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Working Together

to Resolve Behavior

Challenges through

Positive Behavior

Support

Meme Hieneman, Ph.D., BCBA

APBS 2016, San Francisco

What is Positive Behavior

Support?

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Positive behavior support (PBS) is an approach to supporting individuals with behavioral challenges in complex community settings that combines the science of applied behavior analysis with principles from other disciplines (e.g., positive, ecological, and community psychology) to improve not only behavior, but quality of life.

PBS: Collaborative, Individualized

Problem Solving Process

1. Establish Goals

2. Conduct an FBA

– Gather Information

– Analyze Patterns

3. Develop a Plan

4. Implement Strategies

5. Monitor Outcomes

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What defines collaboration?

What does not?

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Tips for Collaboration

– Communicate

– Establish plans

– Stay focused

– Be flexible

– Respect limits

– Show appreciation

– Be accountable

– Document

– Be sympathetic

– Leave people out

– Work in isolation

– Expect perfection

– Drop the ball

– Ignore advice and

perspectives

– Blame/criticize

– Rely on memory

Do this… Not this…

Step 1: Establish Goals

– Broad goals for child, as well as family and

other support providers

– Specific behaviors of concern

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What do we want to change?

Domains of Quality of Life

Social Relationships

Self Advocacy

Health and Safety

Productive Activity

Community Participation

How do we identify goals?

– Ask child/family/support team

– Watch what the child currently does

– Compare behavior to same-aged peers

– Use person-centered planning process

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Warren: A Positive Vision

Now:

Highly structured activities in home and

community

1:1 supervision

Meltdowns when things go wrong

Perseverates on topics/issues

Social isolation

Gets off task and fails to do work

Go to friend’s house without parents

Establish regular homework routine

Try out activities (boy scouts, run club)

Have chores and get allowance

Independent self-care and clean up

Recognize and adapt to social cues

Engage in clubs and sports

Complete homework

Communicate with friends - sleepover

Coping skills to avoid meltdowns

Big Goals:

Multiple, high quality friendships

Physically active

College bound

Confident and comfortable

NO LIMITS

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“Try It” Activity 1___ years from now we would like our child to

_________.By this same time, we

would like to ________________.

Behaviors of Concern

– What you would like your child to say or do

(including do more often or better)?

– What behaviors would you like your child to stop

or decrease?

– Be objective, avoid assumptions

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What is “problem” behavior?

– Dangerous – endangers self or others

– Destructive – results in property damage

– Disruptive – interferes with activities

– Disturbing – causes social isolation

– Detrimental – delays development

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Is the behavior worthy of intervention?

Baseline

How often?

How long?

How intense?

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Date Frequency

3/21 llll lll3/22 lll

Date Start Stop Duration

3/21 3:16 4:03 47 min3/21 6:10 6:45 35 min

Date Intensity

3/21 0 1 2 3

3/22 0 1 2 3

Warren: Behaviors of Concern

– Completing tasks and activities

– Communicating needs and wants

– Hitting peers and siblings

– Crying and dropping to the floor

– Throwing or damaging materials

– Perseverating on topics (questions)

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“Try It” Activity 2Our child is unable to

______ and/or says or does _______, which interferes with achieving our goals.

(This occurs _____, and _____ would be acceptable).

Step 2: Conduct an “Informal FBA”(Functional Behavioral Assessment)

– Gather Information

– Ask: Interview others people

– Watch: Observe across situations

– Analyze Patterns

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Analyzing Patterns

Antecedent Behavior Consequences

What happensbefore behavior

What the child says or does

What happens after behavior

Who

What

Where

When

Positive behavior, as well as problem

behavior

Gets (e.g., items, attention)?

Avoids (e.g., demands)?

Setting Events: Circumstances (e.g., health, relationships, activity schedule) that affect the probability of behavior

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Warren: Patterns Affecting

Behavior

Antecedent Behavior ConsequencesUnstructured social situations (e.g., free time, sports, games, family events)

Repetitive comments or questions, crying,dropping, hitting

Avoids situations and social demands

Has difficulty completing tasks with precision –makes errors

Crying, throwing or destroying materials, refusing activities

Obtains assistance or task is modified or delayed

Setting Events: Unclear expectations related to social interactions or

tasks, physical discomfort (e.g., uncomfortable clothes), changes in routines or schedules (e.g., when parents were away, changes in caregivers)

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“Try It” Activity 3When ________ happens

our child says or does

_________, which results in

him or her getting/avoiding

____________(your best guess, for now)

Antecedent Behavior Consequence

Step 3: Develop a Plan (BIP)

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Being Proactive Teaching Management

Changing environment to prompt positive behavior and make problem behavior unnecessary

Teaching skills to replace the problem behavior or allow the individual be more successful

Responding to behavior to reinforce positive and not negative behavior

Modifying setting events and enhancing lifestyle to improve behavior

Supporting caregivers to implement interventions consistently

Proactive StrategiesIf the function of the behavior is…

Then proactive strategies should focus on…

Attention Increasing amount of attention providedLetting person know when attention is availableProviding independent activities when busyPrompting to request attention appropriately

Tangibles/activities Clarifying what items/activities are availableRemoving “off-limit” items from surroundingsOffering alternatives to items/activities deniedPrompting to request or negotiate alternatives

Escape/avoidance Modifying characteristics of settings or activitiesAllowing opportunities to choose what and whenShortening activities or providing periodic breaksReminding how to request break/stop correctly

Sensory stimulation Providing other, appropriate sensory stimulation(e.g., keeping engaged in desirable activities)Blocking access to inappropriate stimulationPrompting appropriate forms of stimulation

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Teaching StrategiesIf the contexts/functionof the behavior relates to

Teach skills such as…

Attention Replacement: Teach individual to request attention such as proximity, interaction, or physical contactDesired: Teach individual to wait or entertain him/herself

Tangibles/activities Replacement: Teach individual to request items or activities or initiate access on ownDesired: Teach individual to accept “no”, wait, or negotiate alternative item/activities

Escape/avoidance Replacement: Teach individual to say “no” or “later”, take breaks, or other ways to escapeDesired: Teach individual to remain on task or in the designated area

Sensory stimulation Replacement: Teach individual to obtain sensory input through alternative appropriate actionsDesired: Teach individual to tolerate boredom and appropriate time and place

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Management StrategiesIf the behavior occurs when Then consequences should focus on…

Attention is withdrawn Increase level and frequency of desired attention following positive behaviorMinimize attention (e.g., by ignoring, walking away) when problem behavior occurs

Tangibles/activities are withheld Provide access to tangibles/activities only following appropriate behavior (e.g., requests)Withhold tangible reinforcers after problem behavior (including “negotiation”)

Difficult or unpleasant activities are presented

Allow breaks, escape, changes in environment, or reductions in demands for appropriate behavior (e.g., participation)Withhold or delay escape for problem behavior

Sensory stimulation is unavailable

Allow access to items and activities that provide appropriate sensory stimulationBlock access to inappropriate events

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Changing Settings/Creating Supports

– Enlist other family members, educators, service

providers, friends, neighbors, and others

– Rearrange physical environment to make expectations

and limits amore evident

– Change activity schedule or nature of tasks required

(e.g., Premacking schedule)

– Support development/enhancement of relationships

– Enroll child in community or recreational activities

– Find ways to “fill the buckets” or regular caregivers

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Warren: Behavior Plan

Being Proactive Teaching Management

Written expectations and examplesSocial stories for complex interactionsPersonal spaceTraining for peersGradually increasing expectations

Requesting breaks, assistance, and/or explanationSelf-soothing (e.g., perspective-taking, breathing)Social/conversation skills

Responding quickly to communicationFeedback on social interactions (peer)Homework checklistChecking off workChoice of activities for completing work

Setting event strategies: Preparing schedule and environment in advance, anticipating challenges, group teaching and rewards

Supporting caregivers: Simple written plans, developing lists and examples, team meetings with feedback on progress

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“Try It” Activity 4: Brainstorm Ideas

Being Proactive Teaching Management

Setting event strategies:

Supporting caregivers:

Step 4: Implement Strategies

– Create an action plan

– What needs to occur?

– Who will complete it?

– When will it be done?

– Use strategies consistently

– Adjust as needed

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Ensuring Contextual Fit

Systems

Caregivers

Environment

Individual

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“Try It” Activity 5In order to put our plan in

place, ______ needs to be

accomplished by _____ by

______.

Step 5: Monitor Outcomes

– Reductions in behaviors of concern

– Increases in

– replacement behaviors

– skills needed for daily living

– Improvements in overall quality of life

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Frequency Record: Chores/WeekN

um

ber

of

tim

es h

ou

seh

old

cho

re o

n li

st is

co

mp

lete

d

20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20

19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19 19

18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18

17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17 17

16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16

15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15

14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14 14

13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13 13

12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12 12

11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11

10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10 10

9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9

8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8

7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7 7

6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6 6

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4

3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3 3

2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Dat

es

CountingTimingRating

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Weeks:

Ch

alle

ngi

ng

Be

hav

ior

Number of Aggressive

Episodes

Average Duration

Average Severity 3 2 1 3 2 1 3 2 1

Po

siti

ve B

eh

avio

r

Routines Completed

Hygiene

Put away

Cooking

Exercise

Laundry

Chores

“Words” Used

Attend to me

May I _____

Stop/Later

3 = resulted in injury 2 = caused some level of discomfort 1 = made contact or attempt, no discomfort

Warren: Data From School

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Warren: Other Outcomes

– Competes successfully in triathlons, boy scouts, family

gatherings, and outings with friends

– On grade level and excelling in preferred subjects –

preparing to transition to a new school

– Able to discuss concerns and avoid “melt-downs” –

parents guide him through problems

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“Try It” Activity 6To objectively evaluate

progress for our child, we

will ______________ to

capture behavioral and

lifestyle changes.

Support for the Entire Family

(or Program/Classroom)

– Vision and expectations

– Physical organization

– Scheduling and routines

– Rewards for positive behavior

– Consistent consequences

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Physical Organization

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Scheduling and Routines

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Rewards and Consequences

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“Try It” Activity 7What might you be able to

do that would benefit your

entire family (or classroom/

program/agency) using the

principles of PBS?

In Summary,

we address behavior by…

– Understanding Patterns

– Becoming Proactive

– Teaching New Skills

– Responding Effectively

– Enhancing Lives

– Working Together

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Hieneman, Childs, & Sergay; 2006

meme@pbsapplications.us

Free Resources & References

– APBS Families Site: http://apbs.org/new_apbs/families.html

– Fox, L. & Duda, M. (No Date). Positive Behavior Support. Technical Assistance Center on Social Emotional Intervention for Young Children at www.challengingbehavior.org

– Hieneman, M., Nolan, M., Presely, J., et al. (1999). Facilitator’s Guide: Positive Behavior Support. RRTC-PBS, Child & Family Studies, USF at http://apbs.org/files/PBSwhole.pdf

– Janney, R., Black, J, & Ferlo, M. (1989). A problem-solving approach to challenging behaviors: Strategies for parents and educators of people with developmental disabilities and challenging behaviors. ERIC database. http://eric.ed.gov/?id=ED323734

– Parenting Special Needs Magazine articles http://parentingspecialneeds.com

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