Creating Successful Environments: Antecedent Strategies in

>www.dpw.state.pa.us >www.dhs.pa.gov

Creating Successful Environments: Antecedent Strategies in the Behavioral

Support Plan (BSP)


Overview of Behavioral Supports

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>www.dpw.state.pa.us >www.dhs.pa.gov 3

Behavior = everything a person or living thing does

• Overt Behavior = all observable actions• Covert Behavior = thoughts, feelings, emotions, memories, etc..


Most behaviors are learned

Behavior is communication

Behavior serves a function

Behavior is an individual’s best attempt at getting what they want or need out of a situation

If (challenging) behavior is occurring with regularity….. it is being reinforced

Assumptions of Behavior



BSS provides specialized interventions that assist a participant to increase adaptive behaviors to replace or modify challenging behaviors of a disruptive or

destructive nature that prevent or interfere with the participant’s inclusion in home and family life or community life.

The BSS promotes consistent implementation of the Behavioral Support Plan (BSP) and Crisis Intervention Plan (CIP) across environments and across people with

regular contact with the participant, such as family, friends, neighbors and other providers.

Consistency is essential to skill development and reduction of problematic behavior. BSS includes both the development of an initial BSP and ongoing

behavioral supports.




Functional Behavior Assessment (FBA) • An FBA should not be a “one time” thing

• Should be conducted for every concerning behavior• Should be re-evaluated when there are changes to (or newly presenting)

behaviors and/or context in which behavior is occurring• A quality FBA should:

• Demonstrate there is enough evidence to hypothesize a function of a challenging behavior• If not, make recommendations to rule out medical or mental health

causation before continuing. • Tell us the ABC’s of the targeted behavior…


(Antecedent)

• Describes the environment or situational context the challenging behavior is occurring in

(Behavior)

• Defines the challenging behavior in measurable/ observable terms

(Consequence)

• Identifies the variables that have historically reinforced the challenging behavior

ABC’s of Behavior


Antecedents

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• Behavior that is often displayed prior to the target behavior

• “warning sign”

Precursors

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Antecedent vs Precursor

• An environmental event, situation, condition or stimulus that increases or decreases the likelihood of a target behavior and/or its precursors

• “trigger” - immediate• “motivating operation” or

“setting event” - slow fuse

Antecedents


• Deprivation / Satiation• Not taking medication• Side effects to a new medication• Not getting an adequate amount of sleep• The absence or presence of a specific person• Hunger• The temperature in the room• Stress

Examples:

Setting Events- Motivating Operations


Antecedent Analysis

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Antecedent analysis includes identification of environmental events that:

• increase the likelihood that target behavior and its precursors will occur• decrease the likelihood that target behavior and its precursors will occur• increase the likelihood that precursor behavior will escalate to target behavior• decrease the likelihood that precursor behavior will escalate to target behavior• increase the likelihood that target behavior will continue and/or escalate• decrease the likelihood that target behavior will continue and/or escalate


What antecedents make this behavior more or less likely to occur?

Where is this behavior most likely to occur?

During what activities is this behavior least likely to occur?

With whom is this behavior least likely to occur.

Basic Questions:


What to Analyze?

• Settings• Successful • Challenging

• specific persons• times of the day• typical and atypical events• sensory preferences and barriers• physical and mental health• medications

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Antecedent Analysis

Examples:

• Scatter-plot• ABC Narrative Recording Form• ABC recording Form• FAST -R• QABF• Motivational Assessment Scale• Problem Behavior Questionnaire• Ecological Inventories

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category/12.Scatterplot1.png

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category/ABC+Narrative+Recording+Form.pdf

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category/ABC_recording_form.JPG

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category_Indirect/FAST(1).pdf

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category_Indirect/QABF.pdf

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Pre-Test/See+Assessment_Select+Category_Indirect/MotivationAssessmentScale.pdf

https://palms-awss3-repository.s3-us-west-2.amazonaws.com/Drexel+Course/Audio/pdf/problem_behavior_questionnaire(2).pdf

https://www.myodp.org/course/view.php?id=1680


What was he doing just

prior to engaging in the target behavior?

Who had asked him to

do that?

How was the request made,

e.g., what tone of voice

was used?

You said that last Saturday

he did not exhibit any of these target behaviors.

How had he spent that

day?

Who was his support staff

last Saturday?

Additional Sample Questions


FBA

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Condition (antecedent)

• likely environmental predictors of the

destructive/disruptive behavior

Behavior

• observable description of

destructive/disruptive behavior

Hypothesized Function

• data-based description of the function of

behavior

(how the behavior has been historically

reinforced)


Antecedent Strategies

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FBA

BSP

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FBA to BSP


• likely environmental predictors of the destructive/disruptive behavior

Behavior

• observable description of destructive/disruptive behavior

Hypothesis

• data-based description of the function of behavior (how the behavior has been historically reinforced)


• In the same situational/environmental context as above

Behavior

• we hope to see X (a more socially –acceptable, less destructive/disruptive behavior)

Criteria

• how much support is needed, how much/how often, how long.


Antecedent Strategies:

help to remove/reduce identified antecedents to the behavior of concern

make the behavior unnecessary in specific situations

assist with the performance of the replacement behavior (cues and prompts)

are pro-active and put in place before the challenging behavior occurs


What will we do ahead of time to make the challenging behavior less likely to occur?

• Make tasks easier / shorter in duration• Make environment less overwhelming• Develop cues/prompts to increase replacement behavior• Make the challenging behavior unnecessary be providing

the historical reinforcer ahead of time


How will we make the challenging behavior less likely to occur?

• Choice• Prompting• Priming (visual and environmental cues)• High-probability sequence• Noncontingent reinforcement• Time delay• Contriving motivating operations



Considerations for Strategies

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Is it important for the person to be in that setting?

Is it important that the person engage with that environment at the current frequency?

Is there technology available that could help decrease the aversiveness of sensory environments?

Does the person have the skills needed to be successful in that environment?

What opportunities does this environment provide the person related to their long-term vision for a meaningful life?

What is realistic for the support team to implement?



“Attention Seeking”• Provide unconditional, preferred attention periodically (intervals) throughout

the day• When preferred attention not available, let participant know ahead of time and

include information about when preferred attention will be available again• Provide other preferred activities or items when attention must be withdrawn

• Remind (prompt) participant that if they need preferred attention to request attention using the more appropriate replacement behaviors identified in the BSP.

Function Based Antecedent Strategies


“Access to Activity”• Use visual aids to help prepare and schedule,

• Help participant develop schedule for the day / week…• Schedule non-preferred activities in between preferred activities

• Remind participant of next availability to engage in the more preferred activity

• Provide choices of alternative activities when more preferred activity will not be available



“Escape or Reduce Task”• Use visual aids to help prepare and schedule,

• Help participant develop schedule for the day / week…• Schedule non-preferred activities in between preferred activities

• Prompt coping skills / transition skills before transitions to non-preferred activities• Shorten the length / decrease the difficulty of non-preferred activities• Remind participant of replacement behaviors to use ahead of time (ask for a break,

say no, ask for assistance, etc…)• Avoid presenting task requests during particularly difficult times



“Obtain Item”:• *Adults in ODP programs should be able to access their own property and

items at any time, strategies should not focus on removing access to personal property or other items that an individual values.• Make sure there is access to desired items ahead of challenging situations

• Create a schedule that includes reminders of more appropriate times to access preferred items.

• Change environmental setting • Consider appropriateness of any rule that might prevent or delay access to a

preferred item.



“Automatic: Obtain Stimulation”:• Make sure there is access to items that may be engaging for

participant when in non-engaging environments• Prompt coping skills ahead of time• Modify environment to be more sensorily friendly based on

individual preference• Provide alternative areas where the participant may feel more

comfortable using more distracting self-stimulatory behaviors



“Automatic: Escape Circumstance”:• Avoid environments that involve know overwhelming sensory experiences (loud,

crowded, bright, smelly, etc…)• Provide technology that can reduce the aversiveness of the environment if the

environment cannot be avoided (ear defenders, noise cancelling headphones, sunglasses, stim tools, etc…)

• Decrease the amount of time in environment and provide reminders of how long the participant will be in the environment

• Prompt coping skills ahead of time• Remind ways to request breaks or leave setting before escalating to target behavior



• Address physiological needs• Recognize indicators that participant is uncomfortable or otherwise below their

baseline presentation Provide choice Reduce demands / avoid environments Remind participant to communicate in a way that is realistic for them in the moment

and provide alternatives

Strategies for Setting Events


FBA

BSP

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• likely environmental predictors of the destructive/disruptive behavior

Behavior

• observable description of destructive/disruptive behavior

Hypothesis

• data-based description of the function of behavior (how the behavior has been historically reinforced)


• In the same situational/environmental context as above

Behavior

• we hope to see X (a more socially –acceptable, less destructive/disruptive behavior)

Criteria

• how much support is needed, how much/how often, how long.


What will we do ahead of time to make the challenging behavior less likely to occur?

• Make tasks easier / shorter in duration• Make environment less overwhelming• Develop cues/prompts to increase replacement behavior• Make the challenging behavior unnecessary be providing

the historical reinforcer ahead of time



• Teach skills that have same function and as efficient as the challenging Bx.

• Must meet the same outcome identified as the function in the FBA,

Replacement Strategies

• Teach skills that are not-functionally equivalent but lessenthe need for the individual to achieve that function in that situation. • Think “coping skills”

• May also reinforce “warning signs” when challenging behavior is dangerous

Alternate Strategies

Replacement/ Alternate Strategies


• If the alternative strategy is focused on compliancewith a request, there must be a more appropriate replacement behavior taught that allows the participant to escape or delay the request.

Note about Alternative Strategies


Strategies that tell support team members how to respond to a number ofbehaviors that may be seen in a previously challenging environment/situation.

Must be implemented consistently by all team members to be effective.

What was the original function again?

Consequence Strategies


• When replacement skill happens… same reinforcer that previously reinforced the challenging behavior

Reinforce Replacement Behavior

• When alternate behavior happens • Same reinforcer that previously reinforced the challenging behavior• Pair the natural reinforcement provided from the alternative skill

Reinforce Alternate Behavior

• No longer provide reinforcement for the destructive/disruptive behavior Extinction

Consequence Strategies


FBA

BSP

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EXAMPLE: RIO


• When asked to clean his room

Behavior

• Rio slams the door and curses

Hypothesis

• In order to delay cleaning his room


• When asked to clean his room

Behavior

• Rio will clean his room, or ask for a break to delay cleaning his room

Criteria

• With less than 2 prompts, 9/10 opportunities for 13 consecutive weeks


During the initial plan development…

• Work with Rio and his family on making a compromise about what a clean room looks like

• Help Rio clean to a standard that everyone can agree to for now and take a picture to show what a clean room looks like.

• Create a schedule with Rio ahead of time to indicate when he will clean.

• Clean in chunks that Rio can stay engaged with. He says he gets frustrated with cleaning after 15 minutes.

• Ask Rio to see what areas he has most difficulty with. Observe Rio to see if more formal supports might be needed with certain tasks

• Ask Rio how he would like to be reminded to clean his room when he misses scheduled cleaning times or when it does not look like the reference picture after cleaning.


• Review Rio’s cleaning schedule with him on Monday’s. It is kept on the bulletin board above his desk along with his “clean room reference picture”

• Rio has indicated he gets frustrated with cleaning after 15 minutes. Make sure to offer a break to Rio after he has been cleaning for 10 minutes.

• Ask Rio if there is any steps, he needs help with before cleaning.

• Acknowledge that cleaning is boring for Rio and you know it’s hard for him

• Ask Rio to review the clean room reference picture before cleaning

• If Rio has missed scheduled cleaning remind him while you are reviewing the daily schedule at the beginning of your shift. Let Rio pick when to add cleaning to the schedule for the day.



• Rio will ask for a break• Rio will say “not right now” and indicate when he will clean

his room nextReplacement

Strategies

• Rio will use “square breathing“ before responding• Rio will begin to clean his room (goal)


Replacement / Alternate Strategies


Reinforce Replacement

BehaviorWhen Rio asks for a break (delays cleaning)

• Say sure thing and tell Rio you will set a timer for 10 minutes

• When the timer goes off ask Rio if he is ready to go back to cleaning

When Rio says he will clean later (delays cleaning)

• Say sure and ask him when he wants to clean and if he needs a reminder,

• Ask him to update his cleaning calendar

• Tell him you will remind him at the time he specified

Reinforce Alternative

BehaviorWhen Rio cleans his room:

• Offer praise and remind Rio that now you have time to work on more fun stuff. Ask Rio what he wants to do with the extra time.

• Make sure the team does not mention cleaning again until his next scheduled cleaning passes

When Rio uses deep breaths after being asked to clean

• Ask him if he needs a break and if so offer one

• Ask him if he needs assistance and if so offer a reasonable amount of help ,but do not clean for him.

Extinction

When Rio curses or slams the door after being asked to clean

• Tell Rio that if he asks for a break you will give him one

• Prompt Rio to ask for a break• Immediately give him a break

and follow strategies to reinforce the asking for a break behavior.


FBA

BSP

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EXAMPLE: Brutus


• When in overwhelming environments, (such as new places, crowded public spaces, places with bright lights and/or loud / buzzing noises)

Behavior

• Brutus will elope without notifying staff

Hypothesis

• In order to escape the environment


• When in overwhelming environments, (such as new places, crowded public spaces, places with bright lights and/or loud / buzzing noises)

Behavior

• Brutus will tell staff he wants to leave by using words or by grabbing their hand

Criteria

• independently, 8/10 opportunities for 13 consecutive weeks


During the initial plan development…

• Work with Brutus and his team to identify a list of known overwhelming environments and determine some general characteristics of those environments

• Determine how important to Brutus it is to be in those environments and figure out the frequency that Brutus prefers to be in those environments

• Determine if technology may help decrease the aversiveness

• Assess baseline skills and alternative skills that Brutus can use to communicate

• Identify some warning signs that may occur before elopement

• Find out how Brutus would like to be prompted when supporters notice warning signs


• Before leaving for an event, review the schedule with Brutus and ask him if he thinks any of the environments will be overwhelming for him

• Make sure Brutus has his headphones with him• Review these safety steps with Brutus before

every outing:• If you feel overwhelmed, try your deep

breathing technique or put on your headphones

• We can leave whenever you want us to• Let me know in words or if you are having

trouble speaking just squeeze my hand.• If we get split up for any reason, we will meet

at the car which is located _____• If Brutus is showing warning signs (pacing, not

responding to verbal engagement, snapping his bracelet) ask him if he is doing ok or if he would like to delay the outing. If already out, ask if he would like to leave.

• Avoid multiple trips or days in a row of overwhelming environments

• Remind Brutus of his goal to be able to be more independent in the community and how the environment relates to his goals


• Brutus will ask to leave or squeeze a supporter's handReplacement Strategies

• Brutus will use his muscle tension exercises, or put on his headphones and attempt to remain in the environment


Replacement / Alternate Strategies


Reinforce Replacement

BehaviorWhen Brutus asks to leave or squeezes your hand

• Say let's get going and immediately leave the area with Brutus.

• Prompt Brutus to use his deep breathing skill on the way to the car

• Review the situation and see how Brutus would like to proceed once he as returned to baseline.

Reinforce Alternative

BehaviorWhen he initiates coping skills (tension exercise or headphone use):

• Check in with Brutus to see if he is ok and offer a choice to try to stay or to leave

• If he chooses to stay, offer praise for tying and remind him of how well he is doing towards his goal.

• If he chooses to leave, follow instructions for reinforcing replacement behavior

SafetyWhen Brutus attempts to elope without telling staff:

• Always keep Brutus in line of sight and follow him if he attempts to elope without letting you know where he is going.

• If Brutus elopes, immediately go to the car or other agreed upon location to wait for Brutus

• Also, Call Brutus on his cell phone and attempt to meet up with him

• If after 5 minutes you cannot locate Brutus call XXXXXXXX for emergency support.


Do the strategies:• Align with the functional hypothesis?• Align with participant preference / provide choice?• Avoid difficult circumstances?• Make the situation better?• Prompt replacement / alternative behaviors?• Seem realistic for the team to implement?

Assessing Antecedent Strategies:


• Functional Behavioral Assessment (FBA https://www.myodp.org/course/view.php?id=1644

• Addressing Motivation Issues: https://www.myodp.org/course/view.php?id=1261 https://www.myodp.org/course/view.php?id=1262

• Staff Influence on Challenging Behaviors https://www.myodp.org/course/view.php?id=697

• Application of Applied Behavior Analysis https://www.myodp.org/course/view.php?id=1279

• Working as One Team: https://www.myodp.org/course/view.php?id=1295

Related Trainings on myodp.org

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• Reinforcement Strategies https://www.myodp.org/course/view.php?id=1674

• Importance of a Checklist: https://www.myodp.org/course/view.php?id=1681

• Using Consult / Indirect Services to Improve Service Implementation Across the Support Team https://www.myodp.org/course/view.php?id=1659

• Stages of Learning https://www.myodp.org/course/view.php?id=1294 –

• Best Practices for Interviewing Participants https://www.myodp.org/course/view.php?id=1673

• Positive Behavior Support and Lifestyle Changes/Interventions https://www.myodp.org/course/view.php?id=1613


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• Data Collection https://www.myodp.org/course/view.php?id=619 - https://www.myodp.org/course/view.php?id=1263 - https://www.myodp.org/course/view.php?id=1264 - https://www.myodp.org/course/view.php?id=1300 –

• Human Rights and Restrictive Procedures: Human Rights in Depth• https://www.myodp.org/course/view.php?id=1509

• Using Ecological Inventories to Support Skill Building During Transitions https://www.myodp.org/course/view.php?id=1680


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• Geiger, Carr, & LeBlanc (2009). Function-Based Treatments for Escape-Maintained Problem Behavior: A Treatment Selection Model for Practicing Behavior Analysts Behavior Analysis in Practice, 3(1), 22-32.

• Grow, Carr, & LeBlanc (2010). Treatments for Attention-Maintained Problem Behavior: Empirical Support and Clinical Recommendations Journal of Evidence-Based Practices for Schools Vol. 10, No. 1. 70-92

• Hieneman M. (2015). Positive Behavior Support for Individuals with Behavior Challenges. Behavior analysis in practice, 8(1), 101–108. https://doi.org/10.1007/s40617-015-0051-6

• National Collaborating Centre for Mental Health (UK). Challenging Behaviour and Learning Disabilities: Prevention and Interventions for People with Learning Disabilities Whose Behaviour Challenges. London: National Institute for Health and Care Excellence (UK); 2015 May. (NICE Guideline, No. 11.) 10, Environmental interventions. Available from: https://www.ncbi.nlm.nih.gov/books/NBK355381

• Nosik, M. R., & Carr, J. E. (2015). On the Distinction Between the Motivating Operation and Setting Event Concepts. The Behavior analyst, 38(2), 219–223. https://doi.org/10.1007/s40614-015-0042-5

References



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Creating Successful Environments: Antecedent Strategies in