The Power of Positive Behavior Supports

1. The Power of Positive Behavior Supports September 14, 2007 Presenters: Courtney McEuin, Psy.D. Kristin Shaner, M.Ed. Belinda Powell, B.S.

2. Part 1: Overview and Key Elements • Kristin Shaner, M.Ed. • Part 2: Selected Outcome Studies of PBS • Belinda Powell, B.S. • Part 3: Implementation and Challenges • Courtney McEuin, Psy.D.

3. The PBS Philosophy • PBS is an approach to supporting individuals that primarily emphasizes: • Improving contexts (e.g., living environments, classroom), and • Expanding personal competencies (e.g., Skill building). • Improving these aspects for individuals will: • Keep the primary purpose of supports the goal; i.e., helping the individual reach their highest potential in learning and living; and • Reduce many “problem” behaviors that are a result of context (school, room, playground) and person variables

4. Environment has too much/too little sensory stimulation Schedules, expectations, and limits are inconsistent, chaotic, or confusing PROBLEM/REACTIVE FOCUS Lack of responsiveness by caregivers: personal care or social interaction Problem behaviors: Self-harm or harm to others, Aggression, Passivity, withdrawal, Noncompliance, etc Reactions: Ignore Reinforce Restrain etc Boredom Lack of self-determination. Choice-making, and Control over the environment Consequence-based (reactive) interventions Inadequate communication skills Inadequate ability to entertain self Lacks task-specific skills Insufficiently addressed information concerning Mental/medical health, preferences, history, etc

5. POSITIVE BEHAVIOR SUPPORTS FOCUS Environment has best sensory stimulation Schedules, expectations, and limits are Clear and consistent Improved functioning Quality of life Progress toward higher goals Responsive caregivers Available engaging experiences The individual takes an active role in choice making (ALSO RESULTS IN) Improved communication skills Less Problem behaviors: less need for Reactive interventions Ability to self-entertain Gains task- or situation-specific abilities Optimal medical/mental health, preferences accommodated

6. What does this mean? • The shift in focus is: • Less on deficits and problems of the individual as an endpoint, and • More on building strengths, competencies, preferences, learning, and beneficial life experiences. • Lessening deficits, pathologies, or problems is not enough in itself. The questions would follow: So now what? How is this person’s life better?

7. Examples of the Shift In Focus • Client A engages in self-harming behavior. PBS questions: Is this individual’s daily life stimulating enough? What is going on when he/she does not engage in self-harm? Why reduce self-harming behavior? • Client B constantly tries to get out of a room. PBS questions: When is it ok for him/her to leave the room? Can the room be made more appealing? Is the environment beneficial to the individual or is it an agency preference? • Client C loves going out to eat but grabs at things and makes a mess in public. PBS questions: What kind of learning experiences would best enable him/her to be more successful while dining in public?

8. The Problem With Problem Behaviors: • Often, “problem” behaviors are the last resort for getting results from the surrounding environment. We label them “problems”, but they work somehow for the individual. • If the problem behaviors are reduced, everyone else feels better. • However, that does not mean the individual is better off if he/she does not have an equally (or more) effective replacement behavior taught, learned, used, and responded to by others. • Learned Helplessness- when exhibiting acting out behaviors do not result in desired outcomes, can result in passivity or appear as “contentment”.

9. Key Terms • Positive Behavior- Behaviors that exhibit competencies, are socially appealing or inclusive, and are beneficial to the individual’s progress and well-being • Supports- help, training and provided learning experiences to address individualized needs or desires (support does not mean control or management) • Normalization/Inclusion- Helping the individual to experience life as similar as possible to members of the larger community

10. More Key Terms • Person-Centered Planning: The needs of the individual determines the array of services provided. • Self-determination: Choice and decision-making, problem-solving, personal goal setting, self-management, self-instruction, self-advocacy, etc. In other words, the individual becomes as much the causal agent in his own life as is possible, within responsible care parameters.

11. More Key Terms • Quality of Life indicators: examples are improvements in peer relationships, communication, skill sets, participation in preferred activities, and self-determination. Should be tracked and measured empirically. • “Problem behavior is of note to the extent that it interferes with achieving positive results with respect to these…(Quality of Life) variables” (Carr et al, 2002)

12. More Key Terms • Life Span Perspective: modifying supports according to changing developmental and lifespan circumstances • Ecological Validity: interventions result in changes in real-life and environments. • Stakeholder participation and social validity: wide inclusion of participants in the identification of goals and methods • Systems change: improve the living and learning contexts surrounding the individual to see lasting change for the better

13. Emphasis on Prevention: anticipate needs and optimal structure of environment to prevent problems instead of reacting to problems after they occur. • Multiple methods of information collection for integrated case formulation: data recording, questionnaires, interviews, historical information, testing, self-report, trials, interdisciplinary input. • Molar assessments: looking at larger groups or contexts, e.g, behavior patterns common across multiple individuals in a given setting or time frame.

14. In A Nutshell: • Focus on supporting the individual’s progress toward desired outcomes, expanding their competencies and opportunities. • “Problem” behaviors must be considered within the context of relevance to goal progress and structural changes needed in the environment. Functional behavioral assessment will give clues to the context or competency variables that need to be addressed. • Functional Analysis: involves systematically manipulating consequences to verify their impact on behavior.

15. Outcome Studies

16. Carr et al. (1999) • A Research Synthesis requested by the US Department of Education: Office of Special Education Programs • PBS is widely applicable to individuals with serious behavior problems • PBS was effective in reducing problem behaviors in one-half to two-thirds of cases • When PBS interventions are based on a previous functional assessment, success rates almost doubled

17. Clarke et al. (2002) • A Hillsborough County Public School System Tampa, Florida Case Study • A female middle school student with serious behavior problems • A PBS Intervention Applied • the student’s problem behavior in the classroom decreased from an average of 75% to 31%.

18. A PBS Intervention Applied cont’d • The student increased her level of engagement in school activities from 12% to 80%. • The percentage of days that the student’s affect was rated as positive (e.g. happiness) increased from 26% to 42%

19. Carryover Effects following the PBS Intervention: • Problem behavior further decreased to 29% • The engagement level increased to 85% • The percentage of days that the student’s affect was rated as positive decreased to 33%

20. Dunlap et al. (2001) • A study of two mothers and their children who were diagnosed with autism • Looked at the parents’ use of functional assessment and PBS procedures • Successful use of the functional assessment checklist leads to: • decreased problem behaviors (i.e. hitting the door with an object) • increased replacement behaviors (i.e. knocking on the door)

21. Horner (2000) • Study consisted of 530 middle school students • Implementation of PBS school wide resulted in a 47% annual reduction in the number of office discipline referrals • Future direction – PBS is more than just a tool to reduce disruptive behavior; it is a technology for engineering the individuals environment for productivity and safety

22. Smith-Bird and Turnbull (2005) • A research synthesis of four research studies with a PBS and family components • Linked PBS to Family Quality-of-Life Domains and Indicators • REMINDER: PBS is an approach that measures Quality of Life Indicators

23. Quality of Life Domains 1. Family Interaction 2. Parenting 3. Emotional Well-Being 4. Physical/Material Well-Being 5. Disability-Related Support Quality of Life Indicators 1. Family enjoys time together 2. Family members help children with schoolwork 3. Family has necessary supports to handle life stress 4. Family members feel safe in their community 5. Family members with special needs have the necessary supports to develop friendships.

24. Prior to applying a PBS intervention: • Individuals exhibited problem behavior that interfered with ability to learn in a classroom environment • Individuals exhibited problem behavior that interfered with daily living at home • Caregivers had unexpressed feelings about the individuals’ problem behaviors • Caregivers felt anger directed toward the individual with the problem behavior

25. A PBS Intervention Applied: • Caregivers begin expressing emotions regarding the individual’s problem behavior • Caregivers became more involved in the individual’s PBS plan by offering support and suggestions • Caregivers start to gain hope that the individual’s behavior will improve

26. Carryover Effects Following the PBS Intervention: • Individuals showed improved communication and less tantrums • Level of aggressive behavior decreased to a more tolerable level

27. Implementation of PBS Programs

28. The Implementation Model • There is no one definitive model • There are many ways to implement PBS Plans • Models must take into account current organizational structure, characteristics of the individual, living environment, level of family involvement, and staff expertise.

29. Barriers to Implementation • Continued focus on problem behaviors • Lack of understanding of criteria used to design PBS Plans or Insufficient knowledge of procedures

30. Recommended elements • Person-centered planning - Keeps the focus on supporting lifestyle change vs. behavior change • Team-based approach - Promotes shared responsibility for change

31. Behavior Guidelines • To facilitate pro-social behaviors • To address infrequent, non-harmful, maladaptive behavior • To address behaviors that may stigmatize

32. Developing a PBS Plan • Identify the Goals of Intervention -Strengths and needs, team members to be involved in BS, situations and settings which require intervention.

33. Developing a PBS Plan • Gather Information - Description of the problem behavior. - Events, times, and situations that might predict the behavior. - What might maintain the behavior? - Direct observation of the behavior.

34. Developing a Hypothesis • Analyze patterns of behavior. • Identify circumstances in which behavior of concerns is most or least likely to occur. • What does the individual gain or avoid by initiating the behavior?

35. Designing PB Support Plan • Clearly describes behavior of concern, outlines goals of intervention and identifies patterns of behavior that serve a function. • Modifies social and physical environment to increase positive behavior. • Teaches and reinforces specific behaviors. • Includes crisis management procedures to ensure safety.

36. Implementing the Plan • Provide resources and training to ensure effective implementation. • Create an action plan which includes method of monitoring the program and a timeline of goal achievement.

37. Evaluating the Effectiveness of the Plan • Decrease in problem behavior. • Increase in appropriate behavior. • Generalization and maintenance of behavior change. • Goal achievement.

38. Vignettes

39. Questions and Answers

40. Thank You!