DOCUMENT RESUME

ED 328 000 EC 233 212

AUTHOR Hitzing, WadeTITLE Positive Learning: An Alternative to Behavior

Management. Instructor's Guide.INSTITUTION Minnesota Univ., Minneapolis. Inst. on Community

Integration.SPONS ACENCY Administration on Developmental Disabilicies (DHHS),

Washington, D.C.; Minnesota Governor's PlanningCouncil on Developmental Disabilities, St. Paul.

PUB DATE 89CONTRACT ADD-07DD0282NOTE 242p.

PUB TYPE Guides - Classroom Use - Guides (For Teachers) (052)

EDRS PRICE MF01/PC10 Plus Postage.DESCRIPTORS Antisocial Behavior; *Behavior Modification;

*Behavtor Problems; *Caregivers; *PositiveReinforcement; Postsecondary Education; *SevereDisabilities; Staff Development; *Teaching Methods

IDENTIFIERS *Behavior Management

ABSTRACTThis course is designed to help direct caregivers of

people with severe disabilities to understand and participate in apositive approach to behavior management. Notes on implementation andcontent of each section are provided, as are sheets for overheadprojection, worksheets, and handouts. The course is organized in 15sections lasting a total of 8 hours. In addition to introductory andsummarizing sections, the course Includes a lecture and groupdiscussion illustrating the need for behavior management; alecture/discussion of the history of behavior "cures," including thetendency toward "quick fix" alternatives; a videotape illustratingthe failure of most community services to accommodate behaviorchallenges; a lecture/discussion and exercise examining the types ofpeople with disabilities for whom support programs are designed andthe failure for many to accommodate people with disabilities;lectures and discussions on understanding behavior challenges andreasons for behavior; a lecture/discussion contrasting supportlearning and managing behavior; and a small group exercise based on acase study. A list of 12 suggested readings and four videotapes isincluded. (PB)

Reproductions supplied by EDRS are the best that can be madefrom the original document.

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DSPARTIOINT Or EDUCATIONOffice el Edutebonel IleeSerch snd unprommentEDUCATIONAL RESOURCES DIFONNAT/ON

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received from Me person m orgendetionoriginating a

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Positive Learning: An Alternative to Behavior Management

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'PERMISSION TO REPRODUCE THISMAT RIAL HAS BEEN GRANTED BY

a_14A-th

TO THE EDUCATIONAL RESOURCESINFORMATION CENTER (ERIC)."

Funded by a grant from theMinnesota Governor's Planning Council on Developmental Disabilities,

Minnesota State Planning Agency, 300 Centennial Office Building,658 Cedar Street, St. Paul, Minnesota 55155

and

A grant from the Administration on Developmental Disabilities, entitled the"Statewide System for Training Direct Care Service Providers in Community Programs Project"

(ADD Grant No. 07DD0282), to the Institute on Community Integration, University ofMinnesota, Room 6 Pattee Hall, 150 Pillsbury Drive S.E.,

Minncapolis, Minnesota 55455

3

Positive Learning: An motive to avior manaimnost'

"-

Produced byThe Minnesota Governor's Planning Council

on Developmental Disabilities

Graphic Design, Editing, Production byCarol Kittelson and Janet Leadholm

Kittelson & Leadholm

Course Design byQuest Learning Systems, Inc.

Photography by Ann Marsden

Acknowledgment to:

Colleen Wieck, Ph. D.Executive Director

Developmental Disabilities Council

David HancoxMining Director

Miriam KarlinsSpecial Consukant

ii

5

The Editorial Review Board:

Peter AmpeRick Amado, Ph.D.

Dean BarrWendy Bartzh

Roger BetzRon Rucker

Paul Thorenson

For more information, contact:Minnesota Governor's Planning Council on Developmental Disabilities,

300 Centennial Office Building, 658 Cedar Street, St. Paul, Minnesota 55155(612) 296-4018 or (612)296-9962 TDD

c iii

so

NOTES ON USING THIS MANUALCOURSE OUTLINECOURSE GOALS AND OBJECTIVES

1

59

Session 1 NOTES AND CONTENT 13

SECTION A: Introduction 15SECTION B: A Common Story 17SECTION C: Discussion of A Common Story 27SECTION D: Great and Desperate Cures 39SECTION E: Videotape *An Elephant at Mouse Place" 57SECTION F: Ralph's Story 61SECTION G: Ralph's Story Exercise 75SECTION H: Sv Amary and Closing 81

Union 2 NOTES AND CONTENT 83

SECTION A: Introduction to Session 2 85SECTION B: Summary of Ralph's Story 87SECTION C: Understanding Behavior Challenges 89SECTION D: Understanding Reasons for Behavior 107SECTION E: Supporting Learning vs. Managing Behavior 111SECTION F: Kathy's Story Exercise 125SECTION G: Course Summary 131

OVERH EADS 133WORKSHEETS / HANDOUTS 229RESOURCES 291

'7 v

b>0-C1

(X)

The content upon which this course is based is found in the inside column ofeach page. Ilstructor's notes and guidelines appear in the outside column. Thesenotes are intended to help less-experienced instructors create an interesting andeffective classroom experience. More experienced instructors may feelfree to add their own ideas. Overheads and handouts are provided tohelp reinforce key points.

This course is designed to be delivered in two four-hour sessions, but can becombined into ont eight-hour session.

Notos T. Instructor

This course has been specifically developed to help people responsible forproviding direct care to individuals with severe disabilities understand andparticipate in an alternate approach to Behavior Management.

This course is organized into a total of 15 sections. Overheads and several videoswhich can be used to augment the lecture or to demonstrate a particulartechnique are incorporated into the course.

The time recommended for each section is provided in the notes that prefacethe sections.

Before teaching this course we recommend that you become familiar with allof this material, review all videos and tapes plus the handbooks which gowith some of the videos.

CI.)

1

Behavior

Notes

Fermat

This course is designed to be delivered via a combination of lecture, slide orvideotape presentations, large and small group discussions, and role playing.

As you study the various classroom sections, you will notice that the role playingsegments call fot participation by at least three individuals. If your class size is toosmall to permit that level of participation and still generate adequate discussion,you may have to modify your delivery.

In some cases, existing videotape presentations may be substituted. You may wishto develop your own videotape using a home video camera with friench;and associates serving as your cast.

Time

This course is designed for a total of eight hours of classroom instruction dividedinto two four-hour sessions to be held on two different dates.

You may find that 7-our specific circumstances demand delivery over a differenttime frame. The course may easily be combined into one-day long session witha lunch break.

Additionally, while this course has been developed for stand-alone delivery,it may be combined with additional material as part of a more comprehensivecourse in the support of inclividuals with disabilities.

1 0

2

Behavior

N otes

Motrials

Originals of all required visual aids, overheads, and handouts are included in thismanual. In order to deliver this material as designed, you will have to makeoverhead copies of these originals and sufficient copies of all handout materialsfor your class. In addition, the following equipment is required:

1. Overhead projector.

2. Projection screen.

3. VHS format video cassette recorder (VCR) or video playback unit.

4. Markerboard or flip chart pad with easel.

5. Two or three colored markers.

3

Behavior1

-

SESSION 1

A. INTRODUCTIONLecture, 5 minutes

B. "A COMMON STORY"Lecture, 20 minutes

C. DISCUSSION OF "A COMMON STORY"Large and small group discussion, 60 minutes

D. GREAT AND DESPERATE CURESLecture/discussion, 45 minutes

E, VIDEOTAPE: "AN ELEPHANT AT MOUSE PLACE"Videotape/discussion, 30 minutes

F. RALPH'S STORYLecture, 30 minutes

G. RALPH'S STORY EXERCISE

Indiv!dual/Small-group exercise, 80 minutes

N. SUMMARY AND CLOSINGLecture, 10 minutes

51 2

Behavior

Course Outline

SESSION 2

A. INTRODUCTION TO SESSION 2Lecture, 10 minutes

B . 'SUMMARY OF RALPH'S STORY EXERCISELecture/discussion, 15 to 60 minutes

C. UNDERSTANDING BEHAVIOR CHALLENGESLecture/discussion, 30 minutes

D . UNDERSTANDING REASONS FOR BEHAVIORSmall-group activity, 30 minutes

E. SUPPORTING LEARNING VS. MANAGING BEHAVIORLecture/discussion, 45 to 55 minutes

F. KATHY'S STORY EXERCISESmall-group exercise, 50 minutes

G. COURSE SUMMARYLecture, 20 minutes

7

UPON COMPLETION OF THIS COURSE, STUDENTS SHOULD BE ABLE TO:

1 .0 Understand that challenging behavior has a strong communicative functionand that people often respond in a disruptive, dangerous manner becausewe are not providing supports and services that meet their needs.

1.1 Recognize that before implementing a plan to decrease the person'schallenging behavior, they must look comprehensively at the person'slife and attempt to identify all the factors that are contributing to theproblem behavior.

1.2 Recognize that traditional behavior plans, especially those that focus onproviding rewards or punishments, usually ignore (leave unchanged)many of the factors which are causing the problem behavior.

1.3 Understand that we often are "FORCED" to implement more aversiveand restrictive behavior change procedures, than might be necessary,because important factors causing the problem behavior are ignored.

1.4 State the importance of the communicative intent of most problembehavior and the necessity of first attempting to meet the person'sneeds before trying to change her/his behavior.

2.0 Understand that there are no "GREAT AND DESPERATE CURES."Helping another person change his/her behavior will probably require acomprehensive plan that deals with all major aspects of the person's life.

2.1 Recognize that in the history of services for people with challengingbehavior there are many examples of misguided efforts to find a"CURE," a "QUICK FDC' for problem behavior.

1 4

10

Behavior

Gaols & Objectives

2.2 Recognize that this tendency to seek simple, easy solutions forcomplex, difficult problems can be also be seen in other areas ofhuman behavior - such as weight control.

2.3 Understand the importance of avoiding the use of behavior plans in a"QUICK WEIGHT LOSS" approach to behavior change.

2.4 Understand that a good service plan begins with efforts to support theperson and provide services that meet the her/his needs beforeimplementing teaching plans to change the person's behavior.

3.0 Recognize that when challenging behavior is caused at least in part by aninadequate program of supports and services, we must attempt to firstindividualize these services to better meet the person's needs. This strategy isin contrast to the more traditional approach of implementing a behavior planthat focuses on decreasing specific "TARGET BEHAVIORS" through a seriesof rewards and punishments.

3.1 Recognize that it can be difficult to support people with challengingbehavior because most community-based programs were not designedto meet their needs.

3.2 Understand that most challenging behavior makes sense, from the pointof view of the person engaged in it, especially when you realize howfar our services are from meeting the needs of the person withchallenging behavior.

3.3 Through the Practicum Exercise, increase their skills in advocating forpeople with challenging behavior by giving them experience in:

Figuring out why people engage in challenging behavior.

Explaining to others why people engage in challenging behavior.

4.0 Recognize that there are causes for challenging behavior especially withrespect to environmental influences that precede and follow behavior.

1 5

Behavior

Goals & Objectives

4.1 Recognize that there are always reasons for why people do what theydo; there are causes for challenging behavior.

4.2 Understand that the first step to helping decrease behavior challenges isto understand the cause(s) for the behavior.

4.3 Understand that while there are physical causes for challengingbehavior, they are rarely the cause for the challenging behavior.

4.4 Describe the major environmental causes for challenging behavior,through the use of the 'VICIOUS CYCLE DT &GRAM."

4.5 Differentiate between environmental influences that precede(antecedents) versus follow (consequences) tlse behavior.

4.6 Understand that most challenging behavior is learned and that "WE" arethe ones who teach it.

4.7 Look at the situation from the person's point of view, "LISTEN TO" theperson's challenging behavior and understand what the person is tryingto communicate.

5.0 Distinguish between simply managing a person's behavior versussupporting her/him in learning to change through listening, negotiation andeffective positive teaching strategies.

5.1 Discriminate between simply ma laging a person's behavior, usually todecrease problem behavior, versus supporting the person in learningmore appropriate behaviors.

5.2 Recognize that they should always begin by attempting to support theperson in learning more appropriate behaviors by changing services tobetter meet the needs of the person and teach alternativt! behaviors.

5.3 Determine that often the major "PROBLEM" they should deal with is noLthe challenging behavior of the person; rather it is the fact that theperson has been provided services which are not individualized and donot meet his/her needs.

1 1

Sess14 Notes qnd Content

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14

Introduction

Format

Lecture

Tine

5 minutes

Materiels

Overhead 1

Behavior

Session 1

15

Notes

1. Introduce yourself

and hove the students

introduce themselves.

2. Dispiny Overhead 1,course goolS. In cleor

terms that the students

con easily understand,

list the goals of the

course.

16

Behavior

Session 1

2 0

NA Common Store

Format

Lecture

Time

20 minutes

Materiels

Overheads 2 - 8

Handout 1 - A Common Story

Behavior

Sess;on 1

17

Behavior

Session 1

Obfoctivu

Upon completion of this section, studentsshould be able to:

1.1 Recognize that before implementing aplan to decrease the person'schallenging behavior, they must lookcomprehensively at the person's life andattempt to identify all the factors that arecontributing to the problem behavior.

1.2 Recognize that traditional behaviorplans, especially those that focus onproviding rewards or punishments,usually ignore (leave unchanged) manyof the factors which are causing theproblem behavior.

1.3 Understand that we often are "forced"to implement more aversive andrestrictive behavior change procedures,than might be necessary, becauseimportant factors causing the problembehavior are ignored.

1.4 State the importance of thecommunicative intent of most problembehaviors and the necessity of firstattempting to meet the person's needsbefore trying to change her/his behavior.

2218

Behavior

Session 1

Section B: Content

"A COMMON STORY"

At a regional training conference several years ago,the organizers arranged for an evening sessionduring which the participants could talk informallywith the presenters about working with peoplewith challenging behaviors. The participantswanted to describe the problems they faced andhoped that the presenters would have somethingto share that might help them do a better job.

The presenters were not sure they helped anyonethat night. But they learned a very importantlesson. They learned the lesson because fivedifferent people told them the "same" story. Thespecifics of each story were of course differentbut the fundamental message was the same.Here is what happened.

Each participant began his or her story bydescribing a person with challenging behavior.Each person was different, as were theirbehaviors. One fellow was described as havingsevere temper tantrums, a woman hit herself in thehead repeatedly, a student bit and kicked otherstudents, etc. Each was the subjet of a behaviorplan designed to decrease or eliminate thechallenging behavior.

Notes

1. Tell "A Common

Story" to the students,

using overheads 2 - 8.

2. Ask the students toindicate by show ofhand whether the

questions included

toward the end of thestory ore true for them.

Don't make comments

it,t have them noticewhether that's happenedfor them.

19

20

Behavior

Session 1

FOR EXAMPLE:

The man with the severe temper tantrumswas being forced to sit alone in an emptyroom, for 15 minutes, if he cried (a time outprogram).

The woman who was self-injurious wasignored when she hit herself (an extinctionprogram). She was frequently praised whenshe did not hit herself.

The student earned tokens when he did notact aggressively towards other students andwas denied access to his favorite activitywhen he did (a DRO/punishment program).

Each of the participants explained that they werenot totally happy with the results of the plans. Thebehavior of some of the people had improved afterthe plans weie implemented, but not enough to besatisfied with the results. For example, one of theparticipants (Mr. Louis) worked in a group homeand he described a man (Bob), with severe tempertantrums. He said that while the time out prof, 2mhad reduced the frequency of temper tantrums by50%, Bob was still having seven to ten tantrumseach week. The tantrums were described as aserious problem. Mr. Louis said that if it weren't forthe tantrums Bob could move to an apartmentliving program which he really wanted to do.

Mr. Louis wanted to know if the program wasappropriate for Bob had any chance of workingmore effectively, etc. But first, he said "Wait,before you answer, there are a few more thingsyou need to know about Bob."

24

s Behavior

Session 1

YOU NEED TO KNOW THAT:

"Bob lives in the 'wrong' place."

He used to live in an apartment of his own but helost his ,,ob and couldn't afford to stay there. Ourgroup home was the only available placement.

"Bob lives with th 'wrong' people."

The other men in the group home all have mentalretardation and are far less skilled than he is. Herefuses even to admit that he is mentally retardedand wants nothing to do with his housemates.

0 "We don't have enough steff."

*

In addition to the tantrums, Bob steals from hishousemates. We don't have enough staff to providefor appropriate supervision.

"We haven't had appropriate training."

Bob has very limited speech, but hardly any of thestaff know how to sign. The psychologist says thatBob has serious mental health problems we don'tknow what that means.

"He hates his day program at thworkshop."

When Bob lived in the apartment he had a goodjob working for a landscaping company. He lostOat job when tit was moved to the group homehe couldn't get to work on time from our side oftown. He hates "sit down packaging" type work.

21

22

Behavior

Session 1

"Now," said Mr. Louis, "you know the whole story.Anyway, we've been thinking of doubling the durationof the time out period from 15 to 30 minutes. What doyou think? Might that work?"

I am not trying to make of Mr. Louis. His questionabout increasing the time out period might have beenmisguided but it was sincere. However, he had justclefuly described five major problems in Bob's lifecach of which was probably contributing directly totemper tantrums. He did not seem to see that the timeout program, no matter what the duration, hadnothing to do with, and could not help correct,these problems.

The presenters didn't know what to say. It wasn'tsimply that increasing the time out period to 30minutes was doomed to fail. Maybe if Bob was reallyafraid of, or hated the isolation, he would have fewertantrums. There is no doubt that if we are "bigger,"more "powerful" than Bob we can probably devise asufficiently aversive procedure so that he will learn tostop telling us about what bothers him. No matter howtroubling it is to him to live where he is not happy, tolive with people he dislikes, to work at a job he findsboring and low paying we can probably devise areward or punishment procedure to shut him up.

But will we or Bob have gained much? Is there anyreason to be happy if the time out program doessucceed in eliminating the temper tantrums? Shouldwe celebrate the fact that we have found a way toforce a person to live where he doesn't want to, withpeople he dislikes and to work each day at a job hehates but at the same time keep quiet about it?

Of course, the details of each of the other participants'stories were different. But a fundamental theme ranthrough each of the five stories.

26

Behovior

Session 1

2. c Team awareof contributing

factors.

Behavior Plan:Rewards &

Punishments.

If unsuccessful,increased rewards

& punishments.

Results:Suspended orvery restrictive

procedures used.

STORY ThEMES

1. Person with a disability ( $ages in behaviorthat is disruptive, harmful, dangerous(challenging behavior).

2. Members of the service planning teamare usually aware of factors in theperson's life that are contributing to thechallenging behavior.

23

24

Beh

avio

r

Ses

sion 1

3. A Beh

avio

r

Plan is

impl

emen

ted

to decr

ease

the

targ

eted

beha

vior

s.

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Plan

usua

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som

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com

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follo

win

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Elim

inat

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any

rein

forc

emen

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for

the

"PR

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M"

beha

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(ext

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.

Mak

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sure

that

the

cons

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the

targ

et

beha

vior

are

unpl

easa

nt,

thro

ugh

the

use of

priv

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rem

oval

,

rest

rict

ions

,

pain

ful

stim

uli,

etc.

Prov

idin

g

pow

erfu

l

rew

ards

for

not

enga

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in the

"PR

OB

LE

M"

beha

vior

.

4. If plan

does

not

prod

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the

desi

red

chan

ges,

the

"PO

WE

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of the

rew

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and

puni

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is incr

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d.

Mor

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cons

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are

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even

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as rew

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for

appr

opri

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beha

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.

B.

Thr

ough

out

the

proc

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fact

ors

that

are

clea

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infl

uenc

ing

the

pers

on's

beha

vior

such

as whe

re

they

live,

with

who

m,

activ

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sche

dule

s,

choi

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etc.

,

rem

ain

larg

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unch

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d

6. Far

too

ofte

n

the

resu

lts

are:

The

re is not

suff

icie

nt

impr

ovem

ent

in

the

chal

leng

ing

beha

vior

and

the

pers

on

is

susp

ende

d

from the

serv

ice

prog

ram

.

The

beha

vior

plan is

"SU

CC

ESS

FUL

,"

but

only

afte

r

very

rest

rict

ive

proc

edur

es

are

impl

emen

ted.

PS

Pehovior

Session 1

All of the participants showed, in the telling oftheir stories, that they were aware, at least atone level, that a number of factors werecontributing to the person's challenging behavior.However when it mme to actually doingsomething to help, they acted as if they did notunderstand. Surely none of the members of Bob'sservice planning team believed that he was havingsevere temper tantrums b..-cause he had been"DEPRIVED" of time out. In the past, didn't theyunderstand that the use of time out, for whateverduration, would do nothing to alleviate theproblems caused by his placement in the grouphome and work assignment?

111YOU MAY BE ThINKING:

"So what? What is to be gained by acknowledgingthese other factors? How will this help Bob?"Well, of course there is at least one obviousbenefit. If the team clearly acknowledged thatBob's residential and work placement were notmeeting his needs, that they needed more trainedstaff, etc. they or someone else just might dosomething about it! People who know a personwell and are personally committed to supportingthe person can often develop a plan, centered onthe specific needs of the person, and help makethe kinds of major changes not one of thembelieved was possible.

But you're right if you are thinking that it is oftennot possible to make immediate changes, eventhough they may be desperately needed. A veryreal absence of available alternatives probably did"FORCE" the team to accept Bob's initial placementat the group home and workshop. At the time

25

26

Behavior

Session 1

there probably was not enough money to pay forextra staff or more training. However, unless theteam explains, in Bob's plan, that they feel that hischallenging behavior is at least partially caused bytheir weaknesses (inappropriate placement, lack oftraining, etc.) the needed changes may never bemade, even if they become possible. For instance,if funds do become available, why would theadministrators of the agency which serves Bob hireextra staff or arrange for advanced staff training ifthey believe that Bob simply needs a morepowerful behavior plan? If they see the issue asonly *BOB'S PROBLEM" not "OUR PROBLEM."

Even if it seems necessary to accept the currentsituation for the foreseeable future it is stillimportant to acknowledge that we are part of theproblem, not just Bob. Have you ever noticed howdespite your best intentions you find yourselffeeling resentful towards a person with challengingbehavior? Especially if you have been a target oftheir "CHALLENGE?* Ever been mad at the personwhen a plan that "OUGHT TO WORK" is failing'Clearly some of this is just human nature. It showsyou care. But, if we were honest, we would admitthat far too often we hold the person responsiblefor actions that are clearly controlled by conditionswe have helped create. Bob did not pick the grouphome or his housemates. He did not have a chanceto vote on the tax levy that failed, causing a cut inthe new staff positions.

Clearly acknowledging our (the system's) role incontributing to Bob's challenging behavior shouldhelp decrease our resentment and increase ourmotivation to make the changes necessary to bemore supportive of Bob and design the kind ofindividualized services that are necessary tomeet his needs.

30

!I 1

Discussion of NA Cameo Stove

Format

Large/small group discussion

Tine

60 minutes

Materials

Overheads 9 - 17

Worksheet 1

Behavior

Session 1

3127

Behavior

..

28

Session 1

Objectives

Upon completion of this section, studentsshould be able to:

1.1 Recognize that before implementing aplan to decrease the person'schallenging behavior, they must lookcomprehensively at the person's life andattempt to identify all the factors that arecontributing to the problem behavior.

1.2 Recognize that traditional behaviorplans, especially those that focus onproviding rewards or punishments,usually ignore (leave unchanged) manyof the factors which are causing theproblem behavior.

1.3 Understand that we often are "forced"to implement more aversive andrestrictive behavior change procedures,than might be necessary, becauseimportant factors causing the problembehavior are ignored.

1.4 State the importance of thecommunicative intent of most problembehavior and the necessity of firstattempting to meet the person's needsbefore trying to change her/his behavior.

32

Behavior

Session 1

Section Cs Content

One of the central themes of this lesson is that theperson's challenging behavior is often caused, atleast in part, by the fact that the services andsupports provided are not individualized and arefar from meeting the person's needs.

Further, the lesson shows that if these needs areignored that implementation of a behavior plan may:

1. Not work at all because powerful factorsthat are influencing the person's behaviorremain unchanged.

2. Require the use of restrictive teachingprocedures to be effective again becauseobvious "CAUSES" for the person's problembehavior are ignored.

CI r's...' t.,

Notes

1. Make the points listed

in the content provided.

29

Note: The exercise

described below can beused to reinforce these

ideas. The exercise can

be used within a lectureor small group

discussion session.

2. Ask each participantto think of (select) a

person with disabilities

who also showschallenging behaviors.

Display overhead 9,and ask students to

answer three series of

questions (Step 1, Step

2, and Step 3).

Explain that you'll

provide some examples

before they start this

exercise.

30

Behavior

Session 1

Step 1

"What is it that seems to disturb, frustrateor upset the person?"

"Are there situations or settings that seemto disturb or upset the persoar

Sftp 2

"How do you know that the person isdisturbed or upset by these situations?"

"How did the person let you know thatthey were upset?"

Shop 3

when the person is faced with thesetypes of disturbing or frustrating situationswhat do you think he/she needs fromother peopler

What help or support might the personask for if she/he could clearlycommunicate?"

3 4

Behavior

Session 1

HOW TO ANSWER THESE QUESTIONS:

Make sure that you try to answer from theperson's point of view not from the point ofview of what you think he/she needs.

EXAMPLE 1

Stop 1

Mary, who has severe hearing and visualimpairments, seems to be disturbed at her dayprogram when she becomes confused about whatshe is supposed to be doing as her workassignment. She also has trouble in makingtransitions from one assignment to the next.

Stop 2

Mary shows that she is upset or confused by bitingher hands, pulling at her hair and sometimesslumping to the floor.

Stop 3

Mary does not talk so the staff had to make theirbest guess based on their knowledge of Mary.After thinking about the situation, from Mary'spoint of view, they guessed that what she wouldask for was a dear way to understand what task oractivity she was supposed to be working on and away to know what's next when it was ,ime tochange tasks. Simply telling !:,er about it using herlimited repertoire of tranual signs was noteffective so they developed a more "CONCRETE"sign language.

3. Provide examples ofhow to answer these

questions to make :-.rethat the participants

understand the intent of

the questions. Display

overheads 10-15 insequence as you discussthe examples.

31

Behavior

Session 1

They selected objects that were associated witheach task or activity and began to systematicallyuse them as prompts for the current activity if sheseemed to be confused as she worked and as acue for the next task when thery were changingfrom one task to another.

For example, they used a dinner plate to cue thelearning activity for "setting the table," a bar ofsoap for a self-care activity, and a piece of clothingfor a sorting task. These procedures helped Mary alot she became upset at times but much lessthan before.

Things improved even more when Mary figuredthat she could have some control over herschedule of activities by using the "communicationobjects" to show the staff what she wanted to do.

EXAMPLE 2

It.. 1

Bob does not do well in noisy situations. He seemsto be very sensitive to loud sounds, especiallythose that he has no control over. Crowds,especially noisy ones really upset him.

36

32

4)

e

4,

Behavior

Session 1

Sftp 2

Bob doesn't talk but he does let people know he isupset in a variety of different ways. He may put hishands over his ears, begin to yell and even runaway. He may attempt to hit the people who arebeing noisy. If he is in his room he may turn hisradio up to "DROWN OUT' the noise sz: the otherpeople in the group home,

Sftp 3

It wasn't hard to figure out that Bob would ask forpeople to stop making so much noise and to beallowed to spend some time alone or at least withonly a few other people. While it wasn't possibleto make major changes in where Bob lived andworked staff were able to make a few changes thatreally seemed to help.

Bob switched bedrooms with another residentwhich helped him be further away from the noiseof the home. They also showed Bob how he coulduse a portable radio with earphones to mask thenoise of his co-residents without having to play hisstereo so loud that it disturbed everyone else. Atwork they changed his work setting so that he wasremoved from the major flow of noise and activity.They also allowed him to wear the earphones atwork, which seemed to help there too.

11 .041 I

33

4. Hand out the"Commor StoryWork,heet" for studentsto use to record theiranswers.

Allow the students atleast 10 minutes tocomplete their answersto the three questions.

5. Aftet the studentshave written down theirindividual answers,divide them into groupsof two or three and askthem to present theiranswers to their partneror the other members dtheir group. It probablydoes not make sensefor them to critiqueeach other's answers;the purpose is to simplyhave them heor abouta wide range ofsituations.

AHow about 5 minutesfor this step.

34

Behavior

Session 1

6. Next, askparticipants to shareinteresting exampleswith the larger group.Allow about 15minutes for this step.

7. Clearlyocknowledge that it isoften very difficult tofigure out what theperson would ask for,what they needespecially for personswho hove o hard timeunderstanding. Underthese conditions, wemake our best bet, acton it and see if wewere right. If our guesswas correct wecontinue; if we werewrong we opologize,make onother guessand give it another try.

8. Ask the students toraise their hand if theywrote any of thefollowing as answers toStep 3:

or "He would ask meto put him in the timeout room.

or "She would ask meto take her radioaway.

.

or "He would ask meto ignore him, act likehe doesn't ex.st."

9. It is very unlikelythat any of the studentswill raise their hands.You should then askthem the followingquestion:

If none of you gaveanswers like these forStep 3, then why dowe so often implementbehavior programs thatare consistent withthese answers?

Behavior

Session 1

WHAT YOU ARE ATTEMPTING TO SHOW THESTUDENTS ARE:

Step 1

There are a variety of different situations, settings,etc., that may disturb or confuse the person.

Shop 2

People "TELL" us about these situationsin a variety of different ways. Often this type ofcommunication is labeled as disruptive orinappropriate behavior.

0 Shop 3

We figure out what the person wants (i.e. how wemight help them deal with the situation describedin Step 1) the answer is often fairly straightforward. Most students will probably developanswers in Step 3 of the exercise that arereasonably connected to the situations described inStep I. Of course it may not be possible to alwaysdo what the person wants or needs. The point isnot whether we can always do what is needed butfor the trainees to appreciate the imponance oflooking at the situation from the person's point ofview and how the person's requests for assistanceare usually very reasonable and typical of howmost people would feel in the same situation.

35

Provide examples as

shown on overheads16 and 17.

10. Ask students if anyof them really believethat Bob yells or plays

his radio too loudbecause he kasn't hadhis radio talci;n awayenough in the past?

That we are making upfor this neglect by taking

his radio away now?

Ask if any of them

believe that the cause forMary's disruptivebehavior at her dayprogram is that she

hasn't been punished

enough in the past?That Mary yells because

she hasn't gotten enough

candy for being quiet?

36

Behavior

Session 1

EXAMPLES OF AVERSIVE BEHAVIORMANAGEMENT

Stop 1

Bob does not do well in noisy situations. He seemsto be very sensitive to loud sounds, especiallythose that he has no control over. Crowds,especially noisy ones really upset him.

Stop 2

Bob doesn't talk but he does let people know thathe is upset in a variety of different ways. He mayput his hands over his ears, begin to yell and evenrun away. He may attempt to hit the people whoare being noisy. If he is in his room he may turnhis radio up to "drown out" the noise of the otherpeople in the group home.

Stop 3

Bob's radio is taken away for 15 minutes each timehe plays it too loud. If Bob remains agitated he isplaced in the time out room until he calms down.

ANOTHER EXAMPLE OF AVERSIVE BEHAVIORMANAGEMENT

Stop 1

Mary, who has severe hearing and visualimpairments, seems to be disturbed at her dayprogram when she becomes conAised about whatshe is supposed to be doing as her workassignment. She also has trouble in makingtransitions from one assignment to the next.

4 0

Behavior

Session 1

Step 2

Mary shows that she is upset or confused by bitingher hands, pulling at her hair and sometimesslumping to the floor.

Pep 3

Mary's teacher sprays a water mist in her facewhen she pulls her hair or yells. She is given candyfor remaining quiet.

The concern is not whether the programs will besuccessful if we define success as a decrease inMary and Bob's disruptive behavior. We canusually develop a behavior plan that will work. Iftaking Bob's radio away for 15 minutes is noteffective, we can try taking it away for an entireday. If the frequency of Mary's bIting does notdecrease when we spray her face with water, wecan try squirting Tabasco sauce in her mouth.

There is little doubt that if we are stronger andmore powerful that we will be able to escalate tomore restrictive and aversive procedures that willbe effective in managing the person's behavior.However, as the written lesson pointed out, Boband Mary mzy not see this as a success. Suchbehavior programs may only be serving to shut theperson up about conditions and situations that theyfind disturbing or confusing. Such behavior plansdo nothing to change the original conditions thatled to the person learning the disturbing behaviors.

4

11. Explain what the

reol conce.::n is.

Make it clear to thestudents that you

understand and share

their concern about the

person's disruptive

behavior. It is le;:imatefor them to be

concerned about'-g,lping the person learn

less disruptive woys to

deol with her/his angerand confusion.

However, helping theperson change his/herbehavior should not

begin until we have

attempted to implement

the kinds of changes in

our behavior that are

usually described in the

answers to Step 3 in theprocess.

37

IM

Greet and Desperate Cores

Format

Lecture/discussion

Tine

45 minutes

Materials

Overheads 18 24

Handout 2 "Great and Desperate Cures"

Handout 3 Joey's Story

Behavior

Session 1

4 339

40

Behavior 0Session 1

Ole loctives

Upon completion of this section, studentsshould be able to:

2.1 Recognize that in the history of servicesfor people with challenging behaviorthere are many examples of misguidedefforts to find a "CURE," a "QUICK FIX"for problem behavior.

2.2 Recognize that this tendency to seeksimpie, easy solutions for complex,difficult problems can be also be seen inother areas of human behavior such asweight control.

2.3 Understand the importance of avoidingthe use of behavior plans in a "QUICKWEIGHT LOSS" approach to behaviorchange.

2.4 Understand that a good service planbegins with efforts to support the personand provide services that meet theher/his needs before implementingteaching plans to change the person'sbehavior.

4 4

Behavior

Session 1

Section D: Content

The history of human services is filled with manydiffert - ways we have tried to "CURE" peoplewith aibabilities - especially people with disruptive,dangerous, challenging behavior. Valenstein haswritten a book titled "GREAT AND DESPERATECURES" that provides examples such as:

In the late 1800s a German neuralogist published abook on electrotherapy. Weak electric currentswere used to "stimulate the patient's nervoussystem" and improve behavior.

--00W11-1,

""'"....,.....-

IIIIIk_ .

lir

-

ar

4.

Electrical stimulation device invented by Dr. John Butler ofNew York. It was said to be °especially salubrious in cases ofrhe unatism, nervous exhaustion, neuralgia and paralysis.(From Harper's, 1881)

Notes

1. Present 'Great and

Desperate Cures," using

content provided ond

overheads 1 8 23.

41

Beh

avio

r

Ses

sion 1

Hyd

roth

erap

y,

whi

ch

invo

lved

bath

s,

douc

hes,

wet

pack

s,

stea

m

and

hose

s

was

also

used

freq

uent

ly

in the

early

1900

s.

In the

late

1800

s, a

psyc

hiat

rist

inoc

ulat

ed

patie

nts

in men

tal

hosp

itals

with

vacc

ines of

tube

rcul

osis

,

typh

oid

feve

r,

mal

aria

and

othe

r

infe

ctio

us

dise

ases

.

His

theo

ry

was that

high

feve

r,

brou

ght

on by the

infe

ctio

ns,

cure

d

his

patie

nts.

He

beca

me

very

fam

ous

and

was

also

very

wro

ng.

Late

r

hot

bath

s,

hot

air.

, radi

othe

rmy,

infr

ared

-ligh

t

bulb

cabi

nets

and

spec

ial

elec

tric

"mum

my

bags

"

wer

e

also

used to in

duce

high

body

tem

pera

ture

s.

The

se

"tre

atm

ents

"

wer

e

less

dead

ly

but

did

little

othe

r

than

mak

e

the

peop

le

very ho

t.

Sle

ep

ther

apy

or

"pro

long

ed

narc

osis

"

was

used in the

1920

s

and

30s.

Dru

gs

wer

e

used

to keep

patie

nts

in men

tal

hosp

itals

unco

nsci

ous,

usua

lly

for

one

or two

wee

ks

som

etim

es

as long as a mon

th.

"Cur

e"

rate

s of

70% to 80%

wer

e

repo

rtel

.

Oth

er

ther

apie

s

have

incl

uded

:

Usi

ng

smal

l

dose

s

of

cyan

ide

to stim

ulat

e

the

nerv

ous

syst

em

indu

cing

asep

tic

men

ingi

tis

Hyp

othe

rmia

,

cool

ing

the

body

Ele

ctro

conv

ulsi

ve

ther

apy

Lobo

tom

ies

4 6

42

Behavior

Session 1

BEFORE YOU THINK TOO HARSHLY OF OURANCESTORS LOOK AROUND, NOW. WHAT AREOUR "GREAT AND DESPERATE CURES?"

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IT;sits 4.;tft o use a Ul\ly. oewce. ,

wt.A

cal\ at otAti krve 'At 41;114

6ilict 0 )Cs Universal Press Syndicate

11

43

.

Co'TT

Behavior

Session 1

The need to find ME "KEY TO THE PROBLEM," the"ONE 'MING MAT WILL SUCCEED" is dearly with usstill today. This notion of a quick, dramatic solution, isnot limited to the field of human services. Look at theadvertisement on this page.

1E4P LP LP C-PLIE1,

t

Cd

Cd

C.

....

, .)..

7,1,---- No Other .

,.f::-. -, Remedies ButDr. Kittelson's

.... Reduce

Obesity '

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p..

A% Miradle .tuiletsDiet pills* sie goaraileed,to sviadd

.<

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Each pl.P

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i oslio

roroll rsor3r_ror3 r_r3 Lon cm

45

Behavior

Session 1

Anyone with even a basic understanding ofnutrition knows that the way to stay healthy, keepcontrol of your weight is to follow theseguidelines:

Eat well balanced meals.Don't eat too much.Exercise regularly.Get enough sleep.Don't smoke.Drink, if at all, only in moderation.

We all know that these guidelines are true, yetmany of us often act as if they weren't. We eat toomuch. We smoke. We drink too much alcohol.Our major recreation is watching other peopleexercise on T.V.

We know the guidelines are true but we also haveexperience that says they are difficult to follow.It is one thing to know that you should not eat toomuch and it's another thing to say NO to thebanana cream pie.

We want the advertisement on the overhead to betrue. If it were true we could ignore thenutrition/exercise guidelines and just buy the"MAGIC BULLET' diet pills. This kind of thinkingmaintains our multi-billion dollar diet industry.

5 ()

46

Qukk Vhight Lou APProoch toBohavior Chong*

e

e

Behavior

Session 1

It is true that a sensible diet can help some people,some of the time. It might help a person loseweight but we all know that to maintain ourhealth takes a lot of work and requires us to lookat and possibly change many different aspects ofour life. Still, we hold out hope for the special,miracle diet. Some of you are probably wonderingright now, about how you might order the "FAT-AWAY MAGIC BULLETS," even at $10 a pill.

PEOPLE WITH CHALLENGING BEHAVIOR

Given the above way of thinking, is it toosurprising that when we are faced with helpingsupport a person with disabilities who has severebehavior challenges that we adopt the:

There is a very strong parallel between the conceptof a diet and that of a behavior plan. The ideal dietis one that requires very little of the user few, ifany, major changes in eating habits, no exercisebut still produces quick, dramatic , esults.

Similarly the "IDEAL" behavior plan is one thatrequires very little change in our (the system's)behavior. It is easy to implement, yet results inquick, dramatic reductions in or elimination ofbehavior problems.

2. kk students forexample7 of "great and

desperate cures" theyknow of from either the

past or present.

47

3. Present the first IA rt

of "Joey's Story," using

overheod 24.

48

Behavior

Session 1

Just like our interest (obsession?) in finding amirade diet can cause us to ignore real problemssuch as over eating, lack of exercise, etc. the use ofa 'BEHAVIOR PUN APPROACH" to supportingpeople with severe behavior challenges helps usignore real issues in the person's life that need ourattention. Look at the story below.

JOEY'S STORY

Joey was ten years old. He went to school in aclass designated for students with mentalretardation and "SEVERE BEHAVIORDISTURBANCES." Joey, lilce the other boys andgirls in the class, was often involved in hitting,kicking and crying. In addition, Joey usually didnot follow the instructions of the teacher becauseof this behavior he had been labeled by the schoolpsychologist as "EXTREMELY NON-COMPLIANT."

Joey was sent to a university diagnostic center forfurther evaluation. The evaluators agreed that hewas indeed "NON-COMPLIANT' andrecommended the behavior plan that follows.

52

Behavior

Session 1

,

NON-COMPLIANCE TRAINING PROGRAM

I. Joey's parents and school staff begin a compliancetraining program as a first step in establishing controlover his behavior. This program involves:

A. 3 4 training sessions lasting about 10 minutesshould be conducted daily. During these sessionsspecific tasks that you know Joey can do should bepresented. The meaningfulness of the tasks issecondary to requiring compliance to demands ofthe task situation.

B. When Joey first attempts to run away or tantrumhe should be immediately brought back to the on-goingtask and required to comply. Physical prompts andmanual guidance may be used to guide him through thetask. A new acthity should not be introduced until hehas complied with the original task. Reinforamentshould not be given until the entire task is completed.

2. A time out program should be implemented in order toreduce his aggressive and non-compliant behaviors.His self-injurious behavior should be ignored. If hebecomes aggressive or repeatedly refuses to comply todemands, he should be escorted to the time Gut roomand be required to remain in the room for a minimumof 10 minutes.

3. He should receive frequent reinforcement for hispositive social behaviors and interactions.

rld.....r

I. -

r: r.I P 049

Behavior

Session 1

Their plan was based on the assumption thatthe only problem to be solved was Joey'sBEHAVIOR (not following instructions and refusingto behave himself) and that the solution could beas simple as the implementation of a behaviorplan. The evaluators beheved that the school staffcould "FIX" Joey (teach him to be compliant) inonly 30 40 minutes of training each day. Therewas no need to need to change anything else justimplement the behavior plan (diet) and hisproblem would be solved.

Similar to the way special diets igriore theprinciples of good nutrition this type of limitedbehavior plan ignores the fundamentals of goodteaching. The members of Joey's evaluation teamapparently did not attempt to answer any of thefollowing questions:

Does Joey trust his teacher, feelsafe in the classroom?

Does Joey enjoy any of hisclassroom activities?

Does Joey get to choose any ofhis assigned activities?

Are the assigned tasks too challenging?...too boring?

54 950

Behavior

Session 1

Does Joey know how to say "No" inany other way than by being aggressiveor disruptive?

Would Jaw's teacher honor his saying "No"if he weren't aggressive?

There are of course many more questions wev:ould ask if we were making a serious attempt tounderstand why Joey bevives the way he doesand to then develop a teaching plan that calls forchanging all the relevant factors. We would baseour plan on an understanding that:

1. We (the system) are the ones who will haveto change the MOST.

2. We will have to changc. FIRST, if Joey is 0 behelped. We would understand that muchabout the classroom environment may needto change, not just Joeys behavior.

After deciding not to implement the behavior planthe school staff spent time in Joey's class, trying toget an over-all picture and not just focusing on his"NON-COMPLIANT behavior. His parents and staffasked questions such as:

What does Joey like to do?

What does Joey do well?

What real choices does Joey have?

What mistakes have we made in the past?

Are we repeating them now?

4. Piesent the rest of

"Joey's Story."

51

i

52

Behavior

iession 1

WHAT THEY FOUND WAS INTERESTING.FOR EXAMPLE:

Joey's teacher admitted that in her opinion,ujoey did not like any of the tasks he wa-assigned in the classroom."

He did enjoy recess and mus;c class, but hadbeen excluded from both because of hisdisruptive behavior.

Joey's teacher said she allowed him to choosemost of his educational assignments.However, she admitted that the only realchoices presented to Joey were to:

(1) Do something he did not want to do,when asked by the teacher.

(2) Refuse the teacher's request.

The teacher aide almost never ASKED Joey todo things. He usually TOLD Frn what to do,in a very demanding tone of voice.

Mike, the student who sat next to Joey, hadfrequent temper tantrums and also oftenrefused to follow the teacher's instructions.Mike's tantrums seemed to keep Joey on edgeand it seemed like he might be imitating someof Mike's more aggressive behavior.

Behavior

Session 1

BASED ON THESE OBSERVATIONS ThE SCHOOLSTAFF MADE A NUMBER OF CHANGES IN THEIRTEACHING AND SUPPORT PROCEDURES.FOR EXAMPLE:

It was not possible, at that time, to move Joeyto a class where he could spend more timewith students who would serve as better rolemodels. However, they were at'e to arrangefor joey to spend more time in otherclassroom settings especially gym classand music.

It took extra staff to make these arrangementswork, but they showed the schooladministrators that they had already beenusing extra staff to intervene in crises createdby Joey's aggressive behavior.

The teacher arranged for a few newclassroom activities, based on choices madeby Joey. The activities weren't dearlyMEDUCATIONAL" but staff figured that onceJoey was happier about being in dass theycould gradually introduce more educationallyoriented activities.

The aide tried to be more supportive andmade less demands on jcly. He learned toask rather than command.

r, ,...e . ,

53

Behavior

Session 1

Now of course these and the other changesimplemented by the staff did not result inimmediate, dramatic changes in Joey's behavior,but then neither would the compliance trainingbehavior plan. The staff came to see that therewould be no quick solutions, no "GREAT ANDDESPERATE CURE" for Joey.

They also understood that Joey needed to changetoo. They knew that if Joey could learn to followinstructions more consistently, to complete tasksthat were not always the most interesting thing tohim, that they and Joey would be better off. Theyknew they needed to help him learn to deal withdelays in getting what he wanted, to handlefrustration without being so disruptive.

With this in mind they also implemented a newteaching program that focused on helping Joeylearn alternatives to disruptive and dangerousbehavior when he was frustrated or angry. Theteacher showed Joey huw to raise his hand andask for help instead of yelling.

5C

54

Behavior

Session 1

Given Joey's difficulties in learning new skills histeacher knew that just demonstrating appropriatebehavior and waiting for Joey to behave himselfwould not be enough so;

1. He had other students model the appropriatebehavior.

2. He shaped Joey's behavior by at firstenthusiastically rewarding any behaviors heshowed in frustrating situations that were lessdisruptive or aggressive.

3. He rewarded Joey for following directionsand completing tasks by allowing him to shiftto preferred activities rather than by givinghim even mare work to do.

The staff realized that this would take some time toaccomplish and would require everyone thatworked with Joey to be supportive.

Looking back at the initial compliance training planthey wondered how any of them could havebelieved that 10 minute training sessions to"FORCE" compliance could have ever beensuccessful. Even worse, what if they hadimplemented the Plan and Joey had eventuallybeen forced to comply? Now understanding howfar they had been from meeting Joey's needs,would that really have been a success?

55

rs!

S.

56

.s; 'as ,"

Ak'\" s

ss.

ss.

. A

60

e

Behavior

Session 1

Videotape: °An Elephant at Meuse Place"

Fermat

videotape/discussion

T.30 minutes

Matioris Is

"An Elephant at Mouse Place" videotape

Videotape player

C 1_

57

Behavior

Session 1

Objectivos

Upon completion of this section, studentsshould be able to:

3.1 Recognize that it can be difficultto support people with challengingbehavior because most community-based programs were not designedto meet thcir needs.

3.2 Understand that most challengingbehavior makes sense, from the point ofview of th t. person engaged in it,especially when you realize how far ourservices are from meeting the needs ofthe person with challenging behavior.

6 2

58

Sution Es Conteid

Behavior

Session 1

Notes

1. Briefly introduce the

videotape.

2. Show the videotape.

3. Conduct a discussion

of the videotope,reinforcing the points

made in the video.

59

Behavior

Session 1

. '1. .

Ralph's Story

Format

Let.-ture

Thu

30 minutes

Materials

Overheads 25 29

Handout 4 Ralph's Story

61

8

o84(5.

8

-ss.4E -go a) S 00

tit19;'EtiEU°R.E-8A-0111E

v

(4

e

o

Behavior

Session 1

Section F: Contont

Even though this is Ralph's story, first you need tolearn about a fellow named Leroy.

LEROY

Leroy is 38 years old, about 6'2" and weighs about195 lbs. He enjoys wearing sleeveless T-shirts,denim overalls and big, black army boots. Leroyhas been labeled as moderately retarded and alsohaving schizophrenia.

People who know Leroy well are not sure aboutthese labels, but it is clear that he finds :.t verydifficult to learn naw tasks, has great difficultyexpressing himself and does, at least at times, seemto be confused by voices that he hears "in hishead." The people in Leroy's life all agree that theyhave a very difficult time getting along with him.

While at times Leroy shows a good sense of humorand can be cooperative, most of the time he failsto complete his work assignments, refuses tofollow simple directions, often picks on and stealsfrom other clients and has already injured two staffat the workshop and one at his group home. Thereare times when staff feel that they must hold himto protect him or someone else it takes three orfour of the strongest staff to hold him safely.

Notes

1. Present "Ralph's

Story,' using overheads25 29.

ri 63

Behavior

Session 1

Looking closer at the workshop Leroy attendsmight give you a better understanding of hissituation. Leroy attends the Ajax IndustrialCenter because:

1. Its catchment area includes the ICF/MRresidential program he recently moved to.

2. His vocational rehabilitation worker decidedthat he was not appropriate for their servicesbecause of his disruptive behavior.

3. It was the only program that wouldaccept him.

Even though everyone agreed that his skills andpast work history dearly indicated that, in mostways he fit their criteria for the competitive orsupported work program, the team decided that heshould be placed in the work adjustment program.At this workshop, individuals are placed in thework adjustment program if they are considerednot to be "READY" for more advanced programseither due to skill deficits, or as in the case ofLeroy, because of "SEVERE BEHAVIORPROBLEMS." There are seven other clients inLeroy's group supervised by two staff.

Leroy spends most of the day assigned tc "WORK"tasks that are similar to the contracts that he maysome day "GRADUATE" to. However, both Leroyand his supervisors know that he does not do realwork. In fact, the items that Leroy packages areunpacked by a woman working at another table inthe work adjustment area. He then has the task ofputting them back in the boxes again.

P S

64

Behovia

Session 1

What happened yesterday is a good example ofthe problems that occur at the workshop. WhenLeroy first sat down at his table in the workadjustment room the supervisor told him he wouldbe working on a new job. The workshop hadobtained a new contract, and he wanted Leroy tolearn to compiete one of the assembly tasksrequired in the contmct work. The supervisorplaced a pile of bolts, nuts, washers and bags infront of Leroy.

From the beginning, it was clear that Leroy did notneed to "LEARN" the task. He quickly assembledthree bolts and placed them appropriately in theparts bag. The real question was not whethr, Leroycould learn to do the task he already knew how

but rather whether he would do what he wastold, when he was told, without being disruptive orhurting himself or anyone else.

Leroy worked steadily for about 15 minutes, thenhe began to ask for a break. The behavior plandeveloped for Leroy classifies his requests forbreaks as inappropriate avoidance behavior andcalls for the staff to ignore him and if necessary,redirect him back to the task. The staff memberfollowed the plan and simply ignored Leroy'srepeated reqi tests to lake a break," "get a cup ofcoffee," "go to the bathroom? Leroy's requests hadno visible effect on the supervisor, although he didpraise him the few times he did return to work.

After abnut 15 minutes of having his breakrequests ignored, Leroy said, "I'm quitting ... youcan't make me work," and shoved his chair backfrom the table. He sat there glaring at his

65

Behavior

Session 1

supervisor. The supervisor ignored Leroy for about10 minutes and then quietly asked him severaltimes to "Please go back to work." The first timeLeroy said "No!" later he simply ignored thesupervisor.

The supervisor was erperienced enough to knowthat it would be a mistake to try to force Leroy'schair back to the table. He knew that it couldresult in a real fight so he decided to take the workto Leroy. He pcked up one of the bolt assemblies,held it in from of Leroy and asked him to pleaser,o back to work.

At first Leroy ignored him, but after a few minuteshe grudgingly completed the bolt assembly.Thinking that it might now work, the supervisorsaid, "Let's move you back to the table." Leroyimmediately said "Nor The supervisor decided tobe a little more assertive and said "'Come on Leroy,you know you have to work," AS he put his handson Leroy's chair. Leroy looked up at the supervisorand yelled "No! No! I won't? The supervisorquickly decided that it would be a mistake to backdown now and began to gradually drag the chairtoward the table. Leroy immediately slammed bothhis arms to the chair, just missing the supervisor'shands. The supervisor jumped back and said, "OK,we can't make you work but if you don't work,you won't get paid and yor .2.on't get a break."

Immediately Leroy began to yell. He threw thebolt, breaking the window in front of his table.Then he began to cry and bite his hand and lips.The supervisor told Leroy to stop. He didn't. The

66

Behovior

Session 1

other work adjustment supervisor called for help.It took four of the staff about 40 minutes to calmLeroy down, once they were able to hold him in asafe position on the floor. The staff of the ICF/MRfacility were called and after Leroy had calmeddown they took him back to the residential facility.Later that day at a special team meeting, Leroy wassuspended from the workshop for the rest of theweek. The behavior specialist was instructed todevelop a more powerful behavior program andbe ready to implement it by the time Leroyreturned next Monday.

Now we can move on to Ralph. Don't forget whatwe've learned about Leroy. We will come back tohim later.

RALPH

Something is missing at the agency where youwork! No matter where you work, whether at agroup home, workshop, supported workprogram, etc. What's missing is an bx10 colorpicture of Ralph!

Ralph is 24 years old, about 5'4" and weighs in atabout 155 lbs. He takes great pride in hisappearance button down collars, pressed pantsmuch better dressed than most of us.

Ralph has Down Syndrome which makes it harderfor him to learn, limits his ability to generalizewhat he has learned to new situations and hasresulted in him being much shorter than he wouldlike he plays a lot of basketball.

67

Behavior

Session 1

Ralph is very good natured he smiles a lot and isvery easy going. You might even say that he is"OVER" compliant. As a matter of fact you couldwalk up to Ralph at the workshop and ask him torun around the room four times in a row. Heprobably would do it without a question evenif he had ,tver met you before.

You never have a problem with Ralph. He may notbe the fastest worker at the shop, but he is reliableand very seldom complains.

You may be wondering why you need a pictureof Ralph for the lobby of your workshop or abovethe fireplace at home. Sure Ralph is a nice guy,maybe especially nice, but so are many people.Why his picture? The answer is simple youshould hang a picture of Ralph somewhere in theprogram, especially in a place you have to walkpast eveiy day to remind you, and everyoneelse that works with you that

Of course, the people who actually designed thefacility and program you work in did not know thefellow named Ralph in this story, but they musthave had people like him in mind when they mademany of their important planning decisions.

How do I know they designed the program forRalph, or at least for fellows like Ralph? Of courseI've never even seen your program but I bet thefollowing description is more true than not.

72

I.I.

Behavior

Session 1

Most Community-Based Service Programs:

ProgramHistory

StaffRatio

StaffTraining

Prograr-Options

IndividualChoices

Rules &Regulations

69

Behavior

Session 1I

MOST COMMUNITY-BASED SERVICE PROGRAMS:

PROGRAM HISTORY:

Years ago, when the program began most of theindividuals had only mild or moderate disabilities.Over the years the program has begun to acceptpersons with more severe disabilities but still hasonly limited experience with persons who haveseverely disruptive, possible dangerous behavior.

STAFF RATIOS:

Most of the staff supervisors in day programs areresponsible for 12 15 maybe even 20 employees.The ratios are better in most residential programs,one to three at hest, to one to eight in some largerprograms. However, it is usually more difficult toprovide close supra ision in home settings.

STAFF TRAINING:

While there may be a basic inservice orientationprogram, few of the staff have had intensivetraining and guided supervision in teachingpersons who have great difficulty in learning andcommunication, especially those with severelydisruptive behavior.

PROGRAM OPTIONS:

Many of the individuals were placed in theirparticular day or residential program because itwas the best one available, sometimes the onlyone available. Teams try hard to make the programfit the individual but far too often it is the otherway around.

7 4

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71

Behavior

Session 1

You are probably starting to get the picture. Theprogram planners must have had Ralph in mindwhen they developed the budget, determinedstaffing patterns, etc. Luckily, most of the time itworks for fellows like Ralph. But guess what?

"We Des Weed the Prewar for Ralph andthem Leroy showed op!

Leroy must feel like the tourist from Georgia whoexpected to get to Mexico City on a big, modern,air conditioned bus. When the bus arrived hefound that it was small, old, not air conditioned(except for the hole in the roof) and was routed toMexico City via Saint Paul, Minnesota.The touristwas even further surprised when he complained tothe staff of the bus line and was told to:

"BE QUIET," "STOP COMPLAINING," "LOOKAROUND, NO ONE ELSE IS MAKING A FUSS."

Of course, that's not how most bus lines operate -they would go out of business. When a businessmakes a promise to meet our individual needs andthen doesn't, we expect our money back, or at theleast, an apology. However, far too often humanservice programs operate like the bus line in thisstory. We operate under federal and state laws thatare supposed to guarantee people with disabilitiesthat they will receive an individualized programbased on what they actually need rather thansimply what is available, in the least restrictivesetting, etc., etc.

76

72

Behavior

Session 1

Most of the time programs make very sincereattempts to make good on these promises. Toooften however, funding shortages, rules imposedby others that we cannot change, the complexity ofthe needs of those we serve all make it impossibleto do what we know we need to. It is nothing tobe ashamed of, unless we know of improvementsthat could be made but are being ignored. It is alsotrue that, even with such major limitations ourprograms often are helpful especially for peoplelike Ralph.

Leroy has not learaed to play the role so oftendemanded of people with intellectual disabilities.People with mental retardation often learn thattheir life is less disruptive if they say "YES"; dowhat they are told, rather than voice their ownopinion; learn to please others rather thanthemselves. There is a good side to this of course.We all know that it is necessary to learn tocompromise, to do things or follow instructionsthat don't always please us, etc. It is also clear thatLeroy's life, and ours, will be more calm and lessdangerous if he can learn to be a little more likeRalph. The important question is how can wesupport him in learning more adaptive and lessdangerous ways of voicing his criticisms.

P-... P

73

Ralph's Story Exorcise

Format

Individual/small-group exercise

Time

80 minutes

Materials

Worksheet 2 Ralph's Story In-class Exercise

Worksheet 3 Ralph's Story Practicum

Behavior

Session 1

75

0

CO

Behavior

Session 1

Section Gs Contest

RALPH'S STORY IN-CLASS EXERCISE

YOU COULD LOOK AT FACTORS SUCH AS:

Have there been inconsistencies in staffing,scheduling that are difficult for the personto understand and accept?

Are there situations that we know theperson has a difficult time dealing with suchas crowds, loud noises etc. but are still a partof her/his everyely life?

How much choice does the person haveover who they live or work with?

Does he/she have any real friends?Especially friends who advocate on behalfof the person?

How well do we do at communicating withthe person?

How well do we understand the person'sattempts to communicate

How much of the person's program reallyreflects his/her indivIdual needs?

F .1.

Not*.

Use the worksheet 2:

"Ralph's Story In-clas

Exercise' andconduct the followingexercise based on the

structure and makeup

of the class.

When the course is a

oneday class:

1. If the students all

work together, divide

them into groups of twoor three; otherwise, hoveindividuals complete the

exercise. (5 minutes.)

2. Have the smallgroups or individuals gothr, ugh the procticum

exercise for at least one

person that they know.

Allow about 20 minutesfor this step.

77

3. When eachindividual/group hascompleted the form,

have individuals/grovpsdescribe their person

and the conclusions they

came to as they

completed the exercise.C-mment as

appropriate toencourage students toexpand their views of

people with disabilitiesand the possible reosons

for the behaviorproblems.

Allow about 5 minutes

per person or amaximum of 40 to 50minutes for this step.

4. Take about 5 minutesto summarize some of

the most important points

brought out by the

students.

78

Behavior

Session 1

IMPORTANT:

From the person's point of view, from his/her ownexperience, does the challenging behavior work?Does Whelp the person GAIN what they want?ESCAPE from or avoid what they do not want or like?

MOST IMPORTANT:

Does the person really have any other options orchoices that also work, or, is her/h 31(uationsimilar to Leroy's? Leroy didn't know of some of theoptions that might have been available to him. Hemight have been able to complain tc, his casemanager or his legal rights representative but he didn'tknow he could. I Tiowever, he did know that saying hedidn't want to work, even asking repeatedly to stop,DID NOT WORK. From his point of view disruptiveand aggressive behavior worked almost every time.

We might be able to see that his aggressive behavioralso caused Leroy lots of problems, but when youhave no other alternatives you go with yourexperience and usually continue with what hasworked most of the time.

I

s

Behavior

Session 1

AS YOU THINK ABOUT WHAT YOUARE GOING TO SAY, KEEP ME FOLLOWINGPOINTS IN MIND:

a. Please talk for the person. In other words, usefirst person statements. Use language like:

"I sometimes do the following things ,

"The reasons I often bite my hand are

This may seem awkward at first, we are allmore used to talking like:

"The client's challenging behaviors are ...." or

"The learner has behavioral difficultie;because of the following ..."

but it is very important that you present theperson's case as exactly as you think theywould, if they could.

b. Don't worry about ::oming up with solutionsor snswers as to Low to deal with thechallenging behavi: vs yet. In this exercise weare simply trying to improve oerunderstanding of the causes or rtasons forchallenging behavior. Don't let anyoneconvince you that your understanding mustbe wrong simply because you don't have aready solution to the problem.

c. This is not a debate and there are no obviousright or wrong answers.

,

5. Hand outWorksheet 3 of ioeat home version of

"Ralph's story practicum"

exercise and encouragestudents to go through

the exercise again with

an individual, this t

using additionalinformation about the

individual.

If the course is divided

into two sessions:

1 . Hond out

Worksheet 3 of theat home version of the

practicum exercise and

explain exactly how the

students are to perform

the exercise before the

next session. Point out

that they will be shoring

their conclusions at the

next session.

2. At the beginning ofthe second session, go

through steps 3 and 4

above.

79

Note: If the students are

not likely to complete this

exercise between

classes, then be sure to

fit the exercise into the

class itself. It can also be

done a second time bythose students who are

il ling to take the timebetween classes.

If the class consists of

those who do not yetwork with individualswith disabilities:

Go through the same

exercise, but instead of

having studen;b t,e

someore they know andwork with, prepore cosestudies, similar to the

"stories" presented in this

curriculum, and havestudents use that

information for the

exercise.

80

Behavior

Session 1

IMPORTANT:

Keep in mind, we are not trying to condone orapologize for the person's disruptive or aggressivebehavior. We are simply trying to understand whythe person engages in the challenging behavior.

To say "I understand why Leroy acts so disruptiveand sometimes dangerous" is not the same assaying "I accept his behavior its O.K. for him tohurt others."

Listening to, understanding and in a senserespecting the person's reasons for his/herbehavior, is the first step toward helping theperson make more adaptive, less dangerousthoices.

* Behavior

Session 1

Summary end Coshes

Forret

Lecture

The

10 minutes

Materiels

Student handouts and worksheets for Session 1

r vies of overheads used in Session 1

5

81

Notes

1 . Review the main

points presented in this

session.

2. Give studentshandouts from this

session, including copies

of overheads andworksheets.

82

Behavior

Session 1

Sediee N: Cooteot

This section has been developed to bring the firsthalf of the session to a close with a review of thematerial covered in the previous sections.

C

S

sr

\,

:.

Introduction

Format

Lecture

Tins

10 minutes

Matirrials

Overhead 1

Behavior

Session 2

SB85

Hefts

1. Display overhead 1and review the mainpoints presented in

Session 1.

2. Using overhead 1,briefly explain whatSession 2 will include.

86

Behavior

Session 2

:.

Summary of Ralph's Story Exorcise

Format

Large-group discussion

Thu*

60 minutes if exercise was completedbetween sessions

Behavior

Session 2

15 minutes to summarize points if there was nobreak between sessions

Materials

Worksheets 2 3

S 087

Notes

1. If the exercise was

completed in class, atthis point, simply review

some of the main points.If the exercise wascompleted between

sessions, at this point,

have students share their

conclusions as explainedin Session 1, section G.

88

Behavior

Session 2

ONocitives

Upon completion of this scztion, studentsshould be able to:

3.3 Increase their skills in advocating forpeople with challenging behavior bygiving them experience in:

Figuring out why people engagein challenging behavior.

Explaining to others why peopleengage in challenging behavior.

91

e Behavior

Session 2

tiodrstaodhap Behavior Oa Nooses

Format

Lecture/discussion

Tiro

35 minutes

Materials

Overheads 30 34

Handout 5 Understanding Behavior Challenges

289

90

Objectives

Upon completion of this section, studentsshould be able to:

4.1 Recognize that there are always reasonsfor why people do what they do; thereare causes for challenging behavior.

4.2 Understand that the first step to helpingdecrease behavior challenges is tounderstand the cause(s) for the behavior.

.... Understand that while there are physical

causes for challenging behavior, they arerarely the cause for the challengingbehavior.

4.4 Describe the major environmental causesfor challenging behavior, through theuse of the "VICIOUS CYCLE DIAGRAM."

4.5 Differentiate between environmentalinfluences that precede (antecedents)versus follow (consequenLes) thebehavior.

4.6 Understand that most challengingbehavior is learned and that "WE" arethe ones who teach it.

4.7 Look at the situation from the person'spoint of view, "LISTEN TO" the person'schallenging behavior and understandwhat the person is trying tocommunicate.

PS

Behovior

Session 2

Section Cs Content

This lesson begins with the followingfundamental assumption:

MERE ARE ALWAYS REASONS FOR WHYPEOPLE BEHAVE THE WAY THEY DO.

It is true that we cannot always identify the reasonsor causes for a person's behavior. As you will seein this lesson the causes for behavior can be verycomplex and difficult to understand. However, wemust begin with the working assumption that thereare reasons and that if we ask the right questionswe will be able to discover them and use ourunderstanding to help the person.

CAUSES FOR PROBLEM BEHAVIOR

There are many different reasons why a personmight be engaging in challenging behavior. Forexample there may be physical causes for theperson's problem behavior. These conditions carbe genetic as in the case of Tay Sach's risease oracquired later in life such as in the case of braininjuries. However, while there are examples ofphysical conditions which are directly related tosevere behavior challenges such examples are notcommon and are not likely to be the cause ofmany of the behavior challenges you encounter.

'Tay Sach's Disease a genetic condition that usuallyresults ir severe self-injurious behavior.

Notes

1. Ask the students to

think of someone they

know {preferably oneof their clients) who

"misbehaves." Then

hove them suggest

reasons why that

person might be

"misbehaving" reasonsdeeper than the obvious.

2. Using overheads30-34, present thecontent on

"Understanding BehaviorChallenges."

91

..

,s\>.

'2A'

441

Behavior

Session 2

PHYSICAL CAUSES

Even though physical conditions rarely account forwhy the nerson is engaging in challengingbehavior they should always be checked out.There are many examples of persons engaging inself-injury such as head banging because of earinfections, chronic headaches, impacted ear canals,dental problems, temporal lobe seizures etc.

Especially if a person shows a dramatic and rapidchange in behavior, it usually makes sense tocarefully examine whether there could be aphysical cause for the behavior.

ENVIRONMENTAL CAUSES

Most of what we know about human behaviorclearly supports the notion that our behavior isstrongly influenced by our environment, especiallyour LEARNING EXPERIENCES. A carefulexamination of the VICIOUS CYCLE chart mayhelp in your understanding of how ourenvironment and past learning experienceseffect behavior.

FACTORS THAT PRECEDE ME BEHAVIOR

Common sense tells us that there are many thingsthat make us happy, bored, confused, interested,angry, depressed, satisfied, etc. We are dearly notall the same what bores me may interest you,what makes you mad I fray think is funny. Forpeople with disabilities the situation is often ever .more complicated.

r C 93

Behavior

Session 2

For example, many people with autism areextremely sensitive to differences in touch, tasteand noise. Read the following quotes from TempleGrandin, a person with autism.

"Like birthday parties. They were torturefor me. The confusion mated by the noisemakers suddenly going off startled me. Iwould invariably react by hitting anotherchild or by picking up an ashtray oranything else that was handy and flinging itacross the room."

"Even today, sudden loud noises such as acar backfiring, will make me jump and apanicky feeling overwhelms me. Loud, high-pitched noises such as a motorcycle's sound,are still painful to me."

Often it may not be just one thing, it may be aconibination of many different environmentalfactors. See another quote from Ms. Grandin:

"But as a child, the 'people world' was oftentoo stimulating to my senses. Ordinary dayswith a change in schedule or unexpectedevents threw me into a frenzy, butThanksgiving or Christmas was even worseAt those times our house bulged withrelatives. The clamor of many voices, thendifferent smells perfume, cigars, dampwool caps or gloves people moving aboutat different speeds, going in differentdirections, the constant noise and confusion,the constant touching, were overwhelming."

9 794

I

Behavior

Session 2

WE REACT, IN PART, BASED ON HOW WE FEEL

It's not surprising that when people feel frightened,angry or in pain, they often behave in ways thatare disruptive and even sometimes dangerous.Our experience tells us that when people arebored or confused their behavior often becomesmore erratic and less predictable. So far this wouldnot present much of a problem. The real troublebegins in the next phase of the process.

WE DISCOVER THAT DISRUPTIVE EVENAGGRESSIVE BEHAVIOR OFTEN "WORKS"

This is when the role of learning begins to play apowerful role in shaping our behavior. We all learnfrom our experiences and tend to repeat thoseactions that work for us. Behaviors that work arestrengthened (rewarded/reinforced) and those thatdon't or result in pain or discomfort are weakenedand eventually eliminated. The consequences orresults of our behavior are very important indetermining our future actions.

EVEN MOUGH THE DISRUPTIVE BEHAVIOROFTEN "WORKS," ON A SHORT-TERM BASIS INME LONG RUN MORE PROBLEMS ARE CREATED

Alienation, exclusion from programs, etc. Thisusually increases th.: discomfort and confusion inthe person's life, which results in even moredisruptive behavior. This "VICIOUS" cycle is clearlyevident in the lives of many people withchallenging behavior.

C. r)4 Ss.) 95

Behavior

Session 2

Vicious Cycle

Things I don't likeor understandcause me to..

(1 ('. I-,

96

Behavior

Session 2

We can see an example of this TYPE OF CYCLEin the story of Leroy, from one of the earlierlessons. Remember the day that Leroy wasassigned a new task? Let's look at that situationfrom the point of view of how Leroy's behaviorworked, or did not work for him.

Leroy worked steadily for about 15 minutes, thenhe began to ask for a break. The behavior plandeveloped for Leroy classified his requests forbreaks as inappropriate avoidance behavior andcalled tor the staff to ignore him and if necessary,redirect him back to the task.

His supervisor followed the plan and consistentlyignored Leroy's repeated requests to "take abreak," "get a cup of coffee," "go to the bathroom."Leroy's requests had no visible effect on thesupervisor. However, he did praise Leroy the fewtimes he returned to work.

Is it unreasonable that Leroy would rather take abreak than assemble nuts and bolts that someoneelse is simply going to take apart? The few dollarsa week that he earned at this task were notsufficient to make it any more interesting.

It's worth noting that it is also not all thatunreasonable, at least from a staff point-of-view,that Leroys supervisor wanted him to complete thepackaging tasks. There was an objective related towork on Leroy's IP and if he did well he thoughcLeroy might be able to "graduate" from the workadjustment program and join the other employeeson the workshop floor.

1 tr:

97

98

Behavior

Session 2

The superv;sor would probably say that he isaying to teach Leroy to "work consistently" byprlising him and that by ignoring Leroy'scomplaining and asking for frequent breaks he willlearn that such behavior is inappropriate.

Leroy might tell a different story!

He might say that he is learning that "it does nothelp to ask to stop work." He might say that "noone listens to me" and that he has no role indecision making at the workshop.

After about 15 minutes of having his requests for abreak ignored, Leroy said "I'm quitting ... you can'tmake me work" and shoved his chair back fromthe table. He sat there glaring at his supervisor.The supervisor ignored Leroy for about 10 minutesand then quietly asked him several times to "Pleasego back to work." The first time Leroy said "No!,"after that he simply ignored the supervisor.

From Leroy's point of view he had fmally foundsomething that worked. If the supervisor wouldn'tlet him have a break he would just go ahead andtake matters into his own hands.

Is it surprising that he refuses the supervil.nr'srequests to return to work? What has he got togain, other than a little praise and probablymore work?

The supervisor was experienced enough to knowthat it would be a mistake to try to force Leroy'schair back to the table. He knew that it couldresult in a big fight so he decided to take the workto Leroy. He picked up one of the bolt assemblies,

1 e 1

Behavior

Session 2

held it in front of Leroy and asked him to pleasego back to work. At first Leroy ignored him, butafter a few minutes he grudgingly completed thebolt assembly. Thinking that it might now work,the supervisor said, "Let's move you back to thetable." Leroy immediately said "No!"

It was probably a very wise decision for thesupervisor to decide not to force the issue withLeroy by attempting to immediately drag his chairback to the table. He waited till Leroy calmeddown a little and then "took the work to him" Hewanted to teach Leroy, as gently as possible, thathe could not avoid work by moving away from thetable. It's not clear why, but Leroy cooperated,at least at first.

Did Lerors cooperating work, from hispoint of view?

Not really. The supervisor said "Good workingLeroy" but then proceeded to try to get him tomove back to the table. Leroy's cooperativebehavior led to more requests to return to work.Not such a good deal from his point of view.

The supervisor decided to be a little more assertiveand said "Come on Leroy, you know you have towork," as he put his hands on Leroy's chair. Leroylooked up at the supervisor and yelled"No! No! I won't."

Leroy has learned his lesson no morecooperation. He continued to say NO!,even louder.

199

Behavior

Session 2

The supervisor quickly decided that it would be arr)stake to back down now and began to graduallydrag the chair toward the table. Leroy immediatelyslammed both his arms to the chair, just missingthe supervisor's hands. The supervisor jumpedback and said, "OK, we can't make you work, butif you don't work, you won't get paid and youdon't get a break."

Leroy finally found a "SIGN" that worked andworked quicldy, one that the supervisor clearlyunderstood. He might have been a little confusedabout why he had to yell so loud and slam hisarms repeatedly on the chair just to be heard but ifthat's -what it took to get through to the supervisorthen he would just have to do it.

Now, I don c really believe that Leroy thought allthese things, but I do believe that the above is afair description of what he was being taught by thesupervisor. He was learning that cooperation andtask completion usually lead to more taskassignments. He was learning that simple verbalcomplaints or requests for breaks had no effect. Helearned very concretely that disruptive, aggressivebehavior got him what he wanted. From Leroy'spoint of view it was the only way he could getwhat he wanted.

Immediately Leroy began to yell. He threw thebolt, breaking the window in front of his table.Then he began to cty and bite his hand and lips.The supervisor told Leroy to stop. He didn't. Theother work adjustment supervisor called for help.

1CO

Behavior

Session 2

It took four of the staff about 40 minutes to calmLeroy down, once they were able to hold him in asafe position on the floor. The staff of the ICF/MRfacility were called and after Leroy had calmeddown they took him back to the residential facility.

LEROY'S SUPERVISOR MADE A ERIOUSMISTAKE. HIS "MESSAGE" TO LEROY WAS:

"YOU MUST WORK"

"I WILL IGNORE YOUR EFFORTS TOAVOID OR ESCAPE WORK"

"THE ONLY TH7NG 'MAT WORKS AROUNDHERE IS TO DO WHAT I SAY"

Leroy did in fact discover that simply asking to quitdidn't work. He found out that minimal efforts toescape or avoid work, like moving away from thetable, also didn't work. But Leroy has a longhistory that says to him:

"ESCALATE"

"START YELLING"

"THROW ThINGS""BITE YOUR HAND""HIT SOMEONE"

101

Behavior

Session 2

These behaviors have always worked. In the !ongrun, which Leroy does not understand or caremuch about, these behaviors also have had aserious negative impact on his life. He has been i

restrained, placed in seclusion, expelled fromprograms and even institutionalized because ofthem. These behaviors have been labeled asinappropriate, maladaptive, abnormal, even crazy.However, to Leroy they work in the short term andthat is all that he understands now.

Unless we make some important changes, thesituation usually gets even worse. Leroy continuesto hit his supervisor and the supervisor, in turn,continues to restrain Leroy. Quite naturally whatlittle positive working relationship they did have isdiminished. The supervisor pays less and lessattention to Leroy unless of course he is beingdisruptive. Leroy is even less likely to have anypositive experiences at work, which in turn makesit more likely that he will try to quit or leave. evertime he is less likely to even try the non-aggressiveways of quitting such as asking for a break,simply trying to walk away, etc. these have neverworked. Leroy learns to skip these steps and movedirectly to what does work dangerous anddisruptive behavior.

You may be thinking that you would not find itrewarding to be restrained, to be expelled from api ogram. Please do not judge the situation fromyour point of view. You must learn to look at whatis happening from Leroy's point of view.

15102

e

e

Behavior

Session 2

That is not the same thing as sayilig that Leroy'sbehavior is "CORRECT" or "RIGHT." It simplymeans that if we are to understand why Leroydoes what he does, we must understand hispoint of view.

What we think of as "NEGATIVE KITENTION" mayin fact be rewarding to people with long historiesof challenging behavior.

For example it is probably true that criticism,negative ksedback, being yelled at, etc. ispunishing to most people. Whether it is true formost people is not the issue here. Leroy's point ofview is all that should be considered if we are tounderstand him.

LOOK AT THE SITUATION THROUGH HIS EYES:

Leroy does not have a positive workingrelationship with anyone at the workshop. Whyshould he care whether they are pleased with hisbehavior? Why should he change his behaviorbased on their criticism?

If Leroy behaves himself, follows instructions, doesnot cause trouble, etc., he will probably beignored. At times he may be praised for hisappropriate behavior, but that is nothing comparedto the immediate attention provided by the "crisisteam" when he is disruptive. He becomes thecenter of attend Dn, for the entire workshop.

1, C 103

Behavior

Session 2

IMPLICATIONS FOR CHANGE IN OUR SERVICES

Look back at the "VICIOUS CYCLE" diagram. It isdear that based on the understanding of thecause(s) cor behavior problems shown in thediagram that we can consider making changes in atleast two major areas, if we are to help the personchange his/her behavior. First, we can try todecrease the person's exposure to situations thatare confusing frustrating, boing, frightening, etcSecond, we can assist them in learning alternativebehaviors that also work for them, but that are notdisruptive, dangerous or confusing.

1 0 7

104

a.

o _,;\,;. \kt\"

.4k

'''','\ ,s: : '', ., I w

J

' ,'41,t,F ',

k, '',.`b'x -i

. 5 5 \ 5 2'

'** s ',Z*

w

S4', :;;:,

i?±..:S\h,, , , , ,%::

t..\

t '4' ,-5.\.?,:.4,''\' 4,4

'

' s', N,,,`,' N's' A .

s5 \ ' " ' '

- ,

-;.\-"

4r

, *\

4

,- ''''s,s

'\'' ' '4.t S'.' .

,t 4,V: :,e,44. \..k

::°5..."5:' S., l', 4

.i,A.,. S...,07.4i.

skt

4)

-:.

I

Understoadhsg Reasons for Behavior

Format

Small group activity

Tine

30 minutes

Materials

None

Behovior

Session 2

1 I 0107

Behavior

Session 2

Obfectives

upon completion of this section, studentsshould be able to:

4.1 Recognize that there are always reasonsfor why people do what they do; thereare causes for challenging behavior.

4.2 Understand that the first step to helpingdecrease behavior challenges is tounderstand the cause(s) for the behavior.

4.7 lzlok at the situation from the person'spoint of view, "listen to" the person'schallenging behavior and understandwhat the person is trying tocommunicate.

Pi108

MOAN

1. Ask students to think

of a task or activity thatthey ore required to

perform but that they

teally hate doing. Ask

several to state the task

or activity they

selected.

2. Pick a volunteer (astudent who can easily

act the role). Have the

student "act out" withyou (the instructor) the

following scenario:

The instructor tells the

student to perform the

despised activity.

The student must

communicate to theteacher that he/she

does not want to

perform the activity, but

the student may not

Behavior

Session 2

communicate verballyat all either through

speech or writing.

The instructor's job is to

totally misinterpret the

student's signals. This

role-playing should take

only a few minutes.

3. Have the studentwho performed the

role play tell the class

how he/she felt aboutnot being understood.

Explain that the feelings

are similar to those felt

by persons with

developmental

disabilities who areunabie to communicate

what's going onfor them.

4. Divide the class intogroups of two anu hove

each pair perform theactivity described in

step 2. Have eachperson act out both the

person trying to

communicate and theone not understanding

the communication, as

explained above.

5. When both partnershave performed both

roles, they should take a

few minutes to share

their experiences with

the other, particularly

how it felt to be

misunderstood.

6. Finally, ask a coupleof students to share their

experiences with the

whole group.

109

Behovior

Session 2

Supporting Looming vs. Managing liolkovior

Format

Lecture/discussion

Time

45 55 minutes

Materiels

Overheads 35 47

Handouts 6 7

Carl, Merle, Mary and the Angry Bus Driver

Kathy's Story Success Is In theEye of the Beholder

Behavior

Session 2

Objectivu

Upon completion of this section, studentsshould be able to:

5.1 Discriminate between simply managinga person's behavior, usually to decreaseproblem behavior versus supportingthe person in learning moreappropriate behaviors.

5.2 Recognize that they should always beginby attempting to support the person inlearning more appropriate behaviors bychanging services to better meet theneeds of the person and teachalternative behaviors.

5.3 Determine that often the major*PROBLEM" they should deal with is notthe challenging behavior of the person;rather it is the fact that the person hasbeen provided services which are notindividualized and do not meethis/her needs.

1 1

112

:-0

Behavior

Session 2

Session 11: Contont

CARL, MERLE, MARY AND THE ANGRYBUS DRIVER

Carl works in a group home. Mary, who is Carl'ssupervisor was very concerned about his workperformance. One of Carl's most important jobresponsibilWes is to help the men who live in thehome in preparing to go to work each morning.Carl works well with two of the men. They areready for work on time each day. The third man,Merle is a different matter. At Jeast once a weekMerle is still eating breakfast and not evencompletely dressed when the bus comes.

Mary has talked to Carl about this often, each timeemphasizing how important it is for Merle to beready for work in time to take the bus. The talksdon't seem to have helped ... twice in the lastweek the bus driver had to wait for Merle andonce he was so late Carl had to call a taxi.

Mary has developed a new plan that she thinksmay work. Today she told Carl that if in the futureMerle is late for the bus she will write an incidentreport and place it in his personnel file. If Carl getsmore than one incident report over a two weekperiod he will receive a written reprimand. If hereceives more than three reprimands in a month hewill be fired. However, if he helps Merle get readyfor work on time every day for two weeks in a rowshe will arrange for him to have spg:cial time offfrom the job. Mary told Carl that she wished thatthese procedures weren't necessary, but that shefelt like she had to implement them.

I I G

Notes

1. Read the first th;ee

paragraphs of "Carl,Merle, Mary, and theAngry Bus Driver."

113

2. Display overhead35 and ask forresponses to thequestions posed inthe story:

ar What is missing inthe above story?

ar Do you agree withMary's approach todealing with Carl's"problem" behavior?

Spend 10 to 15 minutesdiscussing thesequestions.

3. Present the nextsection of the story, andthen miew it usingoverheads 36 and 37.

114

Behavior

Session 2

QUESTION:

"WHAT IS MISSING IN THIS STORY? "

"DO YOU AGREE WITH MARY'S APPROACH TODEALING WITH CARL'S "PROBLEM" BEHAVIOR?"

You might not agree with Mary's choice of apunishment approach to changing Carl's behavior.

You might be concerned that the piocedures maynot work and Merle will continue being late andCarl will be fired.

However, there's an even more basic weakness toMary's approach to dealing with the problem. Shenever tried to find out why Carl wasn't doing whathe was supposed to do. She might have then beenable to develop a plan to help Carl succeed,based on this information.

I I 7

Behavior

Session 2

TALKING WITH CARL AND OBSERVING THEMORNING ROUTINE MIGHT HAVE SHOWN:

That Carl was afraid of Merle and ignored himas much as possible to avoid the possibility ofa fight. Because he ignored him, Merle sataround most of the morning without gettingready for work.

That Carl was not experienced in helping aperson as severely disabled as Merle. Hedidn't know how to provide Merle with thephysical and verbal cues he needed to wash,brush his teeth, get drersed, etc.

That one of the other men was taking upmost of Carl's time each morning. Althoughhe was working hard; Carl did not have thetime to help both men.

You are right if you are thinking there couldhave been many other reasons for Carl notbeing able to get Merle ready for the bus.However, it's pretty clear Mary's plan Irdnothing to do with any of them.

1 1 Q.4_ U

CI

1!5

Behavior

Session 2

MARY HAD DEVELOPED A PLAN TO MANAGECARL'S BEHAVIOR. HER PLAN INVOLVED:

Punishing him if Merle was late by puttingincident reports in his file which could lead toreprimands and eventually, to behig fired.

Rewarding him for two weeks of goodbehavior (Merle not being late) by arrangingfor time off.

Neither of these two consequences have anythingdirectly to do with whatever is causing Carl'sfailure to help Merle. Mary's plan is based on theassumption that Cads will be afraid of losing hisjob and will therefore, do whatever is Lecessary tosucceed. It might "WORK," but it has an evenbetter chance of failing Filing incident reportswon't help Carl overcome his fear of Merle. Thethreat of losing his job won't teach Carl how toprovide Merle with the types of cues andinstructions that he might understand.

Mary did not begin by trying to understand whyCarl wasn't performing as he should, which wouldhave then allowed he: possibly to develop a planto help him based on what she had learned. Youmight be thinking that none of the reasons listedabove were tnie and that Carl just needed someextra *MOTIVATION" to do his job. This could betrue, but we'll never know without asking thequestion, WHY? which Mary failed to do.

Let's look at a similar situation but this time wewill be concerned with the behrior of a personwith severe disabilities.

116

Behavior

Session 2

KATHY'S STORY SUCCESS IS IN THE EYE OFTHE BEHOLDER

Kathy was 9 years old and labeled profoundlyretarded. She has been living at a state institutionfor persons with mental retardation for the lastnine months. Each morning one of the aideswalked Kathy across the grounds to her schoolprogram. She was scheduled to stay at school untilthe early afternoon.

Kathy had lots of difficulty adjusting to the schoolprogram. During the first few months she oftencried and tried to run out of the room. Her teacher,Mr. Richards, handled these situations by ignoringher crying, as much as possible, and gentlyredirecting her back to her desk if she attemptedto run from the classroom. These proceduresworked to reduce the crying and running away.During her sixth month at school she only hadthree tantrums and attempted to run away onlyonce. However, Mr. Richards became concernedabout a new behavior that presented evenmore serious problems.

During her seventh month at the Center, Kathybegan to vomit while at school. At first it onlyoccurred infrequently but it gradually increaseduntil she was throwing up every day.

I

4. Present the first part

of Kathy's Story, using

overheads 38 and 39.

117

Behavior

Session 2

Some of the members of her team felt that shemight be overly anxious about school andrecommended that the physician prescribe a mildtranquilizer. The Doctor agreed with the requestbut the change in medication did nothing todecrease the vomiting behavior. The team thendecided to suspend her from school for a month.This of course worked perfectly to decreasevomiting behavior at school. She couldn't throw upat school unless she was actually there! However,when Kathy returned to school she immediatelyreturned to the vomiting behavior.

Hoping to get a new perspective on the situation,the teacher asked the Center's behavior specialist,Roberta Fox to visit the classroom and see if shemight be able to help. The first day Roberta visitedthe classroom Mr. Richirds described what hadbeen happening about the results of the changein medication and the school suspension. Asshe was finishing the description they heard asound, looked up and saw Kathy throwing up ather desk. She and the student who sat in front ofher were a mess.

Mr. Richards immediately called for an aide toescort Kathy back to her cottage to be cleaned upand get a change of clothes. Ms. Fox asked theteacher if what she had just seen was typical ofmost days. Mr. Richards said yes, that almost everytime Kathy threw up she had to be returned to hercottage and that often she did not return to schooluntil the next day. Ms. Fox returned the next daywith the following plan for decreasing Kathy'svomiting behavior.

1 9 1.1... A.... A.

118

Behovior

Session 2

At first it looked as though the plan might notwork. Kathy threw up repeatedly during the firstfew days. In fact, on the third day she threw up, orat least tried to throw up 23 times. However, afterthe third day things began to kip.. --ve. As thegraph shows the frequency of the ',....:ting steadilydecreased over the next 27 days and by the 30thday of the new procedures she went the entire ciaywithout vomithg. The graph below shows thefrequency of vomiting over the 30 day period. Shenever threw up in class again.Mr. Richards and Roberta Fox had accomplishedtheir objective. Kathy never threw up at schoolagain. Do you consider this a success story? Let'slook at the "SUCCESS" of the behavior plan fromthe point of view of all the people concerned.

NUMBER OF DAYS

100-ii. I s..,

119

5. Ask students toaddress the questions:

"What about Kethy?"

"Why might Ko;hy bebehaving the woyshe is?"

Stop for a 5 to10 minute

discussion on these

questions.

6. Present the

remainder of the story,

using overheads

40 46.

120

Behavior

Session 2

Mr. Richards "It certainly was a success. Theroom smells nicer. Kathy looks better. Now maybewe can get on to school work."

Ms. Fox "I was more than happy to help Mr.Richards. We eliminated the target behavior fasterthan I thought we would. Maybe I can publish thisas a research study?

WHAT ABOUT KAM-IY??

Kathy cannot talk, but pretend for a minute thatshe could. I:ow do you think she would answerthe success question' Suppose we were tointerview her on the 30th day of the new behaviorplan, the first time she went the whole day withoutthrowing up what is she going to say?

"I JUST LOVE IT HERE!"

"MY SCHOOL WORK IS VERY INTERESTINGA1.70 I AM LEARNING A LOT."

OR

"I STILL HATE IT HERE. ID STILL RATHERLEAVE. I JUST DCa'T TELL ANYONE ABOUT

IT ANYMORE ...."

Kathy is not likely to answer that the"BEHAVIOR INTERVENTION PLAN" was a successbecause nothing was done to help her withher "PROBLEM?

e Behavior

Session 2

HER "PROBLEM" WAS 'MAT EITHER:

1. She disliked/was afraid of theclassroom setting

2. Nothing at school was more interesting orengaging than being back in the day room ofher ward. The Behavior Plan did nothing tochange these "PROBLEMS." The BehaviorPlan was just that a behavior plan.

The teacher and Ms. Fox implemented a plan thatwas successful in making an improvement inKathy's behavior but did nothing to help the basicreasons behind the problem behavior. Let's look atthe situation more closely.

MS. FOX'S ANALYSIS OF ME SITUATION WASIN A SENSE CORRECT. SHE SAW 'THAT:

Kathy either did not like the classroom orwanted to be back on her ward.

Mr. Richards had "accidentally" reinforcedthe vomiting behavior by letting her leave(escape) the classroom.

Over a period of weeks Kathy learned tovomit to leave the classroom.

ignoring the vomiting (not allowingKathy to leave) would eliminate the"ACCIDENTAL" reward.

121

BehaVie7

Session 2

OVER A MIRTY DAY PERIOD KATHY GAVE UP.SHE STOPPED VOMITING.

There Is no doubt that if people are placed insituations that they find unacceptable they will tryto find a way to leave. They will often do whateverworks - tantrums, aggression, even vomiting.There is also no doubt that if you are bigger thanthey are, if yr.,11 are in control, you can make surethat nothirig woecs. That's what they did to Kathy.At first IC; ithy was successful in running from theclassroom, but then the teacher learned to beat herto the door. Later she had tantrums and sometimeswas sent back to the ward to "CALM DOWN." Theteacher was then instructed to ignore the tanuums.

One day while she was having a tantrum shechoked and threw up. The teacher immediatelysaid "Take her back to the ward, clean her up. Nomore school today, she is too upset."

Kathy didn't understand much of what the teachersaid but she did learn a new sign:

VOMITING - "I WANT TO LEAVEME CLASS IMMEDIATELY."

122

s

Behavior

Session 2

It wasn't at all clear to Kathy why the teacherrequired such an unusual sign, why he hadn'tunderstood what Kathy meant by running awayand crying both of which seemed to be moreobvious to her. But she was happy for small favorsand each day followed the teacher'sINSTRUCTIONS" by throwing up when shewanted to leave class.

Now of course I don't think that Kathy actuallythought all these things out so logically andrationally but at the same time it is an accuratedescription of the important events and alsomakes it dear where the focus of our attentionshould be. We should be most concerned withanswering the question Why does Kathy wantto leave the class?

There is no arguing with the fact that vomitingbehavior is "INAPPROPRIATE" that Kathy would bebetter off if she stopped doing it. In fact, if wereally wanted to stop the vomiting quickly it wouldprobably have been more efficient to teach her toexchange a token to leave class. Each day wecould give her a blue poker chip. If she hands thechip tu the teacher she is immediately allowed toleave the class no questions asked. In far lessthat 30 days she would probably have learned the"exchange" value of the token and use it to leaveclass rather than resorting to vomiting.

1 `' G723

#

124

Behavior

Session 2

MANY OF YOU ARE PROBABLY THINKING:

"Wait just a minute. Kathy may not be throwing upanymore, but now we have a different 'problem.'She spends very little time in school. Most days shehands in the token after only a few minutes andleav es school."

Right! Now we have the "REAL" problem. The onewe should have been most concerned with allalong, that is, the school setting eitherfrightens/disturbs her or offers her nothing moreinteresting/fun and engaging than the day roomback on the ward. Ms. Fox should have helpedKathy's teacher figure out what was frighteningKathy or how to interest her in at least someactivities in the class. That would not have been aneasy task. It was difficult to undersi.md Kathy'slikes and dislikes, except for the vomiting, andbecause of her limited experiences and profounddisabilities her interests were fairly limited. But thefact is they made only minimal efforts in thisdirection they were too focused on eliminatingthe vomiting behavior.

I I) r. ,1- t I

e Behavior

Session 2

Small - group Isre Ise for Kathy's Story

Format

Small - group c...xercise

Thee

50 minutes

Materials

Overhead 47

128 125

Behavior

Session 2

Obbmitives

Upon complaion of this section, studentsshould be able to:

5.1 Discriminate between simply managinga person's behavior, usually to decreaseproblem behavior versus supportingthe person in learning moreappropriate behaviors.

5.2 Recognize that they should always beginby attempting to support the person inlearning more appropriate behaviors bychanging services to better meet theneeds of the person and teachalternative behaviors.

5.3 Determine that often the major"PROBLEM" they should deal with is notthe challenging behavior of the person;rather it is the fact that the person 1 asbeen provided services which are notindividualized and do not meethis/hef needs.

126

Behavior

Session 2

Section Fs Content

GOALS

HAVE THE PARTICIPANTS UNDERSTAND THAT:

The teacher should have first listened toKathy and not simply set out to manage herbehavior.

There were many different ways the teachercould have changed Kathy's school programto deal with whatever was confusing orfrightening her.

We must learn to defme the success of ourprograms r. ot just in terms of how they meetour (the system's needs) but also the needs ofthe person with a disability.

1. 7rIE CAUSE(S)FOR KATHY'S VOMITINGBEHAVIOR.

What about the school setting might beconfusing, frightening, boring her. Instructthem to be specific and concrete.

2. THE CHANGES THEY MIGHT MAKE IN THECLASSROOM BASED ON THESE CAUSES.

I 3 ( i

Nehas

1 . Divide participants

into small groups of

three to six people.

2. Display overhead47 and have students

discuss the two itemslisted.

Have someone in each

group keep a written !ist

of the potential causes

and the changes thatmight be made.

Allow about 10 minu!asfor this discussion.

127

3. Have each of thegroups report on their

discussion. Use the

Small Group Discussion

overhead (47) to recordthe findings of the

groups as they report.

Allow about 20 minutesfor this discussion.

Ensure that you cover the

"general discussion"points listed here.

128

Behavior

Session 2

GENERAL DISCUSSION POINTS

Participants will probably focus on potentialnegative features of the school program.They may mention features such as:

a. The classroom activities were tooboring or too challenging, confusing,frustrating, etc.

Ask them to be specific, tri describe thespecific features that might be causingthe frustration, boredom, etc.

b. The attitude of the teacher.

c. The behavior of other students.

They may speculate that :here is nothing allthat bad about the classroom setting and thatKathy would simply rather be back on theward.

Be sure to point out that they were able to lista number of changes that the teacher mighthave made to make the school program moreacceptable to Kathy. Yet, the teacher madeonly one change she ignored Kathy'srequats to leave.

Make sure they understand the importance ofthe contingency between vomiting andleaving the classroom. They may makestatements such as:

13 i

e

Behavior

Session 2

"SHE WAS FRIGHTENED."

"THE WORK WAS TOO CHALLENGING."

"KATHY WANTED TO GO BACK TO mr. WARD."

Such statements describe only one aspect of the"CAUSE" for the vomiting behavior. Show theparticipants that the notion that the school workwas too boring/challenging COMBINED with thefact that she was able to escape or avoid the workonly if the threw up. People don't develop highrates of severely disruptive behavior simplybecause they have unpleasant feelings. Severelychallenging behavior is usually the result of theperson learning that unpleasant situations can bequickly improved if he/she resorts to disruptivedangerous behavior.

Someone may notice that this was onesituation where it was not necessary to teachan acceptable alternative behavior. Kathyknew how to express her desire to leave theroom by simply going to the door. She didnot resort to more disruptive forms ofbehavior until this simple form of request wasignored. The issue is not one of teachingKathy appropriate behavior but decidingwhere and when we will honor her requests(listen to her).

129

Beh

avio

r

Sess

ion 2

Maj

or

Poin

t It is very

diff

icul

t

to avo:

d

the

tem

ptat

ion

to desc

ribe

the

prob

lem

as

"KA

TH

Y'S

PRO

BL

EM

BE

HA

VIO

R"

whi

ch

usua

lly

lead

s

to a

man

agem

ent

inte

rven

tion

that

focu

ses

only

on the

pers

on's

chal

leng

ing

beha

vior

.

It is mor

e

diff

icul

t

to lear

n

to firS

t

ask

"wha

t

can I do to help

r

To

wor

k

to

decr

ease

the

mot

ivat

ion

for

the

pers

on to

enga

ge in the

disr

uptiv

e

beha

vior

by mee

ting

her/

his

need

for

supp

ort

and

unde

rsta

ndin

g.

It is

impo

rtan

t

to

ackn

owle

dge

that if ex

tens

ive

atte

mpt

s

wer

e

mad

e

to figu

re

out

"WH

AT

WA

S

UPS

ET

TIN

G

KA

TH

Y"

and

none of the

chan

ges

help

ed,

the

team

wou

ld

have to

even

tual

ly

addr

ess

the

issu

e

of

figu

ring

out

the

leas

t

intr

usiv

e/rr

sive

way

poss

ible

to elim

inat

e

the

vom

iting

beha

,

.or

(man

age

her

beha

vior

).

,

Thi

s

is also

true for

Car

l's

situ

atio

n

(des

crib

ed

in the

wri

tten

less

on). If C

arl's

supe

rvis

or

wor

ks

with

him

to mak

e

the

chan

ges

they felt

mig

ht

help

him do a

bette

r

job of

wor

king

with

Mer

le

and

noth

ing

seem

s

to help

she

may ne

ed to

impl

emen

t

disc

iplin

ary

proc

edur

es

(atte

mpt

to

man

age

his

beha

vior

).

But

only

afte

r

mak

ing a se

riou

s

atte

mpt

to unde

rsta

nd

his

beha

vior

and

wor

k

to

impl

emen

t

supp

ortiv

e

chan

ges.

130

0

Course Summary

Fermat

Lecture

Time

20 minutes

Metairie&

Worksheets 4 6 for practicum exercises

Handouts for all sections, including copies ofOverheads for all students

Behavior

Session 2

114131

Notes

1. Hand out to studentsthe two procticum

exercises they can dosubsequent to the class.

Encourage them to

"practice" their skill bycompleting these

activities.

2. Hand out all of theremaining student

handouts for Session 2

(and Session 1 if nothanded out at that time.)

132

Behavior

Session 2

Section CI: Cathie

This section has been developed to bring thesecond half of the session to a close with ameaningful review of the material covered in theprevious sections.

1 13

SESSION I

A. OVERHEAD 1

I. OVERHEADS 2 - 8

C. OVERHEADS 9 - 17

D. OVERHEADS 18 - 24

F. OVERHEADS 25 - 29

SESSION 2

A. OVERHEAD 1

C. OVERHEADS 30 - 34

E. OVERHEADS 35 - 47

1 P G133

Behavior Overhead 1

ALS

1 Understand that people often respond in adisruptive, dangerous mannei Decause we arenot providing supports and services that Jneettheir needs.

2. Recognize that helping another personchange his/her behavior will probably requirea comprehensive plan that deals with allmajor aspects of the person's life.

3. Recognize that, with challenging behavior,fiist individualize services to better meet theperson's needs rather than using rewardsand punishments on "TARGET BEHAVIORS."

4. Recognize that there are many causes for,challenging behavior.

5. Distinguish between simply managing aperson's behavior versus supporting her/himin learning to change through listening,negotiation and effective positive teachingstrategies.

135

0

Behavior Overhead 2

A COMMON STORY

Behavior Problem

Bob has severe tantrums. Sometimes ittakes several of us to calm him down.

Behavior Plan

0 If Bob does not comply after you ask himat least two times to "CALM DOWN,"escort him to the time out room and makesure that he stays there until he is calmat least for 15 minutes.

Results

Since the time out plan was implementedthe frequency of tantrums has beenreduced by 50%. However, he still has7 to 10 tantrums each week.

137

Behavior Overhead 3

SHOULD WE CONTINUE THETIME OUT PROGRAM?

WHAT CHANGES COTJLD WE MAKE?

FIRST, HOWEVER, YOU NEED TOKNOW THAT:

"Bob lives in the 'WRONG' place"

"Bob lives with the 'WRONG' people"

"We don't have enough staff"

"We haven't had appropriate training"

"He hates his day program at theworkshop"

- CI 1.,'1 43

a

139

0

Behavior Overhead 4

"NOW YOU KNOW THE WHOLE STORY.

WHA7 DO YOU THINK ...

WOULD INCREASING ME TIME PERIODTO 30 MINUTES BE MORE EFFECTIVE?

Mr. Louis had described five majorproblems that were probably directlycontributing to Bob's tantrum behavior.

A "TIME OUT" program will not improveany of the five problems.

01,

What right do we have to try to"make Bob behave appropriately"(shut up about what is bothering him)without first trying to meet his needs bydealing with some of the things thatare disturbing him?

141

Behavior Overhead 5

HOW MIGHT BOB BENEFIT BY THETEAM ACKNOWLEDGING THAT THERE

ARE PROBLEMS IN BOB'S LIFE THAT AREDIRECTLY CONMIBUTING TO HIS

CHALLENGING BEHAVIOR?

Once the problems are identified it may bepossible to modify Bob's service plan todeal with at least some of them now.

If the necessary changes can't be madeimmediately, it would still be possible tomaLe plans for the changes to be madeonce it does become possible.

143

Behavior Overhead 6

HOW MIGHT BOB BENEFIT?

It might help to reduce the resentment thatpeople feel when they are the target ofBob's challenging behavior.

Understanding that at least some of thereasons for Bob's challenging behavior areconditions that they (the system) helpedcreate which he probably had no choicein may help people be more supportive.

There is no doubt that everyone, includingBob, will benefit if he can learn lessdisruptive ways to show his discomfortand ask for help.

What better way to begin the teachingprocess than by first showing him that weare trying to help raake things betterfor him?

145

Behavior Overhead 7

BEFORE ASKING HIM TO CHANGE.

Is there any doubt that it would be easierto help Bob learn to handle frustration anddisappointment if they could first reducesome of the frustration and disappointmentin his life?

147

Behavior Overhead 8

2 1---Team awareof contributing

factors.

4.

If unsuccessful,increased rewards

& punishments.

1-----Results:Suspended orvery restrictive

procedures used.

149

gehavior Overhead 9

QUESTIONS TO ANSWER:

Step 1:

"What is it that 3eems to disturb, frustrate or upsetthe person?"

"Are there situations or settings that seem todisturb or upset the person?"

Step 2:

"Hew do you know that the person is disturbed orupset by these situations?"

"How did the person let you know that theywere upset?"

Step 3:

"When the person is faced with these types ofdisturbing or frustrating situations what do youthink he/she needs from other people?"

"What help or support might the person ask for ifshe/he could clearly communicate?"

151

Behavior Overhead 10

Step 1

"What is it that seems to disturb, frustrate or upsetthe person?"

"Are there situations or settings that seem todisturb or upset the person?"

Example 1:

Mary has severe hearing and visual impairments.

Is disturbed when confused about what work sheis supposed to be doing

Has trouble in making transitions from oneassignment to the next.

4 rs153

Behavior Overhead 1 1

Step 2:

"How do you know that the person is disturbedor upset by these situations?"

"How did the person let you know that theywere upset?"

Example 1:

Mary shows that she is upset or confused by bitingher hands, pulling at her hair and sometimesslumping to the floor.

155

Behavior Overhead 12

Step 3:

"When the person is faced with these types ofdisturbing or frustrating situations what do youthink he/she needs from other people?"

"What help or support might the person ask for ifshe/he could clearly communicate?"

Example 1:

A clear way to understand what task or activityshe was to be working on.

A way to know when it was time to change tasks.

They selected objects that were associated witheach task or activity and began to use them asprompts. For example: dinner plate to cue theactivity for "setting the table".

Things improved more when Mary began usingthe "communication objects" to show the staffwhat she wanted to do.

157

Behavior Overhead 1 3

Step 1:

`What is it that seems to disturb, frustrate or upsetthe person?"

"Are there situations or settings that seem todisturb or upset the person?"

Example 2:

Bob does not do well in noisy situations.He is very sensitive to loud sounds he has nocontrol over. Noisy crowds really upset him.

1.4 ;' 159

6

Behavior garerheod 14

Step 2:

"How do you know that the person is disturbedor upset by these situations?"

"How did the person let you know that theywere upset?'

Example 2:

Bob lets people know he is upset by putting hishands over his ears, yelling or running away. Hemay hit people who are noisy. Or turn his radioup to "DROWN OUT" the noise.

161

Behavior Overhead 1 1'

Step 3:

"When the person is faced with these types ofdisturbing or frustrating situations what do youthink he/she needs from other people?"

What help or support might the person ask for ifshe/he could clearly communicate?"

Example 2:

Bob would ask for people to stop making somuch noise and to be allowed to spend more timealone or with only a few people.

Boo switched bedrooms to be further away fromthe noise of the home.

Bob was shown how to use a portable radio withearphones. At work he was removed from themajor flow of noise and activity and allowed towear earphones.

163

15;1

Behavior Overhead 16

EXAMPLES OF AVERSIVE BEHAVIORMANAGEMENT:

Step 1.

Bob does not do well in noisy situation.. -

seems to be very sensitive to loud sounds,especially those that he has no control over.Crowds, especially noisy ones, really upset him.

Step 2.

Bob doesn't talk but he does let people he isupset in a variety of different wys. He may puthis hands over his ears, begin to yell and even runaway. He may attempt to hit the people who arebeing noisy. If he is in his room he may turn hisradio up to "drown out" the noise of the otherpeople in the group home.

Step 3.

Bob's radio is taken away for 15 minutes eachtime he plays it too loud. If Bob remainsagitated he is placed in the time out room untilhe calms down.

152 165

Behavior Overhead 1 7

EXAMPLES OF AVERSIVE BEHAVIORMANAGEMENT:

Step I.

Mary, who has severe hearing and visualimpairmentJ, seems to be disturbed at her dayprogram when she becomes confused about whatshe is supposed to be doing as her workassignment. She also has trouble in makingtransitions from one assignment to the next.

Step 2.

Mary shows that she is upset or confused by bitingher hands, pulling at her hair and sometimesslumping to the floor.

Step 3

Mary's teacher sprays a water mist in her facewhen she pulls her hair or yells. She is givencandy for remaining quiet.

1 " rs,167

Behavior Overhead 1 II

GREAT AND DESPERATE CURES

In the late 1800s a German neurologist publisheda book on electrotherapy. Weak electric currentswere used to "stimulate the patient's nervoussystem" and improve behavior.

....deP1,1:"111Zint

.00"11.01-

g L

Electrical stimulation device invented by Dr. John Butlerof New York. It was said to be "especially salubrious incases of rheumatism, nervous exhaustion, neuralgia andparalysis. (From Harper's, 1881)

1 t;4.. I , `....

169

Behavior Overhead 1 9

Il

NAVANE

"Everything seems to work better... including me"

"It feels good to be useful again"

For the chronic psychotic patient,Navane can mean improved

motivation and more competentwork performance.

Improvement generally occurswithout serious side effects.

171

Behavior Overhead 20

SINEQUAN(doxepin HCL)

Restores life's true colors.

Anti-depressant effectivenesswith once-a-da, dosing.

156 173

Fil I111

SIMS'

The result of a Mother's Plight.

Self-Injurious BehaviorInhibiting System

A New Concept inAversive Therapy

Extinguishes Self-InjuriousBehavior When Nothing

Else Works.

175

Behavior Overhead 22

i,nLpLPLPS

"J

D..

Lr3 Lrl Limp Lore'

No OtherRemedies ButDE Kittelson'sReduceObesity

FAT-AWAY

'Miracle Bullets'

Diet pills that are guaranteed to work!

Lose Weight-Noneed to exercise!

Fool Groat-Eat all you want!!!

Ore lor Now

Each pill costs only

IU

gu

rm

a LP Lr3 cp LP Lop

_

177

Behavior Overhead 13

PEOPLE WITH CHALLENGING BEHAVIOR

Given the above way of thinking, is itsurprising that when we are faced withhelping support a person with disabilitieswho has severe behavior challenges thatwe adopt the:

["Quick Weight Loss"Approach to Behavior Change

179

Behavior Overhead 24

NON-COMPLIANCE TRAINING PROGRAM

1 Begin a compliance trairrIng program toestablish control over Joey's behavior. Thisprogram involves:

a. 3 - 4 training sessions conducted daily.Present specific tasks that Joey cando. Compliance more importantthan meaningfulness.

b. When Joey first attempts to run away ortantrum, he should be immediatelybrought back to the on-going task andrequired to comply. Physical promptsand manual guidance may be used.

2. A time out program to reduce his aggressiveand non-compliant behaviors. Ignore sclf-injurious behavior.

3. Frequent reinforcement for his positive socialbehaviors and interactions.

6 181

Behavior Overhead 25

LEROY

Big and strong.

Labeled as moderately retarded andmentally ill.

Assigned to the work adjustment group atthe workshop.

Has the skills for real work but doesn'tget to because of his dangerous anddisruptive behavior.

MOST OF HIS TIME IS SPENT IN"MAKE WORK"

1 6:183

Behavior Overhead 26

TYPICAL WORKSHOP SITUATION:

Leroy starts on a new task that he alreadyhas the skills to complete.

After a short period of work, he begins toask for a break.

Following the behavior plan, his supervisorignores the requests.

Leroy becomes more upset.

The supervisor continues to ignore him,and Leroy moves away from the table.

He refuses requests to return to the table,so the instructor takes the work to him.

.11;:::,

185

Behavior Overhead 27

TYPICAL WORKSHOP SITUATION:

At first Leroy cooperates.

The supervisor tries to move Leroy back tothe table.

Leroy says No!

The supervisor tries again, becomes moreassertive.

Leroy yells No!

The supervisor tries to drag the chair to thetable, and Leroy slams his arms down andbegins to yell.

The situation escalates until Leroy"EXPLODES," is sent home and expelledfrom the workshop.

187

Behavior Overhead 28_

RALPH

Good natured, well-behaved.

Almost always follows instructions, younever have a problem with him.

Most community programs are designedfor people like Ralph. Look at:

PROGRAM HISTORY.

STAFF RATIOS.

STAFF TRAINING.

PROGRAM OPTIONS.

CLIENT CHOICES.

RULES/REGULATIONS.

1 R.; 189

Behavior Overhead 29

WE DESIGNEDTHE PROGRAM FOR RALPH,

AND THENLEROY SHOWED UP!

191

0

Behavior Overhead 30

UNDERSTANDING BEHAVIORCHALLENGES

BASIC ASSUMPTION:

There are always reasons for why peopledo what they do.

The first step in helping people changethei- behavior is to understand the causesfor their behavior.

Behavior Overhead 3 1

PHYSICAL CAUSES FOR PROBLEMBEHAVIOR:

Do occur but only rarely.

When in doubt, check it out.

Careful physical exams are evenmore important with people who havedifficulty communicating with us abouthow they feel.

Inappropriate use of behaviorcontrolling medication can be a causefor challenging behavior.

1n7195

1

Behavior Overhead 32

ENVIRONMENTAL CAUSES:

Our behavior is strongly influenced byour environment, especially our learningexperienc.s.

Vidous cycle:

Feel angry, confused, bored. I may...

Respond by hurting myself or others,yelling, crying. Then I discover...

Aggressive, disruptive behavior works forme.

Things I don't like or don't understand cancause me to...

Feel angry...

j (S

197

Behavior Overhead 33

Vicious Cycle

Feel angry,contUsed, bored.

may...

Things I don't likeor understandcause me to..

Disruptivebehavior works

for me.

Hurtmyself

orothers.

vr

199

Behavior Overheod 34

LOOK AT THE SITUATION THROUGHLEROY'S EYES:

Leroy does not have a positive workingrelationship with anyone at the workshop.

Why should he care whether they arepleased with his behavior?

Why should he change his behavior based0 on their criVcism?

If Leroy behaves himself followsinstructions, does not cause trouble, etc.,he will probably be ignored. At times hemay be praised for Hs appropliatebehavior, but that is nothing compared tothe immediate attention provided by the"crisis team" when he is disruptive hebecomes the center of attention, for theentire workshop.

179 201

0

Behavior Overhead 35

CARL'S STORY BRIEF REVIEW:

Cal works in a group home

Carl has trouble getting Merle ready forwork on time.

Mary, Carl's supervisor, has talked to himabout the problem. It hasn't helped.

Mary then developed a disciplinaryprocedure based on threats andreprimands (punishment).

471 203

Behavior Overhead 36

ANALYSIS:

It is clear that Mary did not make anattempt to find out why Carl was having aproblem getting Merle ready on time.

Her plan is based on the assumption thatthe only reason for Carl's "FAILURE" is thathe doesn't care enough is not motivatedenough:

The threat of punishment(reprimands and firing)

The promise of reward(increase in pay)will provide the motivation.

1 72205

Behavior Omhead 37

ANALYSIS: (CONT.)

However, if it is not a problem ofmotivation, her plan will probably fail.

Punishment for failing and rewards forsucceeding won't:

Provide Carl with the teaching skills heneeds to work well with Merle.

Solve the problem of too few staff.

Mary should have first attempted to findout why Carl was having problems andtried to help based on this.

1 7 Li 207

0

Behavior Overhead 38

KATHY'S STORY

She was nine years old. Lived at theinstitution for 9 months.

She had difficulty adjusting to herschool program. Lots of tantrums andrunning away.

These behavior problems graduallydecreased.

She began throwing up in class At firstonly infrequently, later every day.

Drugs didn't help. School exclusiondidn't help.

Most of the time she was returned to herward to be cleaned up. Often she did notreturn to school.

They developed a BEHAVIOR PLAN.

0209

Behavior Overhead 39

POTENTIAL REASONS FOR KATHY'SCHALLENGING BEHAVIOR.

CHANGES WE MIGHT MAKE:

I

211

6

Behavior Overhead 40

BEHAVIOR PLAN

SUBJECT: Kathy D.

BEHAVIOR: Vomiting behavior. Throwingup anywhere and anytimewhile at school.

BASELINE: Every day but only once perday, Kathy is usually returnedto her cottage after throwingup which artificially limits thefrequency of the behavior.

ANALYSIS: ICathy may be throwing upeither because

(1) she wants to leave theclass or because

(2) she wants to return to hercottage.

i 7 C

213

0

Behavior Overhead 4 1

The current procedure of allowing her toleave the class and return to her cottageimmediately after throwing up may beserving to reinforce the vomiting behavior.

BEHAVIOR PLAN:

We must stop the reinforcement for thevomiting behavior. From now on Kathywill not be allowed to leave the classroomand return to her cottage. She must remain

0 in the classroom until the end of theschool day. Cottage staff should provideextra clothes so that Ms. Hits can changeher clothes in the classroom. The vomitingbehavior must be ignored as much aspossible. If it is necessary to change herclothes she should not 1,Je talked to andunder no circumstances should anyone actupset. This is an extinction program.

If Kathy goes at least ten minutes withoutthrowing up, or trying to throw up, sheshould be praised (reinforced) and giventwo M&Ms.

215

Behavior Overhead 42

CHART OF FREQUENCY OF VOMITING

25

20

15

10

5

I0 II 4 . I 4 4 II 4 11114111111.11.11.! I

i 2 3 6 if id' i2 i4 i6- fg -26 22 24 27 SciNUMBER OF DAYS

17C 217

Behavior Overhead 43

All of us will have to deal with a personwnose behavior, at times, is disturbing,dangerous, disruptive.

WHAT CAN WE LEARN FROMKATHY'S STORY?

First try te understand the causes for theperson's behavior. Ask why?

Try to figure out how the behaviorworks for them.

Ask what you might be able to do to helpthe person not just eliminate the"BE avIOR PROBLEM."

Do not be satisfied with a plan that simplymanages the person's behavior.

Often a person's disruptive behaviorshould be thought of as communicationand should be "LISTENED" to.

219

Behavior Overhead 44

RESULTS:

Kathy threw up a lot at first 23 times onthe third day of the behavior plan.

Gradually over a 30 day period thevomiting was eliminated.

She never threw up in class again.

IS THIS A SUCCESS STORY?

From the point of view of the:

Teachez?

Behavior specialist?

The other studentse

IS ()221

Behavior Overheod 41

WHAT ABOUT KATHY?

Is it a success story from her point of view?

Would she say "I love it at school!"

"I wish everyone had such a nicebehavior plan!"

OR MIGHT SHE SAY:

"I still hate it here!"

"I'm still bored, frightened, confused."

"I just don't tell anyone about it anymore!!"

223

Behavia Overhead 46

LOOKING ATKATHY'S "PROBLEM" BEHAVIOR

AS COMMUNICATION:

Kathy said "I want to leave" in many ways:

She ran out of the classroom.

She had temper tantrums

The teacher was told to ignorethese behaviors.

However, vomiting did work.

From Kathy's point of view the teacherfinally understood that she wanted toleave.

In a sense the teacher "REQUIRED"Kathy to vomit in order to leave theclassroom.

It was the only "SIGN" that worked.

4L2

,225

Behavior Overhead 47

THE CAUSE(S) FOR KATHY'SVOMITING BEHAVIOR:

THE CHANGES THAT MIGHTBE MADE IN THE CLASSROOM BASED

ON THESE CAUSES:

M

227

Behavior

SESSION I

I. HANDOUT 1

C. WORKSHEET 1

D. HANDOUTS 2 - 3

F. HANDOUT 4

0. WORKSHEET 2 - 3

SESSION 2

B. WORKSHEETS 2 - 3

C. HANDOUT 5

E. HANDOUTS 6 - 7

0. WORKSHEETS 4 - 6

1R4 229

Worksheet 1

Step 1:

A Common Story

WHAT IS IT THAT SEEMS TO DISTURB, FRUSTRATE OR UPSET THE PERSON?

ARE THERE SITUATIONS OR SETTINGS THAT SEEM TO DISTURB OR UPSETTHE PERSON?

Stop 2:

HOW DO YOU KNOW THAT ME PERSON IS DISTURBED OR UPSET BYMESE SITUATIONS?

HOW DID ME PERSCN LET YOU KNOW MAT THEY WERE UPSET)

1 5 23 i

Stop 3:

WH EN ME PERSON IS FACED WITH THESE TYPES OF DISTURBING ORFRUSTRATING SITUATIONS WHAT DO YOU MINK HE/SHE NEEDS FROMOMER PEOPLE?

WHAT HELP OR SUPPORT MIGHT ME PERSON ASK FOR IF SHE/HE COULDCLEARLY COMMUNICATE? (MAKE SUkE MAT YOU MY TO ANSWER FROMTHE PERSON'S POINT OF VIEW-NOT FROM ME POINT OF VIEW OF WHATYOU MINK HE/SHE NEEDS).

,

232

Worksheet 2

PURPOSE:

Ralph's Story In-class Exercise

To gain expeeence in looking at the world from the point of view of the personwith challenging behavior. To help in understanding why challenging behavioroccurs, which is the first step in helping the person change his/her behavior.

DIRECTIONS:

1. Select a person you know well who has been labeled as having challengingbehavior.

2. Develop an explanation for the person's challenging beha vior from her/hispoint of view. Try to understand and be able to explain why the personoften engages in the challenging behavior. Look at the situation from theperson's point of view. Why would the person say, if he/she couldcommunicate clearly and accurately, they did what they did?

YOU COULD LOOK AT FACTORS SUCH AS:

Have there been inconsistencies in staffing, scheduling that are difficult forthe person to undeistand and accept?Are there situations that we know the person has a difficult time dealingwith such as crowds, loud noises etc. but are still a part ofher/his everyday life?How much choice does the person have over who they live or work with?Does he/she have any real friends? Especially friends who advocate onbehalf of the person?How well do we do at communicating with the person?How well do we understand the person's attempts to communicate?How much of the person's program really reflects his/her individual needs?

From the person's point of view, from his/her own experience, does thechallenging behavior work? Does it help the person gain what they want? Escapefrom or avoid what they do not want or like?

187 233

MOST IMPORTANT:

Does the person really have any other options or choices that also work, or, isher/his situation similar to Leroy's? Leroy didn't know of some of the options thatmight have been available to him. He might have been able to complain to hiscase manager or his legal rights representative but he didn't know he could.However, he did know that saying he didn't want to work, even asking repeatedlyto stop, did not work. From his point of view disruptive and aggressive behaviorworked almost every time.

We might be able to see that 1- '...s aggressive behavior also caused Leroy lots ofproblems, but when you have -to other alternatives you go with your experienceand usually continue with what has worked most of the time.

3. Use the following space to record your conclusions.

4. Prepare to explain the reasons for the person's challenging behavior to yourfellow students.

234

s

Worksheet 2 continued

AS YOU ThINK ABOUT WHAT YOU ARE GOING TO SAY,KEEP THE FOLLOWING POINTS IN MIND:

Please talk for the person. In other words, use first person statements. Uselanguage like "I sometimes do the following things ," "The reasons Ioften bite my hand are " This may seem awkward at first, we are all moreused to talking like "The client's challenging behaviors are ...." or "Thelearner has behavioral difficulties because of the following ..." but it is veryimportant that you present the person's case as exactly as you aiink theywould, if they could.

Don't worry about coming up with solutions or answers as to how to dealwith tka c: challenging behaviors yet. In this exercise we are simply trying toimprove .)ur understanding of the causes or reasons for challengingbehavior. .`or.'t let anyone convince you that your understanding must bewrong simpi, vcause you don't have a ready solution to the problem.

This is not a debae and there are no obvious right or wrong answers.

IMPORTANT NOTE:

Keep in mind, we are not trying to condone or apologize for the person'sdisruptive or aggressive behavior. We are simply trying to understand why theperson engages in the challenging behavior.

To say "I understand why Leroy acts so disruptive and sometimes dangerous" isnot the same as saying "I accept his behavior it's O.K. for him to hurt others."

Listening to, undustanding and in a sense respecting the person's reasons forhis/her behavior, is the first step toward helping the person make more adaptive,less dangerous choices.

I.R9235

Worksheet 3

Ralph's Story Practicum

Trying to understand why people engage in challenging behavior by looking atthe world from their point of view.

PROCEDURE:

I. Choosc at least two different situations in whk h the person you selectedengaged in behavior ihat was disruptive or possibly dangerous.

2. Use the space provided on these two pages to document potential reasonsfor the challenging behavior, from the point of vicw of the person.

YOU COULD LOOK AT FACTORS SUCH AS:

Have there been inconsistencies in staffing, scheduling that are difficult forthe person to understand and accept?Are there situations that we know the person has a difficult time dealingwith such as crowds, loud noises, etc., but are still a part of heilhiseveryday life?How much choice does the person have over who they live or work with?Does he/she have any real friends? Especially friends who advocate onbehalf of the person?How well do we do at communicating with the person?How well do we understand the person's attempts to communicate?How much of the person's program really reflect; his/her individual needs?

SITUATION 1:

Briefly describe what happened (who did what to whom?)

If the person could communicate clearly what might she/he say were thereason(s) for the problem behavior?

190 237

Describe facts about the person's life, things you know about the services that areprovided to support what they have to say.

SITUATION 2:

Briefly describe what happened (who did what to whom?)

If the person could communicate clearly what might she/he say werethe reason(s) for the problem behavior?

Describe facts about the persons life, things you know about the servicesthey are provided that support what they have to say.

Be ready to describe what you have learned to the other studentsand defend your conclusions.

238II),

Worksheet 4

EXAMPLE 1:

Management vs. ListeningPracticum Exercise

Select a person with challenging behavior that you know well.

Think back about the person's past, look through appropriate records andidentify at least one example of when the person'ss challenging behavior wasmanaged rather than "LISTENED TO" when a plan involving rewardsand/or discipline was used to decrease the person's challenging behaviorwhich was not based on the causes for the person's behavior.

Document:

A description of the challenging behavior

A description of the behavior plan

The results of implementing the plan

Any ideas you have about the potential causes for the challenging behavior andwhat might have been done to help rather than implementing the b.!havior plan

1 92 239

240

EXAMPLE 2:

Using the same person as above, or picking a new person whom you alsoknow well, identify at least one example of when the person's challengingbehavior was "listened to" rather than managed when a plan based on thecauses for the person's behavior was implemented.

Document:

A description of the challenging behavior

A description of the changes staff made in setting, activities, demands, schedule,etc. to better meet the needs of the person

The results of implementing the plan

Ideas you have about why the plan wol ked, if it did or did not succeed.

..:.1.- 0

Worksheet 5

Management vs. ListeningPracticum Exercise 1

DESCRIPTION OF ME CHALLENGING BEHAVIOR

DESCRIPTION OF ME BEHAVIOR PLAN

241

242

RESULTS OF IMPLEMENTING THE PLAN

IDEAS YOU HAVE ABOUT THE CAUSE(S) FOR THE CHALLENGING BEHAVIORAND WHAT MIGHT HAVE BEEN DONE DIFFERENTLY TO HELP THE PERSON

-: c -.;... t.)

Worksheet 6

Management vs. ListeningPracticum Exercise 2

DESCRIPTION OF THE CHALLENGING BEHAVIOR

DESCRIPTION OF THE PIAN TO HELP/SUPPORT ME PERSON

19 c 243

eRESULTS OF IMPLEMENTING THE PLAN

IDEAS YOU HAVE A71UT ' 7HY THE PLAN WORKED, IF IT DID NOT SUCCEED.

244 1 0P-7

Handout 1

A Common Story

At a regional training conference several years ago, the organizers arranged for anevening session during which the participants could tallc informally with thepresenters about working with people with challenging behaviors. Theparticipants wanted to describe the problems they faced and hoped that thepresenters u ould have something to share that might help them do a better jot

The presenters were not sure they helped anyone that night. But they learned avery important lesson. They learned the lesson because five different people toldthem the "same" story. The specifics of each story were of course different - butthe fundamental message was the same. Here is what happened.

Each participant began his or her story by describing a person with challengingbehavior. Each person was different, as were their behaviors. One fellow wasdescribed as having severe temper tantrums, a woman hit herself in the headrepeatedly, a student bit and kicked other students, etc. Each was the subject of abehavior plan designed to decrease or eliminate the challenging behavior.

O FOR EXAMPLE:

The man with the severe temper tantrums was being forced to sit alone inan empty room for 15 minutes if he cried (a time out program).

The woman who was self-injurious was ignored when she hit herself (anextinction program). She was frequently praised when she did not hit herself.

The student earned tokens when he did not act aggressively towards otherstudents and was denied access to his favorite activity when he did (aDRO/punishment program).

Each of the participants explained that they were not totally happy with theresults of the plans. The behavior of some of the people had improved after theplans were implemented, but not enough to be satisfied with the results.

For example, one of the participants (Mr. Louis) worked in a group home and hedescribed a man (Bob), with severe temper tantrums. He said that while the timeout program had reduced the frequency of temper tantrums by 50%, Bob was stillhaving seven to ten tantrums each week. The tantrums were described as aserious problem. Mr. Louis said that if it weren't for the tantrums Bob could moveto an apartment living program which he really wanted to do.

245

Mr. Louis wanted to know if the program was appropriate for Bob - had anychance of working more effectively, etc. But first, he said "Wait, before youanswer, there are a few more things you need to know about Bob."

YOU NEED TO KNOW MAT:

"Bob lives in the 'wrong' place.°

He used to live in an apartment of his own but he lost his job and couldn't affordto stay there. Our group home was the only available placement.

"Bob lives with the 'wrong' people.°

The other men in the group home all have mental retardation and 'ire far lessskilled than he is. He refuses even to admit that he is mentally retarded and wantsnothing to do with his housemates.

"Ws don't have enough staff."

In addition to the tantrums, Bob steals from his housemates. We don't haveenough staff to provide for appropriate supervision.

"We haven't had appropriate trabsing."

Bob has yew limited speech, but hardly any of the staff know how to sign. Thepsychologist says that Bob has serious mental health problems - we dor't knowwhat that means.

"He hates Ms day program at the workshop."

When Bob lived in the apartment he had a good job v. orking for a landscapingcompany. He lost that job when he was moved to the group home. He couldn'tget to work on time from our side of town. He hates "sit down-packaging"type work.

"Now," said Mr. Louis, "you know the whole stoiy. Anyway, we've been thinkingof doubling the duration of the time out period from 15 to 30 minutes. What doyou think? Might that workr

246

Handout lcontinued

I am not trying to make fun of Mr. Louis. His question about increasing the timeout period might have been misguided but it was sincere. However, he had justclearly described five major problems in Bob's life each of which was probablycontributing directly to temper tantrums. He did not seem to see that the time outprogram, no matter what the duration, had nothing to do with, and could not helpcorrect, these problems.

The presenters didn't know what to say. It wasn't simply that increasing the timeout period to 30 minutes was doomed to fail. Maybe if Bob was really afraid of, orhated the isolation, he would have fewer tantrums. There is no doubt that if weare "bigger," more "powerful" than Bob we can probably devise a sufficientlyaversive procedure so that he will learn to stop telling us about what bothers him.No matter how troubling it is to him to live where he is not happy, to live withpeople he dislikes, to work at a job he fmds boring and low paying, we canprobably devise a reward or punishment procedure to shut him up.

But will we or Bob have gained much? Is there any reason to be happy if the timeout program does succeed in eliminating the temper tantrums? Should wecelebrate the fact that we have found a way to force a person to live where hedoesn't want to, with people he dislikes and to work each day at a job he hatesbut at the same time keep quiet about it?

Of course, the details of each of the other participants' stories were different. Buta fundamental theme ran through each of the five stories.

20o247

248

STORY THEMES

2. Team awareof contributing

factors.

4.

If unsuccessful,increased rewards

& punishments.

6.'..----Results:

Suspended orvery restrictive

procedures used.

Handout I continued

1. Person with a disability engages in behaviorthat is disruptive, harmful, dangerous (challenging behavior).

2. Members of the service planning team are usually aware of factors in theperson's life that are contributing to the challenging behavior.

3. A Behavior Plan is implemented to decreasethe targeted behaviors. The Plan usually involves some combination of thefollowing:

Eliminating any reinforcement for the "PROBLEM" behavior (extinction).

Making sure that the consequences of the target behavior areunpleasant, through the we of privilege removal, restrictions, painfulstimuli, etc.

Providing powerful rewards for not engaging in the"PROBLEM" behavior.

4. If plan does not produce the desired chark;es,the "POWER" of the rewards and punishers is increased. More aversiveconsequences are I Td. I:erns and activities even more important to theperson are withheld, to be given later as rewards for appropriate behavior.

5. Throughout the process, factors that are dearly influencing the perso, i'sbehavior such as where they live, with whom, activity schedules, choices,etc., remain largely unchanged.

6. Far too often the results are:

There is not sufficient improvement in the challenging behavior and theperson is sl.:spended from the service program.

The behavior plan is "SUCCESSFUL", but only after very restrictiveprocedures are implemented.

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All of the participants showed, in the telling of their stories, that they were aware,at least at one level, that a number of factors were contributing to the person'schallenging behavior. However when it came to actually doing something to help,they acted as if they did not understand. Surely none of the members of Bob'sservice planning team believed that he was having severe temper tantrumsbecause he had been "DEPRNED" of time out. In the past, didn't they understandthat the use of time out, for whatever duration, would do nothing to alleviate theproblems caused by his placement in the group home and work assignment?

YOU MAY BE THINKING:

"So what? What is to be gained by acknowledging these other factors? Hcw willthis help Bob?" Well, of course there is at least one obvious benefit. If the teamclearly acknowledged that Bob's residential and work placement we-e notmeeting his needs, that they needed more trained staff, etc. they or someone elsejust might do something about it! People who know a person well and arepersonally committed to supporting the person can often develop a plan, centeredon the specific needs of the person, and help make the kinds of major changesnot one of them believed was possible.

But you're right if you are thinking that it is often not possible to make immediatechanges, even though they may be desperately needed. A very real absence ofavailable alternatives probably did "FORCE" the team to accept Bob's initialplacement at the group home and workshop. At the time there probably was notenough money to pay for extra staff or more training. However, unless the teamexplains, in Bob's plan, that they feel that his challenging behavior is at leastpartially caused by their weaknesses (inappropriate placement, lack of training,etc.) the needed changes may never be made, even if they become possible. Forinstance, if funds do become available, why would the administrators of theagency which serves Bob hire extra staff or arrange for advanced staff training ifthey believe that Bob simply needs a more poweiful behavior plan? If theysee theissue as only "BOB'S PROBLEM" not "OUR PROBLEM."

250

Handout I continued

Even if it seems necessary to accept the current situation for the foreseeable futureit is still important to acknowledge that we are part of the problem, not just Bob.Have you ever noticed how despite your best intentions you find yourself feelingresentful towards a person with challenging behavior? Especially ifyou have beena target of their "CHALLENGE?" Ever been mad at the person when a plan that"OUGHT TO WORK" is failing? Clearly some of this is just human nature. It showsyou care. But, if we were honest, we would admit that far too often we hold theperson responsible for actions that are clearly controlled by conditions we havehelped create. Bob did not pick the group home or his housemates. He did nothave a chance to vote on the tax levy that failed, causing a cut in the new staffpositions.

Clearly acknowledging our (the system's) role in contributing to Bob's challengingbehavior should help decrease 01 li resentment and increase our motivation tomake the changes necessary to be more supportive of Bob and design the kind ofindividualized services that are necessary to meet his needs.

2 0 .`,.

251

Handout 2

Grout and Desperate Cures

The history of human services is fill, xl with many different ways we have triedto "CURE" people with disabilities especially people with disrupth e, dangerous,challenging bthavior. Valenstein has written a book titled "GREAT ANDDESPERATE CURES" that provides examples such as:

In the late 1800s a German neurologist published a book on electrotherapy.Weak electric currents were used to""stimulate the patient's nervous system"and improve behavior.

111.11110.E_

te.

elecuiml stimulation device invented by Dr. John Butler of New York. Itwassaid to be *especially salubrious in cases of rheumatism, nervous exhaustion,neuralgia and paralysis. (From Harper's, 1881)

205253

Hydrotherapy, which involved baths, douches, wet packs, steam and hoseswas also used frequently in the early 1900s.

In the late 1800s, a psychiatrist inoculated patients in mental hospitals withvaccines of tuberculosis, typhoid fever, malaria and other infectious diseases.His theory was that high fever, brought on by the infections, cured hispatients. He became very famous and was also very wrong.

Later hot baths, hot air, radiothermy, infraredlight bulb cabinets and specialelectric "mummy bags" were also used to induce high body temperatures. These"treatments" were less deadly but did little other than make the people very hot.

Sleep therapy or "prolonged narcosis" was used in the 1920s and 30s. Drugswere used to keep patients in mental hospitals unconscious, usually tor oneor two weeks sometimes as long as a month. "Cure" rates of 70% to 80%were reported.

Other therapies have included:

Using small doses of cyanide to stimulate the nervous system inducingaseptic meningitis

Hypothermia, cooling the body

Electroconvulsive therapy

Lobotomies

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n 0 c

Nandout 2 continued

BEFORE YOU MINK TOO HARSHLY OF OUR A. :CESTORS LOOKAROUND, NOW. WHAT ARE OUR "GREAT AND DESPERATE CURES"?HERE ARE JUST A FEW EXAMPLES:

NAVANE

"Everything seems to work better ... including me"

"It feels good to be useful again"

For the chronic psychotic patient, Navane can mean improvedmotivation andrnore competent work performance.

Improvement generally occurs without serious side effects.

SINEQUAN (doxepin HCL)

Antidepressant effectiveness with once-a-thy dosing.Restores life's true colors.

SIBIS"

The result of a Mother's Plight.

Self Injurious Behavior Inhibiting System

A New Concept in Aversive Therapy

Extinguishes Self-Injurious Behavior

2 (17 255

The need to find ME "KEY TO ME PROBLEM," the "ONE THING THAT WILLSUCCEED" is dearly with us still today. This notion of a quick, dramatic solution,is not limited to the field of huma . services. Look at the advertisement on back.

JEEP EP LPJJJJJDS------aq No MIr

Dr.

IthReduce

Obesity .6etaJ

FAT-AWAY

"Miracle Bullets" B.

Diet pills that are guaranteed to work! rgi

Lose Weight-Noneed to exercise!

1'

Fool Great-Eat all you wanell

Order NowSEach pill costs only

$ 1 0.00 ia LIPPEPLP cnclaricidP dEPLITi

256

Handout 2 continued

ANYONE WITH EW'N A BASIC UNDERSTANDING OF NUTRITION KNOWSTHAT THE WAY TO STAY HEALTHY, KEEP CONMOL OF YOUR WEIGHT IS TOFOLLOW ThESE 3UIDELINES:

Eat well balanced meals.Don't eat too much.Exercise regularly.Get enough slap.Don't smoke.Drink, if at all, only in moderation.

We all know that these guidelines are true, yet many of us often act as if theyAreren't. We eat too much. We smoke. We drink too much alcohol.Our major recreation is watching other people exercise on T.V.

We know the guidelines are true but we also have experience that says they aredifficult to follow.It is one thing to know that you should not eat too much and it's another thing tosay NO to the banana cream pie.

We want n e advertisement on the overhead to be true. If it were true we couldignore the nutrition/exercise guidelines and just buy the'MAGIC BULLET" diet pills. This kind of thinking maintains our multi-billiondollar diet industry.

It is true that a sensible diet can help some people, some of the time. It mighthelp a person lose weight - but we all know that to maintain our health takes alot of work and requires us to look at and possibly change many different aspectsof our life. Still, we hold out hope for the special, miracle diet. Some of you areprobably wond2ring right now, about how you might order the "FAT - AWAYMAGIC BULLETS," even at $10 a pill.

2 r257

PEOPLE WITH CHALLENGING BEHAVIOR

Given the above way of thinking, is it too surprising that when we are faced withhelping support a person with disabilities who has severe behavior challenges thatwe adopt the:

QUICK WEIGHT LOSS APPROACH TOBEHAVIOR CHANGE

There is a very strong parallel between the concept of a diet and that of abehavior plan. The ideal diet is one that requires very little of the user few, ifany, major changes in eating habits, no exercise but still produces quick,dramatic results.

Similarly the "IDEAL" behavior plan is one that requires very little change in our(the system's) behavior. It is easy to implement, yet results in quick, dramaticreductions in or elimination of behavior problems.

Just like our interest (obsession?) in finding a miracle diet can cause us to ignorereal problems such as over eating, lack of exercise, etc. the use of a "BEHAVIORPLAN APPROACH" to supporting people with severe behavior challenges helps usignore real issues in the person's life that need our attention. Look at the storybelow.

4.. ,., ti

258

Handout 3

Joey's Story

Joey was ten years old. He went to school in a class designated for students withmental retardation and "SEVERE BEHAVIOR DISTURBANCES." Joey, like the otherboys and girls in the class, was often involved in hitting, kicking and crying. Inaddition, Joey usually did not follow the instructions of the teacher. Because ofthis behavior he had been labeled by the school psychologist as "EXTREMELYNON-COMPLIANT"

Joey was sent to a university diagnostic center for further evaluation. Theevaluators agreed that he was indeed "NON-COMPLIANT' and recommended thebehavior plan that follows.

NON-COMPLIANCE TRAINING PROGRAM

1. Joey's parents and school staff begin a compliance training program as a firststep in establishing control over his behavior. This program involves:

A. 3-4 training sessions lasting about 10 minutes should be conducteddaily. During these sessions specific tasks that you know Joey can doshould be presented. The meaningfulness of the tasks is secondary torequiring compliance to demands of the task situation.

B. When Joey first attempts to run away or tantrum he should beimmediately brought back to the on-going task and required to comply.Physiml prompts and manual guidance may be used to guide himthrough the task. A new activity should not be introduced until he hascomplied with the original task. Reinforcement should not be givenuntil the entire task is completed.

2. A time out program should be implemented in order to reduce his aggressiveand non-compliant behaviors. His self-injurious behavior should be ignored.If he becomes aggressive or repeatedly refuses to comply to demands, heshould be escorted to the time out room and be required to remain in theroom for a minimum of 10 minutes.

3. He should receive frequent reinforcement for his positive social behaviorsand interactions.

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Their plan was based on the assumption that the only problem to be solved wasJoey's BEHAVIOR (not following instructions and refusing to behave himself) andthat the solution could be as simple as the implementation of a behavior plan. Theevaluators believed that the school staff could "FIX" Joey (teach him to becompliant) in only 30-40 minutes of training each day. There was no need toneed to change anything else just implement the behavior plan (diet) and hisproblem wou!d be solved.

Similar to the way special diets ignore the principles of good nutrition this type oflimited behavior plan ignores the fundamentals of good teaching. The members ofJoey's evaluation team apparently did not attempt to answer any of the followingquestions:

Does Joey trust his teacher, feel safe in the classroom?

Does Joey enjoy any of his classroom activities?

Does Joey get to choose any of his assigned activities?

Are the assigned tasks too challenging? ..too boring?

Does Joey know how to say "No" in any other way than by being aggressiveor disruptive?

Would Joey's teacher honor his saying "No" if he weren't aggressive?

There are of course many more questions we would ask if we were making aserious attempt to understand why Joey behaves the way he does and to thendevelop a teaching plan that calls for changing all the relevant factors. We wouldbase our plan on an understanding that:

1. We (the system) are the ones who will have to change the MOST.

2. We will have to change FIRST, if Joey is to be helped. We would understandthat much about the classroom environment may need to change, not justJoey's behavior.

Handout 3 continued

After deciding not to implement the behavior plan the school staff spent time inJoey's class, trying to get an over-all picture and not just focusing on his"NON-COMPLIANT" behavior. His parents and staff asked questions such as:

What does Joey like to do?

What does Joey do well?

What real choices does Joey have?

What mistakes have we made in the past?

Are we repeating them now?

WHAT THEY FOUND WAS INTERESTING. FOR EXAMPLE:

Joey's teacher admitted that in her opinion, "Joey did not like any of the1111 tasks he was assigned in the classroom."

He did enjoy recess and music class, but had been excluded from bothbecause of his disruptive behavior.

Joey's teacher said she allowed him to choose most of his educationalassignments. Hlwever, she admitted that the only real choices presented toJoey were to:

(I) Do something he did not want to do, when asked by the teacher.

(2) Refuse the teacher's request.

The teacher aide almost never ASKED Joey to do things. He usually TOLDhim what to do, in a very demanding tone of voice.

Mike, the student who sat next to Joey, had frequent temper tantrums andalso often refused to follow the teacher's instructions. Mike's tantrumsseemed to keep Joey on edge and it seemed like he might be imitating someof Mike's more aggressive behavior.

2 1 3 261

BASED ON THESE OBSERVATIONS ME SCHOOL STAFF MADE A NUMBER OFCHANGES IN THEIR TEACHING AND SUPPORT PROCEDURES. FOR EXAMPLE:

It was not possible, at that time, to move Joey to a class where he couldspend more time with students who would serve as better role models.However, they were able to arrange for Joey to spend more time in otherclassroom settings especially gym class and music.

It took extra staff to make these arrangements work, but they showed theschool administrators that they had already been using extra staff tointervene in crises created by Joey's aggressive behavior.

The teacher arranged for a few new classroom activities, based, on choicesmade by Joey. The activities weren't clearly "EDUCATIONAL" but stafffigured that once Joey was happier about being in class they could graduallyintroduce more educationally oriented activities.

The aide tried to be more supportive and made less demands on Joey. Helearned to ask rather than command.

Now of course these and the other changcs implemented by the staff did notresult in immediate, dramatic changes in Joey's behavior but then neither wouldthe compliance training behavior plan. The staff came to see that there would beno quick solutions, no "GREAT AND DESPERATE CURE" for Joey.

They also understood that Joey needed to change too. They knew that if Joeycould learn to follow instructions more consistently, to complete tasks that werenot always the most interesting thing to him, that they and Joey would be betteroff. They knew they needed to help him learn to deal with delays in getting whathe wanted, to handle frustration without being so disruptive.

With this in milid they also implemented a new teaching program that focused onhelping Joey learn alternatives to dinuptive and dangerous behaviorwhen he wasfrustrated or angry. The teacher showed Joey how to raise his hand and ask forhelp instead of yelling.

262

Handout 3 continued

Given Joey's difficukies in learning new skills his teacher knew that justdemonstrating appropriate behavior and waiting for Joey to behave himself wouldnot be enough so;

1. He had other students model the appropriate behavior.

2. He shaped Joey's behavior by at first enthusiastically rewarding anybehaviors he showed in frustrating situations that were less disruptive oraggressive.

3. He rewarded Joey for following directions and completing tasks by allowinghim to shift to preferred activities rather than by giving him even more workto do.

The staff realized that this would take some time to accomplish and would requireeveryone that worker' with Joey to be supportive.

Looking sack at the initial compliance training plan they wondered how any of themcould have believed that 10 minute training sessions to "FORCE" compliance couldhave ever been successful. Even worse, what if they had implemented the Plan andJoey had eventually been forced to comply? Now understanding how far they hadbeen from meeting Joey's needs, would that really have been a success?

2 1 5263

Handout 4

Ralph's Story

EVEN THOUGH THIS IS RALPH'S STORY, FIRST YOU NEED TO LEARN ABOUTA FELLOW NAMED LEROY.

LEROY

Leroy is 38 years old, about 6'2" and weighs about 195 lbs. He enjoys wearingsleeveless Tshirts, denim ov..ralls and big, black army boots. Leroy has beenlabeled as moderately retarded and also having schizophrenia.

People who know Leroy well are not sure about these labels, but it is clear that hefinds it very difficult to learn new tasks, has great difficulty expressing himself anddoes, at least at times, seem to be confused by voices that he hears "in his head."The people in Leroy's life all agree that they have a very difficult time gettingalong with him.

While at times Leroy shows a good sense of humor and can be cooperative, mostof the time he fails to complete his work assignments, refuses to follow simpledirections, often picks on and steals from other clients and has already injuredtwo staff at the workshop and one at his group home. There are times when stafffeel that they must hold him to protect him or someone else it takes three orfour of the strongest staff to hold him safely.

Looking closer at the workshop Leroy attends might give you a betterunderstanding of his situation.

LEROY ATTENDS ME AJAX INDUSTRIAL CENTER BECAUSE:

1. Its catchment area includes the ICF/MR residential program he recentlymoved to.

2. His vocational rehabilitation worker decided that he was not appropriate fortheir services, because of his disruptive behavior.

3. It was the only program that would accept him.

216265

Even though everyone agreed that his skills and past work history clearlyindicated that, in most ways he fit their criteria for the competitive or supportedwork program, the team decided that he should be placed in the work adjustmentprogram. At this workshop, clients are placed in the work adjustment program ifthey are considered not to be "READY for more advanced programs either due toskill deficits, or as in the case of Leroy, because of "SEVERE BEHAVIORPROBLEMS." There are seven other clients in Leroy's group which is supervisedby two staff.

Leroy spends most of the day assigned to "WORK" tasks that are similar to thecontracts that he may some day "GRADUATE" to. However, both Leroy and hissupervisors know that he does not do real work. In fact, the items that Leroypackages are unpacked by a woman working at another table in the workadjustment area. He then has the task of putting them back in the boxes again.

What happened yesterday is a good example of the problems that occur at theworkshop. When Leroy first sat down at his table in the work adjustment roomthe supervisor told him he would be working on a new job. The workshop hadobtained a nev contract, and he wanted Leroy to learn to complete one of theassembly tasks required in the contract work. The supervisor placed a pile ofbolts, nuts, washers and bags in front of Leroy.

From the beginning, it was clear that Leroy did not need to "LEARN" the task. Hequickly assembled three bolts and placed them appropriately in the parts bag. Thereal question was not whether Leroy could learn to do the task he already knewhow but rather whether he would do what he was told, when he was told,without being disruptive or hurting himself or anyone else.

Leroy worked steadily for about 15 minutes, then he began to ask for a break. Thebehavior plan developed for Leroy classifies his requests for breaks asinappropriate avoidance behavior and calls for the staff to ignore him and ifnecessary, redirect him back to the task. The staff member followed the plan andsimply ignored Leroy's repeated requests to "take a break," "get a cup of coffee,""go to the bathroom." Leroy's requests had no visible effect on the supervisor,although he did praise him the few times he did return to work.

1.1

266

Handout 4 continued

After about 15 minutes of having his break requests ignored, Leroy said, "I'mquitting ... you can't make me work," and shoved his chair back from the table.He sat there glaring at his supervisor. The supervisor ignored Leroy for about 10minutes and then quietly asked him several times to "Please go back to work."The first time Leroy said "No!" later he simply ignored the supervisor.

The supervisor was experienced enough to know that it .,1/4.-,1d be a mistake to tryto force Leroy's chair back to the table. He knew that it coulL . -ult in a real fightso he decided to take the work to Leroy. He picked up one of the bolt assemblies,held it in front of Leroy and asked him to please go back to work.

At first Leroy ignored him, but after a i-ew minutes he grudgingly completed thebolt assembly. Thinking that it might now work, the supervisor said, "Let's moveyou back to the table." Leroy immediately said "No!" The supervisor decided to bea little more assertive and said "Come on Leroy, you know you have to work," ashe put his hands on Leroy's chair. Leroy looked up at the supervisor and yelled"No! No! I won't." The supervisor quickly decided that it would be a mistake toback down now and began to gradually drag the chair toward the table. Leroyimmediately slammed both his arms to the chair, just missing the supervisor'shands. The supervisor jumped back and said, "OK, we can't make you work - butif you don't work, you won't get paid and you don't get a break."

Immediately Leroy began to yell. He threw the bolt, breaking the window in frontof his table. Then he began to cry and bite his hand and lips. The supervisor toldLeroy to stop. He didn't. The other work adjustment supervisor called for help.It took four of the staff about 40 minutes to calm Leroy down, once they wereable to hold him in a safe position on the floor. The staff of the ICF/MR facilitywere called and after Leroy had calmed down they took him back to theresidential facility.

Later that day at a special team meeting, Leroy was suspended from the workshopfor the rest of the week. The behavior specialist was instructed to develop a morepowerful behavior program and be ready to implement it by the time Leroyreturned next Monday.

Now we can move on to Ralph. Don't forget what we've learned about Leroy. Wewill come back to him later.

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268

RALPH

Something is missing at the agency where you work! No matter where you work,whether at a group home, workshop, supported work program, etc. What'smissing is an 8x10 color picture of Ralph!

Ralph is 24 years old, about 5'4* and weighs in at about 155 lbs. He takes greatpride in his appearance button down collars pressed pants much betterdressed than most of us.

Ralph has Down Syndrome which makes it harder for him to learn, limits hisability to generalize what he has learned to new situation:, and has resulted in himbeing much shorter than he would like he plays a lot of baskethall.

Ralph is very good natured he smiles a lot and is very easy going. "ou mighteven say that he is "OVER" compliant. As a matter of fact you could walk up toRalph at the workshop and ask him to run around the room four times in a row.He probably would do it without a question even if he had never metyou before.

You never have a problem with Ralph. He may not be the fastest worker at theshop, but he is reliable and very seldom complains.

You may be wondering why you need a picture of Ralph for the lobby of yourworkshop or above the fireplace at home. Sure Ralph is a nice guy, maybeespecially nice, but so are many people. Why his picture? The answer is simpleyou should hang a picture of Ralph somewhere in the program, especially in aplace you have to walk past every day to remind you, and everyoneelse that works with you that:

°The Pregren Wes Designed for Rebid°

Of course, the people who actually desigr.A the facility and program you work indid not know the fellow named Ralph in this story, but they must have hadpeople like him in mind when they made many of their important planningdecisions.

How does a person know they designed the program for Ralph, or at least forfellows like Ralph? Of course I've never even seen your program but I bet thefollowing description is more true than not.

0 , c

Handout 4 continued

Most Community-Based Service Programs:

ProgramHistory

StaffRatio

ProgramOptions

IndividualChoices

Rules &Regulations

PROGRAM HISTORY:

Years ago, when the program began most of the individuals had only mild ormoderate disabilities. Over the years the program has begun to accept personswith more severe disabilities but still has only limited experience with personswho have severely disruptive, possible dangerous behavior.

STAFF RATIOS:

Most of the staff supervisors in day programs are responsible for 12 15 maybeeven 20 employees. The ratios are better in most residential programs, one tothree at best, to one to eight in some larger programs. However, it is usually moredifficult to provide close supervision in home settings.

269

STAFF TRAINING:

While there may be a basic inservice orientation program, few of the staff havehad intensive training and guided supervision in teaching persons who have greatdifficulty in learning and communication, especially those with severely disruptivebehavior.

PROGRAM OPTIONS:

Many of the individuals were placed in their particular day or residential programbecause it was the best one available, sometimes the only one available. Teamstry hard to make the program fit the individual but far too often it is the Dther wayaround.

INDIVIDUAL CHOICES:

Most teams encourage client decision making. Some individuals even have"INCREASED DECISION MAIUNG" as an objective in their service plan.In reality however, most of the big decisions such as program placement, workassignments, selection of housemates, daily and weekly artivity schedules, whatfood is purchased at the store, etc. are made by people other than the individual.

RULES/REGUIATIONS:

The agency has a policy in its bylaws that states, "Persons who are a danger tothemselves or others must be expelled from the program."

You are probably starting to get the picture. The program planners must have hadRalph in mind when they developed the budget, determined staffing patterns, etc.Luckily, most of the time it works for fellows like Ralph. But guess what?

"We Daelioned the Program. ter Ralph° and thew Leroy showed up!

Leroy rr st feel like the tourist from Georgia who expected to get to Mexico Cityon a big, modern, air conditioned bus. When the bus arrived he found that it wassmall, old, not air conditioned (except for the hole in the roof) and was routed toMexico City via Saint Paul, Minnesota. The tourist was even further surprisedwhen he complained to the staff of the bus line and was told to:

270

Handout I

"BE QUIET," "STOP COMPLAINING," "LOOK AROUND, NO ONEELSE IS MAKING A FUSS."

Of course, that's not how most bus lines operate they would go out of business.When a business makes a promise to meet our individual needs and then doesn't,we expect our money back, or at the least, an apology. However, far too ofterihuman service programs operate like the bus line in this story. We operate underfederal and state laws that are supposed to guarantee people with disabilities thatthey will receive an individualized program based on what they actually needrather than simply what is available, in the least restrictive setting, etc., e-:..

Most of the time programs make very sincere attempts to make good on thesepromises. Too often however, funding shortages, rules imposed by others that wecannot change, the complexity of the needs of those we serve all make itimpossible to do what we know we need to. It is nothing to be ashamed of,unless we know of improvements that could be made but are being ignored. It isalso true that, even with such major limitations our programs often are helpfulespecially for people like Ralph.

Leroy has not learned to play the role so often demanded of people withintellectual disabilities. People with mental retardation often learn that their life isless disruptive if they say mYES'; do what they are told, rather than voice theirown opinion; learn to please others rather than themselves. There is a good sideto this of course. We all know that it is necessary to learn to compromise, to dothings or follow instructions that don't always please us, etc. It is also clear thatLeroy's life, and ours, will be more calm and less dangerous if he can learn to bea little more like Ralph. The important question is how can we support him inlearning more adaptive and less dangerous ways of voicing his criticisms.

2 22271

Handout 5

Understanding BehaviorChallenges

INMODUCTION

This lesson begins with the following fundamental assumption:

MERE ARE ALWAYS REASONS FOR WHY PEOPLEBEHAVE ME WAY THEY DO.

It is true that ye cannot always identify the rclsons or causes for a person'sbehavior. As you will see in this lesson the causes for behavior can be verycomplex and difficult to understand. However, we must begin with the workingassumption that there are reasons and that if we ask the right questions we will beable to discover them and use our understanding to help the person.

CAUSES FOR PROBLEM BEHAVIOR

There are many different reasons why a person might be engaging in challengingbehavior. For example there may be physical causes for the person's problembehavior. These conditions can be genetic as in the case of Tay Sach's Disease oracquired later in life such as in the case of brain injuries. However, while there areexamples of physical conditions which are directly related to severe behaviorchallenges such examples are not common and are not likely to be the cause ofmany of the behavior challenges you encounter.

PHYSICAL CAUSES

Even though physical conditions rarely a 'count for why the person is engaging inchallenging behavior they should always k-a checked out. There are manyexamples of persons engaging in self-injury such as head banging because of earinfe%:tions, chronic headaches, impacted ear canals, dental problems, temporallobe seizures etc. Especially if a person shows a dramatic and rapid change inbehavior, it usually makes sense to carefully examine whether there could be aphysical cause for the behavior.

ENVIRONMENTAL CAUSES

Most of what we know about human behavior clearly supports the notionthat our behavior is strongly influenced by our environment, especially our

'Tay Sach's Disease - a genetic condition that usually results in severe self-injurious behavior.

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learning experiences. A careful examination of the vicious cycle chart may help inyour understanding of how our environment and past learning experienceseffect behavior.

FACTORS THAT PRECEDE THE BEHAVIOR

Common sense tells us that there are many things that make us happy, bored,confused, interested, angry, depressed, satisfied, etc. We are ckarly not all thesame what bores me may interest you, what makes you mad I may think isfunny. For people with disabilities the situation is often even more complicated.For example, many people with autism are extremely sensitive to differences intouch, tastc and noise. Read the following quotes from Temple Grandin, a personwith autism.

"Like birthday parties. They were torture for me. The confusion created by thenoise makers suddenly going off startled me. I would invariably react by hittinganother child or by picking up an ashtray or anything else that was handy andflinging it across the room.

"Even today, sudden loud noises such as a car backfiring, will make me jump anda panicky feeling overwhelms me. Loud, highpitched noises such as amotorcycle's sound, are still painful to me."

Often it may not he just one thing, it may be a combination of many differentenvironmental factors. See another quote from Ms. Grandin:

"But as a chd, the 'people world' was often too stimulat:Aig to my senses.Ordinary days with a change h schedule or unexpected events threw me into afrenzy, but Thanksgiving or Christmas was even worse. At those times our housebulged with relatives. The clamor of many voices, then different smells perfume,cigars, damp wool caps or gloves people moving about at different speeds,going in different directions, the constant noise and confusion, the constanttouching, were overwhelming."

WE RE _ T, IN PART, 3ASED ON HOW WE FEEL

It's not surprising that when people feel frightened, angry or in pain, they oftenbehave in ways that are disruptive and even sometimes dangerous. Ourexperience tells us that when people are bored or confused their behavior oftenbecomes mule erratic and less predictable. So far this would not present much ofa problem. The real trouble begins in the next phase of the process.

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s

Vicious Cycle 1

Handout 5 continued

WE DISCOVER TFIAT DISRUPTIVE EVEN AGGRESSIVE BEHAVIOROFTEN "WORKS"

This is when the role of learning begins to play a powerful role in shaping ourbehavior. We all learn from our experiences and tend to repeat those actions thatwork for us. Behaviors that work are strengthened (rewarded/reinforced) andthose that don't or result in pain or discomfort are weakened and eventuallyeliminated The consequences or results of our behavior are very important indetermining our future actions.

EVEN 11-1OUGH ME DISRUPTIVEBEHAVIOR OFTEN 'WORKS," ON ASHORTTERM BASIS IN 'ME LONG RUNMORE PROBLEMS ARE CREATED

Alienation, exclusion from programs. etc.This usually increases the discomfortand confusion in the person's life,which results in even moredisruptive behavior. This"VICIOUS" cycle is clearlyevident in the lives of manypeople with challengingbehavior.

We can see an example of this TYPE OFCYCLE in the story of Leroy, from one ofthe earLcr lessons. Remember the day thatLeroy was assigned a new task? Let's look atthat situation from the point of view of howLeroy's behavior worked, or did not work for him.

Leroy worked steadily for about 15 minutes, then he began to ask for a break. Thebehavior plan developed for Leroy classified his requests for breaks asinappropriate avoidance behavior and called for the staff to ignore him and ifnecessary, redirect him back to the task. His supervisor followed the plan andconsistently ignored Leroy's repeated requests to "take a break," "get a cup ofcoffee," "go to the bathroom." Leroy's requests had no visible effect on thesupervisor. However, he did praise Leroy the few times he returned to work.Is it unreasonable that Leroy would rather take a break than assemble nuts and

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bolts that someone else is simply going to take apart? The few dollars a week thathe earned at this task were not sufficient to make it any more interesting.

It's worth noting that it is also not all that unreasonable, at least from a staffpointofview, that Leroy's supervisor wanted him to complete the packagingtasks. There was an objective related to work on Leroys IP and if he did well hethought Leroy might be able to "graduate" from the work adjustment program andjoin the other employees on the workshop floor.The supervisor would probably say that he is trying to teach Leroy to "workconsistently!' by praising him and that by ignoring Leroy's complaining and askingfor frequent breaks he will learn that such behavior is inappropriate.

Leroy might tell different story!

He might say that he is learning that "it does not help to ask to stop work." Hemight say that "no one listens to me" and that he has no role in decision makingat the workshop.

After about 15 minutes of having his requests for a break ignored, Leroy said "I'mquitting ... you can't make me work" and shoved his chair back from the table. Hesat there glaring at his supervisor. The supervisor ignored Leroy for about 10minutes and then quietly asked him several times to "Please go back to work."The first time Leroy said "No!," after that he simply ignored the supervisor.

From Leroy's point of view he had finally found something that worked. If thesupervisor wouldn't let him have a break he would just go ahead and takematters into his own hands.

Is it surprising that he refuses the supervisor 's requests to return to work? Whathas he got to gain, other than a little praise and probably more work?

The supervisor was experienced enough to know that it would be a mistake to tryto force Leroy's chair back to the table. He knew that it could result in a big fightso he decided to take the work to Leroy. He picked up one of the bolt assemblies,held it in front of Leroy and asked him to please go back to work. At first Leroyignored him, but after a few minutes he grudgingly completed the bolt assembly.Thinking that it might now work, the supervisor sa;d, "Let's move you back to thetable." Leroy immediately said "No!"

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Handout 5 continued

It was probably a very wise decision for the supervisor to decide not to force theissue with Leroy by attempting to immediately drag his chair back to the table.He waited till Leroy calmed down a little and then "took the work to him." Hewanted to teach Leroy, as gently as possible, that he could not avoid work bymoving away from the table. It's not clear why, but Leroy cooperated,at least at first.

Did Leroy's cooperating work, from his point of view?

Not really. The supervisor said "Good working Leroy" but then proceeded to tryto get him to move back to the table. Leroy's cooperative behavior led to morerequests to return to work. Not such a good deal from his point of view.

The supervisor decided to be a little more assertive and said "Come on Leroy, youknow you have to work," as he put nis hands on Leroy's chair. Leroy looked up atthe supervisor and yelled "No! No! I won't."

Leroy has learned his lesson no more cooperation. He continued to say NO!,even louthr.

The supervisor quickly decided that it would be a mistake to back down now andbegan to gradually drag the chair toward the table. Leroy immediately slammedboth his arms to the chair, Just missing the supervisor's hands. The supervisorjumped back and said, "OK, we can't make you work but if you don't work,you won't get paid and you don't get a break."

Leroy finally found a "SIGN" that worked and worked quickly one that thesupe,visor dely understood. He might have been a little confused about whyhe had to yell so loud and slam his arms repeatedly on the chair just to be heardbut if that's what it took to get through to the supervisor then he would just haveto do it.

Now, I don't really believe that Leroy thought all these things, but I do believethat the above is a fair description of what he was being taught by the supervisor.

He was learning that cooperation and task completion usually lead to more taskassignments. He was learning that simple verbal complaints or requests for breakshad no effect. He learned very concretely that disruptive, aggressive behavior gothim what he wanted. From Leroy's point of view it was the only way he cou:dget what he wanted.

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Immediately Leroy began to yell. He threw the bolt, breaking the window infront of his table. Then he began to cry and bite his hand and lips. The supervisortold Leroy to stop. He didn't. The other work adjustment supervisor called forhelp. It took four of the staff about 40 minutes to calm Leroy down, once theywere able to hold him in a safe position on the floor. The staff of the ICF/MRfacility were called and after Leroy had calmed down they took him back to theresidential facility.

LEROY'S SUPERVISOR MADE A SERIOUS MISTAKE.HIS "MESSAGE" TO LEROY WAS:

"YOU MUST WORK""I WILL IGNORE YOUR EFFORTS TO AVOID OR ESCAPE WORK""THE ONLY THING THAT WORKS AROUND HERE IS TO DO WHAT I SAY"

Leroy did in fact discover that simply asking to quit didn't work. He found outthat minimal efforts to escape or avoid work, like moving away from the table,also didn't work. But Leroy has a long history that says to him:

"ESCALATE"

"START YELLING"

"'MEOW THINGS""BITE YOUR HAND""HIT SOMEONE"

These behaviors have always worked. In the long run, which Leroy does notunderstand or care much abuat, these behaviors also have had a serious negativeimpact on his life. He has been restrained, placed in seclusion, expelled fromprograms and even institutionalized because of them. These behaviors have beenlabeled as inappropriate, maladaptive, abnormal, even crazy. However, to Leroythey work in the short term and that is all that he understands now.

Unless we make some important changes, the situation usually gets even worse.Leroy continues to hit his supervisor and the supervisor,, in turn, continues torestrain Leroy. Quite naturally what little positive working relationship they didhave is diminished. The supervisor pays less and less attention to Leroy unless ofcourse he is being disruptive. Leroy is even less likely to have any positiveexperiences at work, which in turn makes it more likely that he will try to quit orleave. Over time he is less likely to even try the non-aggressive ways of quitting -

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Handout 1

such as asking for a break, simply trying to walk away, etc. - these have neverworked. Leroy learns to skip these steps and move directly to what does work -dangerous and disruptive behavior.

You may be thinking that you would not find it rewarding to be restrained, to b,:expelled from a program. Please do not judge the situation from your point ofview. You must learn to look at what is happening from Leroy's point of view.That is not the same thing as saying that Leroy's behavior is "CORRECT" or"RIGHT" It simply means that if we are to understand why Leroydoes what he does, we must understand his point of view.

What we think of as "NEGATIVE ATTENTION" may in fac: be rewarding to peoplewith long histories of challenging behavior.

For example it is probably true that criticism, negative feedback, being yelled at,etc. is punishing to most people. Whether it is true for most people is not theissue here. Leroy's point of view is all that should be considered if we are tounderstand him.

LOOK AT ME SITUATION THROUGH HIS EYES:

Leroy does not have a positive working relationship with anyone at the workshop.Why should he we whether they are pleased with his behavior? Why should hechange his behavior based on their criticism,

If Leroy behaves himself, follows instructions, does not cause trouble, etc., he willprobably be ignored. At dmes he may be praised for his appropriate behavior, butthat is nothing compared to the immediate attention provided by the "crisis team"when he is disruptive. He becomes the center of attention, for theentire workshop.

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IMPLICATIONS FOR CHANGE IN OUR SERVICES

Look back at the "VICIOUS CYCLE" diagram. It is clear that based on theunderstanding of the cause(s) for behavior problems shown in the diagram thatwe can consicier making changes in at least two major areas, if we are to help theperson change his/her behavior. First, we can try to decrease the person'sexposure to situations that are confusing frustrating, boring, frightening, etc.Second, we can assist them in learning alturnative behaviors that also work forthem, but that are not disruptive, dangerous or confusing.

" -.A. la) 1

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Handout 6

Carl, Mrl, Mary and theangry bus driver

Carl works in a group home. Mary, who is Carl's supervisor was very concernedabout his work performance. One of Carl's most important job responsibilities isto help the men who live in the home in preparing to go to work each morning.

Carl works well with two of the men. They are ready for work on time each day.The third man, Merle is a different matter. At least once a week Merle is still eatingbreakfast and not even completely' dressed when the bus comes.

Mary has talked to Carl about this often, each time emphasizing how important itis for Merle to be ready for work in time to take the bus. The talks don't seem tohave helped ... twice in the last week the bus driver had to wait for Merle andonce he was so late Carl had to call a taxi.

Mary has developed a new plan that she thinks may work. Today she told Carlthat if in the future Merle is late for the bus she will write an incident report andplace it in his personnel file. If Carl gets more than one incident report over a twoweek period he will receive a written reprimand. If he receives more than threereprimands in a month he will be fired. However, if he helps Merle get ready forwork on time every day for two weeks in a row she will arrange for him to havespecial time off from the job. Mary told Carl that she wished that these proceduresweren't necessary, but that she felt like she had to implement them.

QUESTION:

"What is missing in the above story?"

"Do you agree with Mary's approach to dealing withCies "problem" behavior?"

You might not agree with Mary's choice of a punishment approach tochanging Carl's behavior.

You might be concerned that the procedures may not work and Merle willcontinue being late and Carl will be fired.

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However, there's an even more basic weakness to Mary's approach to dealing'vith the problem. She never tried to find out why Carl wasn't doing what he wassupposed to do. She might have then been able to develop a plan to help Carlsucceed, based on this information.

TALKING WITH CARL AND OBSERVING ITIE MORNINGROUTINE MIGHT HAVE SHOWN:

That Carl was afraid of Merle and ignored him as much as possible to avoidthe possibility of a fight. Because he ignored him, Merle sat around most ofthe morning without getting ready for work.

That Carl was not experienced in helping a person as severely disabled asMerle. He didn't know how to provide Merle with the physical and verbalcues he needed to wash, brush his teeth, get dressed, etc.

That one of the other men was taking up most of Carl's time each morning.Although he was working hard; Carl did not have the time to help both men.

You are right if you are thinking there could have been many other reasons forCarl not being able to get Merle ready for the bus. However, it's pretty clearMary's plan had nothing to do with any of them.

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Handout 6 continued

MARY HAD DEVELOPED A PLAN TO MANAGE CARL'S BEHAVIGHER PLAN INVOLVED:

Punishing him if Merle was late by putting incident reporus in his file whichcould lead to reprirnands and eventually, to being fired.

Rewarding him for two weeks of good behavior (Merle not being late) byarranging for time off.

Neither of these two coasequences have anything directly to do with whatever iscausing Carl's failure to help Merle. Mary's plan is based on the assumption that Carlwill be afraid of losing his job and will therefore, do whatever is necessary toAicceed. It might "WORK," but it has an even better chance of failing. Filing incidentreports won't help Carl overcome his fear of Merle. The threat of losing his job won'tteach Carl how to provide Merle with the types of cues and instructions that hemight understand.

Mary did not begin by trying to understand why Carl wasn't performing as he should,which would have then allowed her possibly to develop a plan to help him based onwhat she had learned. You might be thinking that none of the reasons listed abovewere true and that Carl just needed some exua "MOTIVATION" to do his job. Thiscould be true, but we'll never know without asking the question, WHY? whichMary failed to do.

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Ha n dou t 7

Kothy's Story - Success Is inthe eye of th beholder

Kathy was 9 years old and labeled profoundly retarded. She has been living at astate institution for persons with mental retardation for the last nint months. Eachmorning one of the aides walked Kathy across the grounds to her school program.She was scheduled to stay at school until the early afternoon.

Kathy had lots of difficulty adjusting to the school program. During the first fewmonths she often cried and tried to run out of the room. Her teacher, Mr.Richards, handled these situations by ignoring her crying, as much as possible,and gently redirecting her back to her desk if she attempted to run from theclassroom. These procedures worked to reduce the crying and running away.During her sixth month at school she had only three tantrums and attempted torun away only once.However, Mr. Richards became co.tcerned about a newbehavior that presented even more serious problems. During her seventh monthat the Center, Kathy began to vomit while at school. At first it only occurredinfrequently but it gtadually increased until she was throwing up every day.

Some of the members of her team felt that she might be overly anxious aboutschool and recommended that the physician prescribe a mild tranquilizer. TheDoctor agreed with the request but the change in medication did nothing todecrease the vomiting behavior. The team then decided to suspend her fromschool for a month. This of course worked perfectly to decrease vomitingbehavior at school. She couldn't throw up at school unless she was actually there!However, when Kathy returned to school she immediately returned to thevomiting behavior.

Hoping to get a new perspective on the situation, the teacher asked the Center'sbehavior specist, Roberta Fox to visit the classroom and see if she might be ableto help. The first day Roberta visited the classroom Mr. Richards described whathad been happening, about the results of the change in medication and the schoolsuspension. As she was finishing the description they heard a sound, looked upand saw Kathy throwing up at her desk. She and the studeut who sat in front ofher were a mess.

bit.. Richards immediately called for an aide to escort Kathy back to her cottage tocleaned up and get a change of clothes. Ms. Fox asked the teacher if what she

had just seen was typical of most days. Mr. Richards said yes, that almost everytime Kathy threw up she had to be returned to her cottage and that often she didnot return to school until the next day. Ms. Fox returned the next day with thefollowing plan for decreasing Kathy's vomiting behavior.

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At first it looked as though the plan might not work. Kathy threw up repeatedlyduring the first few days. In fact, on the third day she threw up, or at least tried tothrow up 23 times. However, after the third day things began to improve. As thegraph shows the frequency of the vomiting steadily decreased over the next 27days and by the 30th day of the new procedures she went the entire day withoutvomiting. The graph below shows the frequency of vomiting over the 30 layperiod. She never threw up in class again.

Mr. Richards and Roberta Fox had accomplished their objective. Kathynever threw up at school again. Do you consider this a success story? Let's look atthe "SUCCESS" of the behavior plan from the point of view of all thepeople concerned.

Mr. Richards "It certainly was a success. The room smells nicer. Kathy looksbetter. Now maybe we can get on to school work."

Ms. Fox "I was more than happy to help Mr. Richards. We eliminated thetarget behavior faster than I thought we would. Maybe I can publish this as aresearch study."

WHAT ABOUT KATHY??

Kathy cannot talk, but pretend for a minute that she could. How do you think shewould answer the success question? Suppose we were to interview her on the30th day of the new behavior plan, the first time she went the whole day withoutthrowing up what is she going to say?

"I JUST LOVE IT HERE!"

"MY SCHOOL WORK IS VERY INTERESTING AND I AM LEARNING A LOT"

OR

"I STILL HATE IT HERE. I'D STILL RAMER LEAVE. I JUST DONT TELL ANYONEABOUT IT ANYMORE ...."

Kathy is not likely to answer that the "BEHAVIOR INTERVENTION PLAN" was asuccess because nothing was done to help her with her "PROBLEM."

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Handout 7 continued

FREQUENCY OF VOMITING

2 3 6 8 10 12 14 16 18 20 22 24 27 30NUMBER OF DAYS

HER "PROBLEM" WAS THAT EITHER:

1 She disliked/was afraid of the classroom setting

2. Nothing at school was more interesting or engaging than being back in theday room of her ward. The Behavior Plan did nothing to change these*PROBLEMS.* The Behavior Plan was just that a behavior plan.

The teacher and Ms. Fox implemented a plan that was successful in making animprovement in Kathy's behavior but did nothing to help the basic reasons behindthe problem behavior. Let's look at the situation more dosely.

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MS. FOX'S ANALYSIS OF THE SITUATION WAS IN A SENSE CORRECT.SHE SAW THAT:

Kathy either did not like the classroom or wanted to be back on her ward.

Mr. Richards : -I "accidentally" reinforced the vomiting behavior by lettingher leave (escape) the classroom.

Over a period of weeks Kathy learned to vomit to leave the classroom.

Ignoring the vomiting (not allowing Kathy to leave) would eliminate the"ACCIDENTAL" reward.

OVER A ThIRTY DAY PERIOD KAnlY GAVE UP. SHE STOPPED VOMITING.

There is no doubt that if people are placed in situations that they findunacceptable they will try to find a way to leave. They will often do whateverworks - tantrums, aggression, even vomiting. There is also no doubt that if youare bigger than they are, if you are in control - you can make sure that nothingworks. That's what they did to Kathy. At first Kathy was successful in runningfrom the classroom, but then the teacher learned to beat her to the door. Later shehad tantrums and sometimes was sent back to the ward to "CALM DOWN." Theteacher was then instructed to ignore the tantrums.

One day while she was having a tantrum she choked and threw up. The teacherimmediately said "Take her back to the ward, clean her up. No more schooltoday, she is too upset."

Kathy didn't understand much of what the teacher said but shedid learn a new sign:

VOMITING - "I WANT TO LEAVE THE CLASS IMMEDIATELY."

It wasn't at all clear to Kathy why the teacher required such an unusual sign, whyhe hadn't understood what Kathy meant by running away and crying both ofwhich seemed to be more obvious to her. But she was happy for small favors andeach day followed the teacher's "INSTRUCTIONS" by throwing up when shewanted to leale class.

e: r ....,

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Nondout 7 continued

Now of course I don't think that Kathy actually thought all these things out sologically and rationally but at the same time it is an accurate description of theimportant events and also makes it clear where the foc,.s of our attention shouldbe. We should be most concerned with answering the question Why does Kathywant to leave the class?

There is no arguing with the fact that vomiting behavior is "INAPPROPRIATE," thatKathy would be better off if she stopped doing it. In fact, if we really wanted tostop the vomiting qi ickly it would probably have been more efficient to teach herto exchange a toker. to leave class. Each day we could give her a blue poker chip.If she hands the chip to the teacher she is immediately allowed to leave the class

no questions asked. In far less that 30 days she would probably have learnedthe "exchange" value of the token and use it to leave class rather than resortingto vomiting.

MANY OF YOU ARE PROBABLY THINKING:

"Wait just a minute. Kathy may not be throwing up anymore, but now we have adifferent 'problem.' She spends very little time in school. Most days she hands inthe token after only a few minutes and leaves school."

Right! Now we have the "REAL" problem. The one we should have been mostconcerned with all along, that is the school setting either frightens/disturbs heror offers her nothing more interesting/fun and engaging than the day room backon the ward. Ms. Fox should have hriped Kathy's teacher figure out what wasfrightening Kathy or how to interest her in at least some activities in the class.That would not have been an easy task. It was difficult to understand Kathy's likesand dislikes, except for the vomiting, and because of her limited experiences andprofound disabilities her interests were fairly limited. But the fact is they madeonly lainimal efforts in this direction they were too focused on eliminating thevomiting behavior.

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Behavior

o

Videotapes

TIllE:

PRODUCER:

TIME:

PRODUCER:

TIM :

PRODUCERS:

A NEW WAY OF THINKING

Minnesota Governor's Planning Council on DevelopmentalDisabilities & Minnesota UAP on Developmental Disabilities (1988)300 Centennial Office Building, 658 Cedar StreetSt. Paul, Minnesota 55155(612)296-4018 or (612)296-9962 TDD

AN ELEPHANT AT MOUSE PLACE

Kittelson & LeadholmMinnesota Governor's Planning Councilon Developmental Disabilities (1990)300 Centennial Office Building, 658 Cedar StreetSt. Paul, Minnesota 55155(612)296-4018 or (612)296-9962 TDD

REGULAR LIVES

Tom Doodwin & Gerardine Wurzburg(1988 ) Syracuse UniversityWE'l'A Educational ActNitiesP.O. Box 2626Washingm, D.C. 20013

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Behavior

Resources

TITLE: TASK ANALYSIS, PROMPTING AND ERROR CORRECTION

PRODUCER: Oregon Research InstituteTape 1: Task Analysis andTape 4: Error CorrectionResearch Press2612 N. Mattis Avenue, Champaign, Il 61821(217) 352-3273

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A., i Li

Behavior

Resources

SUGGESTED READINGS FOR SUPPORTING PERSONSWITh "CHALLENGING BEHAVIOR."

Donnellan, Anne, M.,LaVigna, Gary, M., Negri-Schoultz, Nanette, andFassbender, Lynette, L (1988) Ersarta.Mithgazinishment. New York, N.Y.:Teachers College Press.

Grandin, Temple and Scariano, Margaret M. (1986) Emergence: Labeled Autistic,Novato, California: Arena Press

LaVigna, Gary W. and Donne Ilan, Anne M. (1986) Alternatives to Punishment.New York, N.Y.: Irvington Publishers, Inc.

'Lovett, Herbert (198) Cognitive Counselin2 and Persons With Special Needs.Praeger.

Meyer, Luanna H. and Evans, Ian M. (1989) Nonaversive Intervention for BehaviorProblems. Baltimore, MD.: Brookes.

Mount, Beth and Zwernik. (1988) It's Never To Early. It's Never Too Late. St. Paul,Minnesota. Metropolitan Council.

Perske, Robert (1980) /slew LIfe Injhe Neigbohood. Nashville, Tennessee:Abingdon.

"Perske, Robert (198) Circles of Friends. Nashville, Tennessee: Abingdon.

Rioux, Marcia H. (1988) The Language of Pain. Downsview, Ontario:The G. Allen Roehr Institute.

Sheehan, Susan (1982) Is There No Place On Earth For Me? Boston,Massachusetts: Houghton Mifffin

Sutherland, Allan T. (1984) Disabled We Stand. Bloomington, Indiana:Indiana University Press.

Turnbull, Ann P. and Turnbull, H. Rutherford (1978) Bargintl.sacals_Qut.Columbus, Ohio: Charles E. Merrill

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Funded by a grant from theMinnesota Govemoes Planning Council on Developmental

Disabilities, Minnesota State Planning Agency,300 Centennial Office Building, 658 Cedar Street, St. Paul, Minnesota 55155

and

A grant from the Administration on Developmental Disabilkies, entitledthe 'Statewide System for Training Direct Care Service Providers in

Communky Programs Pro Oct' (ADD Grant No. 07DD0282), to the Instituteon Community Integration, University of Minnesota.

Room 6 Panee Hall, 150 Pillsbury Drive S.E., Minneapolis, Minnesota 55455

41'. 4 (1)4, '** 4