Polk County Positive Polk County Positive Behavior Support Behavior Support (PBS) Academy(PBS) Academy

PBS 101PBS 101

Training ObjectivesTraining Objectives

To learn what PBS is as both To learn what PBS is as both philosophy and toolsphilosophy and tools

Learn the basics of how we set the Learn the basics of how we set the tone for the environment-to help tone for the environment-to help or hinderor hinder

Learn basic tools of PBSLearn basic tools of PBS Learn how to use data to drive Learn how to use data to drive

decisionsdecisions

What is PBSWhat is PBS

It is a philosophy and a set of toolsIt is a philosophy and a set of tools A way of thinking and doingA way of thinking and doing Positive behavior support offers a Positive behavior support offers a

proactive process for proactive process for – addressing behavioral challenges, addressing behavioral challenges, – teaching adaptive skills, and teaching adaptive skills, and – improving quality of life.improving quality of life.

Polk County PBS Polk County PBS Mission & ValuesMission & Values

We are an inter-agency coalition We are an inter-agency coalition promoting positive support to enhance the promoting positive support to enhance the quality of life for persons with disabilities.quality of life for persons with disabilities.

We make decisions based on:We make decisions based on:– Dignity & respectDignity & respect– Long-term commitmentLong-term commitment– System consistencySystem consistency– Person-centeredPerson-centered– Empowerment through training, support, & Empowerment through training, support, &

educationeducation– Reducing the need for right restrictionsReducing the need for right restrictions– Promoting full citizenship and the exercise of Promoting full citizenship and the exercise of

choice choice

Link Associates’ Mission Link Associates’ Mission StatementStatement

Providing people with mental Providing people with mental disabilities disabilities

opportunities to achieve their personal opportunities to achieve their personal goals.goals.

Link Associates’ ValuesLink Associates’ Values Dignity & RespectDignity & Respect

Quality Services Quality Services Caring EnvironmentsCaring Environments

Personal Choice Personal Choice Long Term CommitmentLong Term Commitment

Insert Agency PBS Insert Agency PBS PolicyPolicy

Section One: PhilosophySection One: Philosophy

How you see me!

How I want to live!

Universal Enhancement Strategies

Things of Value

TARGETBEHAVIOR

Spontaneity

Positive rituals

Dining out

Exercising

Day at the spa

Dancing

Sex

FriendsVoting

Having a will

Family

Fishing

Movies

Vacationing

Good Health

Grilling out

Music

Volunteering

Work

Pets Hiking

Religion

Gardening

GEMGEM

GGood ood EEnough for nough for MMe e ––Tom PomerantzTom Pomerantz

I have come to the frightening conclusion I have come to the frightening conclusion that I am the decisive element in my that I am the decisive element in my environment. It is my personal approach, environment. It is my personal approach, which creates the climate. My daily mood which creates the climate. My daily mood makes the weather. I possess tremendous makes the weather. I possess tremendous power to make a person’s life miserable power to make a person’s life miserable or joyous. I can be a tool of torture or an or joyous. I can be a tool of torture or an instrument of inspiration. I can humiliate instrument of inspiration. I can humiliate or humor, hurt or heal. In all situations, it or humor, hurt or heal. In all situations, it is is MYMY response that decides whether a response that decides whether a crisis will be escalated or de-escalated crisis will be escalated or de-escalated and a person humanized or dehumanized. and a person humanized or dehumanized. ( Adapted- Halm Ginott)( Adapted- Halm Ginott)

Life

We must provide an environment that is healthy enough fora life to happen.

Dan Berkowitz

Effective Behavioral Support..requires the design of an environment that makes problem behaviors:

Prove It!Prove It!Prove that:•treating people with dignity and respect •meeting unmet needs•bondingdecreases the frequency and intensity of challenging behavior.

Does it Matter?!

Respect – Fundamental Respect – Fundamental to PBSto PBS

A personal quality that is non-A personal quality that is non-contingent provided without contingent provided without judgment and given equally to all judgment and given equally to all persons.persons.

People should not have to earn your People should not have to earn your respect they should be the recipient respect they should be the recipient of your respect without condition.of your respect without condition.

Defining Defining Characteristics of PBSCharacteristics of PBS

Person centeredPerson centered Collaborative on-going processCollaborative on-going process Data-driven decision makingData-driven decision making Prevention, positive, proactive Prevention, positive, proactive

strategiesstrategies Meaningful outcomesMeaningful outcomes

IS NOTIS NOT SimpleSimple Short termShort term Just Decrease Just Decrease

BehaviorBehavior ReactiveReactive Aversive (punish)Aversive (punish) Observable Observable

BehaviorBehavior Experts DecideExperts Decide

ISIS ComprehensiveComprehensive Long termLong term Teach Useful SkillsTeach Useful Skills ProactiveProactive Positive (reinforce)Positive (reinforce) FunctionFunction Involve IndividualInvolve Individual

If an individual doesn’t know how to read, we teach.If an individual doesn’t know how to read, we teach.

If an individual doesn’t know how to swim, we teach.If an individual doesn’t know how to swim, we teach.

If an individual doesn’t know how to multiply, we If an individual doesn’t know how to multiply, we teach.teach.

If an individual doesn’t know how to drive, we teach.If an individual doesn’t know how to drive, we teach.

If an individual doesn’t know how to behave, If an individual doesn’t know how to behave, we…………………teach?.................punish?we…………………teach?.................punish?

Why can’t we finish the last sentence as Why can’t we finish the last sentence as automatically as we do the others?automatically as we do the others?

Tom Herner (NASDE President, Counterpoint 1998, p.2)Tom Herner (NASDE President, Counterpoint 1998, p.2)

BreakBreak

Section 2: ToolsSection 2: ToolsHow we get to a Life!How we get to a Life!

Four Steps to Designing Four Steps to Designing an an

Effective Behavior Effective Behavior Support PlanSupport Plan

Step OneStep One

Step TwoStep Two

Step Step ThreeThree

Step FourStep Four

Gather InformationGather Information

Develop a HypothesisDevelop a Hypothesis

Build a Support PlanBuild a Support Plan

Evaluate Evaluate effectiveness and effectiveness and modify support modify support plan as neededplan as needed

Step 1: Gather Step 1: Gather InformationInformation

Person Centered PlanningPerson Centered Planning– Get to know the personGet to know the person

Five Essential Goals of Five Essential Goals of Person Centered Person Centered

PlanningPlanning Expressing preferences and making Expressing preferences and making

choices in everyday lifechoices in everyday life Gaining and maintaining satisfying Gaining and maintaining satisfying

relationshipsrelationships Having opportunities to fulfill respected Having opportunities to fulfill respected

roles and live in dignityroles and live in dignity Being present and participating in Being present and participating in

community lifecommunity life Continuing to growContinuing to grow

Characteristics of Characteristics of Person-Centered Person-Centered

PlanningPlanning Includes focuses on the individualIncludes focuses on the individual Respects the individual and their dreams and Respects the individual and their dreams and

choiceschoices

Emphasizes strengths, abilities, and capacitiesEmphasizes strengths, abilities, and capacities

– Strength based Training principlesStrength based Training principles

Individualized supportsIndividualized supports

Empowers the consumer and teamEmpowers the consumer and team

Tools for Person-Tools for Person-centeredcenteredPlanningPlanning

Essential Lifestyle planEssential Lifestyle plan Insert tool your agency uses.Insert tool your agency uses.

What is behavior?What is behavior?

Anything a person says or doesAnything a person says or does– 90% of behavior is communication90% of behavior is communication– Must be observable and measurableMust be observable and measurable– Must meet the “dead man’s test”Must meet the “dead man’s test”

*If a dead man can do it, it’s NOT *If a dead man can do it, it’s NOT behaviorbehavior

Behavior is method ofBehavior is method of: communication both : communication both verbally & physically of hopes, dreams, fears, verbally & physically of hopes, dreams, fears, anxieties, preferences, intentions and anxieties, preferences, intentions and prioritiespriorities

Behavior is also a method toBehavior is also a method to: cope with or : cope with or respond to demands from others control and respond to demands from others control and impulses, conform to generally accepted impulses, conform to generally accepted social conduct, and or influences of the social conduct, and or influences of the environmentenvironment

Behavior is the result of complex neurological Behavior is the result of complex neurological and sensory process.and sensory process.

He Had A BehaviorHe Had A BehaviorOf course he had a

behavior! If he didn’t he’d be DEAD! There is:

walking behavior talking behaviorsitting behavior standing behaviorsmiling behavior eating behavior

Have you ever been outside when there wasn’t any weather?

Behavioral DefinitionBehavioral Definition

Definition of behavior needs to be Definition of behavior needs to be clear, concise, and specificclear, concise, and specific

A description of what you will see A description of what you will see when the behavior occurs.when the behavior occurs.

Written so that everyone can Written so that everyone can agree when the behavior occurs.agree when the behavior occurs.

Specific Target Specific Target BehaviorsBehaviors

ExamplesExamples high-pitched high-pitched

screamscream Kicks chair overKicks chair over Hits others/selfHits others/self Completes tasksCompletes tasks

Non-ExamplesNon-Examples Poor impulse Poor impulse

controlcontrol Angry, frustratedAngry, frustrated AggressiveAggressive Pay attentionPay attention

Lack of Lack of UnderstandingUnderstandingTo call

someone lazy,

uncooperative or

stubborn is to admit we

don’t understand

them.

She’s just plain stubborn. She refused to take her meds again!

Step 1: Gather Step 1: Gather InformationInformation

Functional AssessmentFunctional Assessment

What is Functional What is Functional AssessmentAssessment

A functional assessment is a A functional assessment is a process for identifying clear, process for identifying clear, predictive relationships between predictive relationships between events in a person’s environment events in a person’s environment and occurrences of a challenging and occurrences of a challenging behavior.behavior.

– Not a data collection formNot a data collection form– Not an eventNot an event

Why Conduct a Why Conduct a Functional Assessment?Functional Assessment?

provides clear informationprovides clear information allows strategies to be based on the allows strategies to be based on the

function(s) of challenging behaviorfunction(s) of challenging behavior leads to more durable outcomesleads to more durable outcomes reduces the need for reactive reduces the need for reactive

interventions and crisis plansinterventions and crisis plans addresses the needs of an individualaddresses the needs of an individual increases quality of lifeincreases quality of life

Find answers to the Find answers to the BIG QuestionsBIG Questions

Under what conditions do the Under what conditions do the challenging behaviors occur?challenging behaviors occur?

What are the outcomes?What are the outcomes?

Under what conditions do the Under what conditions do the challenging behaviors not occurchallenging behaviors not occur

A Functional Assessment A Functional Assessment Identifies Goals of Identifies Goals of

InterventionIntervention Defines specific target behaviors to Defines specific target behaviors to

increase and decreaseincrease and decrease Pinpoints circumstances in which Pinpoints circumstances in which

intervention will occurintervention will occur Identifies desired lifestyle changes, such Identifies desired lifestyle changes, such

asas– Participation in integrated activitiesParticipation in integrated activities– Enhanced independence and satisfactionEnhanced independence and satisfaction– Expanded social networksExpanded social networks– Work!!! Work!!!

What are the basics?What are the basics?

Gather information about the Gather information about the challenging behavior through challenging behavior through direct observation, interviews, direct observation, interviews, record reviews and/or rating scalesrecord reviews and/or rating scales

Develop a hypothesis after Develop a hypothesis after analyzing the information analyzing the information regarding the variables that starts regarding the variables that starts and maintains behaviorand maintains behavior

Group WorkGroup Work

Worksheet 1Worksheet 1

The ABC’s of a Functional The ABC’s of a Functional Behavioral AssessmentBehavioral Assessment

Setting EventSetting Eventthe state a person is in, e.g., the person is tired, or the state a person is in, e.g., the person is tired, or hungry; a state that predisposes a person to behave hungry; a state that predisposes a person to behave in a certain way given a particular antecedent. in a certain way given a particular antecedent.

AntecedentsAntecedentsany stimulus which precedes a behavior occurrenceany stimulus which precedes a behavior occurrence

BehaviorsBehaviorsany observable act of an individual; the activity one any observable act of an individual; the activity one performs in the presence of a particular stimulusperforms in the presence of a particular stimulus

ConsequencesConsequencesthe events which occurred following behaviorthe events which occurred following behavior

What are What are Consequences?Consequences?

Consequences are events Consequences are events that follow a behavior.that follow a behavior.

Positive or NegativePositive or Negative

Results or Functions of Results or Functions of BehaviorBehaviorGet

SensoryAttention

Tangible

Get

Away

Tangible

SensoryAttention

Results or Functions of Results or Functions of BehaviorBehavior

SensorySensory EscapeEscape AttentionAttention TangibleTangible Meet an unmet needMeet an unmet need

Why do people display Why do people display challenging behaviors?challenging behaviors?

• Biological/Medical Reasons:Biological/Medical Reasons: Drugs/medicineDrugs/medicine Seizure activitySeizure activity Allergies/hormonal changesAllergies/hormonal changes To mask pain or discomfortTo mask pain or discomfort

• Self-RegulationSelf-Regulation To maintain a level of arousalTo maintain a level of arousal Reaction to a change in sensory inputReaction to a change in sensory input

• Reinforcement:Reinforcement: Internal-it feels goodInternal-it feels good External-to serve a purpose in one’s External-to serve a purpose in one’s

environmentenvironment

• Absence of Alternative SkillAbsence of Alternative Skill Most behaviors have the goal to Most behaviors have the goal to

communicatecommunicate Messages are sent through behaviorMessages are sent through behavior Control is the key wordControl is the key word

Practice the ABC’sPractice the ABC’s

Which is the Antecedent, Behavior and Which is the Antecedent, Behavior and the Consequence in each of these the Consequence in each of these examplesexamples..– 1. During dinnertime, Ben watches the staff pass the tea pitcher 1. During dinnertime, Ben watches the staff pass the tea pitcher

to a peer. Ben then passes the water pitcher to the staff, who says to a peer. Ben then passes the water pitcher to the staff, who says “ Thank you” to Ben.“ Thank you” to Ben.

– 2. Betty repeatedly teases Samantha. Following the teasing 2. Betty repeatedly teases Samantha. Following the teasing remark, Samantha throws a magazine at Betty. The staff tells remark, Samantha throws a magazine at Betty. The staff tells Samantha not to throw things.Samantha not to throw things.

– 3. A staff person tells Natasha that a visitor will be visiting her in a 3. A staff person tells Natasha that a visitor will be visiting her in a few minutes. Natasha puts on a new dress. The visitor tells few minutes. Natasha puts on a new dress. The visitor tells Natasha how nice she looksNatasha how nice she looks

Alternative BehaviorsAlternative Behaviors

What is the best way to decrease What is the best way to decrease a behavior that is a barrier to a behavior that is a barrier to getting a life?getting a life?

Find an alternative behavior that Find an alternative behavior that serves the same function or serves the same function or purpose – gets the same results.purpose – gets the same results.

Setting Event AntecedentProblemBehavior

DesiredBehavior

AlternativeBehavior

Consequence

Consequence

Competing Behavior Pathway

Setting Events TriggeringAntecedents

MaintainingConsequences

Desired Behavior TypicalConsequences

Problem Behavior

Acceptable Replacement Behavior

Scream,

Hit head

Approach by Staff

Staff move away; avoid request

Interact nicely; do what’s asked

Staff positive attention,

Asked to do something

Tired

Competing Behavior Pathway

Take what you can get; Take what you can get; closest to what you want! closest to what you want!

Reinforce even small Reinforce even small improvement or steps to improvement or steps to reaching the objectivereaching the objective

Step 2: Develop a Step 2: Develop a HypothesisHypothesis

What is a hypothesisWhat is a hypothesis

Your “best guess” about the Your “best guess” about the function of challenging behaviorfunction of challenging behavior

Hypothesis FormulaHypothesis Formula

When this occurs (what is the When this occurs (what is the setting event/antecedent)….setting event/antecedent)….

The individual does (behavior)The individual does (behavior)

To access or avoid (consequences To access or avoid (consequences or functions)or functions)

A Sample HypothesisA Sample Hypothesis

When Sean…..When Sean…..((setting eventsetting event) did not get to sleep before 11 ) did not get to sleep before 11

p.m. the previous evening or does not feel p.m. the previous evening or does not feel well,well,

((antecedentantecedent) is not engaged with others or ) is not engaged with others or when he’s engaged in activities for 15 when he’s engaged in activities for 15 minutes or longerminutes or longer

((behaviorbehavior) he screams, slaps his face and ) he screams, slaps his face and pulls his hairpulls his hair

((Consequences/functionConsequences/function) to gain access to ) to gain access to staff attentionstaff attention

Setting Events TriggeringAntecedents

MaintainingConsequences

Desired Behavior TypicalConsequences

Problem Behavior

Acceptable Replacement Behavior

Screams, Slaps face, pulls hair

Not engaged w/ Others, or engaged too

long

Gets staff attention

Staff attention

Stayed up late/doesn’t

feel well

Sean’s Competing Behavior Pathway

Linking Hypothesis Linking Hypothesis Statement to Behavior Statement to Behavior

InterventionsInterventions A hypothesis statement links A hypothesis statement links

behavior interventions to:behavior interventions to:– short-term prevention of problematic short-term prevention of problematic

situationssituations– Teaching alternative skillsTeaching alternative skills– Responses to challenging behaviors, Responses to challenging behaviors,

including crisis managementincluding crisis management– Long-term preventionLong-term prevention– Lifestyle changesLifestyle changes

In any situation there are In any situation there are three things involved:three things involved:

1 The Environment1 The Environment 2 The person2 The person 3 3 YOUYOUIt cannot be guaranteed that you will be It cannot be guaranteed that you will be

able to control the environment or the able to control the environment or the person served; however, you can person served; however, you can control your own behavior.control your own behavior.

Step 3 : Build a Step 3 : Build a Support PlanSupport Plan

What is a Behavior What is a Behavior Support PlanSupport Plan

A written document that summarizes A written document that summarizes strategies that assist in preventing strategies that assist in preventing challenging behavior from occurring and challenging behavior from occurring and helps the consumer learn helps the consumer learn new skillsnew skills

The plan should:The plan should:– develop and maintain skillsdevelop and maintain skills– enhance opportunities for learning and self-enhance opportunities for learning and self-

fulfillmentfulfillment– Focus on positive rather than negative Focus on positive rather than negative

techniquestechniques

How do we collect this How do we collect this information?information?

Direct observation dataDirect observation data Incident reportsIncident reports InterviewsInterviews

– ConsumerConsumer– ParentsParents– Service providersService providers– OthersOthers

Informal anecdotal reportsInformal anecdotal reports– Communication logsCommunication logs– Progress notesProgress notes

A support plan is not A support plan is not written in stone. It was written in stone. It was made to be changed as a made to be changed as a

person grows and person grows and changes.changes.

Step 4: Evaluate Step 4: Evaluate effectiveness and effectiveness and

modify support plan modify support plan as neededas needed

Is the plan working?Is the plan working?

Are there improvements in challenging Are there improvements in challenging behavior?behavior?

Are there increases in skill development?Are there increases in skill development? Are there improvements in quality of life?Are there improvements in quality of life?

– Increased participationIncreased participation– Increases choice/decision makingIncreases choice/decision making– InclusionInclusion

Are there improvements in satisfaction?Are there improvements in satisfaction?– Consumer and familyConsumer and family– Staff and othersStaff and others

Are there improvements in health or well-Are there improvements in health or well-being?being?

Remember, PBS is all Remember, PBS is all aboutabout

Determining the function of Determining the function of challenging behavior and then:challenging behavior and then:– Changing environmentsChanging environments– Teaching new skillsTeaching new skills– Addressing quality of life issuesAddressing quality of life issues– Changing our patterns of interactionChanging our patterns of interaction

Review Training Review Training ObjectivesObjectives

To learn what PBS is as both To learn what PBS is as both philosophy and toolsphilosophy and tools

Learn the basics of how we set the Learn the basics of how we set the tone for the environment-to help tone for the environment-to help or hinderor hinder

Learn basic tools of PBSLearn basic tools of PBS Learn how to use data to drive Learn how to use data to drive

decisionsdecisions

Point of ViewPoint of View

““When you change When you change the way in which the way in which you see things-you see things-the things you the things you

see will change.”see will change.”