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Reducing the Use of Seclusion and/or Restraint through the Use of Functional Behavior Assessment. Fall 2010 MO-CASE Conference Dr. Staci M. Mathes Raytown Quality Schools staci.mathes@raytownschools.org. Process for Students with Behavioral Concerns.

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Reducing the use of seclusion and or restraint through the use of functional behavior assessment l.jpg

Reducing the Use of Seclusion and/or Restraint through the Use of Functional Behavior Assessment

Fall 2010 MO-CASE Conference

Dr. Staci M. Mathes

Raytown Quality Schools

staci.mathes@raytownschools.org


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Process for Students with Behavioral Concerns Use of Functional Behavior Assessment


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Defining Use of Functional Behavior AssessmentFunctional Behavior Assessment

  • FBA IS:

    • A legal process as part of an IEP, documented when behavior is related to a disability-it is a form required in the permanent file for students diagnosed with ED

    • The process that guides the development of a behavior plan

    • A consideration of student perspectives

    • A analysis of what happens before, during and after problem behavior

  • FBA IS NOT:

    • Simply one of the forms to be filled out as part of the IEP process for students with ED

    • A form describing problem behaviors

    • A report of school personnel opinions

    • A list of discipline records

    • A single event


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Sally Student Decreases the Use of Seclusion & Time Out Use of Functional Behavior Assessment

  • Throughout the presentation, Sally will illustrate how the FBA process was used to develop a plan that reduced the use of seclusion/time out.

  • Specific examples of each component of FBA are provided via the case study.


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Relevant Behavioral Background Information Use of Functional Behavior Assessment

  • Describes information related to patterns of behavior

  • Includes length of time problem behaviors have been noted at school (months, years)

  • Expresses changes in intensity

  • Includes relevant problems at home

  • Tells about changes in frequency of problem behaviors

  • Explains medical information

  • Indicates possible contributing factors

    *Does not list discipline logs


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Background Information Use of Functional Behavior Assessment“Sally”

  • Removed from biological parents at age 15 months for severe neglect, malnutrition, and possible physical/sexual abuse

  • Adopted into foster family with 2 biological siblings

  • Mostly successful in kindergarten, began to have difficulty with behavior at school in 1st grade. Parents reported much difficulty at home, even before school behaviors started, referred for special education evaluation.

  • Placed in behavioral skills program beginning of 2nd grade, following evaluation begun at the end of 1st grade.

  • Diagnoses reported by parents included: mood disorder NOS (r/o bipolar disorder), oppositional defiance disorder-severe, reactive- attachment disorder and Axis II-histrionic personality traits.

  • Medications included: Risperdal and Trileptal


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Multiple Data Sources Use of Functional Behavior Assessment*At least one of each

First section of FBA-Data Sources


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Identify Student Strengths and Interests-MAJOR component for developing an EFFECTIVE behavior plan

  • Student strengths-The student CAN…

    • Work independently

    • Show interest in learning

    • Seek assistance when needed

    • Draw well

    • Should be obtained from current information

  • Can be academic, social, behavioral

  • Student interests-The student LIKES…

    • Socializing

    • Playing games

    • Artwork

    • Listening to music

    • Should be obtained from student input

  • Can be academic, social, behavioral


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Data Collection Procedures for Problem Behaviors developing an EFFECTIVE behavior plan

Frequency Data

Duration Data

  • Tally marks

  • TBS

  • Paper clips (or other item) from one pocket/cup to the other

  • Specific data sheets for marking each time it happens

  • Examples of useful frequency data:

    • Talking out/Out of seat

    • # times hit/kick/push/etc.

    • Arguing occurrences

    • Redirections

    • Etc…

      ***Many times this data is more readily available.

  • Note beginning and ending times of episode(s)

  • Data sheets with appropriate time increments to draw lines through for starting and stopping times

  • Examples of useful duration data:

    • Duration of restraint

    • Duration of tantrum

    • Duration of refusal to work

    • Etc…

      ***Many times this data has not been readily available for problem-solving meetings.


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Operationally developing an EFFECTIVE behavior planDefine Behavior

Frequency

How many times?

How often?

Duration

How long does the outburst/shut down last?

How long has it been happening?

Intensity

How many adults are involved when the behavior occurs?

What is the level of severity?


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Sally’s Problem Behaviors developing an EFFECTIVE behavior plan

  • Physical Aggression including hitting, kicking, & pushing staff

  • Verbal Aggression toward staff & peers

  • Turning furniture when angry

  • Use of profane language

  • Jumping, stomping, banging head

  • Running Away/withdrawal

  • Rapid escalation of behavior


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Issues Surrounding Problem Behavior(s) developing an EFFECTIVE behavior plan


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Setting Events developing an EFFECTIVE behavior plan

  • Examples of Life circumstances

    • Death in family/divorce

    • Crisis at home

    • Health issue/medical diagnosis

  • Examples of Routines

    • Hate bus stop, have to go

    • Have to get themselves &/or sibling to school

  • Examples of things that set up the student’s day

    • Did they eat breakfast?

    • Tardy?

    • Incomplete homework

    • Didn’t take medication


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Sally’s Setting Events developing an EFFECTIVE behavior plan

  • Changes in schedule

  • Substitute teachers

  • Changes in medication

  • Home occurrences-discipline, therapy sessions, arguments with siblings, etc.


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Considering Manipulating Setting Events developing an EFFECTIVE behavior plan

  • Life circumstances

    • Communication plan with home

    • Communication plan with doctor(s)-signed release

    • Build in time for students to talk with someone about their situation/concerns/etc.

  • Routines

    • Work with family to support changes in routines

    • Provide time at school to discuss any changes at beginning or end of day, as appropriate

  • Setting up the student’s day

    • Give breakfast/snacks when known setting event

    • Alter student’s schedule if know to be tardy

    • Provide homework time at school

    • Offer medication at school


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Considering Manipulating Location developing an EFFECTIVE behavior plan

  • Behavior(s) occur(s):

    • At the same place?

      • Altering the schedule

      • Changing the environment

    • In the same area of the room?

      • Changing seat

      • Rearrange things

    • During the same type of activity?

      • Transition warning/countdown

      • Change the schedule

      • Reduce/increase the size of the group


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Antecedents developing an EFFECTIVE behavior plan

  • Possible Precipitating Events

    • Non-preferred task

    • Change in routine/environment

    • Preferred activity stopped

    • Negative (or perceived) peer/adult interaction

    • Redirection given

    • Etc…

  • Possible Skill Deficits

    • Academic weakness in the subject

    • Poor social/communication/motor skills

    • Difficulty managing feelings

    • Educational diagnosis

    • Etc…


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Sally’s Triggering Antecedents developing an EFFECTIVE behavior plan

  • Receiving “no” as an answer to her request

  • Requests to work independently

  • Perception that she does not have the skills to complete a task

  • Other students receiving attention

  • Receiving negative feedback (discussing her behavior sheet throughout the day was discontinued as viewing non-plus areas if her day became a triggering antecedent)


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Consider Manipulating Antecedents developing an EFFECTIVE behavior plan

  • Precipitating events

    • Non-preferred task (choices in tasks, pre-warning of task)

    • Change in routine/environment (transition warning, alter schedule)

    • Preferred activity stopped (transition warning, alter schedule)

    • Negative (or perceived) peer/adult interaction (visual redirection, teach class to ignore)

    • Redirection given (visual, near student, phrasing used)

  • Skill deficits

    • Academic weakness in the subject (extra help before independent work, small group)

    • Poor social/communication/motor skills (address in plan, preteach skills prior to opportunity for use)

    • Difficulty managing feelings (positive practice, watch for signs of early anxiety)


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Consequences developing an EFFECTIVE behavior plan

Examples of

Teacher-Directed/

Given by an adult

Examples of things that Naturally occur in the environment

  • Safe spot/removed from classroom

  • Adult attention (redirection/ processing)

  • Physical mgmt.

  • Removal of privilege

  • Denial of positive reinforcement from plan

  • Gain peer/adult attention

  • Isolation

  • Sensory input

  • Avoid peer/adult attention

  • Removal sometimes escapes work


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Consequences Occurring Naturally as a Result of Sally’s Problem Behavior

  • Getting attention from adults &/or peers

  • Escape from undesirable tasks/ environment

  • Perception of control over environment


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Consider Manipulating Consequences Problem Behavior

  • Teacher-Directed

    • Safe spot/removed from classroom

    • Adult attention (redirection/ processing)

    • Physical mgmt.

    • Removal of privilege

    • Denial of positive reinforcement from plan

  • Naturally occur in the environment

    • Gain peer/adult attention

    • Isolation

    • Sensory input

    • Avoid peer/adult attention

    • Removal sometimes escapes work


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To Manipulate or NOT? Points to consider while analyzing behavior(s)

  • Some things cannot and should not be manipulated

    • Family issues/socio-economic status/religious beliefs

    • Medical/health issues

    • Ensure friends outside of school

  • Some things can be helped

    • Medication at school

    • Meals at school

    • Time to get ready for school at school

    • Homework time at school

    • Set up social situations


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Hypothesizing Function- behavior(s) THIS DRIVES YOUR PLAN!!!

  • To Request or Obtain:

    • Peer attention

    • Adult attention

    • Preferred items or activities

    • Sensory stimulation

    • Control

  • To Escape of Avoid:

    • Attention

    • Sensory Stimulation

    • Undesirable environments

    • Undesirable tasks or activities

  • To Communicate Feelings:

    • Be specific-anger, frustration, sadness, fear, etc…


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Sally’s Hypothesized Functions behavior(s)

  • Seeking Attention

  • Escaping & avoiding undesirable tasks

  • Seeking tangible items

  • Communicating feelings

  • Seeking control


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Behavior Intervention Plans/ behavior(s) Success Plans

  • Behavior Plans:

    • Identify positive reinforcement and consequences to be in place for students who exhibit problem behaviors

    • Include prevention, intervention and follow-up

    • Identify replacement behaviors (based on FBA) that must be taught to assist students in eliminating problem behavior(s)

    • Consider student strengths, interests, and preferences as a means of support

  • Behavior Plans Do NOT:

    • Focus on adult reactions to problem behavior(s)

    • Focus on too many behaviors at one time

    • List punishments to be incurred by students who exhibit problem behavior


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Replacement Behavior behavior(s)

  • It is…

    • A substitute behavior for students to use instead of the behavior that is getting them into trouble

    • A behavior that gets better results for the student

    • A behavior that serves the same function!

    • A behavior that is positively reinforced

  • It is NOT…

    • Doing the opposite of the problem behavior

    • A behavior that will please adults (always)

    • A excuse for inappropriate behavior


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Sally’s Goals/ behavior(s) Replacement Behaviors

Classroom & Anger Skills

  • Given adult prompting, Sally will increase ability to follow directions the first time no less than 85% of the time per day for 4 consecutive weeks.

  • Given instruction, Sally will increase ability to manage anger without verbal outbursts or aggressive behavior, using coping skills, with adult prompting, no less than 85% of the time per day for 4 consecutive weeks.

  • Given instruction, Sally will increase ability to work & play cooperatively to at least 85% of the time per day for 4 consecutive weeks.

  • Given directions from an adult, Sally will respond without arguing 85% of the time per day for 4 consecutive weeks.


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Prevention-support that occurs in order to behavior(s) prevent behaviors from occurring

  • Consider data collected regarding each of the following:

    • Location

    • Setting events

    • Antecedents

    • Consequences (teacher-given & naturally occurring)

      What should we manipulate?


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Thinking Points Regarding Positive Reinforcement behavior(s)

*It is NOT bribery, it is predetermined that they will receive it upon performance (like your paycheck)

*It is interest-based

*It is reasonable & enforceable

*It is not always tangible


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Sally’s PBS Plan behavior(s)

  • Environmental modifications

  • Low teacher-to-student ratio for academic instruction

  • Direct supervision while in small group and during large group unstructured activities (i.e. P.E., recess, lunch…)

  • Positive behavioral supports

  • Triage beginning & end of day

  • Developmentally appropriate materials and instruction

  • Visual Schedule with changing menu of student-chosen reinforcement during “reward time” scheduled during the day

  • Level system & token economy

  • Visual “coping skills menu”

  • Target behavior sheet

  • Daily communication with parents

  • Direct social skills instruction

  • Early intervention to break the chain of escalation of inappropriate behavior


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Sally’s PBS Plan Continued behavior(s)

Consequences for appropriate behavior

  • Frequent social reinforcement for use of appropriate behaviors through the use of verbal praise, hugging, high-fives, 1:1 attention.

  • Specific target skills identified from the IEP goals monitored at regular intervals throughout the day based on the student’s schedule and recorded on the target behavior sheet.

  • Based on the target behavior sheet, promotion or maintenance of levels are determined on a weekly basis– incorporating increased privileges for higher levels achieved.

  • Use of visual cues for schedule and coping skills.

  • Concrete positive reinforcement was given.

  • “Bragging rights” were given.

  • Notes home to parents telling “her story.”


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Sally’s PBS Plan Continued behavior(s)

Consequences for inappropriate behavior

  • Adult redirection immediately after inappropriate behaviors with visual cue, prompts for appropriate behavior, provision of choices and developmentally appropriate wait time, prompting to use “coping skills.”

  • Demotion of the level system was used-started over for suspension or aggressive incidents.

  • Opportunities for adult-directed problem solving regarding the inappropriate behavior.

  • Out-of-school suspension was used initially for physical aggression toward staff, but discontinued due to hypothesized function: escape & avoidance of undesirable tasks.

  • Opportunities to complete work missed during the misbehavior.


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Red/Restricted Schedule behavior(s)

  • Red/restricted schedule was implemented to replace out-of-school suspension.

  • Based on the target behavior sheet, red/restricted schedule may be implemented for the following day to practice appropriate behaviors.

  • The student remained in the special education setting for the day, with attention and work tasks brought to him.

  • The student was also given numerous opportunities to practice appropriate behaviors and role play within the setting.


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Checklist for Behavior Plans behavior(s)

  • Does your plan have the following components?

    • Prevention

      • Have you manipulated pieces of their day, as appropriate?

    • Intervention

      • What happens if they engage in the problem behavior?

    • Direct Instruction

      • Who will teach the replacement behavior? And when? Practice?

    • Based on Function(s)

      • Does the replacement feed their function?

    • Team follow-up/debriefing

      • When will the team meet to review progress?

        ***At least quarterly reviews after team follow-up


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Seclusion & Time Out behavior(s)

  • Use of isolation safe room with open, closed or secured door dependent upon behavior.

  • Through the use of seclusion & time out, we significantly decreased the amount of times physical intervention would have been necessary.

  • Sally required withdrawal of attention, as well as a safe environment within which to calm down in order to keep Sally and others safe.


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Sally’s Progress behavior(s)

  • Target behavior sheet data showed improvement in school behavior over time.

  • Number of quiet room uses & duration decreased throughout the school year.

  • Sally was able to maintain her behavior to reach red level (top of level system) more than once throughout the year, though aggressive behaviors caused her to start over on occasion.

  • Sally was able to continue her schedule of spending science, social studies, & library time with her general education class without adult support.


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Sally’s Progress Continued behavior(s)

  • Sally increased self-confidence and academic skills throughout her time in the program, thereby increasing her ability to work independently.

  • Sally was able to maintain her behavior and remain in the public school-not placed outside of the district by school.

  • Sally was not physically restrained once the quiet room was used consistently & coping skills were taught, practiced, prompted and used, though at times, Sally had to be physically escorted into the quiet room to maintain a safe environment.


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Stop spinning your wheel & getting nowhere! behavior(s)

You are working too hard to plan for students not to think about function and develop behavior plans. It’s EFFICIENT & EFFECTIVE to use FBA to guide your planning!

Review your FBA and behavior plan on a regular basis-functions can change, incentives can change, and consequences may lose their effectiveness