comprehensive functional assessment report and recommended support plan

7/24/2019 COMPREHENSIVE FUNCTIONAL ASSESSMENT REPORT AND RECOMMENDED SUPPORT PLAN

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NOTE: This report was written by a participant in Institute for Applied

Behavior Analysis Summer Institute (http://www.iaba.com) on

Assessment and Analysis of Severe and Challenging Behavior.All identifying information has been changed. This report is

presented as an example of the type of report that participants will

be able to write after completing the course.

COMPREHENSIVE FUNCTIONAL ASSESSMENT REPORT

AND RECOMMENDED SUPPORT PLAN

Client Confidential

Date of Report: July 26,

Referral Date: June 27,

Period of Report: July 26 July 28,

IDENTIFYING INFORMATION

NameDate of Birth: November 5, 1966

Address:

Referral Source: Sims and Sims Services, Inc.

REASONS FOR REFERRAL

Mike was referred by Sims and Sims Services, Inc. (SSS) Corie Brown

for an evaluation. The purposes of the evaluation were to assist Mike in

securing the services and programming which would enable him to develop

and to use his capabilities, to get the most out of the educational opportunities
http://www.iaba.com/http://www.iaba.com/


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that can be made available to him and to enable him to develop and to use his

capabilities for more independent, normal living and more productive activity

than his behavior problems presently permit. Accordingly, it was requested that

the evaluation focus on these behavior problems, which were characterized asPhysical Aggression, and the type(s) of behavioral services, support strategies,

programming, professional competencies and skills, and environments

required eliminating, minimizing, or managing them.

Specifically, Mike has engaged in hitting his peer at the work site with a

broom and has tried to hit his peer in the face by engaging in the action of

snapping a cloth at his peers face.

DESCRIPTION OF ASSESSMENT ACTIVITIES

This assessment is based on information obtained from the following

sources:

A. Interviews with Mike Jones (consumer) July 26, (20 min.). Micki

Smith (SSS Job Coach) July 26, (1.5 hours.), and Missy Allen

(Sr. Employment Specialist.) July 26, (45 minutes);

B. Direct Observations of Mike (consumer) in the following settings;

The Steamer Restaurant, work site July 26, (1.75 hours);

C. Review of the following records provided by SSS;

i.) Local Area Cooperative Education Program, Case Study

Summary, 1985.

ii.) DEF Regional Center - I.P.P. Person Centered Plan, 1999

iii.) Developmental Disabilities Center Assessment, 1986

iv.) SSS Individual Service Plan, 1999


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D. A Reinforcement Survey completed by the writer through

information obtained through interviews and records review.

E. Telephone Conferences; Cathy Jones (Mother) July 26, (30

minutes)

BACKGROUND INFORMATION

I. Brief Client Description.

A. General. Mike is a 33 year old Caucasian male of medium,stocky build. He weighs approximately 210lbs and is 5 foot 9

inches in height. Upon meeting Mike I noticed that he was clean

shaven and his hair was neatly combed. He has been diagnosed

as having a mild level of learning disability with Autistic like

tendencies and possible emotional deficits. Mike has blue eyes

and blond hair and has no apparent physical disabilities. His

gross motor skills appear to be within normal range and he is fully

ambulatory, and walks slowly moving side to side. Mike has

difficulties with tasks that require fine motor skills such as tyinghis shoes.

B. Language and Communication Skills. Mike communicates

through use of verbal English language although at times is

difficult to understand as he often speaks quickly and has

difficulties with articulation of some sounds. Mike at times stutters

and exhibits echolalia and preservative speech. Mike is

spontaneous in his use of speech and uses sentences with up to

7 words in them. He can initiate conversation with others althoughdoes not do this consistently. He participates in simple

conversations and can relate personal experiences through I

statements. Mike can understand basic to moderate

conversations and can follow 2 step directions.


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C. Cognitive and Academic Abilities. At the age of nineteen, Mike

was the given the Weschler Adult Intelligence Scale, with results

as follows:

Verbal Subtests Performance Subtests

Information -1 Picture Completion -3

Digit Span -1 Picture Arrangement-4

Vocabulary -2 Block Design -4

Arithmetic - -2 Object Assembly -3

Comprehension -3 Digit Symbol -1

Similarities-4

Verbal IQ=59 Performance IQ=59Full Scale IQ=57

Mike can read his name and some safety words. He can print

single letters and his name legibly, although is inconsistent with

printing his name at times. Mike can recognize coins and bills

and knows that money is needed to purchase items, but cannot

typically make change or count out right amount to make a

purchase. Mike does not appear to have a solid concept of

measurement at this time. Mike can distinguish between day andnight and his concept of time is based upon the consistency of

his daily schedule. Mike can name the present day of the week

and can differentiate between today and tomorrow. He can state

his own birthday and knows the birthdays of those important to

him. Mike can also state the present year.

D. Self Care Skills. Mike can eat with all eating utensils i.e.: spoon,

fork, knife although at times requires prompting to do so. Hedrinks with ease from a glass and uses a napkin to wipe his

hands and face. Mike can independently dress himself and is

unable at this time to tie his shoelaces. Mike is independent at

toileting himself and washing up after elimination. Mike urinates

frequently at times, with the average being approximately 2x an


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hour. Mike is independent with washing with soap and applying

deodorant with respect to his bathing skills and requires

assistance with regulating water temperature. He requires verbal

reminders to wash and comb his hair. Mike can independentlycomplete all steps in oral hygiene routine. He requires verbal

prompting to blow his nose with a tissue and requires physical

hand over hand assistance to shave using a razor and shaving

crme.

E. Domestic Skills. Mike is able to do many household chores with

varying degrees of assistance. He empties the garbage, sweeps

the floor and wipes the counters with verbal prompting to begin

task. He rinses his dishes and places them in the sink aftermeals. He does not load the dishwasher or wash dishes. With

verbal prompting Mike can make his bed, hang up clothes and

place clothes in drawers. Mike is also capable of vacuuming floor,

dusting and polishing, and cleaning windows with prompting. With

varying degrees of assistance, Mike is capable of cleaning the

bathroom and doing his laundry. Mike participates in some

outdoor maintenance tasks such as watering the lawn and plants

with hose and taking the trash out. He does not mow the lawn or

trim the hedges and shrubs. Mike participates in meal prep suchas peeling carrots and potatoes and can prepare simple snacks

and meals independently. He requires assistance with following

recipes and using the oven.

F. Community Skills. In the community skill domain, Mike will use

the telephone to take a social call however he does not ask to

use the phone to place a call nor does he answer the phone

when it rings. He does not know his phone number and requiressomeone to dial the phone for him. Mike carries his identification

card and bus pass with him at all times. He takes the bus

independently but has, on occasion, became confused and was

unable to locate the correct bus. There was limited records

pertaining to Mikes community mobility skills. Mike enjoys


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shopping and requires assistance with the shopping process of

picking out items and paying for them. While he can identify bills

and coins and understands that money is needed to purchase

items, he does not posses the skill to count out the correctamount of money.

G. Recreation and Leisure Skills. Mike spends his indoor rec. and

leisure time watching TV shows and movies. He enjoys listening

to music and playing his Nintendo 64. He also enjoys

participating with the preparation of meals. Mike enjoys going out

to a show at the movie theatre and has gone to see professional

sporting events at community arenas ex: NHL hockey. He attendsthe community center approximately once a week to access

exercises facility and enjoys going shopping.

H. Social Skills. Mikes interaction with others, although limited, is

usually friendly, respectful and focuses around his great sense of

humor and ability to make people laugh. He has a positive and

caring relationship with his parents and older sister, Micki. Mike is

well known by local firemen and city workers and he willexchange greetings with these acquaintances. Mike has 2

friends, Marnie and Jason that join him at his work sites. Mike

has many assets and/or talents in the area of socialization that

include his comedic nature and ability to make people laugh with

his imitations of characters from TV shows. He likes to joke

around and tends to be a newscaster of sorts. He does

experience difficulties with initiating and maintaining friendships

due to his lack of conversation and undesirable social skills such

as: inappropriate humor name calling, and phrases like Imgoing to kill you and also inappropriate sounds passing gas

and loudness in tone of voice.


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II. Living Arrangement and Family History. Mike lives with his mom and

dad in a nice neighborhood in Ennytown, CA. The house is a two-story

house and Mike has his own room. They have a family pet, a Himalayan

cat that resides with them as well. Mike has lived with his parents hisentire life and has an older sister, Micki that he maintains regular contact

with. Micki is married and has a child and Mikes mother stated that

Mike enjoyed being an uncle. Mike maintains a very positive, caring

relationship with his parents and sister. At the time of this assessment, a

home visit was scheduled but was canceled by Mrs. Jones. It was not

rescheduled.

III. Daytime Services Received and Day Service History. Presently, Mike isattending the SSS behavioral day management program with the

focus being on job training and community skills. He attends from

Monday Friday from 0800-1350. He entered this program on

December 6, 1993 and receives a 3:1 staffing ratio. There are 3

participants in his program, himself included. Mike is employed at The

Steamer Bar and Grill and makes $5.25 hr. His mode of transportation

to and from the work site is by city bus. Areas of concern noted at the

day program are off task behavior, dumping of items ex: salt, pepper

and sugar, loud vocalizations and inappropriate name-calling. At presentMikes schedule at the day program is as follows

MONDAY:800-1100 The Steamer Bar and Grill duties include setting

up chairs, windows, set tables i.e.: silverware, sugar, menus,

wiping chairs and booths. 1200-1330 Community Training:

activity in community

TUESDAY:800-1100 The Steamer Bar and Grill duties same as

above 1200-1330 Community Training: department store

WEDNESDAY:800-1100 The Steamer Bar and Grill duties same as

above 1200-1330 Community Training: Borders

Bookstore


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THURSDAY:800-1100 The Steamer Bar and Grill duties same as

above 1200-1330 Bi-weekly banking 1200-1330 Bi-

weekly Community Center workout

FRIDAY:800-1000 Community Training: Border Bookstore 1030-1115

Lunch Out 1130-1330Community Training: Movie at theatre

Mike graduated from school in 1988 and attended the Career

Assessment and Placement Center in Whittier. He received vocational

and mobility training and worked at Rockview Dairy. Due to funding

issues, in 1993 Mike was referred to other programs. Since December

of 1993, Mike has been supported by SSS.

III. Health, Medical and Psychiatric Status. Mike is generally in good

health. He has high blood pressure but monitors his diet as a way of

keeping it under control. He takes no medication at this time and has no

known allergies. Mikes hearing is within the normal range and he has

mild impairment with his vision. Mike does not appear to have any

physical disabilities although is overweight and this appears to have

bearing on the physical exercise that he is willing to participate in. Mikeslast medical examination was in 1999 however which month was

unclear. Mike does not appear to have any cardiovascular or respiratory

problems at this time, nor were any genito-urinary or musculo-skeletal

concerns noted. Although there is no recorded problems with

gastrointestinal, it was noted that Mike eats very quickly at times and this

can cause vomiting after a meal. There have been no recent

hospitalizations with the last one occurring when Mike was a child to

have his tonsils removed. Mike had been on various medications to

control hyperactivity but has not taken medication for behavior control inover 15 years. Psychological testing indicates congenital

maldevelopment of the brain manifesting in extreme hyperactivity, delay

in speech, mental retardation with possible emotional deficits. Autistic

mannerisms noted were namely self-stimulatory behaviors, difficulties in


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pragmatic use of language and the tendency to remain aloof and alone.

It is unknown as to whether Mike is receiving psychiatric services at this

time.

IV. Previous and Current Treatments. There was no available data on

previous treatments for the target behavior of aggression before May

1999. Currently Mike is on a Differential Reinforcement of Other

Behavior (DRO) for aggression and property defacement with the

objective being 2 or less incidents a work shift. For each shift during

which less than 2 incidents occur, Mike earns a certificate. Certificates

can be exchanged as follows: One certificate for a gum ball, Two

certificates for a $0.25 pop at Ralphs, Three certificates for ahamburger. At this time, Mike is successfully meeting the objectives of

the DRO reinforcement schedule. Prior to August 31, 1999, the Focused

Support Strategy was a DROP schedule and it was not deemed

appropriate after changing the focus of the target behavior during Mikes

work shifts.

FUNCTIONAL ANALYSIS OF PRESENTING PROBLEMS

A functional analysis was conducted for Physical Aggression. The

behavior of Property Defacement is also a concern however due to time

constraints it was not possible to address this behavior and it is recommended

that it is addressed in the future. Accordingly, this analysis endeavored to

identify the events that control the emission and non-emission of these

clinically important problems. It is therefore organized around six specific

subcategories of analysis: (1) Description of the Problem. This analysisattempts to describe the presenting problems in such detail that they can be

objectively measured. It presents the topography of the behavior, the cycle

(beginning and ending) of the behavior (if applicable), and the strength of the

behavior (e.g., frequency, rate, duration, intensity). (2) History of the Problem.

This analysis presents the recent and long-term history of the problem. The


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purpose here is to better understand Mike's learning history, and the historical

events that might have contributed to the problem(s). (3) Antecedent Analysis.

The antecedent analysis attempts to identify the conditions that control the

problem behaviors. Some of the specific antecedents explored include thesetting, specific persons, times of the day/week/month, and specific events that

may occur regularly in Mike's everyday life. (4) Consequence Analysis. The

consequence analysis attempts to identify the reactions and management

styles that might contribute to and/or ameliorate the presenting problems. It

also focuses on the effects that the behaviors might have on the immediate

social and physical environment, on the possible function(s) served by the

problem behaviors and on the possible events that might serve to maintain or

inhibit their occurrence. (5) Ecological Analysis . The ecological analysis

attempts to identify the critical mismatches that may exist between the physical,interpersonal and programmatic environments and Mike's needs and

characteristics. (6) Analysis of Meaning. The analysis of meaning is the

culmination and synthesis of the above analyses and attempts to identify the

functions served by the problem behaviors. The functional analysis of

Aggression, organized around these headings, follows.

A. Description of Behavior and Operational Definition.

1. Topography. The hitting or attempted hitting of others with anobject ex.: broom, and the snapping of cloths at others bodies

with in a 3-foot radius.

2. Cycle. The cycle of the behavior starts with the swinging of the

object and the snapping of a cloth at another persons body with

the intent to hit and the cycle stops when there has been a period

of two minutes without an occurrence of the above behaviors.

3. Course. The course of the above behaviors begins graduallywith precursor behaviors noted. The precursor behaviors noted

are rapid physical movement, walking away from peers,

verbalizing that he is upset and loud, inappropriate name-calling

and property defacement. Property defacement includes throwing

rocks at vehicles, pulling at flowers or plants, pulling the cord on


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the bus and kicking dirt. There may be one cycle of precursor

behaviors or there may be several cycles of precursor behaviors

with a period of calm in between. Mike then engages in one or

more of the target behaviors and is remorseful after, vocalizing toself Why did I do that I shouldnt of done that.

4. Strength.

a. Rate. The rate of behavior occurs approximately 2 or less

times a year.

b. Duration. The duration of the episode in which the target

behavior is occurring is short and fast, lastingapproximately 5 sec. The precursor behavior period can

go on for long periods of time, up to several hours.

c. Severity. The severity of the target behaviors is that the

object comes in contact with the body and leaves a red

mark or bruise lasting longer than 5 seconds. For Mike the

severity of the target behavior is that he has internal

feelings of remorse and is regretful for actions. At this time

the external or physical damage is minimal as there hasbeen no physical injuries incurred from the target behavior.

The internal injuries experienced by the recipient of the

target behavior are emotional trauma and are believed to

be severe.

B. History of the Problem. The first appearance of the target behavior is

believed to have occurred in 1994, and the first reported incident found

was in June 1998. There have been only a few incidents of the targetbehavior. The target behavior has been under the control of a daily DRO

schedule until the recent Job Coach gave her notice for termination of

employment and an increase in precursor behaviors have been noted.


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C. Antecedent Analysis. In an antecedent analysis, one tries to identify the

events, situations and circumstances that set the occasion for a higher

likelihood of the behavior and those that set the occasion for a lower

likelihood. Further, in both categories, one tries to identify both the moredistant setting events and the more immediate triggers that influence the

likelihood of the behavior. Below is firstly an analysis of those setting

events and triggers, i.e., those antecedents, that increase the likelihood

of Physical Aggression and their escalation and secondly an analysis of

those that decrease the likelihood. Detailed examples substantiating

each of these, based on actual incidents, are also included.

The setting events that may occur before the behavior that might impact

Mikes daily behavior are events that Mike finds upsetting that arehappening on the news ex: plane crashes, the death of JFK Jr. and

motor vehicle accidents. A sudden change in his daily schedule for ex:

the city bus being late to pick him up and take him to work and the

moods of his peers at the work site are also setting events for Mike. His

perception that his peers are upset with him or if his peers, in Mikes

mind, are not doing their share of or a good enough job at the work site

also effect his daily behavior. Non-occurring setting events that affect

Mikes behavior are that one of his peers is absent from the work site or

did not greet him in the morning when they arrived at work. The targetbehavior is more likely to occur at the work site, as there have been no

incidents at home of the target behavior. The target behavior is more

likely to occur when Marnie, his peer at the job site is present as she

appears to be targeted during the behavior episode. The target behavior

is more likely to occur during the morning hours 0800-1130, between

Tues.- Thurs as this is when Mike is at his work site with Marnie.

Activities or events that are more likely to increase the likelihood of the

target behavior occurring include a news cast that Mike finds upsetting,

his peers moods and behaviors at the work site and witnessing anaccident on the way to work. Activities or events that are more likely to

decrease the likelihood of the target behavior are positive interaction

and communication with Marnie.


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D. Consequence Analysis. When the target behavior occurs, staff removes

the object from Mike and asks him to Stop. They redirect him away

from the area and outside to calm down. They use the phrases Why are

you mad; Who are you mad at Are you mad at Marnie, Jason, staff.The staff try to encourage Mike to calm down and to open up and

discuss what is upsetting him. On one occasion when the target

behavior occurred, staff needed to call in a second staff to talk with Mike

as she was upset with the nature of the incident. Staff notifies Mikes

parents of any incidents of the target behavior and his parents will talk

with him about staying in control. Marnie, who is Mikes friend and is

also targeted when the aggressive behavior is occurring, becomes upset

emotionally when the behavior occurs and thus Mike feels very

remorseful and bad for engaging in the target behavior. The targetbehavior may be maintained by the lack of communication and self

control skills that Mike has.

E. Ecological Analysis. There are a number of ways in which

understanding the ecology surrounding and how it may conflict with

Mike's needs and characteristics, may be helpful in understanding the

meaning of his behavior and in understanding the ecological changes

that may be necessary to provide the necessary support for him. Thebrief discussion addressing this ecological analysis is organized below

around the physical environment, the interpersonal environment and the

programmatic environment.

When Mike is at the work site, which is where the target behavior occurs

most often, he is easily distracted by settings and activities that are

going on around him. While working at The Steamer Bar and Grill, there

are several TVs that are on throughout the establishment and I noted

that Mike was easily distracted by the TVs and would frequently stopworking and watch. I also noted that when he was engaging in a job

duty that was near a window he would often become distracted by the

traffic and would stop working.


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At this job site Mike is joined by two of his peers and at times is

distracted by their activities and what they are doing. As Mikes mood is

directly affected by their moods, I noted that Mike, at times, would cease

working to seek them out. The Steamer Bar and Grill is closed whileMike and his peers are working there as it is in the morning. Mike does

have an opportunity to interact with the manager and other employees

as others are in the environment doing their daily prep work.

Mikes routine at the job site consists of work, break, work, and break

which aides him in completing the various tasks that he has at this site. I

did observe that Mike would try to move on to the next task before the

current task at hand was completed.

F. Impressions and Analysis of Meaning. In considering this functional

analysis and the background information summarized above, there are a

number of factors that are helpful in trying to understand the meaning of

Mike's behavior. It is my impression that Mike engages in the target

behaviors as a way to communicate his feelings of anger and frustration.

This is evident by the precursor behavior name calling that he does

when he becomes upset and when the precursor behavior is not

addressed he continues to try and express that anger and frustration.Mike is very sensitive in regards to others perception of him and of

others behavior that are occurring around him. He becomes upset and

frustrated when he perceives his peers may be mad at him and the

target behavior is directed towards his friend Marnie. While Marnie is

targeted with the aggressive behaviors, she is also the one who is able

to calm him down when he becomes upset and frustrated.

Another function of the target behavior is that he is unable to maintain self-

control. After Mike becomes upset and engages in the target behavior, he isremorseful and talks to himself stating Why did I do that and I shouldnt have

done that. He is unable to maintain self-control over his feelings and the target

behavior is, I feel, is a way of expressing that inability to self regulate.


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MOTIVATIONAL ANALYSIS

A motivational analysis was carried out to identify those events,

opportunities and activities that Mike enjoys and that may be used to enhance

his quality of life and provide him with incentives to improve his behavior and to

enhance his academic progress. The results of the analysis showed a number

of events that could be used effectively as positive reinforcement in a well

designed support plan to reduce the identified behavior problems. These

events include, but are not limited to wrestling, baseball, miniature golf, and

football. Other potential reinforcers include fire station, police stations, planes

and watching TV and movies. Mikes favorite foods are burgers, fries, hot dogs,cake, popcorn and tacos. He also enjoys shopping. These reinforcers, and

others, should be used in a variety of ways, the least of which would be through

the contingencies of formal reinforcement schedules.

MEDIATOR ANALYSIS

A "Mediator Analysis" was conducted for the purposes of identifyingthose persons who might be responsible for providing behavioral support for

Mike, their abilities to carry out the recommended support plan, given the

demands on time, energy, and the constraints imposed by the specific settings,

and motivation and interest in implementing behavioral services as

recommended. This analysis showed the following:

Mikes parents and SSS staff are those who will be responsible for

carrying out the recommended support plan. While I was unable to assess the

level of motivation or cooperation directly with Mikes parents, staff advised methat his parents are very involved with Mike and his program and that SSS staff

have received high levels of cooperation and motivation from them before. The

support staff at SSS has positive interactions with Mike and I feel that this

interaction could promote an atmosphere and conditions under which a

recommended support plan could be implemented. Factors addressed that


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may constrain staffs ability to carry out the recommended support plan are

lack of training in area of the recommended support strategies. It is my

observation that the staff at SSS are motivated to carry out a recommended

support plan.

RECOMMENDED SUPPORT PLAN

A. Long-Range Goal. The long-range goal for Mike is to establish enough

self control over his behavior that he will be able to live and work in the

least restrictive setting possible that is capable of meeting his

developmental and behavioral needs. The goal of his educational planis to provide him with the academic and other skills necessary to meet

his needs, while eliminating those behaviors that tend to stigmatize and

isolate him from full community and social presence and participation.

Additionally, the goal is to transfer the control of Mike's behavior from

external mediators (parents and staff) to internally generated controls.

The plans and objectives presented in the following paragraphs are

intended to increase the likelihood that the following specific outcomes

will occur: Mike would like to move out of his parents and into his own

apartment with people he is familiar with. Mike would also like tocontinue to maintain employment in the

field of his interest.

B. Operational Definition(s).

Physical Aggression.

1. Topography. The hitting or attempted hitting of others

with an object ex. Broom, and the snapping of cloths atothers bodies within a 3-foot radius.

2. Cycle. The cycle of the behavior starts with the swinging

of the object and the snapping of a cloth at another

persons body with the intent to hit and the cycle stops


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when there has been a period of two minutes without an

occurrence of the above behaviors.

C. Short Term Measurable Objectives. The following objectives and plans

are suggested on the assumption that Mike has the opportunity to

continue to attend the SSS behavioral day management program. It is

unlikely that they would be realistic if he did not have these

opportunities. These objectives were also selected as being most

reflective of Mike's priority needs and as being the most realistic given

his level of functioning at this time. Further objectives may be

established as a function of the success or failure of the recommended

strategies.

1. By November 1, Mike will reduce the incidents of Physical

Aggression from baseline rate of 1 or less a month to 0 incidents

a month.

2. By August 1 next year Mike will have maintained a rate for

Physical Aggression at 0.

D. Observation and Data Collection Procedures.

1. Methods.

Behavior Physical Aggression the SSS job coach will

observe Mike for each hour of the program day. Each

incident of the target behavior as defined in topography

shall be recorded on an A.B.C form (See A.B.C. Form)indicating the following:

1.)Date of incident

2.)Start and stop time of incident (Duration)


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3.)Setting and activity at time of incident

4.)Immediately preceding antecedent events

5.)Description of actual behavioral topography

6.)Description of consequences or actions taken by staff

The following information should be summarized on an

Individual Data Summary form (See Individual Data Summary

Form).

2. Observational Reliability.

Behavior Physical Aggression

Once a week, at weekly contact meeting, the SSS

manager will do a Records Check to make sure that all

occurring incidents have been recorded on all required

forms i.e.: A.B.C. form, Daily Progress Notes, and if

applicable Incident Report. If Observational reliability isless than 100% then action should be taken to review the

Plan and method of data collection.

E. Intervention Procedures. In the following paragraphs, a summary of

possible strategies to support Mike is presented. These are by no

means meant to be comprehensive or exclusive of other procedures.

They simply represent a set of starting points that would be elaborated

and modified as services are provided. Support is organized aroundfour primary themes: Ecological Strategies, Positive Programming

Strategies, Focused Support Strategies, and Reactive Strategies.

1. Ecological Strategies. Many behavior problems are a reflection

of conflicts between the individual needs of a person and the


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environmental or interpersonal context, in which the person must

live, go to work or otherwise behave. As part of the above

evaluation, several possible contextual (ecological) conflicts were

identified. It is possible, that by altering these contextualconflicts, that Mike's behavior may change and his progress may

improve, thus eliminating the need for consequential strategies.

In the following paragraphs, a number of "Ecological

Manipulations" are presented with the intention of providing a

better mesh between Mike's needs and the environments in

which he must behave:

a)To reduce the number of distractions at the work site by

turning the televisions off in the work site so that Mike canfocus on the task at hand. As Mike can become distracted by

the TVs being on, and was observed engaging in off task

behavior to watch the TV, it would be a better fit between Mike

and the work site if that distraction were eliminated.

b)Mike should also increase his level of exercise to aid him in

relaxation. Exercising tends to result in greater reduction or

displacement of anxiety. I feel that if Mike increased his

exercise level it would assist him in increasing his feeling of

well being and will, in hopes, decrease his feelings of anxietyand frustration.

c)Implementing a scheduled interaction time each morning with

his peers will benefit Mike in that it will start the day of with

positive interaction and promote a positive work environment.

As Mikes mood and behavior is directly affected by the moods

and behaviors of others, establishing a positive interaction

time to check in establish that no one is angry with each other

would benefit Mike.

2. Positive Programming. Challenging behavior frequently occurs in

settings that lack the opportunities for and instruction in adaptive,

age-appropriate behavior. It is our assertion that environments

that provide instruction to promote the development of functional


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academic, domestic, vocational, recreational, and general

community skills is procedurally important in our efforts to

support people who have challenging behavior. To the extent that

Mike exhibits a rich repertoire of appropriate behaviors that areincompatible with undesired behavior, the latter should be less

likely to occur. Positive programming, therefore, should not only

result in developing Mike's functional skills, but also contribute to

reducing the occurrence of problematic behavior. At the very

least, a context of positive programming should make it feasible

too effectively and directly address Mike's physical aggression. In

the following paragraphs, several initial thrusts for positive

programming are presented:

a. General Skills.

1) Rationale/Logic. Making independent purchase of

choice. I feel that Mike would enjoy going to the

store and purchasing items that he enjoys ex. CD

or movie with his money that he has earned. I feel

that this would give Mike a feeling of independence,

choice and control over his life.

2) Objective. By Feb. 1 next year the objective is for

Mike to independently, without staff assistance and

upon being given a $20.00, go into a store, choose

the item of his choice, take the item to the till, and

complete purchasing transaction of paying for and

waiting for change, and leaving store.

3) Method. To teach Mike this skill, whole taskpresentation should be used.

a)Take Mike to the store of his choice

b)Assist Mike in picking out the item of his choice


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c)Assist Mike in paying for the item

d)Leave the store

e)Praise Mike for a job well done

f)Fade staff out as Mikes independence and

confidence in the steps of the skill increase

b. Teaching Functionally Equivalent Skills. People engage in

seriously challenging behaviors for perfectly legitimatereasons. They use these behaviors to communicate

important messages, to assert themselves, to manage

unpleasant emotions, to escape unpleasant events, and to

gain access to events and activities. One important

strategy for helping people overcome their challenging

behaviors is to provide them with alternative ways of

achieving the same objectives, alternative ways of

satisfying their needs. These alternatives are defined as

functionally equivalent skills because they achieve thesame goal as the challenging behavior or communicate

the same message. The above analysis of Mike's

behavior concluded, among other things, that Mike needs

another way to express his feelings.

1) Rationale / Logic . Derived from the Functional

Analysis of the target behavior, it is felt that the

function of Mikes behavior is a means of

communicating his feelings. I feel that a program toassist Mike in finding more appropriate ways of

expressing his feelings will empower Mike in feeling

more in control of his feelings and social

environment.


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2) Objective. By Nov. 1, , Mike will be able to, without

staff prompting, initiate and express his feelings

using the statement: I am feeling (angry, happy

etc.). I am (angry, happy etc.) because..

3) Method. Implement a social story describing how

to appropriately express our feelings.

a) Create social script detailing how to express

our feelings.

b) Staff is to sit with Mike and role-play the

social script, aiding him in understanding andusing the social script.

c) To be done 2x a week for 10-15min a

session. Staff should also take advantage of

any incidental opportunity to engage in this

script.

Carol Gray has written books on Social

Stories that may be of some use. 1-800-489-0727

c. Teaching Functionally Related Skills. There are many

skills that if learned by the person, may have a direct

impact on the person's behavior. For example, a person

who is taught the difference between demeaning criticism

and well-intended feedback may start acting differently to

the feedback he receives from others. The purpose of thiscategory of strategies, again, is to empower the person; to

give the person greater skills. In the following paragraphs,

skills are identified which are thought to be related to

Mike's aggression.


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Identifying Feelings

1) Rationale / Logic. In order for Mike to express his

feelings, he needs to be able to identify them

correctly. If Mike were able to correctly identify his

feelings, it would make expressing his feelings

easier thus reducing his level of anxiety and

frustration around communicating his feelings.

2) Objective. By Nov. 1, , Mike will be able to, withoutstaff assistance, identify the 3 feelings of anger,

frustrated and sad, 3 out of 3 trials. After this

objective has been met, the 3 additional feelings of

happy, confused and embarrassed can be

implemented to increase Mikes repertoire of

feelings.

3) Method To use a card system, with 3x5 flash

cards.a) Have the word of each objective feeling on

separate flash cards.

b) Have the definition and picture of each

objective feeling on flash cards.

c) Have Mike pair the picture/definition cards with

the word feeling cards.

d) Complete this trial at least 3x a week for 10-15

min a session.

d. Teaching Coping and Tolerance Skills. Many of Mike's

seriously challenging behaviors are a reflection of his

inability to cope with aversive events such as delay in

gratification, denial, the need to perform a non preferred

activity, etc. While some of these behaviors can be


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avoided by positive programming, aversive events are also

naturally occurring. Especially if he is to lead a full life,

from time to time, he will face the disappointments we all

have to face, for example, not getting something that hewants, when he wants it and having to wait for it, i.e.,

delay; not getting something he wants, at all, i.e., denial;

being told by somebody that a relationship is not possible;

being criticized or reprimanded; etc. In the face of these

events and the emotions they understandably arouse,

Mike's coping responses have not had the opportunity to

develop much beyond the primitive responses of a young

child; nor is he likely to develop much beyond this level

through "natural consequences." Rather, it will benecessary to be systematic in applying sophisticated

instructional technology, with the objective of teaching him

these very important coping and tolerance skills. The

following is a recommendation for how to proceed in this

important area of skill development, with the initial focus

being on Mike's establish boundaries.

1) Rationale / Logic. As Mikes mood and behavior is

directly affected by the behaviors and moods ofthose around him and by those events that are

happening in the news that he perceives as

distressing, helping him establish and understand

boundaries between his feelings and others feelings

would be beneficial. I feel that this would be

beneficial in that it would assist Mike in decreasing

his feelings of responsibility and anxiety.

2) Objective. By Nov 1, , Mike will be able to, withconfidence and independence identify the

boundaries between his feelings and those of

others.


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3) Method Use a comic strip conversation script to

help Mike establish boundaries between his

feelings and those of others.

a) Explain to Mike about the comic strip

b) Show him the feeling comic strip

c) Identify the people and the feeling circles

d) Visually show Mike how his feeling and those

of others over lap but do not control or

consume.

e)Praise Mike for a job well done

Carol Gray has written articles in the Morning

News on Comic strip conversations that will

be informative. 1-800-489-0727.

3. Focused Support Strategies. Some of the ecological strategies

that were recommended above, depending on their complexityand/or difficulty, may take time to arrange, and positive

programming will require some time before new skills and

competencies are mastered. Although these ecological and

positive programming strategies are necessary to produce good

long-term quality of life outcomes for Mike, it is also necessary to

include focused strategies for more rapid effects; hence the

inclusion of these strategies in our support plans. Specific

recommendations for the limited but important need for rapid

effects are made below.

ANTECEDENT CONTROL:

Implement an interaction time at the beginning of each day

between Mike and his peers at the work site. This interaction time

will allow Mike and his peers to exchange positive interaction and


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create a positive work environment in hopes of increasing Mikes

social skills and decreasing his feelings of anxiety and sense of

responsibility of others moods.

The interaction time will be facilitated by the SSS job coach and

will maintain a positive tone. All topics of conversation MUST be

positive and interactive between all 3 peers. Some examples of

positive conversation are:

- how nice the weather is

- pay a compliment on what the other is wearing

- pay a compliment on the great work the other did

yesterday at the job site.

-Talk about a desired activity that all 3 individuals will beparticipating in

- Talk about that days activities

At present, Mike is on a daily DRO schedule for the target

behavior, which is at this time, meeting the objective of the

reinforcement schedule. I suggest that Mike continue on this

schedule as long as it proves effective in maintaining the

objective of 2 or less occurrences of the target behavior a day.

I would also suggest that a time based, non-contingent

reinforcement schedule be implemented where once an hour,

every hour Mike receives verbal praise for being at the work site.

This may assist Mike with increasing his self-esteem and

promotes a positive work environment.

4. Reactive Strategies. Efforts to manage the antecedents to Mike's

physical aggression are likely to have a considerable impact on

the rate of their occurrence, as will a daily DRO schedule.However, these behaviors are still likely to occur, at least to some

degree, especially during the initial stages of the implementation

of this support plan, as the necessary adjustments to the plan are

identified and made. Therefore, staff may need measures for

dealing with these behaviors when they occur. Such reactive


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strategies have an even more limited role than the focused

strategies recommended above. Specifically, reactive strategies

are designed to produce the most rapid control over the situation,

in a manner that keeps both Mike and staff as free from risks toinjury as possible and that keep Mike free from risks of exclusion

and devaluation as much as possible. Accordingly, reactive

strategies are not intended to produce any change in the future

occurrence of Mike's challenging behavior. Both rapid and

durable changes, instead, are being sought by the Ecological

Strategies, Positive Programming Strategies, and Focused

Support Strategies described in the preceding sections. These

proactive strategies are also expected to prevent any counter

therapeutic effects that might accrue from the nonaversivereactive strategies being recommended here. The following

procedures are suggested as initial strategies that fit within SSS's

"Emergency Management Guidelines." They, along with other

strategies that fall within the guidelines, which may be considered

in the future, are expected to preclude the need for the physical

management of Mike's behavior, including the need for physical

restraint.

a.)At the first sign of the topography, staff should provideundivided attention to Mike and proceed to implement

the current reactive management plan that is in place

for the above target behavior which is as follows:

b.)If Mike becomes hurtful or engages in the topography

of aggression toward another person, ask him to

please stop and encourage the other person to move

out of his way. Use active listening to reflect his

feelings until he is somewhat calmer. Once he is calm,help him develop a solution to his problem. Remind

him that you are there to help him be successful at his

job.


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c.)In addition to the above strategy, redirect Mike to his

identifying and expressing feelings program.

Encourage him to express his feelings and praise him

for any attempts at the appropriate expression of suchfeelings.

5. Staff Development and Management Systems. Key elements

that will determine the degree of success of this support plan are

staff competence and management systems that assures staff

consistency in providing services to Mike. The following is

recommended:

a. Procedural Protocols. Each strategy and procedure

described above should be broken down into teachable

steps.

b. Three tiered Training.

1) Each staff person would be required to show "verbal

competence" for each procedure. That is, they

would need to describe each and every step in thespecific procedure. Each staff would be scored

using a "+/O" system for each step of the

procedure. A 90% criterion is considered passing.

2) Each person would be required to show "role play

competence" for each procedure. That is, they

would need to demonstrate each step of a

procedure to another member of Mike's support

team. The scoring system would be the same asfor "verbal competence," as described above.

3) Finally, each staff person would need to

demonstrate "in-vivo" procedural reliability; that is,

the ability to carry out each program component of


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Mike's support plan for which they are responsible.

This would require the designated person to

observe each staff person as they provide services

and to see the degree to which what they do agreeswith the written protocols. The scoring procedure

described above would be used again, and 90%

consistency should be considered as minimally

acceptable. For those procedures that do not occur

frequently, such as the need to react to infrequent

behavior, role-play competence should be

reconfirmed on a regular schedule.

c. Periodic Service Review. Mike's entire support planshould be operationalized into a series of performance

standards to be met by the support team and integrated

into a Periodic Service Review. Monthly (initially, weekly)

monitoring should be carried out by the designated

coordinator and the status of the support plan's

implementation should be quantified as a percentage

score. This score should be summarized on a graph and

kept visible to staff as an incentive to achieve and maintain

a score of 85% or better. This should be reviewedregularly by management and feedback should be

provided. More information on how to develop and

implement a Periodic Service Review system can be

provided on request.

COMMENTS AND RECOMMENDATIONS

1. Revisions are certain to be necessary during the initial stages of

implementation and as Mike's responsiveness to this new support plan

are observed. Early revisions and fine tuning are necessary in the initial

implementation of any support plan, especially one as comprehensive

as this one attempts to be.


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2. It is recommended that Mike remain in SSS program and continue to

work at current job placement, The Steamer Bar and Grill in Ennytown

with a 3:1 ratio. Mike appears to have to have adjusted well to this jobplacement and appears to enjoy being there.

3. It is recommended that Mike participate in an expressing feelings

program to assist Mike in becoming more confident and fluent in

expressing his feelings and emotions in a calm and appropriate manner.

4. It is recommended that Mike participate in an identifying feelings and

emotions program to assist Mike in being able to identify his feelingsand to feel more in control of his feelings

5. It is recommended that the positive programming strategies presented

above be provided at least 1.0 hours a week at the SSS program. Given

the nature of Mikes behavior difficulties, it is felt that this level of service

delivery will be needed to improve Mikes social and self-control skills.


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_______________________________________

Writer

_______________________________________

Clinical Director

_______________________________________

Associate Director


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Comprehensive Functional Behavior Assessment Report and Support Plan

Page 32

2002, Institute for Applied Behavior Analysis, All Rights Reserved

SSS

IDENTIFYING FEELINGS PROTOCOL

MIKE JONES

Initial Implementation Date: August 3,

Dates Revised:

1. Step by Step Method:

a)Create three 3x5 flash cards with the words angry, frustrated, sad,

with one of these feelings on each card.

b)Create three 3x5 flash cards with a face picture depicting the above

3 feelings and accompanying definitions on separate cards. That is,

on a 3x5 card is a picture of what the feeling looks likes and the

definition of that one feeling.

c)Choose a quiet area with little to no environmental distractions ex: noTVs on or in view of open windows/blinds and obtain Mikes

attention.

d)Present the 3x5 flash cards that have the faces of and definitions of

the feelings on them to Mike. Discuss with Mike the 3 pictures and

definitions of each feeling.

e)Ask Mike to show you each feeling face. Use the verbatim Show

me the angry face Show me the sad face Show me the frustrated

face.

f)Allow Mike the opportunity to chose on his own. Give him 10-15seconds then move the right feeling card closer to him and ask him

again to Show me the anger card.

g)Praise Mike for a job well done.

h)Show Mike the 3 feeling cards with the word of each feeling on them.

i)Explain the definitions for each feeling. Use verbatim Anger is when

you feel . Give examples that pertain to Mike.


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Page 33


j)Ask Mike to show you the different feeling word cards. Use verbatim

Show me the angry card Show me the frustrated card Show methe sad card.

k)Allow Mike the opportunity to chose on his own. Give him 10-15

seconds then move the right feeling word card closer to him and ask

him again to Show me the sad card.

l)Praise Mike for a job well done.

m)Place one face feeling cards in front of Mike and the 3 word feeling

cards directly above the face card. Ask Mike to place the face feeling

card on top of the matching word card.

n)Allow Mike the opportunity to match on his own. Give him 10-15seconds the move the correct word card closer to the face card and

ask him again to place the face card on the correct word card.

o)Praise Mike for a job well done. Keep the session positive, upbeat

and fun!

p)Complete one full trial 3x a week for approximately 15 minutes each

session.

2. Once a month, a management staff from SSS will go out and observe

the Job Coach carrying out this trial and will document on a ProceduralReliability form whether or not it is being carried out according to the

protocol.

3. If the Procedural Reliability is less than 85% then action should be taken

to review the protocol and the method of deliver.

4. Bi weekly observations by the management staff from SSS will occur

until the Procedural Reliability of 85 % or greater has been reached.

5. Each trial will be recorded on an Identifying Feeling Chart and at the

end of each week, all information from that weeks chart will be

summarized on an Individual summary chart.


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Page 34


6. Once a week, during weekly contact meeting, the SSS manager will

review the records of the Identifying Feeling Chart and the Individualsummary chart

7. Once a month, a management staff from SSS will go out and observe

the Job Coach carrying out this trial and will document on an Identifying

Feeling Chart what is observed.

8. If the Observational Reliability is less that 85% then action should be

taken to review the protocol and scoring criteria.

9. Bi weekly observations by the management staff at SSS will occur until

the Observational Reliability of 85% or greater has been reached.

10. A Pass criteria is scored when Mike can identify and match 3 out of 3

feeling cards for 3 consecutive trials/sessions. Once the Pass criteria

has been meet, the next step is to add more feelings one at a time.

11. A Fail criteria is when the Pass criteria has not been met within 3

months. If a Fail criteria has been met, then review method anddecrease the number of feeling cards in the trial to two.

12. Variations to these protocol requirements should either be because of

non- applicability or explained and documented on the appropriate PSR

Variations Form.

Protocol prepared by: Approved by:

SignatureSignature:

Date Date:


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Page 35


MIKE JONES

IDENTIFYING FEELINGS CHART

SCORING CRITERIA

Score a + for independently, with no prompting or staff assistance

Score a 0 for required prompting from staff

DATE; IDENTIFIED

FACE

CARD

FEELING

WORD

CARD

MATCHED

comprehensive functional assessment report and recommended support plan

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