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PBS and Transition to AdulthoodVincent Winterling, Ed.D.Statewide Director, Delaware Autism Program Director, Vincent Winterling, Ed.D., LLC Consultants
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Objectives Define and describe Positive Behavior Support (PBS) Define and describe the Lifestyle Planning Process Review essential elements of the FBA process Review essential elements of Behavior Intervention Plans Review (if time permits) why plans fail
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Define and Describe Positive Behavior Support
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What is PBS? Applied science Use of educational methods Expand individual’s repertoire Systems change methods Redesign and individual’s living (or learning) environment Achieve quality of life Minimize problem behavior
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PBS: Foundational Considerations Teach skills to increase likelihood of success in important
domains Teach, strengthen, expand positive behavior Utilize systems change to increase opportunities for the
display of positive behavior
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PBS: Overarching Goals Assist individual’s lifestyle to evolve such that all in the
student’s world have experience of change Render problem behavior irrelevant, inefficient, and
ineffective by helping individual achieve goals in socially appropriate manner.
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Positive Behavior SupportDiffers from traditional approaches to behavior
support Function rather than form Proactive rather than reactive Functional Skills Positive Individualized Long-term goals Multi-component / comprehensive
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PBS: Underlying Assumptions Challenging behaviors need to be understood within the
contexts in which they occur.
Challenging behaviors serve a function or purpose for the individual.
Effective interventions are based on a understanding of the individual, the social contexts in which they participate, and the purpose/function of their challenging behavior.
PBS emphasizes person-centered planning and values that respect the dignity, preferences, diversity, and goals of each individual.
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PBS: Defining Characteristics PBS is assessment based. Interventions are directly linked to
environmental influences and hypotheses concerning the function of challenging behavior.
PBS plans are comprehensive, usually involving multiple interventions.
PBS is proactive, involving teaching alternative skills and adapting the environment.
PBS emphasizes carrying out assessment and intervention practices in typical settings that are inclusive in order to promote lifestyle enhancements.
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PBS: Defining Charactertics PBS considers the values, beliefs, and goals of family
members in the assessment and treatment planning process.
PBS is sensitive to the resources available to families and the constraints they face.
PBS looks to build on the strengths of family members and address areas of need.
PBS has a broad view of success that includes (a) increasing the use of alternative skills, decreasing the incidence of challenging behaviors, and making improvements in quality of life.
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Define and Describe Lifestyle Planning Process
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Copyrighted Material of Devereux CARES
School Age (3 to 12 Years) Family Issues
Adjusting to educational systems (IEPs; placement; support services)
Developing advocacy skills Dealing with reactions from
peers groups and community
Locating community resources
Maintaining a healthy family process
Educational Focus Communication Social Skills Play Self-care School-based and
Academics Domestic Community
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Copyrighted Material of Devereux CARES
Adolescence (13 to 17 Years)Family Issues
Addressing emerging sexuality
Dealing with peer rejection and isolation
Addressing more serious behavioral issues
Estate/Trust planning Redefining parental roles
and expectations Learning about post-21
services
Educational Focus Vocational Domestic Self-care Community Communication Social Skills Recreation Functional Academics
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Copyrighted Material of Devereux CARES
Launching (17 to 21 Years)Family Issues
Adjusting emotionally to having an adult son/daughter with special needs
Residential issues Financial and guardianship
planning Developing advocacy skills
for adults
Educational Focus Vocational Domestic Self-care Community Communication Social Skills Recreation Functional Academics
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Transition Planning Carefully planned process Initiated by any team member To establish a plan for either additional training or
employment At least 3-5 years prior to the transition target date Must involve the majority of IDT members and an
employer or service providers, as needed
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Transition Planning Best Practices: Needs of Individuals with Disabilities Transition planning must be comprehensive to
meet the individual’s total life needs. Criterion of Ultimate Functioning (historical) Quality of Life
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Case Conceptualization: Treatment Considerations What are the goals we should be pursuing for our group of
learners? How much of what we do could be considered current
within the field of special education and ABA? With respect to Behavior Intervention Planning should we
be positively focused, assessment driven, and governed by EBP?
How much of what we do could be labeled as Positive Behavior Support? If we can’t be more exclusively positive what barriers prevent
it?
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Case Conceptualization: What are the priorities? What are the priorities for the Support Plan? Who determines them? What is the process for that determination? What is a reasonable (i.e., balanced) program of skill
enhancement and behavior intervention? How is that determination made?
Are there children for whom our model is ineffective? How do we make that determination? How do we resolve that? Do we track them in any way?
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Case Conceptualization: Assessment What is our assessment protocol? For whom is it provided? When? How do we link the findings of assessment to an active plan
of skill enhancement (i.e., teaching) to behavior intervention? How is it used specifically for program planning? Is it proceduralized? And / or systematized in any way?
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Case Conceptualization: Treatment Considerations How much of what we do includes providing either negative
consequences / coercion / punishment to the children / youth in our care?
To what extent does the professional literature guide intervention planning / implementation for our students?
Do we follow any specific guidelines? Should we have guidelines for practice within our
system? How much does the analysis of the results of formative
data collection processes impact on our intervention process? Is there a system level process for managing these
data?
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Case Conceptualization: Additional Treatment Considerations Context for intervention – positive, organized milieu (e.g.,
classroom management)? Presence of supervision, monitoring, and quality
management systems Orientation to collaborative teaming Mediator analysis
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Lifestyle Interventions Considerations (Turnbull & Turnbull, 1996):
Interdependence Inclusion Contribution
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Lifestyle Interventions Long-range outcomes (Risley, 1996):
How is the person doing overall over time? Is she or he happy, satisfied, and safe?Does the person have a stable home and family
and friends on which to base her or his life and future, and after whom to model her or his ways?
Is she or he practicing independence, productivity, and integration?
Is the person continuing to develop new interests, new friends, and new skills?
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Lifestyle Intervention Components (Hedeen, Ayers, Meyer & Waite, 1996) Relationships with others Ecological factors and setting variables Communication and understanding Activity preferences Meaningful curriculum Choice and self-determination User-friendly evaluation strategies
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Best Practices Focus Upon Quality of Life Indicators
Choices and control Opportunities to participate in preferred activities Community inclusion Peer relationships Relationships with family members Increased independence across settings Expressive and receptive communication Are they happy most of the time?
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Person-Centered Planning
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The Philosophy Person-Centered Planning is build on a philosophy that does
the following Takes a capacity-based perspective of the individual Uses natural resources to fulfill a vision Builds a circle of support for the individual that includes friends,
family and service providers
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What is Person-Centered Planning? Person-Centered Planning allows a diverse group of people
who share a common goal or need to align their” Vision, Purposes and goals Understanding of the focus person’s past, present and
future; and Actions for change, mutual support, personal and team
development, and learning. Person-Centered Planning is a planning process But PCP can also be seen as an assessment tool in that it
evaluates where the person has been, what their environment is like now, and where they would like to go in the future.
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What is Person-Centered Planning? PCP can also be an intervention.
PCP has the potential to create and build a strong and effective team dedicated to supporting the individual with problem behavior, and well as each other.
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What Person-Centered Planning is NOT: An easy, one-shot process The answer to all problems The replacement for an IEP A quick fix solution to complex human and/or organizational
problems Something to be done and forgotten A guarantee
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5 Essential Goals of PCP Being present and participating in community (school) life Gaining and maintaining satisfying relationships Expressing preferences and making choices in everyday life Having opportunities to fulfill respected roles and live in
dignity Continuing to develop personal competencies
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Different Approaches
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Different Approaches
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A Sample Person-Centered Plan Britney
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Sample MAP Pages
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Sample Relationship MapRelationship maps are used to find out who is currently involved with the focus person's life and in what capacity. By mapping relationships in this way, it allows conscious changes and developments to be planned and made to the benefit of the focus person
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Sample PATH - Planning Alternative Tomorrows with HopeUsing the focus person's dreams as a starting point, a PATH is used to help plan the steps necessary to achieve those dreams and aspirations. The PATH helps to make clear who's help is needed, how to go back enrolling appropriate assistance, who will help with what, the first steps to be taken, 6 monthly goals, and so on.
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Sample page from an Independent Living proposal
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Sample pages from a kitchen guide/cookbook
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Essential FBA Components
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Copyrighted Material of Devereux CARES
Design and Delivery of PBS Plans Step 1: Conduct an FBA Step 2: Develop a hypothesis statement Step 3: Design PBS plan Step 4: Evaluate plan effectiveness Step 5: Modify plan as needed
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Steps for Conducting a Functional Assessment and Developing a BIPIdentify and operationally define target behaviorPurpose: To identify (and prioritize behaviors that interfere with learning, productivity, and general well-being and agree on exact topography
Strategies: Group consensus
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FBA: Pre-intervention Assessment Identify contextual variables that evolve and maintain
adaptive behavior.
Identify functional relations that maintain challenging
behaviors (environment and challenging behaviors), both
proximal and distal.
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Steps for Conducting a Functional Assessment and Developing a BIPAssess the student’s behavior
Purpose: To identify activities and events associated with occurrences and nonoccurrences of the problem behavior
Strategies: Questionnaires, checklists, conversations, structured interviews, direct observations
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Understanding the Individual with Problem Behavior Gather Broad Information
Individuals strengths and skill limitations (communication, social skills, self-help skills, play, recreation and leisure).
Daily Routines and Activities Preferences and Goals for the Future Medical/Health related Issues Quality of Life Considerations: (opportunities for choice,
exercising control, experiencing social relationships, participating in inclusive settings)
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Understanding the Individual with Problem Behavior Gather Specific Information
When is the individual most and least likely to engage in challenging behaviors?
What specific events appear to be contributing to the challenging behavior?
What functions do the challenging behavior serve for the individual (i.e., what are they communicating)?
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Steps for Conducting a Functional Assessment and Developing a BIP Develop hypotheses Purpose: To formulate data-based (based on assessment
information) hypotheses about why behavior occurs Strategies: Review all assessment information; Develop
hypothesis statements that identify variables that can be manipulated to formulate an intervention
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Developing Hypotheses Strategy:
Review assessment information Develop hypotheses statements about why behavior is occurring
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Steps for Conducting a Functional Assessment and Developing a BIPAssess the accuracy of the hypotheses (optional step)Purpose: To evaluate whether hypotheses are accurate prior to formulating an intervention
Strategies: Brief reversals
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Summary Statements Purpose: to offer and explanation of the problem behavior in
terms of antecedent and setting events and possible function
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Content of Summary Statements Description of antecedent and/or setting events Description of problem behavior Identification of presumed function
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Examples of Summary Statements When Amy is given difficult work (antecedent) she
engages in property destruction (behavior) to escape the task (function).
When Rob has a cold (setting event) and is asked to perform a difficult task (antecedent) he engages in self-injury (behavior) to escape the task (function).
When Sally is left alone without anything to do (antecedent) she engages in hand mouthing (behavior) to gain sensory stimulation (function).
When Tommy is in large groups (antecedent) he engages in aggression (behavior) to obtain attention (function)
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Copyrighted Material of Devereux CARESAll Behavior
Serves a Purpose or“Function”
Gain Access to a Desirable
Stimulus or Event
Escape/Avoid
an Undesirable
Stimulus or Event
Behavior
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Copyrighted Material of Devereux CARES
Escape or Avoid...
Non-Preferred
Object or Activity
(Task)
Social
Interaction
Sensory
Stimulation
Adults Peers
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Steps for Conducting a Functional Assessment and Developing a BIPDesign an intervention/support planPurpose: To formulate an intervention that is directly linked to the hypotheses
Strategies: Consider contextual fit
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Steps for Conducting a Functional Assessment and Developing a BIPCollect data on effectiveness of intervention/support planPurpose: To assure plan effectively reduces problem behavior and increases desirable behavior
Strategies: Direct observation; Review permanent products, natural documents
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Essential Plan Components
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Developing Behavior Intervention Plans Based on hypotheses established in the assessment
process. Person Centered in that goals and intervention strategies
preserve the individuals’ dignity, and reflect their preferences.
Individualized to reflect a good fit between the person’s needs and corresponding intervention strategies.
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Among other components, the written PBSP contains a description of antecedent modifications, functionally equivalent alternative responses (and teaching strategies), differential reinforcement systems, and consequences designed to eliminate or minimize reinforcement after undesirable responses
Objective data is used to determine program effectiveness and to guide modifications in the PBSP
Best Practices
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Outline of a Behavior Support Plan Set Up (description, strengths, vision) Assessment
Operational Descriptions, Routines, FA Hypotheses Foundations (if needed) Prevention Teaching/Education Consequence Procedures
Minimize reward for problem behavior Ensure regular, clear reward for positive behavior Punishers (if needed)
Define safety/emergency procedures (if needed) Evaluation and Monitoring for Improvement
Steps for implementation
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Why Should a Support Plan be Multicomponent? Many variables usually influence whether problem behavior
will occur; therefore effective support most often involves manipulation of several of these variables
Long-term reduction in problem behavior usually requires intervention in several areas
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Best Practices Comprehensive Staff Training and Support
Pre-service and in-service training and workshops Performance checklists Ongoing supervisory feedback and support (structured classroom
observations, supervision meetings, and so on) Weekly classroom team meetings
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Best Practices Family Inclusion and Support
Participate fully in planning Updated routinely on child’s progress Frequent opportunities to communicate with staff Access to informational seminars and training on interventions
and strategies Futures planning
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Copyrighted Material of Devereux CARES
Common Elements of Good Interventions A comprehensive assessment of skills is completed Targeted skills are meaningful to the student and will facilitate
independence Lessons are designed to enhance student motivation Spontaneity is taught early on Communication training occurs across environments and across
the student day Communicative responses that are taught can be understood by
all members of the community
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Change Behavior Successfully Prioritize and work with only 1 or 2 behaviors at a time Require only gradual improvement in behavior Use procedures that are easily implemented and inexpensive
(to the extent possible) Use immediate consequences whenever possible
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Change Behavior Successfully Teach the behaviors you want to see the individuals exhibit Use and fade prompts to increase the likelihood of
appropriate behavior Pair social reinforcers with tangible or activity reinforcers Thoroughly organize and precisely introduce the program to
the individual
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Steps for Changing Behavior Decide on which behavior to change Operationally define the behavior Collect data for a baseline on the behavior Intervene on the behavior Graph and evaluate the ongoing process Revise the program if needed
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Interventionists To-do List Consider the use of program-wide rules
Limit to no more than 5 sspecific, observable, and positively stated
Post rules in prominent places Develop a plan for providing frequent positive feedback for
following rules and routines. Develop consequences for common rule infractions
(consequence should fit the violation and be as mild as possible)
Develop an attention signal Design routines for most common procedures in the
setting
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Interventionists To-do List Analyze the physical setting and modify if needed and
possible Develop lessons and provide regular review of rules and
routines Design activities to maximize engagement in meaningful
tasks Set and plan to achieve goals to improve instructional
delivery
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Things to Remember! Let the data drive your hypothesis development
Individuals may engage in problem behavior for a variety of reasons
A single problem behavior may serve more than one function
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Copyrighted Material of Devereux CARES
PBSP Components of a PBSP
Antecedent Strategies Functional Equivalence Training Differential Reinforcement Consequence Strategies Evaluation and Modification
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Copyrighted Material of Devereux CARES
Characteristics of PBSP Based on assessment results and hypothesis driven Emphasizes skill building Comprehensive, usually involving multiple intervention
components Focus on long-term solutions, not quick fixes Team approach Function rather than form
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Relative to Function
Establishing Operations
Eliminate
Ameliorate Antecedent General Skills Instructional Manipulations Training Consequence
Equivalence Training
Self-Regulation Training
ReductionOrientedConsequence
Categories of Intervention
ImmediatelyBefore
Behavior
AfterBehavior
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What are Antecedent Interventions? Environmental modifications that are made to reduce the
likelihood that problem behavior will occur Antecedent interventions are arranged before the problem
behavior occurs
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What are Antecedent Interventions? Environmental modifications that are made to reduce the
likelihood that problem behavior will occur Antecedent interventions are arranged before the problem
behavior occurs
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Replacement Behavior Behavior that serves the same function as the problem
behavior but is socially appropriate
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How Can We Assure Appropriate Behavior Will Replace Problem Behavior?
Make it effective:Reinforcement should always be
provided at first
Make it efficient:Response should be less effortful than
problem behaviorReinforcement should occur
frequently and quickly
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Rationale for Alternative Skills Instruction Individuals do not have the general skills to cope with
everyday demands; therefore, problem behaviors occur
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Categories of Alternative Skills General skills
Self-management skills
Coping and tolerance skills
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Purpose of Consequences To teach alternative responses to problematic situations To respond to problem behavior in a way that is least likely to
reinforce it
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Consequence ApproachesFeedbackProblem SolvingResponse CostTime OutRestitutionExtinction (Ignore)Natural ConsequencesAdvantages/Disadvantages
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Copyrighted Material of Devereux CARES
PUTTING IT ALL TOGETHER
Look at behaviors,
assess, identify function
Design intervention that teaches child more acceptable behaviors
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Why Plans Fail
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Failure is not an option…
(but does happen)
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Failure is not inescapable BUT its impact can be minimized You cannot strive to serve the most challenging students
and escape failure Failure per se is less of a problem than the refusal to
acknowledge and act upon it At every Devereux Center, at any given time, every
Psychologist and school has a failed BMPThe center has a student whose failed BMP
leaves someone open to injury or other risk management issue.
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Why are plans for high risk students more likely to fail? Behaviors can result from a broad range of biopsychosocial
factors and / or skill deficits Student’s cognitive / skill level Variable mood / affect Psychiatric issues Abuse / victimization history May have more limited range of education / interests / positive
influences Poor case conceptualization / training / implementation of plan
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What did we miss? Plan is not proactive We missed something in the data? Staff not trained sufficiently to implement plan successfully Plan is not positive Plan does not teach new skills (new skills take time to learn) Plan was not given sufficient time to work Plan contains unintended aversives that cause behavior
deterioration Team is not a team