“Do this, Not that! Strategies to Support Individuals and Team

Members”Presented by Justin Creech, BCBA, LBA, LMHP

Virginia Central Region REACH

Learning Objectives

• List 9 effective ways to support individuals and team members• List 9 strategies to avoid when supporting individuals and team

members• List “Green Level Strategies” used at Virginia Central Region

REACH• Identify maintenance strategies used to support consistent

implementation of the “Green Level Strategies”• Use at least one of the effective strategies within the next week

for someone you support

#1Do gain rapport first…DON’T expect people will listen or do what you say without developing a relationship

• Get to know the person• Interests• Goals• Dreams• Values• Strengths

• Treat others with dignity and respect in all forms of communication

#2 Do look to the environment for why people do that they doDon’t assume people do what they do due to internal causes or character flaws

• Are these helpful terms? “They are just ______”• Lazy• Stubborn• Mean• Inappropriate • Manipulative

• Behavior operates upon its environment to generate consequences (Skinner, 1953)

#3Do provide a meaningful dayDon’t provide too much downtime or activities that People don’t care about

• Providing interactive activities increases the likelihood that individuals will enjoy themselves on a daily basis. If the environment does not provide interactive activities, then individuals may experience little enjoyment and frequent boredom (Reid & Parsons, 2002)

• Providing meaningless activities can increase the likelihood that challenging behavior will develop (Reid & Parsons, 2002)

• Non-adaptive behavior is most common during leisure periods on residential settings and frequent occurrence of non-adaptive behavior is an indicator of a nontherapeutic environment (Reid & Parsons, 2002)

Key for Interest/Participation Rating:0 = No interest or participation1 = Brief interest/participation (0-5 minutes)2 = Moderate interest/participation (5-10 minutes)3 = Much interest/participation (10 or more minutes)

Date Item/Activity Interest/Participation Rating(Circle one)

Staff Initials

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

0 1 2 3

#4Do inform people of what to do…Don’t solely rely on telling people what not to do

• “They know better”…..Do they?

• “Don’t do….” ≠ Teaching

• What about teaching:• Conversation skills• Public vs. private areas• Personal space• Coping skills

RATING Look likes Feels like I can try to/ Staff can

5

4

3

2

1

(Buron & Curtis, 2003)

RATING

Look likes

Feels like

I can try to/

Staff can

5

4

3

2

1

Date/Time Number on Scale

Coping Skill NeededCIRCLE

If YES, name coping skill used:

Did use of the coping skill lower the number on the scale?CIRCLE

Yes No Yes No NA

Yes No Yes No NA

Yes No Yes No NA

Yes No Yes No NA

Yes No Yes No NA

93%

7%

% Coping Skills Used Effectively Not effective

#5Do use a 4:1 ratio…DON’T use a 1:1 ratio or worse!

• 4 positive comments to every demand, corrective feedback, or negative comment

• Research• The Gottman Institute, 2019• Madsen & Madsen, 1974• Hart & Risley, 1995• Daniels & Bailey, 2014

• Practical applications

#6Do give effective feedback…Don’t expect the individual to “know” what they are supposed to do and how they are doing

• “Feedback is often the least expensive and easiest method people can use to start improving performance” (Daniels & Bailey, 2014)

• Characteristics of Effective Feedback (Daniels & Bailey, 2014)• Immediate• Individualized• Easily understood• Performance is in the person’s control

#7 DO provide concise, easy to follow recommendations…Don’t write a complex novel and expect people to follow it

• Cheat sheets• Behavior profile

Behaviors for Increase • Functional Communication (sign language) • Cooperation with requests • Staying in designated areas • Duration of engagement in

activities • Maintaining personal boundaries

Behaviors for Decrease • Property destruction (tearing

clothes, hitting doors) • Physical aggression (pushing, hitting,

biting, choking) • Self-injurious behavior (hitting self

in face) • Exit-seeking behavior • Food stealing

TRIGGERS

• New places • Denied requests • Spending long lengths of time in community • Seeing cars (He often wants to get in the cars to go riding) • Visits from sister

PROACTIVE STRATEGIES • Implement Green Level strategies • 1:1 in the community, LOS when in public areas • Keep finger nails trimmed • Support him with walking on unsteady ground or stairs • Provide one direction at a time using short concrete prompts • When in public areas—direct to activity at least every 30 minutes (ex. Puzzle,

dominoes, crafts, cooking/helping in kitchen with support) if not engaged. It is likely his attention to the activity will last 1-3 minutes

• Support with shower, shaving, and eating 3 meals daily (Guardian stated that this helps)

• Reinforce functional communication (He knows the following signs-stop, eat, drink, sit, thank you, shoes, sleep, drive, bye) by providing access to his request, when possible. When you can’t provide access, then acknowledge the communication (“Thank you for telling me you want to go for a ride. We can’t go right now”)

• If he grabs forearm, stop and make the sign for “stop”. You may have to repeat before he lets go. At other times, attempt to avoid his attempts to grab your arm.

• Provide closer supervision when he is around peers or when new people enter the CTH to avoid them being grabbed

• Provide walks at scheduled times 3x a day when weather and staffing permits • Provide van rides at scheduled times in the community 2x a day when staffing

permits WHAT TO DO WHEN CHALLENGING BEHAVIORS HAPPEN

• Maintain a calm, neutral tone while using Safety-Care De-escalation and physical management procedures when appropriate.

• Block self-injurious behavior while prompting incompatible behavior such as holding stuffed animals, clapping, hi-5s, etc.

#8Do provide competency based training…Don’t train people by lecturing only and expect they will do it

• Traditional staff training is usually didactic and not very effective (Parsons, Rollyson, & Reid, 2012)

• Ever heard someone say, “I told them what to do and they still won’t do it”

• Behavioral Skills Training (BST)• Instructions • Model • Rehearsal • Feedback

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Expressing Your Feelings (Goldstein & McGinnis, 1997)1. Tune into what is going on in your body. (before reacting)2. Decide what happened to make you feel that way.3. Decide what you are feeling (Anger, fear, happiness,

excitement, nervous/anxiety, sadness)4. Think about different ways to express yourself and pick on

(ex. talk to staff, use a code word with staff, take a break)5. Express your feeling

Situation—Maggie was expecting the house manager (Janie) to work today. However, Janie was sick and a different staff worked in her place.

Use Behavioral Skills Training (BST) to teach skill below through role-playing scenarios.1-Instruction 2-Model 3-Rehearsal 4-Feedback 5-Generalize

#9 Do collect data…Don’t rely on anecdotal reports solely for information

• Anecdotal reports tend to be subjective and inaccurate

• Collect objective data and provide to team members• Sleep• Bowel movements• Challenging behaviors• Skills (Coping, social, ADL’s, etc.)

Staff 1

Staff 2

Staff 3

“Green Level Strategies”

• Vision & Purpose• To provide basic universal behavior strategies (aka Green Level

Strategies) consistently as a part of daily therapeutic home programming

• Possible expansion to community providers

• 1st phase

Green Level Strategies1. Daily written and visual schedule is available and followed

2. Individuals are informed of any changes in daily schedule and reasons for the change

3. Use a minimum of 4:1 ratio (Positive comments to negative comments, corrective feedback, demands)

4. Reinforce desirable behaviors (ex. Appropriate communication)

5. Withhold reinforcement for undesirable behaviors (ex. Yelling)

6. Interact with individuals a minimum of every 15 minutes when they are in public places

7. Use Safety Care HELP, PROMPT WAIT

8. ABC data forms filled out correctly

Training

• Supervisors and Direct Care Staff• Initial classroom style• Coaching + feedback in natural environment

Green Level Strategy Implementation Check

• See Handout

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Green Level Strategies % Completed CorrectlyDidacticTraining (most staff)

Didactic + FeedbackBaseline

REFERENCES• Buron, K. D., & Curtis, M. (2003). The Incredible 5-point Scale: Assisting Students with Autism

Spectrum Disorders in Understanding Social Interactions and Controlling Their Emotional Responses. AAPC Publishing.

• Daniels, A. C., & Bailey, J. S. (2014). Performance Management: Changing Behavior that Drives Organizational Effectiveness (5th ed.). Atlanta, GA: Performance Management Pub.

• Goldstein, A. P., & McGinnis, E. (1997). Skillstreaming the adolescent: Student manual. Champaign, IL: Research Press.

• Hart, B., & Risley, T. (1995). Meaningful differences in the everyday experiences of young American Children. Baltimore: Paul H. Brookes Publishing Company.

• Kelly, J. (2012). Learning Pyramid. Retrieved from http://thepeakperformancecenter.com/educational-learning/learning/principles-of-learning/learning-pyramid/

• Madsen, C. H., Jr., & Madsen, C.R. (1974). Teaching and discipline: Behavior principles towards a positive approach. Boston: Allyn & Bacon.

REFERENCES• Mount, B. (2000). Person-centered Planning: Finding Directions for Change Using Personal Futures

Planning. Anemia, NY: Capacity Works.

• Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2012). Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice, 5(2), 2-11. Retrieved from https://search-proquest-com.portal.lib.fit.edu/docview/1346801406?accountid=27313

• Reid, D. H., & Parsons, M. B. (2002). Working With Staff to Overcome Challenging Behavior Among People Who Have Severe Disabilities: A Guide for Getting Support Plans Carried Out. HabilitativeManagement consultants.

• Reid, D. H., & Parsons, M.B. (2004). Positive behavior support training curriculum. Washington: American Association on Mental Retardation.

• Skinner, B. F. (1953). Science and human behavior. New York: Macmillan.

• The Gottman Institute. (2019). The Gottman Institute: A Research-Based Approach to Relationships. Retrieved from https://www.gottman.com/about/research/

https://search-proquest-com.portal.lib.fit.edu/docview/1346801406?accountid=27313

“Do this, Not that! Strategies to Support Individuals and Team Members”Learning Objectives#1�Do gain rapport first…�DON’T expect people will listen or do what you say without developing a relationship �#2 �Do look to the environment for why people do that they do�Don’t assume people do what they do due to internal causes or character flaws�#3�Do provide a meaningful day�Don’t provide too much downtime or activities that People don’t care aboutSlide Number 6#4�Do inform people of what to do…�Don’t solely rely on telling people what not to doSlide Number 8Slide Number 9Slide Number 10#5�Do use a 4:1 ratio…�DON’T use a 1:1 ratio or worse!#6�Do give effective feedback…�Don’t expect the individual to “know” what they are supposed to do and how they are doing#7 �DO provide concise, easy to follow recommendations…�Don’t write a complex novel and expect people to follow itSlide Number 14#8�Do provide competency based training…�Don’t train people by lecturing only and expect they will do itSlide Number 16#9 �Do collect data…�Don’t rely on anecdotal reports solely for informationSlide Number 18“Green Level Strategies” Slide Number 20TrainingGreen Level Strategy Implementation CheckSlide Number 23�REFERENCESREFERENCES