positive behavioral support for employment specialists (pbses) bret vaks, mba executive director...

Positive Behavioral Support for Employment Specialists

(PBSES)

Bret Vaks, MBA

Executive Director

Autism Family Services of New Jersey

732-337-4071

bvaks@autismfamilyservicesnj.org

Introductions

• Name• Role• Employer• City-State

PBSES

• The Main Reason People with Disabilities and People with Severe Mental Illness (SMI) Lose their Job

PBSES

• Key Points– We do not use FBA– We do not Bring the Behaviorist or Clinician on the Job– We do not Implement “Formal” Behavior Plans– We do not Pass Judgment on Behavior-Instead we Attempt to

Understand Behavior– We Rely on Instructional Interventions and Coping Skills – Challenging Behaviors may happen because Individuals cannot

Communicate-Therefore we Rely on Technology and Augmentative Communication when Appropriate

• Five Step Process-Investigating the Behavior

1. Is there a Known Setting Event

2. What is the Antecedent

3. What is the Behavior

4. What is the Function of the Behavior

5. Save the Job

PBSES

– People with Intellectual/Developmental Disabilities

– People with Autism Spectrum Disorders

– People with SMI– Individuals with Criminal

Background – Persons who are Forensically

Involved

PBSES Instructional Interventions

• Teach Communication Skills

• Teach Soft Skills

• Teach the Person how to

Transition from one Job Task to

the next

• Teach/Create Structure-Routine

• Encourage Co-workers to Create

Mentoring Relationships and

Teach them what the Individual

may be Communicating by

Understanding Certain Pre-

cursors to Potential Behaviors

PBSES Coping Skills

• Teach People to Cope with– Anger– Stress– Boredom– Change– Disappointment– Fear/Anxiety

PBSES Coping Skills

• Improves self-confidence and self-esteem • Decreases Instruction and Correction Time • Improves independence and Empowerment• Helps individuals to be more Assertive • Decreases the time it takes to Deal with

Crises and Conflicts • Improves Behaviors • Improves Problem Solving

PBSES Coping Skills

• Teach the Person to Self Monitor their Emotions by Developing Self Awareness

• Teach Individual to Identify and Label Feelings

• Use Visual Tools-Apps on the IPOD-IPAD

Assistive Technology

The Investigation of a Behavior

What is the Function of Behavior

• Sensory – or Historic/Institutionalized

Behavior– Satisfies a Need or Impulse with

Internal Triggers, and Internal Rewards

• Escapes or Avoid Demands• Gains Attention • Gets Something

– Obtains Tangible Items or Opportunities to something the person Prefers

– Misunderstanding of Social Cues

– Awkward Circumstances that Resemble Behaviors with Equally Negative Outcomes• Inadvertent Sexual

Harassment

What is the Function of BehaviorLack of Social Skills

Social Skills

• Understanding Workplace Culture

• Workplace Gossip…What is real and when do you Laugh and Walk Away?

• Office Kitchen Rules etc.– Can the Individual

Engage and Initiate Conversation

What is the Function of BehaviorHas Something Changed

– Is there a Medical Issue?• Does the person need new glasses? • Hearing Aid?• Med Changes?• Dental Problems?

– Is there a new Supervisor or Co-worker?– If the Person has SMI-what is happening with Treatment?– Is there an Environmental Factor such as Noise, Poor Lighting or

Distractions that are causing the Individual Problems.– Is there a New Work Task?

• Did the person Forget what to do or is the Behavior Occurring During a Secondary Task?

• Did he or she Actually Learn the Task in the First place

The Investigation of a Behavior

1. Is there a Known Setting Event

Examples: history of task avoidance problems, boredom, illness, stress, exhaustion, mental illness, disability-autism, lack of sleep etc.

2. What is the Antecedent

Examples: requests, told “no,” rude comment, target for teasing

The Investigation of a Behavior

The Investigation of a Behavior

3. The Behavior• This is the Phone Call!

The Investigation of a Behavior

4. What is the Function of the Behavior

• Sensory• Lack of Social Skills• Has Something Changed• Escapes or Avoids Demands• Gains Attention • Gets Something

The Investigation of a Behavior

5. Save the Job

– Develop Instructional Interventions/Coping Skills to Address the Behavior

Example of a Diagram Summary Statement of Problem Behavior

Learning or doing new tasks

Susie’s supervisor asked her to take out the new trash can in the kitchen area of the cafeteria to the outside dumpster

Susie screams obscenities at her supervisor in front of her co-workers and customers and runs out of the cafeteria

Susie gets out of taking the new trash can to the dumpster

Something gets me ready to have a problem…sets me up…

Setting

Event

Something then sets me off…

Antecedent

So I…

Problem

Behavior

And I… Get/Avoid/Delay

What is the Function?

Function

Has Something Changed?

• Yes– You have Trained Susie on how to Empty the Trash Cans in the Dining Room

which are out in the Open– Not on how to empty the Trash Cans in the Kitchen that are tucked away in

Strategic Locations • One is under the Serving area where the wait staff Pick up their meals, and

the other is under the Rack Attached to the Commercial Dish Washer• Susie has Never Emptied these Cans Before

– It may be a bit Challenging-It is somewhat Different as there is at least one Additional Step

• We know Susie has a Potential Setting Event of Learning New Tasks!

Supporting Adults with SMI

What Is SMI?

• A Medical Condition that Disrupt a person’s Thinking, feeling, Mood, or Ability to Relate to others, and Creates Patterns that Interfere with Daily Living and Working – Need a Job Coach!

What Is Mental Illness?

• Stigma

the Shadow Job Coach

The Shadow Job Coach

• The Role of the Job Coach Changes from Teacher to the Person’s Daily Support System Helping them Get Through their Day Especially During a Phase of the Illness when Symptoms Reappear

• Job Coaching without ever Stepping into the Person’s Place of Work– By Phone– By Texting– By Email– By Meeting before the Work Day Starts

and at the end of the day to Debrief

Reviewing Coping/Support Strategies

• Journaling Often Recommended as part of Counseling Helps put Experiences in Perspective For those who can’t Write, use other forms of Communication:

Photos or Icons• Relaxation

A need everyone, many people have trouble relaxing, SMI or not

Strategies that work: o Breathing, Meditation and Visualizationo Exerciseo Long walks with breathing and/or meditation during walking timeo Listening to music

Integration with Mental Health Treatment

The Employment Specialist or Provider Agency Coordinates Plans with an Entire Treatment Team and Meets Regularly or as Treatment and Severity of Symptoms Fluctuate

Members of the Team may Includeo The Individuals Case Manager/VR Counseloro A Psychiatric RNo A Clinician or Staff Psychologisto A Psychiatristo A Neurologist

Supporting Adults with Severe Mental Illness

• Coordinate the Individual’s Care– For Example, an Individual on the

Job begins to Exhibit Paranoia, the Employment Specialists brings this to the Team for possible Solutions and Coordination

– In Turn, if a Psychiatrist Adjusts medications, this is relayed to the other members of the Team including the Employment Specialist

The Experts…Evidenced Based

• National Resource Individual Placement and

Support Model (IPS)

Dartmouth IPS Supported Employment Center

- Dr. Gary Bond

- Deborah Becker, M.Ed.

www.dartmouth.edu/~ips

Criminal Backgrounds

Criminal Backgrounds

• Petty Offense– Infractions that Typically don’t

Warrant Jail Time– A person who commits a petty

offense will usually get a Ticket or Citation

– Typically some of these can be Expunged

• Misdemeanor– Is the lesser of Crimes and is

Punishable in a county jail of one year or less

• Felony– Is Punishable by Over a year in

State or Federal Prison

• A Convicted Felon is someone who has committed a serious criminal offense such as:– Assault in the first degree – Assault that causes serious bodily injury– All degrees of murder, rape or sexual abuse in the first degree– Grand theft– Kidnapping – Embezzlement of large amounts of money serious drug crimes,

and racketeering 

Convicted Felons

Facts about Felons

• Felons cannot:– Practice certain

Professions such as Teaching

– Own Guns– Hide their Criminal

Record when Applying for a Job

Forensic Supports

• Follow Specialized Psyche Eval or Behavioral Risk Assessment with Forensic Protocols

• Typically done by a Forensic Psychologist

• The Individual’s Probation/Parole Office, DD/DMH Case Manager, or VR Counsel Should have Access to these Reports– VR Green Report

• Do not Start Working with an Individual Until you Read these Reports

• Will Specify Level of Risk to the Community

Specialized Psyche Eval or Behavioral Risk Assessment

May Include– Social History– Behavioral/Criminal History– Medical /Psychiatric History– Current Behavioral Issues– Substance Abuse History– Attitude to Treatment– Denial and Minimization of

Offense– Coping Skills/Anxiety Triggers– Sexual Knowledge– Arousal Pattern– Age at onset of behavior– Frequency– Use of Force– Victim Characteristics– Prior Offenses– Method (s) of Treatment

Forensic Supports

• Individuals Should Not be with an Employment Specialist that Matches his or her MO

• Do not Meet them in their Home Alone…Cannot Step Over the Threshold

• Maintaining/Establishing Professional Boundaries

Forensic Supports

• Keeping the Individual Safe while at the Same Time

– Promoting Dignity & Person Centered Planning– Refrain from Passing Judgment– Promoting Pro-Social Behaviors– Celebrating Successes– Keeping them out of the System– Helping the Individual be Active Participants in their

Preferred/Prescribed Method of Treatment

Sex Offender Tier NotificationNJ Regs Similar Around Country

Check with your Prosecutor’s Office or Attorney General’s Office for State Specific Regs

• Sex offenders who Reside in the Community are Classified in one of three "tiers" based on the degree of risk they pose to the Public: – Tier 3-High Risk– Tier 2-Moderate Risk– Tier 1-Low Risk 

• Neighbors are Notified only of High Risk Offenders 

• Schools, select community organizations involved in the care of Children or Women, and certain area Businesses are Notified of Moderate and High Risk Offenders

• Law Enforcement Agencies are Notified of the presence of all Sex Offenders

Sex Offender Tier Notification

Tier 1

• Law Enforcementlikely to encounter

offender

Tier 2

• Law Enforcementlikely to encounter

offender

• Schools & Community

Groups likely to encounter offender

Tier 3

• Law Enforcementlikely to encounter

offender

• Members of the public

likely to encounteroffender

In Your Groups

• Analyze Each Situation• What may be Causing the Behavior?

– What is the Antecedent? – What is the Function?

• Create a Plan of Correction/Support Strategies that may Include Either Coping Skills or Instructional Interventions

Case 1-The Friendly Food Prep Worker

• John is a 27-year-old male that has Down Syndrome. John is a very pleasant and positive. He is very social and friendly. Those who know John describe him as a hard worker who is always eager to please. John reads at an 9th grade level and is able to comprehend basic mathematical computations using addition and subtraction. He has been working as a Food Preparation Aid in an employee cafeteria for a local pharmaceutical company for the last 2 months. John works in the cold food prep department.

Primary Responsibilities

Small Salad Preparation

1. Remove and weigh quantities of mixed greens, mushrooms, carrots, ham, and cheese.

2. After measuring each item to appropriate weight using calibrated scale, place salad items into bowl, remove shrink-wrap from role dispenser and cover salad bowls tightly.

3. Place 8 bowls on a tray and bring them out to the front end display counter in the employee dining area.

4. Remove bowls from tray and place on top of bed of ice in the salad section of the cold food display case.

Problem Behavior

• John’s manager, Mr. Jennings, has recently contacted John’s support agency stating that since his job coach has faded away, John’s work productivity and accuracy have become inconsistent over the past several weeks. Mr. Jennings stated that John sometimes tends to rush which causes him to weigh salad items inaccurately. He added that John forgets to place all the required salad items into the bowls and that John has developed a habit of talking excessively to employees when he goes out to stock the salad display case. Mr. Jennings asked that his job coach come in to provide some job coaching services to help John improve his job performance.

Case 2-The Busy Business Administrative Assistant

• Lisa is a 34-year-old female with General Anxiety Disorder and Major Depression. Lisa is in a Shadow Role as she is afraid to inform her employer about her illness. Lisa is currently on medications and is attending weekly individual and group therapy sessions. Lisa is very introverted. She experiences poor concentration, which sometimes affects her organizational skills and short-term memory. Based on her past work experience, she has demonstrated the ability to work well if her job tasks are clearly outlined and organized. Lisa has a B.A. in Business Administration and is currently working as a Administrative Assistant for a large accounting firm. She has been working there for approximately 6 weeks. This is tax season.

.

Problem Behavior

• She initially started well, adjusting appropriately to her new job. She described to her Job Coach how difficult this job has become at one of their debriefing sessions at the local coffee shop where they meet. She stated that over the past several weeks the accounting volume has increased significantly. As a result of this increased work volume, she is having difficulty performing her primary job functions which include typing, filing, and answering of telephones. She described to her Job Coach that the stress is becoming so severe that she wants to quit and “just get away from it”.

Specific Problem Behaviors

1. She has been flustered at times when she answers the phone, putting people on hold and forgetting to get back to them and transferring calls to the wrong extensions.

2. Misfiling forms and documents.

3. Falling behind on typing of daily memo requests and letters.

4. She thinks her co-workers are talking behind her back.

5. She thinks at least one of her co-workers stole her phone and put it back in her purse when she wasn’t looking.

Case 3-The Case of the Selective Video Stocker

• Ryan is a 42-year-old male with a diagnosis of Fragile X Syndrome and Attention Deficit Hyperactivity Disorder (ADHD). Ryan sometimes has limited patience and can be a bit short tempered. He does not accept constructive or corrective feedback, typically internalizing it as an attack on his intelligence. Testing shows that Ryan reads at a 5th grade level. His letter recognition is good but his reading comprehension is relatively poor. He is able to compute basic addition and subtraction. In his spare time, Ryan loves to watch movies and listen to talk radio shows. He has an uncanny memory for faces and places especially as it pertains to actors and movies. Not surprisingly, he is more of a visual learner, but benefits from verbal and hands-on instruction as well. Ryan has recently begun working at a video store in his hometown. His primary job task is to re-shelve returned videos. Ryan received some initial onsite support from his job coach when he began his new job. However, his employer suggested they facilitate training for him since they provide that to all new employees. Ryan was happy with this suggestion since he was reluctant to have a job coach with him at the job site.

Problem Behavior• Two weeks later Ryan’s manager called and stated that he would like to

have a job coach in to assist with some of the training.

• The manager stated the following:

1. Ryan has been observed shelving videos in the wrong location.

2. Ryan responded somewhat defensively to a co-worker when a more efficient method of shelving videos was suggested, Ryan’s response was, “I know how to do this. I don’t need your help. Leave me the hell alone.” This outburst occurred in from of customers.

3. Lastly, Ryan was found on several occasions returning adult videos to the adult video movie section. At this time he was also observed leisurely walking around this section perusing the video selections. When Ryan was first hired he was told that he would not be returning those videos to this section since the night shift workers do this.

In Your Groups

• Think of a Behavioral Situation you are Currently Facing• What is the Behavior? • What is the Antecedent?• What is the Function of the Behavior?• Create a Plan of Correction/Support Strategies that may

Include Either Coping Skills or Instructional Interventions

In Your Groups

• How Would you feel if you Received a Referral for a Convicted Sex Offender?

• Would you take the Case? • What Supports would you

and your Agency Need? – Do you feel Supported?

THANK YOUQUESTIONS