Amy Foxman, M. Ed. , BCBA Medical, Behavioral, Psychiatric Support Team MHMR Tarrant
Objectives • Define what challenging behavior is in order to recognize it. • Define and understand Positive Behavior Supports. • Get a brief overview of some of the components, processes, and strategies that make up Positive Behavior Supports, as well as best practices.
Contributions • Portions of this presentation were provided by the Center on the Social and Emotional Foundations for Early Learning; http: //csefel. vanderbilt. edu/index. html.
What is challenging behavior? • Brendan Before (V 3 a. 2): Center on the Social and Emotional Foundations for Early Learning
What is challenging behavior? • Repeated behavior that interferes with learning, activities, or engaging with others. • Behaviors not responsive to developmentally appropriate responding procedures. • Causes damage or disruption to self or others.
What are positive behavior supports? • Approach for changing behavior with primary goal of improving individual’s overall quality of life. • Research-based. • About understanding function of the challenging behavior and teaching new skills to replace the challenging behavior. • Holistic approach– considers all factors that impact an individual, family, and behavior. • Uses person-centered values to achieve meaningful outcomes. • Focuses on self-determination and individual and family involvement.
Before PBS • Brendan’s Family Clip (V 3 a. 4): Center on the Social and Emotional Foundations for Early Learning
Changing up our thinking
Old approach to behavioral challenges vs. PBS “Old” approach PBS General intervention for all behavioral challenges Individual interventions that match behavioral function Interventions are reactive Interventions are proactive Focus on reducing behavior Focus on teaching new skills Quick fix Long-term interventions
IDD and Behavioral Functions • • Medical conditions and medications Mental health disorders Past traumatic experiences Often, complex challenging behaviors are maintained by multiple factors with individuals with IDD.
Behavior is functional Common functions of behavior To escape/avoid: -Escape activities -Escape pain -Escape or avoid interactions with others To obtain: -Obtain food -Obtain attention -Obtain activities -Obtain toys/preferred items -Obtain internal stimulation (selfstimulatory behavior, self-injury)
Behavior as communication • Challenging behavior may serve as way to communicate when does not have language to communicate • Challenging behavior may be used instead of language by individual with limited social skills or anxiety • Individual may have learned challenging behavior is effective (achieves desired result)
Examples of behavior as communication • May be trying to say: – “No!” – “I need a break. ” – “Help me. ” – “I want that. ” – “I want more. ” – “I want to stay. ” – “Play/be with me. ”
Process for PBS 1. Establish the PBS team. 2. Conduct an Functional Behavior Assessment: • Identify and define challenging behaviors. • Gather data. • Create hypotheses on behavioral functions (state purpose of the behavior; best guess about why behavior occurs based on data). 3. Develop, implement, monitor, and reevaluate behavior support plan if needed.
The Plan • Determining function is important strategies of plan are based on this. • Plan written in coordination with all team members.
Potential team • • • Individual Parents/family members Guardian Educators (teacher, principal, paraprofessional) Therapists (BCBA, OT, PT, SLP, etc. ) Residential staff Service Coordinators, START Coordinators Physicians Psychologist, Counselor Other(s)
Components of the PBSP • Setting event strategies – Setting event: event that occurs at another time that increases likelihood individual will have challenging behavior. • Prevention strategies • Teaching new skills • How to respond to challenging and positive behaviors • Training in PBSP (staff, family, etc. ) • Monitoring and evaluating outcomes
Behavioral Chain Setting event Antecedent (Trigger) Behavior Consequence
Setting event strategies • Eliminate or reduce the occurrence of setting events • If setting events have already occurred, minimalize their impact. • Examples?
Setting events: Quality of Life • You are more likely to have challenging behaviors when: – Everything you do all day is difficult. – You dislike what you do all day. – You do not have anything to do all day. – You are told what to do all day.
Prevention/Antecedent strategies • Prevention strategies are powerful. • Prevention strategies prevent behavior from occurring. • There are general strategies and targeted strategies based on function.
General prevention strategies 1. 2. 3. 4. Share control Increase predictability Improve overall quality of day Improve relationship, or rapport, with individual
Shared control • Offering choices • Picking your battles
Increase predictability • Reinforcement – Positive reinforcement: when presented after the behavior, increases the future rate or probability of the behavior. (Example: Tim cleans up and afterwards is given five minutes with preferred toy truck. The presentation of his toy truck after clean -up increases the future probability he will clean up. ) • Routines/Activities/Events
Visual timers
Visual schedules
Teaching new skills “If a child doesn’t know how to read, we teach. ” “If a child doesn’t know how to swim, we teach. ” “If a child doesn’t know how to multiply, we teach. ” “If a child doesn’t know how to drive, we teach. ” “If a child doesn’t know how to behave, we…. …. teach? ……… punish? ” “Why can’t we finish the last sentence as automatically as we do the others? ” -Tom Herner (NASDE President, Counterpoint 1998, p. 2), Center on the Social and Emotional Foundations for Early Learning
Teaching new skills Setting event Antecedent Behavior New Skills Consequence
Eric Antecedent: Eating; peers try to join at table. Behavior: Hits peers Replacement: “I want to eat alone. ” Consequence: Eats alone.
Jill Antecedent: Room gets crowded and noisy (lots of sensory stimulation) Behavior: Screams; selfinjury Replacement: Quietly goes to break room Consequence: Leaves room.
Brad Antecedent: Sitting at activity for 30 minutes. Behavior: Falling out of chair; pinching neighbors. Replacement: Break card; ask for a break. Consequence: Removed from activity.
Teaching new skills • Replacement communication: What is individual trying to communicate? • Replacement of sensory • Emotional regulation strategies • Teaching alternative skills and skill deficits
Replacement communication • What is the individual trying to communicate? • Teach an alternative.
Teaching alternative skills • Create or look for situations where challenging behavior may occur. • Catch individual before challenging behavior may occur. • Immediately reinforce appropriate skill each time. • Build in tolerance for delay: slowly delay access to what they are requesting (break, more time, attention).
Remember… • Replacement behaviors take time and energy to teach. • Practice, practice! Different places, situations, people. • Always reinforce!
Emotional regulation strategies • What is emotional regulation? – Awareness and understanding of one’s emotions and how they impact behavior – Ability to regulate and manage emotions in the environment • Must: • Recognize the warning signs of dysregulation! • Use strategies to get oneself calm. • Sometimes problem-solve.
Emotional regulation strategies
Behavioral Chain – Consequence Setting event Antecedent Behavior Consequence
Consequence Strategies • Reinforcement for appropriate behavior • Extinction • Punishment of challenging behavior
Consequence Strategies Inappropriate behavior Consequence 1 Antecedent Appropriate behavior Consequence 2
Consequence Strategies – Typically Used Sitting at activity for 30 minutes Falling out of chair; pinching neighbors Gets removed from activity; big reaction from others. Sitting through activity and completing it Finishes activity. Doesn’t get removed.
Consequence Strategies – Manipulating reinforcement Sitting at activity for 30 minutes Falling out of chair; pinching neighbors Sitting through activity and completing it Gets removed from activity; big reaction from others. 10 minutes computer time! (better than escaping activity)
Manipulating reinforcement • Positive reinforcement: when presented after the behavior, increases the future rate or probability of the behavior. (Example: Tim cleans up and afterwards is given five minutes with preferred toy truck. The presentation of his toy truck after clean-up increases the future probability he will clean up. ) • Make reinforcement better than what may be gotten through performing challenging behavior • Manipulate by making reinforcement larger, delivering it more often, making reinforcement stronger • Deliver reinforcers immediately after correct response • Use behavior-specific praise • Vary reinforcement
Extinction • When previously reinforced behavior is no longer reinforced behavior is then decreased. • Beware of extinction burst. Behaviors may get worse before getting better. • May be difficult to use with teams due to consistency of implementation. • Safety is important consideration. • Always combine with other prevention, teaching, and reinforcement strategies.
Punishment • Last resort – always use positive strategies first. • Immediately follows behavior and reduces likelihood behavior happens again (reinforcement increases likelihood behavior occurs again). • Examples: time out from reinforcement, natural consequences, overcorrection (natural consequence plus more), response cost (removal of a reinforcer contingent on behavior). • If using, make sure behavior is decreasing– about data!
After PBS • V 3 a. 5 Brendan – Support Plan • V 3 a. 6 Brendan’s Family - Support Plan (Center on the Social and Emotional Foundations for Early Learning)
Our plan is “perfect” – what is the problem? ! – Not used. – Not consistently implemented. – Implemented, not maintained over time.
Considerations • The team: Fit for who is implementing the plan • The environment: Fit for environment the plan is implemented. • The individual: Fit for who plan is designed.
The team • Who makes up the team? • What affects the team? – Values – Skills – Attitudes – Comfort – Stressors – Support
The team • Supporting the team – Listening to all – Addressing emotional/personal needs – Conversations about challenging behaviors – Input from all involved – Feedback on strategies used (roleplay, model, etc. ) – Positive reinforcement
The individual • • • Strengths-based approach Increases quality of life in meaningful way Focuses on individual’s interests, preferences, goals Addresses each area of need Outcomes include assisting in: – – Developing and maintaining satisfying relationships Having meaningful work and/or educational opportunities Participating in recreational opportunities Gaining skills to function in his community (Anderson, C. M. & Freeman, K. A. , 2000)
The environment • Environment: Includes physical, routines/activities, schedules, people. • Challenges in implementation: – Logistics. – May not work with every day routines. – Not sustainable. • Alter existing routines as little as possible when creating plans.
In the end… • The process does not end! • Keep • Taking data. • Working with the team and individual. • Monitoring changes as environment, systems, and circumstances change. • Reevaluating the plan for best fit.
Sources Anderson, C. M. , & Freeman, K. A. (2000). Positive behavior support: Expanding the application of applied behavior analysis. The Behavior Analyst, 23, 85 -94. Carr, E. G. , Dunlap, G. , Horner, R. H. , Koegel, R. L. , Turnbull, A. P. , Sailor, W. , … Fox, L. (2002). Positive behavior support: Evolution to an applied science. Journal of Positive Behavior Interventions, 4(1), 4 -16. Center on the Social and Emotional Foundations for Early Learning. (n. d. ) Individualized intensive interventions. Retrieved from http: //csefel. vanderbilt. edu/resources/training_preschool. html.
Amy Foxman, M. Ed. , BCBA Medical, Behavioral, Psychiatric Support Team MHMR Tarrant 817 -569 -5341 Amy. foxman@mhmrtc. org
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