Module V ______________________________________________________

1. V-1 Module V______________________________________________________ Providing Positive Behavioral Interventions and Supports MATERIALS NEEDED FOR MODULE V Overheads/ Power Point slides Projector Flip chart Videotape, VCR, and TV monitor (optional) WHILE SHOWING THIS SLIDE NOTE This module focuses on strategies for supporting students with TBI who exhibit challenging behaviors. The emphasis throughout the module is on positive behavioral interventions and supports. We have already begun discussing the process of FBA, which is the framework we will use in addressing behavioral challenges. If academic planning is carefully carried out, behavioral challenges will decrease. MATERIALS NEEDED FOR MODULE V Overheads/ Power Point slides Projector Flip chart Videotape, VCR, and TV monitor (optional) WHILE SHOWING THIS SLIDE NOTE This module focuses on strategies for supporting students with TBI who exhibit challenging behaviors. The emphasis throughout the module is on positive behavioral interventions and supports. We have already begun discussing the process of FBA, which is the framework we will use in addressing behavioral challenges. If academic planning is carefully carried out, behavioral challenges will decrease.

2. V-2 Module V Goal _______________________________________________________  To provide information about why students with TBI have challenging behaviors and to provide skill in providing positive behavioral interventions and supports. WHILE SHOWING THIS SLIDE NOTE Read the goal of Module V.WHILE SHOWING THIS SLIDE NOTE Read the goal of Module V.

3. V-3 Module V Learning Outcomes______________________________________________________ At the end of this module you will: Understand why students with TBI have challenging behaviors Understand how to use functional behavioral assessment to identify interventions Be familiar with a range of positive interventions and supports Be aware of medications used to control challenging behaviors WHILE SHOWING THIS SLIDE NOTE Review the learning outcomes listed on this slide. WHILE SHOWING THIS SLIDE NOTE Review the learning outcomes listed on this slide.

4. V-4 What challenging behaviors do your students with TBI exhibit?______________________________________________________ EXAMPLES WHILE SHOWING THIS SLIDE ASK What challenging behaviors might students with TBI exhibit? Solicit examples from students with whom participants have worked. We are going to examine reasons for these behaviors. NOTE TO PRESENTER If you have not used Modules II-IV you will want to have participants read the one-page descriptions of SERENA (Module II) and JERRY (Module IV). WHILE SHOWING THIS SLIDE ASK What challenging behaviors might students with TBI exhibit? Solicit examples from students with whom participants have worked. We are going to examine reasons for these behaviors. NOTE TO PRESENTER If you have not used Modules II-IV you will want to have participants read the one-page descriptions of SERENA (Module II) and JERRY (Module IV).

5. V-5 Why do students with TBI have challenging behaviors?_______________________________________________________ WHILE SHOWING THIS SLIDE NOTE We will examine some of the reasons students with TBI exhibit challenging behaviors. But first, we will think about our own behavior.WHILE SHOWING THIS SLIDE NOTE We will examine some of the reasons students with TBI exhibit challenging behaviors. But first, we will think about our own behavior.

6. V-6 Behavioral control is complex______________________________________________________ Consider your own behavior. Do you ever have difficulty controlling your own behavior? Why? Do you act differently in different settings? With different people? On different days? WHILE SHOWING THIS SLIDE NOTE Controlling our behavior is a complex task. Most of us have some difficulty controlling our behavior sometimes. What influences our behavior? Stress the role of context and antecedents on our own behavior. ASK Solicit examples from participants of variable behavior. Use one of these examples with the next slide. WHILE SHOWING THIS SLIDE NOTE Controlling our behavior is a complex task. Most of us have some difficulty controlling our behavior sometimes. What influences our behavior? Stress the role of context and antecedents on our own behavior. ASK Solicit examples from participants of variable behavior. Use one of these examples with the next slide.

7. V-7 Behavioral control requires the intact and integrated functioning of brain systems_____________________________________________ attention and memory regulation (physical and emotional) executive functions (planning and anticipation) speed of processing communication skills WHILE SHOWING THIS SLIDE NOTE Behavioral control requires that multiple brain systems work together to process information, interpret it, and act on it. Use one of the examples provided by participants to illustrate how these factors influence behavior: attention and memory. For example, appropriate behavior requires attention to situational cues and memory of expectations and consequences of behavior. physical and emotional regulation. For example, appropriate behavior requires the ability to control emotions and to regulate physical responses. executive functions, such as planning and anticipation. For example, a student must be able to anticipate what will happen when (s)he exhibits certain behaviors. speed of processing. For example, sometimes a student with TBI will react more slowly to events in the environment than others do. Consequently, a student’s behavior may appear out of place with what is happening now. communication skills. Appropriate behavior requires that a student be able to communicate needs and wants effectively. NOTE Deficits to areas and systems interact to produce challenging behaviors. WHILE SHOWING THIS SLIDE NOTE Behavioral control requires that multiple brain systems work together to process information, interpret it, and act on it. Use one of the examples provided by participants to illustrate how these factors influence behavior: attention and memory. For example, appropriate behavior requires attention to situational cues and memory of expectations and consequences of behavior. physical and emotional regulation. For example, appropriate behavior requires the ability to control emotions and to regulate physical responses. executive functions, such as planning and anticipation. For example, a student must be able to anticipate what will happen when (s)he exhibits certain behaviors. speed of processing. For example, sometimes a student with TBI will react more slowly to events in the environment than others do. Consequently, a student’s behavior may appear out of place with what is happening now. communication skills. Appropriate behavior requires that a student be able to communicate needs and wants effectively. NOTE Deficits to areas and systems interact to produce challenging behaviors.

8. V-8 Students with TBI_____________________________________________________ Difficulty with new memory, working memory, and attention: may not remember instruction, rules or consequences Reduced regulation: may not be able to control emotions or reactions impulsivity disinhibition WHILE SHOWING THIS SLIDE NOTE Students with TBI may have difficulty remembering what they are supposed to do. They may not remember the rules/expectations or the consequences (positive or negative) of their behavior. Students with TBI may have difficulty controlling their emotions or reactions. They may be impulsive and/or disinhibited.WHILE SHOWING THIS SLIDE NOTE Students with TBI may have difficulty remembering what they are supposed to do. They may not remember the rules/expectations or the consequences (positive or negative) of their behavior. Students with TBI may have difficulty controlling their emotions or reactions. They may be impulsive and/or disinhibited.

9. V-9 Students with TBI (cont.)_______________________________________________________ Limited executive functions anticipation and planning: may not know how to avoid difficult situations lack of awareness of others’ expectations difficulty taking the perspective of others Reduced speed of processing may need more time on questions/tasks may miss valuable information WHILE SHOWING THIS SLIDE NOTE Students with TBI may have limited executive functions, such as anticipation and planning. They may get into trouble because they can’t see trouble developing. They may also be unaware of others’ (peers, teachers, parents) expectations of them and have difficulty taking others’ perspectives. Students may have slower than average speed of processing, especially soon after injury. They may need additional time to process information; they may miss out on important information and may have trouble keeping up with conversations or activities.WHILE SHOWING THIS SLIDE NOTE Students with TBI may have limited executive functions, such as anticipation and planning. They may get into trouble because they can’t see trouble developing. They may also be unaware of others’ (peers, teachers, parents) expectations of them and have difficulty taking others’ perspectives. Students may have slower than average speed of processing, especially soon after injury. They may need additional time to process information; they may miss out on important information and may have trouble keeping up with conversations or activities.

10. V-10 Students with TBI (cont.)_______________________________________________________ Communication specific expressive and receptive language limitations use of inappropriate behavior as a means to communicate lack of awareness of social cues physical proximity gestures, eye contact, turn-taking WHILE SHOWING THIS SLIDE NOTE Communication deficits contribute to challenging behaviors. Students may have specific expressive and receptive language limitations that make expressing needs and understanding others difficult. Students may use inappropriate behavior as a means of communication. Students may be unaware of the social messages or cues the often help us evaluate our actions. They may get too close to others and not respect others’ personal space. They may not understand gestures. They may not use eye contact or turn-taking. STRESS The main point is that BRAIN INJURY leads to challenging behavior. Students with TBI may not be able to control their behavior to the same degree that other students can. WHILE SHOWING THIS SLIDE NOTE Communication deficits contribute to challenging behaviors. Students may have specific expressive and receptive language limitations that make expressing needs and understanding others difficult. Students may use inappropriate behavior as a means of communication. Students may be unaware of the social messages or cues the often help us evaluate our actions. They may get too close to others and not respect others’ personal space. They may not understand gestures. They may not use eye contact or turn-taking. STRESS The main point is that BRAIN INJURY leads to challenging behavior. Students with TBI may not be able to control their behavior to the same degree that other students can.

11. V-11 How do we address these challenging behaviors? ______________________________________________________ Functional behavioral assessment is a continuous process (not a one-time event) for identifying (1) the purpose or function of the behavior (2) the variables that influence the behavior (3) components of an effective behavioral intervention plan (BIP) (DPI, May, 2000) WHILE SHOWING THIS SLIDE NOTE We will use the framework of functional behavioral assessment (FBA) to address challenging behaviors. Wisconsin’s DPI has defined FBA as An ongoing process To identify 1) the purpose of the behavior, 2) variables that influence whether the behavior will be repeated, and 3) factors to be addressed in an intervention plan. ASK Ask the participants how many of them are familiar with functional behavioral assessment. WHILE SHOWING THIS SLIDE NOTE We will use the framework of functional behavioral assessment (FBA) to address challenging behaviors. Wisconsin’s DPI has defined FBA as An ongoing process To identify 1) the purpose of the behavior, 2) variables that influence whether the behavior will be repeated, and 3) factors to be addressed in an intervention plan. ASK Ask the participants how many of them are familiar with functional behavioral assessment.

12. V-12 Functional Assessment of Behavior: The Link to Intervention_______________________________________________________ Identify the problem Measure the behavior Identify slow and fast triggers Identify consequences of behavior Identify functions of behavior WHILE SHOWING THIS SLIDE NOTE Functional assessment is a recommended practice in schools because it helps identify the purposes (functions) a behavior might serve. Once we identify the purpose or function of a behavior, we can identify ways to help the student achieve that function in a more appropriate way. Read the steps in the process of functional assessment on the slide above. (We will discuss each one on upcoming slides.) They lead directly to the intervention plan. TURN to the example of Serena’s challenging behavior on the next page (12a). As you show slides 13-17, apply each question to the Serena example. Ask participants to volunteer answers. (Participants might identify different problems, goals, antecedents, and consequences. That is fine. There are multiple problems and goals to be addressed.) WHILE SHOWING THIS SLIDE NOTE Functional assessment is a recommended practice in schools because it helps identify the purposes (functions) a behavior might serve. Once we identify the purpose or function of a behavior, we can identify ways to help the student achieve that function in a more appropriate way. Read the steps in the process of functional assessment on the slide above. (We will discuss each one on upcoming slides.) They lead directly to the intervention plan. TURN to the example of Serena’s challenging behavior on the next page (12a). As you show slides 13-17, apply each question to the Serena example. Ask participants to volunteer answers. (Participants might identify different problems, goals, antecedents, and consequences. That is fine. There are multiple problems and goals to be addressed.)

13. V-13 Serena Example1. Identify the problem______________________________________________________ State the problem clearly What is the problem the teacher is having with Serena? Choose the most critical behavior to address first WHILE SHOWING THIS SLIDE READ Serena example. NOTE The first step in functional behavioral assessment is to identify the problem. State the problem specifically; what exactly is the student doing? ASK What is the problem the teacher is having with SERENA? (e.g., Serena argued with the teacher; she pushed her materials to the floor, she tried to hit the teacher; she swore at the teacher.) Choose a “keystone” behavior or the behavior that drives other behaviors to address first. Target the “worst first.” IN CASE SOMEONE ASKS There are multiple models of functional assessment. The specific steps may be slightly different across models, but the intent is similar.WHILE SHOWING THIS SLIDE READ Serena example. NOTE The first step in functional behavioral assessment is to identify the problem. State the problem specifically; what exactly is the student doing? ASK What is the problem the teacher is having with SERENA? (e.g., Serena argued with the teacher; she pushed her materials to the floor, she tried to hit the teacher; she swore at the teacher.) Choose a “keystone” behavior or the behavior that drives other behaviors to address first. Target the “worst first.” IN CASE SOMEONE ASKS There are multiple models of functional assessment. The specific steps may be slightly different across models, but the intent is similar.

14. V-14 2. Measure the behavior_______________________________________________________ How frequently does the behavior occur? With what intensity? For how long? Why is it important to measure the behavior? WHILE SHOWING THIS SLIDE NOTE The second step in functional assessment is to measure the behavior. How frequently does it occur? How intense is it? How long does it last? ASK How would participants describe SERENA’s behavior? Frequency: (about once a week) Intensity: (very intense) Duration: (a few minutes) Why do we need to measure the behavior? (Because knowing the frequency, intensity, duration, of the behavior helps us 1) determine whether we need to intervene with this behavior, 2) decide how quickly we need to respond to the behavior (e.g., self-injurious behaviors or behavior dangerous to others must be addressed immediately), and 3) begin to identify appropriate intervention strategies (e.g., we will use different strategies for low versus high frequency behaviors). WHILE SHOWING THIS SLIDE NOTE The second step in functional assessment is to measure the behavior. How frequently does it occur? How intense is it? How long does it last? ASK How would participants describe SERENA’s behavior? Frequency: (about once a week) Intensity: (very intense) Duration: (a few minutes) Why do we need to measure the behavior? (Because knowing the frequency, intensity, duration, of the behavior helps us 1) determine whether we need to intervene with this behavior, 2) decide how quickly we need to respond to the behavior (e.g., self-injurious behaviors or behavior dangerous to others must be addressed immediately), and 3) begin to identify appropriate intervention strategies (e.g., we will use different strategies for low versus high frequency behaviors).

15. V-15 3. Identify slow and fast triggers _______________________________________________________ Slow triggers (or setting events) are factors that set the stage for the behavior Internal: brain injury mood, fatigue, hunger External: people, tasks, settings What slow triggers may influence Serena’s behavior? WHILE SHOWING THIS SLIDE NOTE The next step is to identify why the problem is occurring. We can begin by examining “slow triggers” (Tilly, Knoster, & Ikeda, 2000) . Slow triggers or “setting events” are events/factors which are removed from the challenging behavior itself but influence whether the behavior occurs. Slow triggers may include internal factors (such as moods, fatigue, hunger, or disability) and external factors (such as people, tasks, requests, or settings) . TBI itself can be considered a slow trigger because the effects of TBI, such as slowed rate of processing, memory difficulty, or impulsivity, may predispose a child/adolescent to exhibit challenging behavior. ASK Consider SERENA’s behavior. What are antecedents? What happens BEFORE the behavior that might influence it? Internal slow triggers: What internal factors may influence Serena’s behavior? What brain injury factors may influence Serena’s behavior? (limited memory skills and executive functioning skills, impulsivity) What other internal factors may influence her behavior? (Perhaps fatigue, unease over schedule change) External slow triggers: What external factors may set the stage for Serena’s behavior? (Field trip, mother’s change in schedule. Serena’s teacher may be a slow trigger for her behavior also.)WHILE SHOWING THIS SLIDE NOTE The next step is to identify why the problem is occurring. We can begin by examining “slow triggers” (Tilly, Knoster, & Ikeda, 2000) . Slow triggers or “setting events” are events/factors which are removed from the challenging behavior itself but influence whether the behavior occurs. Slow triggers may include internal factors (such as moods, fatigue, hunger, or disability) and external factors (such as people, tasks, requests, or settings) . TBI itself can be considered a slow trigger because the effects of TBI, such as slowed rate of processing, memory difficulty, or impulsivity, may predispose a child/adolescent to exhibit challenging behavior. ASK Consider SERENA’s behavior. What are antecedents? What happens BEFORE the behavior that might influence it? Internal slow triggers: What internal factors may influence Serena’s behavior? What brain injury factors may influence Serena’s behavior? (limited memory skills and executive functioning skills, impulsivity) What other internal factors may influence her behavior? (Perhaps fatigue, unease over schedule change) External slow triggers: What external factors may set the stage for Serena’s behavior? (Field trip, mother’s change in schedule. Serena’s teacher may be a slow trigger for her behavior also.)

16. V-16 3. Identify slow and fast triggers (cont.)_______________________________________________________ Fast triggers are events/stimuli that immediately precede the behavior and influence whether it occurs What fast triggers may affect Serena’s behavior? WHILE SHOWING THIS SLIDE NOTE The next step is to identify the fast triggers that influence behavior. Fast triggers (Tilly, Knoster, & Ikeda, 2000) are events or stimuli that immediately precede a behavior and influence whether that behavior occurs. ASK What fast triggers might have influenced Serena’s behavior? Fast triggers: schedule change, required to do math instead of social studies. WHILE SHOWING THIS SLIDE NOTE The next step is to identify the fast triggers that influence behavior. Fast triggers (Tilly, Knoster, & Ikeda, 2000) are events or stimuli that immediately precede a behavior and influence whether that behavior occurs. ASK What fast triggers might have influenced Serena’s behavior? Fast triggers: schedule change, required to do math instead of social studies.

17. V-17 4. Identify consequences______________________________________________________ What happens after the behavior that influences whether it will occur again? Reinforcement: increases the occurrence of the behavior positive reinforcement: desirable consequence negative reinforcement: avoidance of undesirable consequence Punishment: reduces the occurrence of the behavior WHILE SHOWING THIS SLIDE NOTE What are consequences of Serena’s behavior that might affect whether it happens again? Remember that consequences may have little effect due to memory problems. Discuss terms. Reinforcement and punishment are defined in terms of the outcome of the consequence on the likelihood that the behavior will occur again. Reinforcement increases the likelihood that the behavior will occur again. Positive reinforcement: strengthens behavior through presentation of a satisfying/desirable consequence. Negative reinforcement: strengthens behavior through removal/avoidance of a dissatisfying event/stimulus. Punishment: effects which decrease the occurrence of a behavior. ASK What consequences did Serena experience? Serena didn’t have to go to math and she got to do her social studies. Positive reinforcement for her behavior; may lead to increase in the behavior. Serena was taken to the hallway to work. Positive reinforcement: Serena may enjoy working in the hallway, so this may lead to an increase in the behavior. Negative reinforcement: Serena may want to escape an overly stimulating classroom environment; may lead to increase in behavior. Serena was not allowed to go on the field trip. Depending on how this is perceived by Serena it could be punishment, the behavior will decrease, or negative reinforcement, the behavior will increase because she wanted to avoid the field trip. Remember that Serena may not link this consequence with her behavior.WHILE SHOWING THIS SLIDE NOTE What are consequences of Serena’s behavior that might affect whether it happens again? Remember that consequences may have little effect due to memory problems. Discuss terms. Reinforcement and punishment are defined in terms of the outcome of the consequence on the likelihood that the behavior will occur again. Reinforcement increases the likelihood that the behavior will occur again. Positive reinforcement: strengthens behavior through presentation of a satisfying/desirable consequence. Negative reinforcement: strengthens behavior through removal/avoidance of a dissatisfying event/stimulus. Punishment: effects which decrease the occurrence of a behavior. ASK What consequences did Serena experience? Serena didn’t have to go to math and she got to do her social studies. Positive reinforcement for her behavior; may lead to increase in the behavior. Serena was taken to the hallway to work. Positive reinforcement: Serena may enjoy working in the hallway, so this may lead to an increase in the behavior. Negative reinforcement: Serena may want to escape an overly stimulating classroom environment; may lead to increase in behavior. Serena was not allowed to go on the field trip. Depending on how this is perceived by Serena it could be punishment, the behavior will decrease, or negative reinforcement, the behavior will increase because she wanted to avoid the field trip. Remember that Serena may not link this consequence with her behavior.

18. V-18 5. Identify functions of behavior_______________________________________________________ What functions (purposes) might the behavior serve for the student? (1) to gain access to social interaction (2) to gain access to activities or objects (3) to terminate or avoid unwanted situations (4) to gain access to stimulating events (5) to communicate feelings WHILE SHOWING THIS SLIDE NOTE Functions of behavior can be grouped into five broad purposes: To gain social interaction or access to other people. To gain access to activities or things. To avoid or end a situation the student doesn’t like. To increase stimulation. To communicate feelings. ASK What functions or purposes might Serena’s behavior serve? Functions of Serena’s behavior might include: (2) and (4) She was able to do something she wanted to do (social studies); (3) She escaped something she didn’t want to do (math); (5) She communicated her feelings. NOTE Why is it important to identify functions? Because we need to understand what needs are being met through the behavior in order to help the studen6t meet those needs in another more appropriate way. Adapted from Tilly, Knoster, & Ikeda (2000)WHILE SHOWING THIS SLIDE NOTE Functions of behavior can be grouped into five broad purposes: To gain social interaction or access to other people. To gain access to activities or things. To avoid or end a situation the student doesn’t like. To increase stimulation. To communicate feelings. ASK What functions or purposes might Serena’s behavior serve? Functions of Serena’s behavior might include: (2) and (4) She was able to do something she wanted to do (social studies); (3) She escaped something she didn’t want to do (math); (5) She communicated her feelings. NOTE Why is it important to identify functions? Because we need to understand what needs are being met through the behavior in order to help the studen6t meet those needs in another more appropriate way. Adapted from Tilly, Knoster, & Ikeda (2000)

19. V-19 Jerry Example______________________________________________________ Identify the problem Measure the behavior Identify triggers Identify consequences Identify functions of behavior WHILE SHOWING THIS SLIDE TURN to the example of Jerry on the next page (19a). Discuss the five questions you have already addressed in the Serena example. WHILE SHOWING THIS SLIDE TURN to the example of Jerry on the next page (19a). Discuss the five questions you have already addressed in the Serena example.

20. V-20 Developing the Intervention Plan_______________________________________________________ “If the child’s behavior impedes his/her learning or that of others, the IEP team must consider, when appropriate, strategies, including positive behavioral interventions, and supports to address that behavior.” DPI, 1998  WHILE SHOWING THIS SLIDE NOTE The IEP team must consider “positive behavioral interventions and supports” to address behaviors that interfere with learning. This Wisconsin DPI statement parallels the requirements in IDEA 1997. WHILE SHOWING THIS SLIDE NOTE The IEP team must consider “positive behavioral interventions and supports” to address behaviors that interfere with learning. This Wisconsin DPI statement parallels the requirements in IDEA 1997.

21. V-21 What are positive behavioral interventions and supports?______________________________________________________ Positive interventions: Focus on increasing skills and appropriate behaviors using proactive strategies Supports: people and conditions that facilitate the student’s use of skills and appropriate behavior WHILE SHOWING THIS SLIDE NOTE Positive behavioral interventions are interventions that focus on increasing skills and appropriate behaviors using “proactive” strategies. (We will talk more about proactive strategies on the next slide.) Supports are people and conditions that help students use their skills and engage in appropriate behavior. WHILE SHOWING THIS SLIDE NOTE Positive behavioral interventions are interventions that focus on increasing skills and appropriate behaviors using “proactive” strategies. (We will talk more about proactive strategies on the next slide.) Supports are people and conditions that help students use their skills and engage in appropriate behavior.

22. V-22 Proactive Intervention Strategies_______________________________________________________ Proactive: planned (and often implemented) before the challenging behavior occurs. The intent is to prevent inappropriate behavior and encourage appropriate behavior. WHILE SHOWING THIS SLIDE NOTE Proactive strategies are strategies that are planned before a challenging behavior occurs. Their intent is to prevent inappropriate behavior and help the student behave appropriately. ASK What proactive strategies has JERRY’s core teacher used? (e.g., having him help decide how much work to complete before asking for help; choosing a reward in advance.) What planned strategy did SERENA’s teacher use? (Took her into the hall to calm down.) Were these strategies effective? (Jerry: yes, the teacher says he is doing better; he usually gets his reward. Serena: this intervention probably helped Serena calm down, but she also may have learned that she get what she wants - to do social studies - as a result of her tantrum.)WHILE SHOWING THIS SLIDE NOTE Proactive strategies are strategies that are planned before a challenging behavior occurs. Their intent is to prevent inappropriate behavior and help the student behave appropriately. ASK What proactive strategies has JERRY’s core teacher used? (e.g., having him help decide how much work to complete before asking for help; choosing a reward in advance.) What planned strategy did SERENA’s teacher use? (Took her into the hall to calm down.) Were these strategies effective? (Jerry: yes, the teacher says he is doing better; he usually gets his reward. Serena: this intervention probably helped Serena calm down, but she also may have learned that she get what she wants - to do social studies - as a result of her tantrum.)

23. V-23 Reactive Intervention Strategies______________________________________________________ Reactive: Implemented (and often planned) after the challenging behavior occurs. The intent is to reduce the challenging behavior, but without focus on replacement behaviors or prevention. WHILE SHOWING THIS SLIDE NOTE Reactive strategies react to the behavior. They are implemented after the behavior occurs. Often reactive strategies are impromptu; they aren’t planned. ASK What reactive strategy did Serena’s teacher use following her temper outburst? (She did not allow Serena to go on the field trip. This was reactive because it wasn’t a planned consequence.) What are the limitations of this strategy? (It was focused on behavior reduction only. It didn’t teach Serena how to behave in similar situations. It was inconsiderate toward Serena’s family.) WHILE SHOWING THIS SLIDE NOTE Reactive strategies react to the behavior. They are implemented after the behavior occurs. Often reactive strategies are impromptu; they aren’t planned. ASK What reactive strategy did Serena’s teacher use following her temper outburst? (She did not allow Serena to go on the field trip. This was reactive because it wasn’t a planned consequence.) What are the limitations of this strategy? (It was focused on behavior reduction only. It didn’t teach Serena how to behave in similar situations. It was inconsiderate toward Serena’s family.)

24. V-24 Can we use the same intervention strategies for challenging behaviors that we use with other students?_______________________________________________________ Why? Why not? In what ways do students with TBI differ from other students? WHILE SHOWING THIS SLIDE ASK Do participants think we can use the same intervention strategies for challenging behaviors with students with TBI that we use with other students? (We can use some interventions we use with students with other areas of impairment, but there are other interventions that won’t be effective. We will talk about specific interventions in a little while.) What characteristics of students with TBI differentiate them from other students and influence intervention selection? (Note characteristics on a flip chart.) What specific characteristics of SERENA and JERRY might differentiate them from students with other areas of impairment? (SERENA: e.g., memory difficulty, reasoning limitations, limited planning and anticipation. JERRY: e.g., disinhibition, limited anticipation and planning, lack of awareness of social rules.) IN CASE SOMEONE ASKS Students with other types of impairments may display difficulties with memory, executive functions, communication, etc. However, students with TBI often show a greater degree of deficit. For example a student with learning difficulties may forget assignments or class materials; a student with TBI may forget what classes (s)he is in, the teacher’s name, where classrooms are located, etc. in addition to the assignments and materials. WHILE SHOWING THIS SLIDE ASK Do participants think we can use the same intervention strategies for challenging behaviors with students with TBI that we use with other students? (We can use some interventions we use with students with other areas of impairment, but there are other interventions that won’t be effective. We will talk about specific interventions in a little while.) What characteristics of students with TBI differentiate them from other students and influence intervention selection? (Note characteristics on a flip chart.) What specific characteristics of SERENA and JERRY might differentiate them from students with other areas of impairment? (SERENA: e.g., memory difficulty, reasoning limitations, limited planning and anticipation. JERRY: e.g., disinhibition, limited anticipation and planning, lack of awareness of social rules.) IN CASE SOMEONE ASKS Students with other types of impairments may display difficulties with memory, executive functions, communication, etc. However, students with TBI often show a greater degree of deficit. For example a student with learning difficulties may forget assignments or class materials; a student with TBI may forget what classes (s)he is in, the teacher’s name, where classrooms are located, etc. in addition to the assignments and materials.

25. V-25 Developing the Intervention Plan ______________________________________________________ What is your goal? What do you want the student to do? What triggers, consequences, and functions of behavior will you address? What are the targets of intervention? environment instruction and curriculum teacher, peers, family student What specific strategies could be used? WHILE SHOWING THIS SLIDE NOTE Note that we will work through four steps in planning an intervention with our example of Serena using the worksheet on p 25a. See notes on presenter worksheet. First, decide what your goal is. What do you want the student to do instead of the challenging behavior? Next, review the triggers, consequences, and functions of the behavior. Which of these can you address? Third, decide what the target(s) of your intervention are. As was noted in Module IV, educators have more direct influence over the environment, the instruction, and the curriculum, than they have over the student. Be sure your intervention targets those factors that will PREVENT challenging behaviors before focusing on the student. Once the target(s) of intervention are determined, you can begin to select specific strategies to use. WHILE SHOWING THIS SLIDE NOTE Note that we will work through four steps in planning an intervention with our example of Serena using the worksheet on p 25a. See notes on presenter worksheet. First, decide what your goal is. What do you want the student to do instead of the challenging behavior? Next, review the triggers, consequences, and functions of the behavior. Which of these can you address? Third, decide what the target(s) of your intervention are. As was noted in Module IV, educators have more direct influence over the environment, the instruction, and the curriculum, than they have over the student. Be sure your intervention targets those factors that will PREVENT challenging behaviors before focusing on the student. Once the target(s) of intervention are determined, you can begin to select specific strategies to use.

26. V-26 Serena Example_______________________________________________________ What is your goal? What do you want Serena to do instead of the problem behavior? What is the skill or behavior you are working toward? Is it realistic? WHILE SHOWING THIS SLIDE NOTE “Goal” here is used to refer to the behavior you are working toward - what you want Serena to do. It does not mean an IEP goal. Just as we identified goals when discussing academic problems in Module IV, we need to identify goals – what we want student to do – when we are addressing challenging behavior. When working with students with TBI it is critical to be sure the goal is realistic – does the student have the abilities necessary to attain the goal? ASK Ask participants to identify the goals they would set for Serena. These might include: Serena will express her frustration appropriately. Serena will persist on math tasks. WHILE SHOWING THIS SLIDE NOTE “Goal” here is used to refer to the behavior you are working toward - what you want Serena to do. It does not mean an IEP goal. Just as we identified goals when discussing academic problems in Module IV, we need to identify goals – what we want student to do – when we are addressing challenging behavior. When working with students with TBI it is critical to be sure the goal is realistic – does the student have the abilities necessary to attain the goal? ASK Ask participants to identify the goals they would set for Serena. These might include: Serena will express her frustration appropriately. Serena will persist on math tasks.

27. V-27 Serena Example______________________________________________________ What triggers, consequences, and functions of behavior do you need to address? WHILE SHOWING THIS SLIDE NOTE Refer to the worksheet participants used earlier in this Module to identify triggers, consequences, and functions of behavior. ASK What slow triggers would participants address? What brain injury factors? What other slow triggers? What fast triggers would participants address? What consequences would participants address? What functions of behavior would participants address? WHILE SHOWING THIS SLIDE NOTE Refer to the worksheet participants used earlier in this Module to identify triggers, consequences, and functions of behavior. ASK What slow triggers would participants address? What brain injury factors? What other slow triggers? What fast triggers would participants address? What consequences would participants address? What functions of behavior would participants address?

28. V-28 Serena Example______________________________________________________ What are your targets of intervention? Environment Instruction Curriculum Teacher Peers Family Student WHILE SHOWING THIS SLIDE NOTE As we discussed in Module IV, we need to identify the target of intervention. ASK Ask participants what targets of intervention they would choose to address Serena’s behavior. WHILE SHOWING THIS SLIDE NOTE As we discussed in Module IV, we need to identify the target of intervention. ASK Ask participants what targets of intervention they would choose to address Serena’s behavior.

29. V-29 Developing Positive Interventions: Five Approaches______________________________________________________ 1. Prevent inappropriate behavior 2. Increase appropriate behavior 3. Decrease inappropriate behavior 4. Use communication and group strategies 5. Increase use of self-management strategies WHILE SHOWING THIS SLIDE NOTE This slide lists five positive approaches for designing interventions. Each of these can be proactive, although some (like decreasing inappropriate behavior) are often used in a reactive manner. We will discuss each of these as we plan interventions for SERENA and JERRY. Continue to use the worksheet on page 25a. WHILE SHOWING THIS SLIDE NOTE This slide lists five positive approaches for designing interventions. Each of these can be proactive, although some (like decreasing inappropriate behavior) are often used in a reactive manner. We will discuss each of these as we plan interventions for SERENA and JERRY. Continue to use the worksheet on page 25a.

30. V-30 Serena Example1. Prevent inappropriate behavior_______________________________________________________ What could be done to address the slow and fast triggers that influence Serena’s behavior? WHILE SHOWING THIS SLIDE NOTE Preventing inappropriate behavior is often the primary goal with students with TBI. We can often do this by controlling conditions that precede the behavior. For example, if we know a student always becomes aggressive in noisy, large groups, we can decide to control the environment the student experiences and avoid noisy, large groups. It is important to remember that usually we can’t alter all antecedent conditions that might contribute to challenging behaviors. For example, consider the effects of brain injury themselves as antecedent conditions; unfortunately, we can’t eliminate these. However, we must consider and address the limitations the student experiences as a result of brain injury when planning interventions.WHILE SHOWING THIS SLIDE NOTE Preventing inappropriate behavior is often the primary goal with students with TBI. We can often do this by controlling conditions that precede the behavior. For example, if we know a student always becomes aggressive in noisy, large groups, we can decide to control the environment the student experiences and avoid noisy, large groups. It is important to remember that usually we can’t alter all antecedent conditions that might contribute to challenging behaviors. For example, consider the effects of brain injury themselves as antecedent conditions; unfortunately, we can’t eliminate these. However, we must consider and address the limitations the student experiences as a result of brain injury when planning interventions.

31. V-31 Antecedent Factors that Might Influence Students with TBI ________________________________________________________ Environment Class size Consistency of staff Student-staff ratio Supervision Noise Lighting Space Task Demands Expectations Rate of success Memory demands Time limitations Feedback frequency Support available Stimulation WHILE SHOWING THIS SLIDE NOTE There are many factors that can act as antecedents to challenging behavior. Some factors may be related to the environment; others may be related to the task the student is expected to complete. ASK Do participants think any of these antecedents influenced Serena’s behavior? (e.g., memory demands, success in math, space) WHILE SHOWING THIS SLIDE NOTE There are many factors that can act as antecedents to challenging behavior. Some factors may be related to the environment; others may be related to the task the student is expected to complete. ASK Do participants think any of these antecedents influenced Serena’s behavior? (e.g., memory demands, success in math, space)

32. V-32 Common Classroom Antecedent Control Techniques _________________________________________________________ Classroom rules Classroom routines Classroom schedule Positive student-teacher interactions Positive student- peer interactions Clear expectations Systematic instruction Modeling High rates of success Appropriate educational program Appropriate, engaging activities Advance planning WHILE SHOWING THIS SLIDE NOTE Some common antecedent control strategies used in classrooms are listed on this slide. For example, good teachers often post classroom rules that act as deterrents of misbehavior. They also often establish routines in the classroom to help students understand expectations. ASK What strategies could Serena’s teacher have used to alter the antecedent conditions and prevent Serena’s behavior? WHILE SHOWING THIS SLIDE NOTE Some common antecedent control strategies used in classrooms are listed on this slide. For example, good teachers often post classroom rules that act as deterrents of misbehavior. They also often establish routines in the classroom to help students understand expectations. ASK What strategies could Serena’s teacher have used to alter the antecedent conditions and prevent Serena’s behavior?

33. V-33 Serena Example2. Increase appropriate behavior_______________________________________________________ Teach alternative or incompatible behavior Reward (positively reinforce) appropriate behavior Model appropriate behavior Prompt or cue appropriate behavior Shape appropriate behavior WHILE SHOWING THIS SLIDE NOTE A second approach that can be used to address challenging behavior is to increase the occurrence of appropriate behavior. This can be done in several ways: Teach new behaviors that are alternatives or are incompatible with the behavior you want to eliminate. Reinforce appropriate behavior. Reward the behavior you want to see. Be sure what you choose as a reward is truly rewarding (or reinforcing) to the students. If possible, have the student participate in selection of rewards.* Have teachers and peers model appropriate behavior. Prompt or cue appropriate behavior. Shape appropriate behavior by gradually increasing expectations. ASK Which of these strategies could be used with SERENA? IN CASE SOMEONE ASKS Sometimes teachers object to use of concrete rewards, such as stickers, food, or toys, with students. However, it is critical to remember that students with TBI may need concrete, visible rewards or reinforcers. Always pair concrete reinforcers with praise of effort and success.WHILE SHOWING THIS SLIDE NOTE A second approach that can be used to address challenging behavior is to increase the occurrence of appropriate behavior. This can be done in several ways: Teach new behaviors that are alternatives or are incompatible with the behavior you want to eliminate. Reinforce appropriate behavior. Reward the behavior you want to see. Be sure what you choose as a reward is truly rewarding (or reinforcing) to the students. If possible, have the student participate in selection of rewards.* Have teachers and peers model appropriate behavior. Prompt or cue appropriate behavior. Shape appropriate behavior by gradually increasing expectations. ASK Which of these strategies could be used with SERENA? IN CASE SOMEONE ASKS Sometimes teachers object to use of concrete rewards, such as stickers, food, or toys, with students. However, it is critical to remember that students with TBI may need concrete, visible rewards or reinforcers. Always pair concrete reinforcers with praise of effort and success.

34. V-34 Serena Example3. Decrease inappropriate behavior_______________________________________________________ Maintain focus on positive interventions Use redirection Establish stimulus control Reinforce alternative behaviors Reinforce incompatible behaviors Extinction (when safe) WHILE SHOWING THIS SLIDE NOTE A third strategy for addressing challenging behavior is to decrease inappropriate behavior. This is sometimes done through use of punishment, which is intended to eliminate or decrease the frequency of behavior. However, there are ways to decrease behavior while still maintaining a focus on positive interventions, which is our goal. We can reduce inappropriate behaviors through positive strategies such as: redirection. Direct the student from the inappropriate behavior to a more acceptable one. stimulus control. For example, establish a cue that the student recognizes and responds to that indicates “stop!” or “wait!” or “think!” reinforce alternative and/or incompatible behavior. While this is intended to increase appropriate behavior it also has the effect of reducing inappropriate behavior. extinction. Sometimes educators ignore inappropriate behavior to reduce its occurrence. This works if the function of the behavior is to gain something, such as attention, or escape something, like work. However, ignoring behavior can ONLY be done if the behavior is NOT HARMFUL to the student or others. Often extinction/ignoring is not effective with students with TBI. ASK What strategies might participants use with SERENA? What punishment strategy did SERENA’s teacher use? Was it effective? (She did not allow Serena to go on the field trip. It probably wasn’t effective because it wasn’t immediate; Serena may not have associated it with her earlier behavior. Also, it didn’t teach Serena appropriate behavior.) WHILE SHOWING THIS SLIDE NOTE A third strategy for addressing challenging behavior is to decrease inappropriate behavior. This is sometimes done through use of punishment, which is intended to eliminate or decrease the frequency of behavior. However, there are ways to decrease behavior while still maintaining a focus on positive interventions, which is our goal. We can reduce inappropriate behaviors through positive strategies such as: redirection. Direct the student from the inappropriate behavior to a more acceptable one. stimulus control. For example, establish a cue that the student recognizes and responds to that indicates “stop!” or “wait!” or “think!” reinforce alternative and/or incompatible behavior. While this is intended to increase appropriate behavior it also has the effect of reducing inappropriate behavior. extinction. Sometimes educators ignore inappropriate behavior to reduce its occurrence. This works if the function of the behavior is to gain something, such as attention, or escape something, like work. However, ignoring behavior can ONLY be done if the behavior is NOT HARMFUL to the student or others. Often extinction/ignoring is not effective with students with TBI. ASK What strategies might participants use with SERENA? What punishment strategy did SERENA’s teacher use? Was it effective? (She did not allow Serena to go on the field trip. It probably wasn’t effective because it wasn’t immediate; Serena may not have associated it with her earlier behavior. Also, it didn’t teach Serena appropriate behavior.)

35. V-35 Serena Example4. Communication/group strategies_______________________________________________________ Teach appropriate communication skills such as listening, turn-taking, and empathy Use group interventions, such as support and social skills groups WHILE SHOWING THIS SLIDE NOTE When students are able to learn communication strategies and to participate in group interventions, these approaches can be effective in addressing challenging behaviors. ASK What communication strategies and group interventions could be used with SERENA? WHILE SHOWING THIS SLIDE NOTE When students are able to learn communication strategies and to participate in group interventions, these approaches can be effective in addressing challenging behaviors. ASK What communication strategies and group interventions could be used with SERENA?

36. V-36 Serena Example5. Self-management strategies_______________________________________________________ Goal setting Self-monitoring Self-evaluation Self-reinforcement Relaxation/rest WHILE SHOWING THIS SLIDE NOTE As students with TBI regain self-regulation skills, they become more able to use self-management strategies. Examples of these include: goal setting. Ask the student to help determine goals for ten minutes, for an hour, or for a day/week as the student is able. self-monitoring. Have the student keep track of his/her behavior or performance. self-evaluation. Ask the student to evaluate his or her behavior or performance. self-reinforcement. Have the student give him/herself praise for accomplishments and any concrete reinforcers the (s)he has earned. relaxation and rest. Teach the student to relax, using breathing, muscle relaxation, or imagery; teach the student to take rest breaks when needed. ASK What self-management strategies might be used with SERENA? WHILE SHOWING THIS SLIDE NOTE As students with TBI regain self-regulation skills, they become more able to use self-management strategies. Examples of these include: goal setting. Ask the student to help determine goals for ten minutes, for an hour, or for a day/week as the student is able. self-monitoring. Have the student keep track of his/her behavior or performance. self-evaluation. Ask the student to evaluate his or her behavior or performance. self-reinforcement. Have the student give him/herself praise for accomplishments and any concrete reinforcers the (s)he has earned. relaxation and rest. Teach the student to relax, using breathing, muscle relaxation, or imagery; teach the student to take rest breaks when needed. ASK What self-management strategies might be used with SERENA?

37. V-37 Jerry Example_____________________________________________________ What is your goal? What do you want the student to do? What triggers, consequences, and functions of behavior will you address? What are the targets of intervention? environment instruction and curriculum teacher, peers, family student WHILE SHOWING THIS SLIDE NOTE Use the worksheet provided on the next page (p37a) as you discuss each of these questions.WHILE SHOWING THIS SLIDE NOTE Use the worksheet provided on the next page (p37a) as you discuss each of these questions.

38. V-38 Jerry ExampleWhat specific strategies will you use?_______________________________________________________ 1. Prevent inappropriate behavior 2. Increase appropriate behavior 3. Decrease inappropriate behavior 4. Communication and group strategies 5. Self-management strategies WHILE SHOWING THIS SLIDE NOTE Identify the specific strategies participants would use with Jerry. WHILE SHOWING THIS SLIDE NOTE Identify the specific strategies participants would use with Jerry.

39. V-39 Stages of Recovery and Intervention Use_____________________________________________________ Challenging behaviors differ across early, middle and late stages of recovery Intervention strategies and supports must match the needs and abilities of the student as (s)he recovers WHILE SHOWING THIS SLIDE NOTE It is important to remember that the behavior of students with TBI often changes over time as the student recovers. Consequently, intervention strategies and supports must change over time to match the needs and abilities of the student. The table on the next page shows examples of the needs of students across early, middle and late stages of recovery, and some of the interventions appropriate to each stage.WHILE SHOWING THIS SLIDE NOTE It is important to remember that the behavior of students with TBI often changes over time as the student recovers. Consequently, intervention strategies and supports must change over time to match the needs and abilities of the student. The table on the next page shows examples of the needs of students across early, middle and late stages of recovery, and some of the interventions appropriate to each stage.

40. V-40 Examples of Specific Strategies to Use With Specific Problems_______________________________________________________ Examples of strategies to use with specific problems are presented on the next several pages in your manual. Note that these are just examples. The specific strategies you develop will depend on the unique characteristics of the student, teacher, and context. WHILE SHOWING THIS SLIDE NOTE Pages 40a-40c contain examples of interventions to use with specific problem behaviors that students with TBI might exhibit. Remember that these are just examples. Interventions for specific students must be developed to respond to the unique characteristics of the student, teacher, and context (such as classroom, playground, cafeteria, etc.) Inform participants that the interventions provided in these pages are psycho-social interventions; they don’t include medications, which will be discussed shortly. WHILE EXAMINING PAGES 40a-c Give participants several minutes to look over these pages. WHILE SHOWING THIS SLIDE NOTE Pages 40a-40c contain examples of interventions to use with specific problem behaviors that students with TBI might exhibit. Remember that these are just examples. Interventions for specific students must be developed to respond to the unique characteristics of the student, teacher, and context (such as classroom, playground, cafeteria, etc.) Inform participants that the interventions provided in these pages are psycho-social interventions; they don’t include medications, which will be discussed shortly. WHILE EXAMINING PAGES 40a-c Give participants several minutes to look over these pages.

41. V-41 Evaluate the Plan______________________________________________________ Don’t assume you are finished when you put the plan in place Evaluate how well your interventions are working Keep up frequent communication with all stakeholders: student, parents, teachers, therapists, administrators WHILE SHOWING THIS SLIDE NOTE Once the intervention plan is in place, remember to evaluate how well it is working. Determine how you will evaluate the plan. What are your criteria for success? With whom will you communicate? How often?WHILE SHOWING THIS SLIDE NOTE Once the intervention plan is in place, remember to evaluate how well it is working. Determine how you will evaluate the plan. What are your criteria for success? With whom will you communicate? How often?

42. V-42 Medications with Students with Challenging Behaviors______________________________________________________ Medications are sometimes used to help manage the behaviors of students with TBI It is critical for school personnel to be aware of the potential side effects of a student’s medications Several medications are described on the following pages WHILE SHOWING THIS SLIDE NOTE Up to this point we have focused primarily on psycho-social (individual, group, and environmental) interventions for challenging behaviors. Medications are also used to help manage the behaviors of students with TBI. It is important to stress that sometimes psycho-social interventions aren’t enough. Student with TBI may need assistance from medications to be better able to control behavior. Most medications have side effects, and some side effects adversely affect school performance. Therefore, it is critical for educators to be aware of the medications students are taking and the side effects of these medications. Also, educators are often asked to help physicians and families evaluate the effectiveness of medications. For example, teachers often rate a student’s behavior before and during medication trials. Medications that may be prescribed to manage the behavior of students with TBI are described on the next several pages. Consult the student’s family and physician for further information about any medication a student is taking. WHILE SHOWING THIS SLIDE NOTE Up to this point we have focused primarily on psycho-social (individual, group, and environmental) interventions for challenging behaviors. Medications are also used to help manage the behaviors of students with TBI. It is important to stress that sometimes psycho-social interventions aren’t enough. Student with TBI may need assistance from medications to be better able to control behavior. Most medications have side effects, and some side effects adversely affect school performance. Therefore, it is critical for educators to be aware of the medications students are taking and the side effects of these medications. Also, educators are often asked to help physicians and families evaluate the effectiveness of medications. For example, teachers often rate a student’s behavior before and during medication trials. Medications that may be prescribed to manage the behavior of students with TBI are described on the next several pages. Consult the student’s family and physician for further information about any medication a student is taking.

43. V-43 Crisis Intervention______________________________________________________ When a student’s emotions and behavior are escalating adaptive tension emotional distress physical distress recovery Behavior escalation model developed by Paul White, Community TIES, Waisman Center WHILE SHOWING THIS SLIDE NOTE Sometimes the behavior of students with TBI, despite an appropriate behavior intervention plan, escalates to a level that is threatening to the student and/or others. Many professionals are uncomfortable when facing a student who is becoming out of control. We are providing a brief overview of this topic; suggestions on further resources and training are provided in the reference/resource list. We encourage professionals to obtain intensive training on crisis management if they may be working with students who exhibit challenging behaviors. We are using a model of behavior escalation developed by Paul White of the Waisman Center Community TIES Program, Madison WI. This model delineates stages a student may go through when his/her behavior is escalating. These include: adaptive: the student is doing well tension: the student is beginning to become upset emotional distress: the student exhibits significant signs of distress physical distress: the student becomes threatening to self/others recovery: the student returns to an adaptive stateBehavior escalation model developed by Paul White, Community TIES, Waisman Center WHILE SHOWING THIS SLIDE NOTE Sometimes the behavior of students with TBI, despite an appropriate behavior intervention plan, escalates to a level that is threatening to the student and/or others. Many professionals are uncomfortable when facing a student who is becoming out of control. We are providing a brief overview of this topic; suggestions on further resources and training are provided in the reference/resource list. We encourage professionals to obtain intensive training on crisis management if they may be working with students who exhibit challenging behaviors. We are using a model of behavior escalation developed by Paul White of the Waisman Center Community TIES Program, Madison WI. This model delineates stages a student may go through when his/her behavior is escalating. These include: adaptive: the student is doing well tension: the student is beginning to become upset emotional distress: the student exhibits significant signs of distress physical distress: the student becomes threatening to self/others recovery: the student returns to an adaptive state

44. V-44 Understanding Stages of Challenging Behavior and Stages of Support Guidelines Videotape (optional) WHILE SHOWING THIS SLIDE NOTE The next page in the manual contains Guidelines for Understanding Stages of Challenging Behavior and Stages of Support. Review with participants. Have participants worked with students who have escalated through these stages? Have they found the types of supports listed to be effective? Do they have other suggestions not listed here? VIDEO Show optional videotape “Managing Threatening Confrontations.” NOTE Tell participants that this video depicts a classroom scene in which a student (Jack) with TBI becomes agitated and upset. Explain that the adults in the classroom include the classroom teacher and the educational assistant. At the end of Part I the special education teacher enters the classroom, followed by the principal. Ask participants to look for cues of escalating behavior as they watch. What signs of escalating behavior does Jack display? What events/factors might contribute to it? SHOW Part I of the video. ASK After showing Part I ask participants to share their observations about Jack’s signs of escalation and factors that contributed to his behavior. What strategies would participants suggest be used to prevent Jack’s escalation? SHOW Part II of the video. ASK At each break in the video ask participants what strategies staff are trying to use to keep Jack calm. Are there other strategies the participants would try? WHILE SHOWING THIS SLIDE NOTE The next page in the manual contains Guidelines for Understanding Stages of Challenging Behavior and Stages of Support. Review with participants. Have participants worked with students who have escalated through these stages? Have they found the types of supports listed to be effective? Do they have other suggestions not listed here? VIDEO Show optional videotape “Managing Threatening Confrontations.” NOTE Tell participants that this video depicts a classroom scene in which a student (Jack) with TBI becomes agitated and upset. Explain that the adults in the classroom include the classroom teacher and the educational assistant. At the end of Part I the special education teacher enters the classroom, followed by the principal. Ask participants to look for cues of escalating behavior as they watch. What signs of escalating behavior does Jack display? What events/factors might contribute to it? SHOW Part I of the video. ASK After showing Part I ask participants to share their observations about Jack’s signs of escalation and factors that contributed to his behavior. What strategies would participants suggest be used to prevent Jack’s escalation? SHOW Part II of the video. ASK At each break in the video ask participants what strategies staff are trying to use to keep Jack calm. Are there other strategies the participants would try?

45. V-45 End of Module V WHILE SHOWING THIS SLIDE NOTE This is the end of Module V. WHILE SHOWING THIS SLIDE NOTE This is the end of Module V.