pbs and transition to adulthood vincent winterling, ed.d. statewide director, delaware autism...

PBS and Transition to AdulthoodVincent Winterling, Ed.D.Statewide Director, Delaware Autism Program Director, Vincent Winterling, Ed.D., LLC Consultants

Objectives Define and describe Positive Behavior Support (PBS) Define and describe the Lifestyle Planning Process Review essential elements of the FBA process Review essential elements of Behavior Intervention Plans Review (if time permits) why plans fail

Define and Describe Positive Behavior Support

What is PBS? Applied science Use of educational methods Expand individual’s repertoire Systems change methods Redesign and individual’s living (or learning) environment Achieve quality of life Minimize problem behavior

PBS: Foundational Considerations Teach skills to increase likelihood of success in important

domains Teach, strengthen, expand positive behavior Utilize systems change to increase opportunities for the

display of positive behavior

PBS: Overarching Goals Assist individual’s lifestyle to evolve such that all in the

student’s world have experience of change Render problem behavior irrelevant, inefficient, and

ineffective by helping individual achieve goals in socially appropriate manner.

Positive Behavior SupportDiffers from traditional approaches to behavior

support Function rather than form Proactive rather than reactive Functional Skills Positive Individualized Long-term goals Multi-component / comprehensive

PBS: Underlying Assumptions Challenging behaviors need to be understood within the

contexts in which they occur.

Challenging behaviors serve a function or purpose for the individual.

Effective interventions are based on a understanding of the individual, the social contexts in which they participate, and the purpose/function of their challenging behavior.

PBS emphasizes person-centered planning and values that respect the dignity, preferences, diversity, and goals of each individual.

PBS: Defining Characteristics PBS is assessment based. Interventions are directly linked to

environmental influences and hypotheses concerning the function of challenging behavior.

PBS plans are comprehensive, usually involving multiple interventions.

PBS is proactive, involving teaching alternative skills and adapting the environment.

PBS emphasizes carrying out assessment and intervention practices in typical settings that are inclusive in order to promote lifestyle enhancements.

PBS: Defining Charactertics PBS considers the values, beliefs, and goals of family

members in the assessment and treatment planning process.

PBS is sensitive to the resources available to families and the constraints they face.

PBS looks to build on the strengths of family members and address areas of need.

PBS has a broad view of success that includes (a) increasing the use of alternative skills, decreasing the incidence of challenging behaviors, and making improvements in quality of life.

Define and Describe Lifestyle Planning Process

Copyrighted Material of Devereux CARES

School Age (3 to 12 Years) Family Issues

Adjusting to educational systems (IEPs; placement; support services)

Developing advocacy skills Dealing with reactions from

peers groups and community

Locating community resources

Maintaining a healthy family process

Educational Focus Communication Social Skills Play Self-care School-based and

Academics Domestic Community


Adolescence (13 to 17 Years)Family Issues

Addressing emerging sexuality

Dealing with peer rejection and isolation

Addressing more serious behavioral issues

Estate/Trust planning Redefining parental roles

and expectations Learning about post-21

services

Educational Focus Vocational Domestic Self-care Community Communication Social Skills Recreation Functional Academics


Launching (17 to 21 Years)Family Issues

Adjusting emotionally to having an adult son/daughter with special needs

Residential issues Financial and guardianship

planning Developing advocacy skills

for adults

Educational Focus Vocational Domestic Self-care Community Communication Social Skills Recreation Functional Academics

Transition Planning Carefully planned process Initiated by any team member To establish a plan for either additional training or

employment At least 3-5 years prior to the transition target date Must involve the majority of IDT members and an

employer or service providers, as needed

Transition Planning Best Practices: Needs of Individuals with Disabilities Transition planning must be comprehensive to

meet the individual’s total life needs. Criterion of Ultimate Functioning (historical) Quality of Life

Case Conceptualization: Treatment Considerations What are the goals we should be pursuing for our group of

learners? How much of what we do could be considered current

within the field of special education and ABA? With respect to Behavior Intervention Planning should we

be positively focused, assessment driven, and governed by EBP?

How much of what we do could be labeled as Positive Behavior Support? If we can’t be more exclusively positive what barriers prevent

it?

Case Conceptualization: What are the priorities? What are the priorities for the Support Plan? Who determines them? What is the process for that determination? What is a reasonable (i.e., balanced) program of skill

enhancement and behavior intervention? How is that determination made?

Are there children for whom our model is ineffective? How do we make that determination? How do we resolve that? Do we track them in any way?

Case Conceptualization: Assessment What is our assessment protocol? For whom is it provided? When? How do we link the findings of assessment to an active plan

of skill enhancement (i.e., teaching) to behavior intervention? How is it used specifically for program planning? Is it proceduralized? And / or systematized in any way?

Case Conceptualization: Treatment Considerations How much of what we do includes providing either negative

consequences / coercion / punishment to the children / youth in our care?

To what extent does the professional literature guide intervention planning / implementation for our students?

Do we follow any specific guidelines? Should we have guidelines for practice within our

system? How much does the analysis of the results of formative

data collection processes impact on our intervention process? Is there a system level process for managing these

data?

Case Conceptualization: Additional Treatment Considerations Context for intervention – positive, organized milieu (e.g.,

classroom management)? Presence of supervision, monitoring, and quality

management systems Orientation to collaborative teaming Mediator analysis

Lifestyle Interventions Considerations (Turnbull & Turnbull, 1996):

Interdependence Inclusion Contribution

Lifestyle Interventions Long-range outcomes (Risley, 1996):

How is the person doing overall over time? Is she or he happy, satisfied, and safe?Does the person have a stable home and family

and friends on which to base her or his life and future, and after whom to model her or his ways?

Is she or he practicing independence, productivity, and integration?

Is the person continuing to develop new interests, new friends, and new skills?

Lifestyle Intervention Components (Hedeen, Ayers, Meyer & Waite, 1996) Relationships with others Ecological factors and setting variables Communication and understanding Activity preferences Meaningful curriculum Choice and self-determination User-friendly evaluation strategies

Best Practices Focus Upon Quality of Life Indicators

Choices and control Opportunities to participate in preferred activities Community inclusion Peer relationships Relationships with family members Increased independence across settings Expressive and receptive communication Are they happy most of the time?

Person-Centered Planning

The Philosophy Person-Centered Planning is build on a philosophy that does

the following Takes a capacity-based perspective of the individual Uses natural resources to fulfill a vision Builds a circle of support for the individual that includes friends,

family and service providers

What is Person-Centered Planning? Person-Centered Planning allows a diverse group of people

who share a common goal or need to align their” Vision, Purposes and goals Understanding of the focus person’s past, present and

future; and Actions for change, mutual support, personal and team

development, and learning. Person-Centered Planning is a planning process But PCP can also be seen as an assessment tool in that it

evaluates where the person has been, what their environment is like now, and where they would like to go in the future.

What is Person-Centered Planning? PCP can also be an intervention.

PCP has the potential to create and build a strong and effective team dedicated to supporting the individual with problem behavior, and well as each other.

What Person-Centered Planning is NOT: An easy, one-shot process The answer to all problems The replacement for an IEP A quick fix solution to complex human and/or organizational

problems Something to be done and forgotten A guarantee

5 Essential Goals of PCP Being present and participating in community (school) life Gaining and maintaining satisfying relationships Expressing preferences and making choices in everyday life Having opportunities to fulfill respected roles and live in

dignity Continuing to develop personal competencies

Different Approaches

A Sample Person-Centered Plan Britney

Sample MAP Pages

Sample Relationship MapRelationship maps are used to find out who is currently involved with the focus person's life and in what capacity. By mapping relationships in this way, it allows conscious changes and developments to be planned and made to the benefit of the focus person

Sample PATH - Planning Alternative Tomorrows with HopeUsing the focus person's dreams as a starting point, a PATH is used to help plan the steps necessary to achieve those dreams and aspirations. The PATH helps to make clear who's help is needed, how to go back enrolling appropriate assistance, who will help with what, the first steps to be taken, 6 monthly goals, and so on.

Sample page from an Independent Living proposal

Sample pages from a kitchen guide/cookbook

Essential FBA Components


Design and Delivery of PBS Plans Step 1: Conduct an FBA Step 2: Develop a hypothesis statement Step 3: Design PBS plan Step 4: Evaluate plan effectiveness Step 5: Modify plan as needed

Steps for Conducting a Functional Assessment and Developing a BIPIdentify and operationally define target behaviorPurpose: To identify (and prioritize behaviors that interfere with learning, productivity, and general well-being and agree on exact topography

Strategies: Group consensus

FBA: Pre-intervention Assessment Identify contextual variables that evolve and maintain

adaptive behavior.

Identify functional relations that maintain challenging

behaviors (environment and challenging behaviors), both

proximal and distal.

Steps for Conducting a Functional Assessment and Developing a BIPAssess the student’s behavior

Purpose: To identify activities and events associated with occurrences and nonoccurrences of the problem behavior

Strategies: Questionnaires, checklists, conversations, structured interviews, direct observations

Understanding the Individual with Problem Behavior Gather Broad Information

Individuals strengths and skill limitations (communication, social skills, self-help skills, play, recreation and leisure).

Daily Routines and Activities Preferences and Goals for the Future Medical/Health related Issues Quality of Life Considerations: (opportunities for choice,

exercising control, experiencing social relationships, participating in inclusive settings)

Understanding the Individual with Problem Behavior Gather Specific Information

When is the individual most and least likely to engage in challenging behaviors?

What specific events appear to be contributing to the challenging behavior?

What functions do the challenging behavior serve for the individual (i.e., what are they communicating)?

Steps for Conducting a Functional Assessment and Developing a BIP Develop hypotheses Purpose: To formulate data-based (based on assessment

information) hypotheses about why behavior occurs Strategies: Review all assessment information; Develop

hypothesis statements that identify variables that can be manipulated to formulate an intervention

Developing Hypotheses Strategy:

Review assessment information Develop hypotheses statements about why behavior is occurring

Steps for Conducting a Functional Assessment and Developing a BIPAssess the accuracy of the hypotheses (optional step)Purpose: To evaluate whether hypotheses are accurate prior to formulating an intervention

Strategies: Brief reversals

Summary Statements Purpose: to offer and explanation of the problem behavior in

terms of antecedent and setting events and possible function

Content of Summary Statements Description of antecedent and/or setting events Description of problem behavior Identification of presumed function

Examples of Summary Statements When Amy is given difficult work (antecedent) she

engages in property destruction (behavior) to escape the task (function).

When Rob has a cold (setting event) and is asked to perform a difficult task (antecedent) he engages in self-injury (behavior) to escape the task (function).

When Sally is left alone without anything to do (antecedent) she engages in hand mouthing (behavior) to gain sensory stimulation (function).

When Tommy is in large groups (antecedent) he engages in aggression (behavior) to obtain attention (function)

Copyrighted Material of Devereux CARESAll Behavior

Serves a Purpose or“Function”

Gain Access to a Desirable

Stimulus or Event

Escape/Avoid

an Undesirable

Stimulus or Event

Behavior


Escape or Avoid...

Non-Preferred

Object or Activity

(Task)

Social

Interaction

Sensory

Stimulation

Adults Peers

Steps for Conducting a Functional Assessment and Developing a BIPDesign an intervention/support planPurpose: To formulate an intervention that is directly linked to the hypotheses

Strategies: Consider contextual fit

Steps for Conducting a Functional Assessment and Developing a BIPCollect data on effectiveness of intervention/support planPurpose: To assure plan effectively reduces problem behavior and increases desirable behavior

Strategies: Direct observation; Review permanent products, natural documents

Essential Plan Components

Developing Behavior Intervention Plans Based on hypotheses established in the assessment

process. Person Centered in that goals and intervention strategies

preserve the individuals’ dignity, and reflect their preferences.

Individualized to reflect a good fit between the person’s needs and corresponding intervention strategies.

Among other components, the written PBSP contains a description of antecedent modifications, functionally equivalent alternative responses (and teaching strategies), differential reinforcement systems, and consequences designed to eliminate or minimize reinforcement after undesirable responses

Objective data is used to determine program effectiveness and to guide modifications in the PBSP

Best Practices

Outline of a Behavior Support Plan Set Up (description, strengths, vision) Assessment

Operational Descriptions, Routines, FA Hypotheses Foundations (if needed) Prevention Teaching/Education Consequence Procedures

Minimize reward for problem behavior Ensure regular, clear reward for positive behavior Punishers (if needed)

Define safety/emergency procedures (if needed) Evaluation and Monitoring for Improvement

Steps for implementation

Why Should a Support Plan be Multicomponent? Many variables usually influence whether problem behavior

will occur; therefore effective support most often involves manipulation of several of these variables

Long-term reduction in problem behavior usually requires intervention in several areas

Best Practices Comprehensive Staff Training and Support

Pre-service and in-service training and workshops Performance checklists Ongoing supervisory feedback and support (structured classroom

observations, supervision meetings, and so on) Weekly classroom team meetings

Best Practices Family Inclusion and Support

Participate fully in planning Updated routinely on child’s progress Frequent opportunities to communicate with staff Access to informational seminars and training on interventions

and strategies Futures planning


Common Elements of Good Interventions A comprehensive assessment of skills is completed Targeted skills are meaningful to the student and will facilitate

independence Lessons are designed to enhance student motivation Spontaneity is taught early on Communication training occurs across environments and across

the student day Communicative responses that are taught can be understood by

all members of the community

Change Behavior Successfully Prioritize and work with only 1 or 2 behaviors at a time Require only gradual improvement in behavior Use procedures that are easily implemented and inexpensive

(to the extent possible) Use immediate consequences whenever possible

Change Behavior Successfully Teach the behaviors you want to see the individuals exhibit Use and fade prompts to increase the likelihood of

appropriate behavior Pair social reinforcers with tangible or activity reinforcers Thoroughly organize and precisely introduce the program to

the individual

Steps for Changing Behavior Decide on which behavior to change Operationally define the behavior Collect data for a baseline on the behavior Intervene on the behavior Graph and evaluate the ongoing process Revise the program if needed

Interventionists To-do List Consider the use of program-wide rules

Limit to no more than 5 sspecific, observable, and positively stated

Post rules in prominent places Develop a plan for providing frequent positive feedback for

following rules and routines. Develop consequences for common rule infractions

(consequence should fit the violation and be as mild as possible)

Develop an attention signal Design routines for most common procedures in the

setting

Interventionists To-do List Analyze the physical setting and modify if needed and

possible Develop lessons and provide regular review of rules and

routines Design activities to maximize engagement in meaningful

tasks Set and plan to achieve goals to improve instructional

delivery

Things to Remember! Let the data drive your hypothesis development

Individuals may engage in problem behavior for a variety of reasons

A single problem behavior may serve more than one function


PBSP Components of a PBSP

Antecedent Strategies Functional Equivalence Training Differential Reinforcement Consequence Strategies Evaluation and Modification


Characteristics of PBSP Based on assessment results and hypothesis driven Emphasizes skill building Comprehensive, usually involving multiple intervention

components Focus on long-term solutions, not quick fixes Team approach Function rather than form

Relative to Function

Establishing Operations

Eliminate

Ameliorate Antecedent General Skills Instructional Manipulations Training Consequence

Equivalence Training

Self-Regulation Training

ReductionOrientedConsequence

Categories of Intervention

ImmediatelyBefore

Behavior

AfterBehavior

What are Antecedent Interventions? Environmental modifications that are made to reduce the

likelihood that problem behavior will occur Antecedent interventions are arranged before the problem

behavior occurs

Replacement Behavior Behavior that serves the same function as the problem

behavior but is socially appropriate

How Can We Assure Appropriate Behavior Will Replace Problem Behavior?

Make it effective:Reinforcement should always be

provided at first

Make it efficient:Response should be less effortful than

problem behaviorReinforcement should occur

frequently and quickly

Rationale for Alternative Skills Instruction Individuals do not have the general skills to cope with

everyday demands; therefore, problem behaviors occur

Categories of Alternative Skills General skills

Self-management skills

Coping and tolerance skills

Purpose of Consequences To teach alternative responses to problematic situations To respond to problem behavior in a way that is least likely to

reinforce it

Consequence ApproachesFeedbackProblem SolvingResponse CostTime OutRestitutionExtinction (Ignore)Natural ConsequencesAdvantages/Disadvantages


PUTTING IT ALL TOGETHER

Look at behaviors,

assess, identify function

Design intervention that teaches child more acceptable behaviors

Why Plans Fail

Failure is not an option…

(but does happen)

Failure is not inescapable BUT its impact can be minimized You cannot strive to serve the most challenging students

and escape failure Failure per se is less of a problem than the refusal to

acknowledge and act upon it At every Devereux Center, at any given time, every

Psychologist and school has a failed BMPThe center has a student whose failed BMP

leaves someone open to injury or other risk management issue.

Why are plans for high risk students more likely to fail? Behaviors can result from a broad range of biopsychosocial

factors and / or skill deficits Student’s cognitive / skill level Variable mood / affect Psychiatric issues Abuse / victimization history May have more limited range of education / interests / positive

influences Poor case conceptualization / training / implementation of plan

What did we miss? Plan is not proactive We missed something in the data? Staff not trained sufficiently to implement plan successfully Plan is not positive Plan does not teach new skills (new skills take time to learn) Plan was not given sufficient time to work Plan contains unintended aversives that cause behavior

deterioration Team is not a team

pbs and transition to adulthood vincent winterling, ed.d. statewide director, delaware autism...

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positive behavior supportwhat

behavior supportfunction

function of challenging

goals of family members

personcentered planning

strengths of family

treatment planning process

teaching alternative