FBA: Using a Familiar Tool to Address Behavior in Students with Mental Illness

CESA 5 Mental Health & Behavior SummitSeptember 29-30, 2014Lynn Boreson, presenterlboreson@earthlink.net

Quick Course in Behavior Theory

All behavior has a purpose (function) – it meets a need

There’s nothing wrong with meeting a need – there may be a problem with “how” it’s done

Behavior always occurs in a context…sometimes the intervention is about the context (not the student)

Most behavior is learned and can be unlearned – even syndrome-driven behavior may have some learned or controllable elements

It’s true: when we’re emotionally upset, we can’t “think straight”

Long-term behavior change means positive strategies

The Brain and Behavior

• Threats and emotions affect memory processing

• Examples of threats in school: embarrassment, unrealistic expectations, mismatch with learning style, out of class issues, comparisons to others, competition, “public performance”

• Hierarchy of response to sensory input1. Data affecting survival2. Data affecting emotions3. Data for new learning

What is a Functional Behavioral Assessment (FBA)?

A process for identifyingThe purpose or function of behavior

The variables influencing the behavior

The components of an effective intervention plan

Key Questions to Consider

• What happens? What is seen or heard? What is the behavior of concern? What are the patterns?

• What happens before an incident (antecedents: setting events, triggers)?

• What has happened in the past? Is this a recurring pattern of behavior? A developing pattern? An isolated incident? When is it likely to occur?

• What happens after an incident (maintaining consequence)?

• What is the hypothesis re: function?

• What part does disability play? What part does illness/syndrome play? What part does age/developmental level play?

Context of Behavior: ABCs

Antecedent Behavior

Maintaining

Consequence

When ____ occurs

the student does ____

Because he/she gets or avoids ____ .

Function Based Thinking(Functional-Based thinking: A Systematic Way of Thinking About function and its Role in Changing Students Behavior Problems.

Beyond Behavior, Spring 2010.)

•A continuum of formal (functional behavioral assessment – FBA) to informal

•Constantly asking yourself “Why?” - Why today? Why here? Why now Why me?

•Match the consequence to the function – what is meaningful to the student?

•Helping the student behave more positively, acceptably

Maslow was on the right track…

Physiological needs

Safety

Belonging

Achievement

Self-actualization

Survival

Emotions

Learning

Functions of Behavior

Functions of behavior

• Remember: All behavior has a function to meet a need

• “Escape/avoid” and “get/obtain” are not needs – what’s the underlying need?

• Be specific – is it a physical need? Safety (physical, psychological)? Acceptance?

Functions of BehaviorAdapted from Neel & Cessna; Lewis

To obtain

• Attention (may be a component)

• Objects/rewards/activities

• Choice/control

• Physical comfort

• Permission to do something

• Help/assistance

• Revenge/justice

• Independence/autonomy

• Individuality

To escape/avoid

• Fear

• Frustration

• Failure

• Boredom

• Anxiety

• Discomfort

• Responsibility for own behavior

• Unpleasant tasks, settings, people

Some Students Misbehave Because…

…they can’t do it

• Skill deficit Does the student understand the expectations?

Does the student realize the behavior is inappropriate?

Does the student have the prerequisite skills?

Teach the skill!

…they won’t do it

• Performance deficit Has the student shown the behavior previously?

Is the student uncertain about the appropriateness of the behavior in a particular situation?

Does the student see the value in the appropriate behavior?

Provide opportunities for the student to demonstrate appropriate behavior and be reinforced

Operational Definition of Behavior

• Prioritize behavior(s) to address Look for patterns of behavior, not discrete behaviors Can you group them?

• What will you see and/or hear? What can you measure?

• If needed, develop a response definition (what is a count of “one”?)

• There are no “right” or “wrong” answers…but staff need to be on the same page! What is profanity? Out of seat? Off task? Disruptive? Dangerous?

• Quantifying behavior Averages (3 times per week; twice per hour) Ranges (4-6 times per day – but use carefully) Percentages (80%, 5 times out of 7) In specific situations

Dimensions of Behavior

•Frequency: how often it occurs

•Topography: what it looks like

•Duration: how long it lasts

•Latency: amount of time between “A” and “B”

•Magnitude: force, power, loudness

•Locus: where it occurs

“But there’s no pattern…we can’t predict when the behavior will happen!”• You can’t always see the forest for the trees

It’s hard to take data while you’re teaching You don’t have the “wide angle” view of the class May be something that happened outside of school With older students, may have happened days ago (or more)

• May be a variety of factors – and the combination at any point is critical Example: student didn’t get meds, didn’t sleep well, doesn’t like written

work, room is too hot/stuffy, after 1:00 p.m., non-preferred adult Example: change is usual routine, doesn’t get immediate attention or

feedback, early in the week when he was at dad’s for the weekend, end of the day, new material/skills being introduced, minor problem at recess

• Bring in a fresh set of eyes – this is a team task

FBA and students with mental illness

• Clear definition of behavior What does the illness look like in this student? What characteristics apply? What can we expect? How does that impact learning?

• Differentiate between syndrome-driven behavior and learned behavior Side effects of medication? What can we hold a student accountable for vs. what is the illness?

• Collect baseline data in various phases With/without medication During acute phases of the illness During latency phases During transition phases

Using FBA information to develop meaningful BIPs and

IEPs• When do we treat it as an illness? What is the “point of no

return”?

• May need multiple “plans” On meds, off meds During manic phase, depressed phase, stable phase

• Plan for prevention, intervention, crisis Teaching skills is important, both academic and social/emotional If you’re considering seclusion/restraint, be sure to include that in

the FBA – is that an effective way to de-escalate?

• Monitoring and fidelity of implementation is key

• Adjust expectations realistically It is an illness! Example: RAD – relationships don’t often happen

“Lesson Plans”

•Detail in IEP will depend on a variety of factors

• The force of the IEP behind the BIP

• Too much detail and you have to meet a lot

• If you have a math or spelling goal in an IEP…

Resources

• http://cecp.air.orgPart of the American Institute for Research (AIR) and funded by OSEP and HHS

Information on FBAs (process, background, etc.) Information on Promising Practices in Children’s Mental Health

•www.interventioncentral.org

•www.behavioradvisor.com

•www.disciplinehelp.com

(Caution: schools should not be making diagnoses or interpreting medical information – these sources are for

information only)

• Medications www.pdr.net www.drugs.com www.webmd.com (click on “drugs & supplements) www.nlm.nih.gov/medlineplus/druginformation.html

• Specific illnesses www.mayoclinic.org www.psychcentral.com www.webmd.com www.nlm.nih.gov www.dsm5.org (Diagnostic & Statistical Manual of Mental

Disorders – 5th edition) - Published by the American Psychiatric Association

Cognitive Behavioral Interventions

• A behavioral approach in which individuals are active participants in understanding and modifying their own thoughts, in turn affecting behavior

• Empirically based for School use Students with mental health issues Students with behavioral challenges

• Discovering cognitive deficits or distortions can help with generating solutions

• “Inner speech” mediates behavior, and by using internal language, behavior can change

• Resource: Cognitive-Behavioral Interventions for Emotional and Behavioral Disorders: School-Based Practice. Mayer, Van Acker, Lochman, Gresham. 2011. Guilford Press. (Available from Amazon.com)

Four Common CBIs1. Self-instruction

Positive self-talk to gain self-control over negativity “I think I can, I think I can; I know I can, I know I can!” STOP

Stop Think Options to consider Proceed

2. Attribution re-training Reduce learned helplessness Attribute failure to a remediable cause rather than a lack of ability

3. Problem Solving Develop alternatives to feeling bad Focus on internal control

4. Cognitive Restructuring (Errors in Thinking) Dispute irrational thoughts through logical analysis

A checklist for evaluating FBAs and BIPs(Source: Van Acker, Boreson, Gable, and Potterton. 2005. Journal of Behavioral Education.

Rate using a Likert Scale such as 0-1-2-3)

1) Is the target behavior clearly defined (measureable, observable)?

2) Are there multiple sources of information?

3) Is there a hypothesis related to function of behavior?

4) Is there adequate data to verify o reject the hypothesis? Is the data triangulated?

5) Have replacement behaviors…been identified?

6) Is the BIP clear and specific?

7) Is the BIP consistent with the FBA, with assessment results, and with student needs?

8) Does the BIP address the context of the behavior?

9) Does the BIP address both short-term & long-term strategies?

10) Does the BIP include a plan for monitoring and evaluation?

11) Are necessary teacher/staff supports identified, including consistency with building-level systems for behavior change and support?

Can Strategies Be Reasonably Implemented in Regular Education?

(adapted from Morsink & Lenk, RASE, Nov/Dec 1992)

• Is the strategy easy to implement? Will it take an inordinate amount of time? Will it require additional training for the teacher/others who implement? Does it involve a great deal of preparation and/or follow-up? Will this be a relatively short-term intervention, or will it require on-going efforts? Is it minimal, moderate, or advanced in terms of teacher time and skill?

• Can the strategy be used with any student performing poorly? Will more than just the target student benefit? Is this a strategy that the teacher will be able to use beyond the immediate situation?

• Is the strategy based on the general education classroom curriculum? Are the regular classroom materials, scope/sequence used? Are additional or supplementary materials required?

• Can the strategy be used to teach students to generalize? Will this strategy provide students with a skill that they can use across settings? Do teachers in different disciplines or classes use the same or very similar strategies?

• Is the strategy useful for group instruction? Is complete individualization required or might the strategy be used with small groups or large groups?

• Does the strategy include teaching needed skills? Does the student know all of the component skills?