COORDINATION PBS TEAM

Orientation Guide

20131

What is PBS

It is a philosophy and a set of tools► A way of thinking and doing► Positive behavior support offers a proactive

process for addressing interfering behaviors, teaching adaptive skills, and improving quality of life.

► Positive means we are focusing on increasing adaptive skills, not decreasing interfering behaviors.

What is the PBS Network

An inter-agency coalition promoting positive support to enhance the quality of life for persons with

disabilities.

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Polk County PBS Mission & Values

► We are an inter-agency coalition promoting positive support to enhance the quality of life for persons with disabilities.

► We make decisions based on: Dignity & respect Long-term commitment System consistency Person-centered Empowerment through training, support, &

education Reducing the need for rights restrictions Promoting full citizenship and the exercise of

choice

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PBS Provider Agencies

► Candeo► Case Management► ChildServe► Community Support Advocates► Crest Services► Easter Seals► Eyerly-Ball Residential► ISA/FACT► Link Associates► Lutheran Services in Iowa► Mainstream Living 5

PBS Provider Agencies

► Mosaic► Optimae LifeServices► Polk County Health Services► Progress Industries

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Coordination PBS Team

►Comprised of representatives from each of the case management/service coordination/IHH agencies in Polk County.

►Overall Goal: Embed the PBS Culture into the coordination service delivery system.

What Does Positive Behavior Supports Look Like in Case Management/Care

Coordination?►Used to assist consumers and their

support systems in Identifying interfering behaviors which are

not working for them Understand the triggers, antecedents, and

consequences of the behavior Identify and learn to utilize other behaviors

that are healthy.

IDENTIFY. UNDERSTAND. LEARN 8

PBS Catalyst

► The role of the Case Manager/Service Coordinator/Care Coordinator in PBS is to be a catalyst for moving PBS throughout all services provided to the individuals we support by: Educating support systems

Setting the tone of services: Recovery and Growth

Supporting implementation through Crucial Conversations with providers and team

members.

Asking the right questions

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Questions to Ask

► What about doing an assessment?► What is the unmet need?► What is the person communicating?► What does the person do well?► What behavior would be more desirable? What

can you live with that isn’t bad?► What is the positive behavior with which we

want to replace the interfering behavior?

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Questions to Ask ► What changes in routines have you noticed? In

what routine? - Who, what when, where, how?► What tools could be used to help define what is

happening and lead us to what we might be able to do?

► What is the setting event, antecedent and interfering behavior?

► How are people responding when the behavior occurs (staff and other people around the consumer)?

► What works?► What has been tried before? Why didn’t it

work?► How can we reengineer the environment?

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Defining Characteristics of PBS

►Person Centered►Collaborative on-going process►Data-driven decision making►Prevention, positive, proactive

strategies►Meaningful outcomes

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Five Essential Goals of Person Centered Planning

► Expressing preferences and making choices in everyday life

► Gaining and maintaining satisfying relationships

► Having opportunities to fulfill respected roles and live in dignity

► Being present and participating in community life

► Continuing to grow

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Characteristics of Person-Centered Planning

► Includes and focuses on the individual► Respects the individual and their dreams

and choices

► Emphasizes strengths, abilities, and

capacities

Strengths-Based Training principles

► Individualized supports

► Empowers the consumer and team 14

Person Centered PlanningCollaboration and Teaming

► Effective collaboration and teaming helps:

- reach consensus on top priorities with the person, the family and other team members.

- conduct a functional assessment and develop a hypothesis that explains the reason for the individual’s interfering behavior.

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Respect – Fundamental to PBS

►A personal quality that is non-contingent, provided without judgment, and given equally to all persons.

►People should not have to earn your respect they should be the recipient of your respect without condition.

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IS NOT

► Simple► Short Term► Just Decrease

Behavior► Reactive► Aversive (punish)► Observable

Behavior► Experts Decide

IS

► Comprehensive► Long term► Teach Useful Skills► Proactive► Positive (reinforce)► Function (message

behind the behavior)► Involve Individual

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Person Centered Planning

End of Part One

Part 2: Philosophy of PBS

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The Purpose of Life is a Life of Purpose

How you see me….. How I want to be seen….

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Universal Enhancements

►Pomeranz/Recovery philosophy-get folks into roles-create things of value.

►Identify the life the people we support want and coach them into it.

►If someone has nothing of value, what difference does it make if you take it away?

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Universal Enhancement Strategies

Things of Value

INTERFERING

BEHAVIOR

Spontaneity

Positive rituals

Dining out

Exercising

Day at the spa

Dancing

Sex

FriendsVoting

Having a will

Family

Fishing

Movies

Vacationing

Good Health

Grilling out

Music

Volunteering

Work

Pets Hiking

Religion

Gardening

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GEM

►Good Enough for Me –Tom Pomerantz

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I have come to the frightening conclusion that I am the decisive element in my environment. It is my personal approach, which creates the climate. My daily mood makes the weather. I

possess tremendous power to make a person’s life miserable or joyous. I can be a

tool of torture or an instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it is MY response that decides whether a crisis will be escalated or de-escalated and a person humanized or

dehumanized. (Adapted- Halm Ginott)

Life

We must provide an environment that is healthy enough fora life to happen.

Dan Berkowitz

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Effective Behavioral Support..requires the design of an environment that makes problem behaviors:

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What is a “Behavior”?

►Any action or skill that a person does to accomplish something:

►Examples: Self-inflicted injuries Manipulation Balancing a checkbook Completing homework Attending work

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Behavior is method of: communication both verbally & physically of hopes, dreams, fears,

anxieties, preferences, intentions and priorities

Behavior is also a method to: cope with or respond to demands from others control and

impulses, conform to generally accepted social conduct, and or influences of the environment

Behavior is the result of complex neurological and sensory process.

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Why do people display challenging behaviors?

• Biological/Medical Reasons:Drugs/medicineSeizure activityAllergies/hormonal changesTo mask pain or discomfort

• Self-RegulationTo maintain a level of arousalReaction to a change in sensory input

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• Reinforcement:Internal-it feels goodExternal-to serve a purpose in one’s

environment

• Absence of Alternative SkillMost behaviors have the goal to

communicateMessages are sent through behaviorControl is the key word

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How to Define a Target Behavior

►Definition of behavior needs to be clear, concise, and specific

►A description of what you will see when the behavior occurs.

►Written so that everyone can agree when the behavior occurs.

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Specific Target Behaviors

Examples► high-pitched scream► Kicks chair over► Hits others/self► Completes tasks

Non-Examples► Poor impulse control► Angry, frustrated► Aggressive► Pay attention

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Lack of Understanding

To call someone

lazy, uncooperativ

e or stubborn is to admit we

don’t understand

them.

She’s just plain stubborn. She refused to take her meds again!

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Reframing:► Pejorative Label Obnoxious Rude, arrogant Resistant Lazy, un-invested Manipulative Just looking for attention Close-mouthed Different, odd Stubborn, defiant Tantrum, fit, outburst

► Positive, Hope-Based Good at pushing people

away Good at affecting

people Cautious Good at preventing

more hurts Good at getting needs

met Good at caring about

yourself Loyal to family and

friends Under-appreciated Good at standing up for

yourself Big message

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Prove It!Prove that:•treating people with dignity and respect •meeting unmet needs•bondingdecreases the frequency and intensity of challenging behavior.

Does it Matter?!

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If an individual doesn’t know how to read, we teach.

If an individual doesn’t know how to swim, we teach.

If an individual doesn’t know how to multiply, we teach.

If an individual doesn’t know how to drive, we teach.

If an individual 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) 36

End of Part 2

Part 3: ToolsHow we get to a Life!

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Tools for PBS implementation

►Detailed functional assessment completed annually.

►Behavior Analysis Form completed on identified behavior

►WRAP (Wellness Recovery Action Planning)

► Journaling and self-tracking►Crisis Planning** PBS tools are used by providers and encouraged by Case

Managers/Coordinators

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Four Steps The Provider Uses When Designing an

Effective Behavior Support Plan

Step One

Step Two

Step Three

Step Four

Gather Information

Develop a Hypothesis

Build a Support Plan

Evaluate effectiveness and modify support plan as needed

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Step 1: Gather Information

Functional Assessment

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What is Functional Assessment

► A functional assessment is a process for identifying clear, predictive relationships between events in a person’s environment and occurrences of a challenging behavior. Not a data collection form Not an event*To be created and completed by provider.

Each provider has a variety of assessments to choose from. Our role is to identify when one is needed and request one be done.**

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The ABC’s of a Functional Behavioral Assessment

► Setting Eventthe state a person is in, e.g., the person is tired, or hungry; a state that predisposes a person to behave in a certain way given a particular antecedent.

► Antecedentsany stimulus which precedes a behavior occurrence

► Behaviorsany observable act of an individual; the activity one performs in the presence of a particular stimulus

► Consequencesthe events which occurred following behavior

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Practice the ABC’s

Which is the Antecedent, Behavior and the Consequence in each of these examples. 1. During dinnertime, Ben watches the staff pass the tea pitcher to a peer.

Ben then passes the water pitcher to the staff, who says “ Thank you” to Ben.

2. Betty repeatedly teases Samantha. Following the teasing remark, Samantha throws a magazine at Betty. The staff tells Samantha not to throw things.

3. A staff person tells Natasha that a visitor will be visiting her in a few minutes. Natasha puts on a new dress. The visitor tells Natasha how nice she looks

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Practice the ABC’s

►Setting Event: Person grew up in a home in which he wasn’t getting the attention he needed or deserved.

►Antecedent: His girlfriend broke up with him.

►Behavior: He threatened suicide.►Consequence: He went to the

hospital where he got the attention he needed.

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Alternative Behaviors

►What is the best way to decrease a behavior that is a barrier to getting a life?

►Find an alternative behavior that serves the same function or purpose – gets the same results.

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Take what you can get; closest to what you want!

Reinforce even small improvement or steps to reaching the objective

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Step 2: Develop a Hypothesis

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Hypothesis Formula

►When this occurs (what is the setting event/antecedent)….

►The individual does (behavior)

►To access or avoid (consequences or functions)

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Step 3 : Build a Support Plan

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What is a Behavior Support Plan

► A written document that summarizes strategies that assist in preventing challenging behavior from occurring and helps the consumer learn new skills

► The plan should: develop and maintain skills enhance opportunities for learning and self-

fulfillment Focus on positive rather than negative

techniques

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Behavior Support Plans

► Developed by Integrated Service/Provider staff ► Completed in conjunction with the consumer

and their support team• Develop a plan that assists in preventing

interfering behavior from occurring and helps the consumer learn new skills.

• Should be a living document. It was made to be changed as a person grows and changes.

► Evaluate effectiveness and modify support plan as needed.

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Step 4: Evaluate effectiveness and modify support plan as needed

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Is the plan working?

► Are there improvements in challenging behavior?

► Are there increases in skill development?► Are there improvements in quality of life?

Increased participation Increases choice/decision making Inclusion

► Are there improvements in satisfaction? Consumer and family Staff and others

► Are there improvements in health or well-being?

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Remember, PBS is all about

►Determining the function of challenging behavior and then: Changing environments Teaching new skills Addressing quality of life issues Changing our patterns of interaction

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Point of View

“When you change the way in which you see things-the things you

see will change.”56

Final Thoughts

►There is no such thing as a bad person, just bad luck and bad choices.

►Every person is unique►People do not have limits on what they

can learn, but how and what we teach them is what is limited.

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Treat everyone as though they are who they wish they could

be. (Ghandi)

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Comments/Questions

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