pbs for families of children and adolescents with intellectual and developmental disabilities an...
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PBS for Families of Children and Adolescents with Intellectual and
Developmental Disabilities
An introduction for family support professionals and transitional service specialists
Joseph Ricciardi, PsyD, ABPP, BCBA-DSeven Hills Clinical Associates
Seven Hills Foundation
What is PBS?
PBS: Positive behavior supports
PBS is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person's environment.
Research-based
Better quality of life
Less problem behavior
Learn new skills
Making a “better” environmental fit for the person
What is PBS?
Our Definition of PBS A systematic, person centered approach… …to understanding the reasons for behavior and
applying evidence based practices for prevention, proactive intervention, teaching and responding to behavior…
…with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan.
Massachusetts Department of Developmental Services (DDS, 2013)
What is PBS?
FORMER APPROACHES• Stopping people from demonstrating
challenging behavior (reactive)• Psychotropic medication• Punishment procedures (used after the
challenging behavior occurs)• Separation from the community and
institutionalization
CURRENT APPROACHES (PBS)• Prevent: Anticipating a person’s need
before a challenging behavior occurs• Changing environments to help people
experience a greater degree of success• Teach: Socially-successful skills to make
challenging behaviors ineffective and irrelevant (i.e., the skills are easier and more effective)
• Reinforce: Celebrate valuable achievements and important skills
• Integrate: Actively participate in the community (the person’s natural environment)
PBS is the Current Best Practice for Serving Individuals with IDD and Challenging Behaviors
What is PBS?
The rationale for PBS—three important points
1) PBS reflects a shift in thinking from reacting to challenging behavior to trying to understand and support the individual.
2) PBS assumes that people do what they do for a reason. Their challenging behavior serves a purpose and works for them.
3) The focus shifts reacting to the individual’s challenging behavior to teaching appropriate skills that the individual can use to achieve the same purpose.
The model: a 3-tiered system
Intensive supports—highly individualized strategies that require clinical assessment, design, and guidance
Targeted supports—strategies that are well-understood, target a specific problem with a specific strategy
Universal supports—the patterns, practices, approaches that work best for all kids with IDD and their families
What are “universal supports” in the home? Again, we are looking for those practices that help all
kids with IDD do well—
Health and emotional problems addressed• Physical health• Mental health• Family function• Family supports
Predictable routines• As many “scripted sequences” as possible• Covering the usual, routine, daily activities
Clear expectations and rules• Written, posted positive behaviors• Written, posted rules/consequences
Tier 1: Universal Supports
What are “universal supports” in the home? Again, we are looking for those practices that help all
kids with IDD do well—
Health and emotional problems addressed• Physical health• Mental health• Family function• Family supports
Predictable routines• As many “scripted sequences” as possible• Covering the usual, routine, daily activities
Clear expectations and rules• Written, posted positive behaviors• Written, posted rules/consequences
Supporting basic self-expression• Age appropriate choice offered• Visual accommodations• System for communicating needs and wants
(simple icons, PECS, more advanced AAC)
Quality parent-child interactions• Low use of coercion and punitive
interactions/High use of instruction and praise• “Differential reinforcement” (Prompt, Praise,
Pause skills)• Planned quality parent-child time
Tier 1: Universal Supports
Tier 1: Universal Supports
What are “universal supports” in the home? Again, we are looking for those practices that help all
kids with IDD do well—
Health and emotional problems addressed• Physical health• Mental health• Family function• Family supports
Predictable routines• As many “scripted sequences” as possible• Covering the usual, routine, daily activities
Clear expectations and rules• Written, posted positive behaviors• Written, posted rules/consequences
Supporting basic self-expression• Age appropriate choice offered• Visual accommodations
Quality parent-child interactions
Varied leisure/recreation opportunities• Nothing complicated, and nothing to provoke
struggles• But a little variety, planned, scheduled,
supported
Healthy habits• Healthy sleep habits• Healthy diet• Some physical activity each day
Tier 1: Universal Supports
What are “universal supports” in the home? Again, we are looking for those practices that help all
kids with IDD do well—
Health and emotional problems addressed• Physical health• Mental health• Family function• Family supports
Predictable routines• As many “scripted sequences” as possible• Covering the usual, routine, daily activities
Clear expectations and rules• Written, posted positive behaviors• Written, posted rules/consequences
Supporting basic self-expression• Age appropriate choice offered• Visual accommodations
Quality parent-child interactions
Varied leisure/recreation opportunities• Nothing complicated, and nothing to provokeHealthy habits
A system for monitoring the intervention• Simple methods for assessing response to
intervention (behaviors of concern, skills)• Evaluating consistency of intervention
implementation
“Tier Two”—Targeted Interventions These are specific strategies, applied toward specific
problems Generally, these are easy solutions that come from
someone with experience The trick is to know “where do I begin?”
One strategy: contextual assessment Rather than asking about problem behavior itself,
discuss the occurrence of issues during various “recurring contexts” families encounter each day
“During which routine, daily, family events and activities do problem behaviors occur?”
Tier 2: Targeted Interventions
Typical events and routines that families face every day, and that may become challenges points for parenting a child with a developmental disability:
1. Getting out of bed
2. Sitting down for meals
3. Eating meals
4. Toileting
5. Bathing and self-care
6. Independent play time
7. Limits on certain activities (TV, computer, etc.)
8. Completing household chores and responsibilities
9. Driving in the car
10. Going shopping
11. Going out for a meal
12. Going to church
13. Getting off to bed
Tier 2: Targeted Interventions
Report from the school behavior analyst:Aggression is “escape-motivated” and the intervention includes escape extinction during seated instruction and prompting through refusal of low preference events.
Tier 2: Targeted Interventions
Behavior support: $50.00
THE BCBA
Report from the school behavior analyst:Aggression is “escape-motivated” and the intervention includes escape extinction during seated instruction and prompting through refusal of low preference events.
At home some issues have to be considered: • Is escape extinction possible? Can it be pulled off by a
parent?• Is the formulation relevant for every occurrence of
aggression? • Are there other approaches that might be tried?
Tier 2: Targeted Interventions
Report from the school behavior analyst:Aggression is “escape-motivated” and the intervention includes escape extinction during seated instruction and prompting through refusal of low preference events.
Tier 2: Targeted Interventions
Some findings of contexts of concern:Getting out of bed in the morning: Refuses to leave bed, struggles, and aggression likely. Goes to sleep around 7 PM, with meds. On weekends, sleeps until noon. Often awake around 3-4 AM, struggles to go back to sleep for a while. Interventions?
During prompted voiding: Refuses leave activity to use the bathroom. Or, follows prompts to bathroom, flops on floor, escalates, aggresses. Parents must yield. Interventions?Driving in car, especially long rides: Aggression, screaming. Parents must stop to calm him. Calmed with toys and music. Parents avoid taking him out and often feel “we are being held hostage by him”. Interventions?
Intensive Supports—Guided by Professionals Intensive supports require specialized assessment (the
Functional Behavior Assessment) The goal is to produce a home-based behavior support
plan
Tier 3: Intensive Supports
Must meet two special conditions for families:1) Must be do-able in the home, not “theoretical”
Intensive Supports—Guided by Professionals Intensive supports require specialized assessment (the
Functional Behavior Assessment) The goal is to produce a home-based behavior support
plan
Tier 3: Intensive Supports
Must meet two special conditions for families:1) Must be do-able in the home, not “theoretical”
2) Must not be worse than the problem itself
Intensive Supports—Guided by Professionals Intensive supports require specialized assessment (the
Functional Behavior Assessment) The goal is to produce a home-based behavior support
plan
Tier 3: Intensive Supports
Must meet two special conditions for families:1) Must be do-able in the home, not “theoretical”
2) Must not be worse than the problem itself
Clinicians must meet two conditions as well:1) Interventions must be empirically-supported2) The plan should be “multi-component”—it
addresses the problem through multiple avenues: prevention, teaching alternatives, planned reinforcement, safety plan
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