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Challenging Behavior: A Model forBreaking the Barriers to Social andCommunity IntegrationGary W. LaVigna and Thomas J. WillisInstitute for Applied Behavior Analysis, Los Angeles, CA

A version of this paper was presented at the Annual Conference of theAssociation for Behavior Analysis, San Francisco, CA, May, 1992.

A major value associated with the recent movement toward

community integration for people with a developmental disability

has been the opportunity for social integration and interaction

with the general population. Major barriers remain, however, for

those disabled individuals who exhibit significant challenging

behavior. These barriers may include both the behavior chal-

lenges the person presents as well as the support strategies that

have traditionally been employed to remediate the challenges.

They are barriers because neither may be accepted by society—

thus limiting the person’s opportunity to benefit from the commu-

nity integration movement. Present models for providing support

have not proven fully adequate to the task of breaking these

barriers to social and community integration for individuals who

have severe and challenging behavior. In the following para-

graphs, we present a model of support that we feel may go a long

way toward “Breaking the Barriers.”

OutcomesThe foundation of the model is an

expanded view of the outcome criteriaby which support strategies can be evalu-ated (see Figure 1 on page 10). Tradi-tionally, the success of a support planhas been measured by how quick andhow much the plan has reduced prob-lem behavior (i.e., the speed and degreeof effects). We suggest that you mustgo beyond simple speed and degree ofeffects to conclude that a support planhas been effective. Support strategiesshould be evaluated in terms of thedurability and generalization of theireffects, the side effects they produce,and their social and clinical/educationalvalidity (Favell et al., 1982; Evans &Meyers, 1985). This last outcome re-quirement is perhaps the most impor-tant, for it keeps us focused on the majorpoint of a support plan. That is, not toeliminate the target behavior, per se, butto contribute to the overall quality of theperson’s life. This most critical mea-

A quarterly publication dedicated to the advancement of positive practices in the field of challenging behaviorVolume I • Number 1 ISSN 1083-6187 • October 1995

THE

N E W S L E T T E R

Continued on page 8

C o n t e n t s

Challenging Behavior: A Model for Breaking theBarriers to Social and Community Integration ...... 1

Editors’ Note ............................................................... 2

Positive Programming: An OrganizationalResponse to Challenging Behavior ......................... 3

A Person Centered Approach to SupportingPeople with Severe Reputations ............................ 16

Behavioral Definition ofa Problem Behavior ................................................. 18

Procedural Protocol -Interpersonal Style ................................................... 21

IABA Resources ....................................................... 23

P O S I T I V EPR A C T I C E S

P O S I T I V E P R A C T I C E S • V O L U M E I • N U M B E R 1 • O C T O B E R 1 9 9 5

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Positive Practices

PublisherInstitute for Applied Behavior Analysis

A Psychological Corporation

Co-EditorsGary W. LaVigna and Thomas J. Willis

Managing EditorJohn Q. Marshall, Jr.

Institute for Applied Behavior AnalysisGary W. LaVigna, PhD, Clinical DirectorThomas J. Willis, PhD, Assoc. Director

Services to Employ PeopleJulia F. Shaull, LCSW, MSW

Director of Supported EmploymentStacy L. Daniels, MA

Asst. Director Supported EmploymentSusan Caraway, BA

Manager - Los AngelesAyndrea LaVigna, BA

Manager - Ventura CountyPatricia Speelman, MA

Manager - West Los AngelesDana L. Steinberg, MS

Manager - North Los AngelesKim L. St. Cyr, MA

Manager - Orange County

Social/Community Integration andParticipation

Maryam Abedi, PhDDirector of Supported Living

Heike I. Ballmaier, PsyDManager - North Los Angeles

Ellen J. Lewis, PhDManager - Ventura County

Ann Majure, PhDManager - Ventura CountyCheryl Stroll-Reisler, MAManager - Los Angeles

Competency Based Training ProgramDiane Sabiston, MEd

Program Consultant - Georgia

Professional Training SeriesJohn Q. Marshall, Jr., MEd

Seminar Coordinator - South Carolina

Printed ResourcesBrenda LaVigna

Supervisor - Book Sales

AdministrationJonathan C. Mohn

Director Finance and AccountingRobert H. Shelton

Director of Human Resources andAdministrative Services

Copyright 1995 by:Institute for Applied Behavior Analysis

5777 West Century Blvd. #675Los Angeles, CA 90045 USA

(310) 649-0499

All rights reserved. No portion of thisnewsletter may be reproduced by any meanswithout the express written permission of the

Institute for Applied Behavior Analysis.

Positive Practices (ISSN 1083-6187) is aquarterly publication of the Institute for

Applied Behavior Analysis. Individual issuesare $10.00 each. Subscriptions are $25.00 peryear for delivery within the US and $35.00 per

year for delivery outside of the US. Forsubscription information, change of address or

information on classified advertisementscontact: John Marshall; IABA; PO Box 5743;

Greenville, SC 29606-5743 USA; (864) 271-4161.

.Individuals wishing to contribute articles or

letters to the publication are requested tocontact Gary LaVigna or Thomas Willis;

IABA; 5777 West Century Blvd. #675; LosAngeles, CA 90045 USA; (310) 649-0499.

Editors’ Note…The publication of this newsletter is a response to the many

requests we have received to establish a mechanism for continuedcontact between and among usand the many people over theyears who have participated inour Summer Institute and ourvarious longitudinal trainingprograms. Many people whohave attended our many train-ing seminars have also ex-pressed an interest in receivingmore information about ourpositive approach for sup-porting people with the reputa-tion of having severe and chal-lenging behavior. To our knowl-edge this is the first publicationdedicated solely to the advance-ment of positive practices in the field of challenging behavior. Wehope you will take advantage of this newsletter by using it asinteractively as possible. We hope you will write to us to askquestions, to make comments,to let us know how you areapplying positive practices inyou own work, to make sug-gestions and even to challengeus. We will endeavor to makethis publication as useful as pos-sible to you in our mutual goalof advancing positive practicesin the field. Write and let usknow what you think of thisfirst issue.

Gary W. LaVigna andThomas J. WillisCo-editors

Thomas J. Willis, PhDAssociate Director

Gary W. LaVigna, PhDClinical Director


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Positive Programming - AnOrganizational Response ToChallenging BehaviorBrian McClean M.A., M.Sc. and Patrick Walsh, Ph.D.The Callan Institute for Positive Programs,Whitaker House, St. John of God Brothers, Stillorgan, Co. Dublin, Ireland.

Editors’ Note: Over the years, we have provided longitudinal training in orhave had participants in our two week training institutes from many countries.These have included the countries of Great Britain, Ireland, The Isle of Man,Canada, Spain, Norway, Australia and New Zealand. In this column we plan topublish reports from around the world that describe how people have used theIABA model and the results they have achieved. This first report is from St. Johnof God, a 500 year old religious order in Ireland that provides services to peoplewith psychiatric problems and/or a developmental disability. As a result of thelongitudinal training we provided, they established the Callan Institute ForPositive Programming to disseminate positive practices within their servicesystem.

IntroductionEfforts by service providers the world over to enable people

with disabilities to live and work as integrated members of the

community have led to the need to develop more effective waysof dealing with challenging behavior. Large organizations have a

particularly difficult task in striving to improve the quality of life

of their service users while intervening in positive ways to bringabout a reduction in aggressive or self-injurious behaviors. This

article presents the attempts of one such organization to equip its

staff with the structures, supports, training and expertise to dealpositively with challenging behavior and thereby to enhance its

work of community and social integration.

proved quality of life. A total of 1,447people was surveyed. Using Emersonand Emerson’s 1987 definition of chal-lenging behavior as “behavior that islikely to seriously limit or deny accessto, and use of, community facilities,”406 (28%) of our sample showed chal-lenging behaviors. Significantly, a ma-jority of this group (83%) was male,living in large residential centers (49%)and aged between 30 and 50 years ofage (56%). One can conclude from thesefigures that many of those people withinthe Order’s services have shown chal-lenging behaviors in large residentialcenters for many years. The fact that somany of them are male is due to thehistorical fact that the Order tradition-ally provided services to Irish men whohad learning disabilities and has onlyprovided services to women in recenttimes.

In a similar survey of the intensity ofself-injurious behavior, Oliver, Murphy& Corbett (1987) used a criterion oftissue damage as a more restrictive defi-nition of severe challenging behaviors.In our survey, 224 (15%) showed ag-gressive or self-injurious behavior sosevere as to cause tissue damage duringa one month period (see Fig. 1, page 4).

Traditional Responses toChallenging Behaviors

Research has not fully addressed thestrategies that staff use to manage chal-lenging behaviors in the absence of acomprehensive program of staff train-ing. Recent research conducted at theCallan Institute (McClean and Ryan,1995) examined the factors that predictstaff’s use of aversive behavior man-agement techniques. The study exam-ined incidence analysis sheets (Willisand LaVigna, 1992) and found that, inthe absence of staff training, aversivestrategies are as likely to be used incommunity settings as in large residen-tial centers. They are also as likely to beimplemented by experienced staff as byinexperienced staff. In fact, the factorthat best predicts the staff’s use of aver-sive techniques in the absence of staff

The Services of the St.John of God Order

The St. John of God Order is an inter-national organization which has beenproviding services to people with psy-chiatric and developmental disabilitiesfor five hundred years. The Order pro-vides a variety of services in Ireland.These include two large residential ser-vices, a significant number of grouphomes, day centers, special schools and

adult training and work enterprises. Inall, approximately 1500 children, ado-lescents and adults receive a service.The Order is committed to the prin-ciples of normalization, community in-tegration and the provision of meaning-ful education and work for its serviceusers. However, as a survey conductedrecently (McClean and Walsh, 1995)showed, there have been significantconcerns about the way in which chal-lenging behavior has been perceived toimpede developments leading to im-


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training is the staff’s perception ofwhether the client can be held respon-sible for his or her actions. Thus, clientswho are in receipt of psychotropic medi-cation, or clients who are perceived ashaving a lower level of intellectual func-tioning are more likely to receive nona-versive staff responses. Aversive tech-niques, therefore, are usually used afterblame has been attributed to the person.

This finding is consistent with attri-bution theory, and is an example of thefundamental attribution error (Dunne,1994), where the observer of the chal-lenging behavior has the proclivity tounderestimate the importance of eco-logical factors and situational contin-gencies and to overestimate the contri-bution of dispositional factors, whetherwillful or not. One of the reasons for theimpact of training in Positive Program-ming may well be that it reattributes theexplanations for challenging behaviorsin terms of the fit between the needs andcharacteristics of the person and theneeds and characteristics of the envi-ronment. Thus the proclivity towardsthe fundamental attribution error is re-duced, and therefore aversive methodsare less frequently applied.

In this context, and prior to the intro-duction of staff training in Positive Pro-gramming, a small scale survey wasconducted to establish the repertoire ofmethods available to staff who workwith people who show challenging be-haviors. Sixteen staff were selected forinitial training in Positive Programming.Each staff member selected one indi-

vidual with whom anonaversive behaviorsupport plan would beestablished, and re-ported on the plansand interventions cur-rently existing for thatperson. The resultsof this survey are pre-sented in Figure 2.

Figure 2 showsthat, prior to the in-troduction of stafftraining in nonaver-sive behavior man-agement techniques,

8 of the 16 clients with severe challeng-ing behaviors were actively receiving askills teaching program that was writ-ten. These included general skills teach-ing programs (n = 5), relaxation trainingprograms (n = 2) and one functionallyequivalent skills program which taughtprosocial forms of physical contact. Twoclients were receiving nonaversive fo-cused support programs (in both cases,these were Differential Reinforcementof Other behavior (DRO) programs).Eight of the sixteen clients had a currentIndividual Program Plan, in which staffhad written annual goals for or with theservice user during the previous year.

An alternative way of constructingthese results is that 8 out of 16 clientswith learning disabilities were receiv-ing no formal skills teaching, 14 werereceiving no nonaversive behavioralsupport services, and 8 did not have thebenefit of a staff group meeting to planor coordinate theclient’s goals for theyear. The study,therefore, supportsthe pervasive findingof descriptive or eth-nographic studies ofservice settings forpeople with challeng-ing behavior; that be-havioral approachesare markedly under-utilized (Emersonand Emerson, 1987),that staff workingwith people with

challenging behaviors spend surpris-ingly little time giving them attention(Felce et al., 1987) and that most ser-vices “place no legitimate demands ona particular learner because, to do sorequires programming, intervention andstaff effort” (LaVigna and Donnellan,1986). In their study, Emerson andEmerson (1987) found that the under-utilization of effective behavioral sup-port plans was best explained in termsof staff’s lack of understanding of be-havioral principles and staff orientationtowards custodial rather than commu-nity models of service. Although con-straints in the institutional environmentalso explain the lack of service response,there is a clear need for staff training toaddress the first two sets of barriers toeffective interventions.

Parameters of theOrganizational Response

When facing the kinds of concernsoutlined above, a new service like theCallan Institute must make a number ofdecisions:1. Special Teams or Special Units:

Special teams work to support indi-viduals and their support networksin the individual’s local environ-ment and provide staff training andconsultation on interventions. Spe-cial units allow the person to leavethe local environment and stay insafe, physically secure environ-ments. Special units have a num-

Skill Teaching

Nonaversive Focused Support

Individual Program Plan

Aversive DirectIntervention

0 4 8 12 16

Figure 2: Types of staff response to challengingbehavior prior to the introduction of training inPositive Programming

Figure 1: Proportion of people with severechallenging behaviors across the services

1447 peoplewith a learningdisability224 people withvery severechallegingbehaviors

= 15%


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ber of disadvantages. These in-clude:• Low throughput. Special units

are usually full within a shorttime of opening (Newman andEmerson, 1991). They are gen-erally designed to providetreatment in the short term (3 -6 months). Even when signifi-cant change is achieved, it isdifficult to persuade the client’soriginal support network of thisbecause of the person’s behav-ioral history. The result is thatspecial treatment units quicklybecome special long term resi-dential centers, even thoughthey are not designed for thispurpose.

• Poor generalization. It cannotbe assumed that replacementbehaviors learned in the spe-cial unit will automaticallytransfer on return to the origi-nal environment (Emerson etal., 1987). Generalization mustbe explicitly programmed, andthis requires local staff or fam-ily to develop specialized ex-pertise. Thus, once a servicebegins to program for gener-alization, a special team is re-quired anyway.

• Short term rather than longterm change. Multielement in-terventions which combineecological strategies, func-tional skills teaching, focusedsupport program, and sensi-tive reactive strategies canbring about reductions in chal-lenging behaviors with rela-tive ease. However, short termchange is only one criterion ofeffectiveness. The ultimateobjective is to achieve im-provements in the person’squality of life and to overcomebarriers to community integra-tion. Placement in segregatedfacilities runs contrary to theseobjectives.

• Less staff development. Whena person who presents withchallenging behaviors is re-

moved from his or her localenvironment to a special unit,staff have no opportunity todevelop the skills needed tomanage challenging behaviors.When a new person challengesthe service, another referral tothe special unit is likely. Moreusually, the transfer is per-ceived by the local staff teamas a failure to sup-port the person in thecommunity, withconsequent adverseeffect on staff mo-rale.

However, other re-search highlights issueswhich may moderate thisviewpoint. Challengingbehaviors are a major con-tributor to the stress ex-perienced by parents(Quine and Pahl, 1985)and staff (Emerson and Emerson,1987), and are one of the mainreasons why families seek out-of-home residential placements(Krauss and Seltzer, 1987). Chal-lenging behaviors are one of themost frequently cited reasons forthe breakdown of community place-ments (Schalock, Harper &Genung, 1981). And as mentionedabove, severe aggressive and self-injurious behaviors are more likelyto be met with aversive or intrusiveresponses (restraint or medication)rather than skills teaching, activelistening or ecological adaptations.At least specialized units for peoplewith challenging behaviors havethe potential to overcome the dearthof service options.

2. Special teams or staff training. Asecond decision that needs to beconsidered in the design of an orga-nizational response for over 400people with challenging behaviorsis, given limited resources, whetherto invest in centralized expertise,or whether to attempt to spread theexpertise widely across the service.Many services already have a struc-ture in place consistent with the

centralized expertise model, usu-ally known as the multi-disciplin-ary team. The danger of this modelis that staff can come to rely on apsychologist, psychiatrist or behav-ior nurse specialist to initiatechange, to conduct behavioral as-sessments or to coordinate indi-vidual plans, since they are believedto possess the specialist expertise

to do so. In most services, themultidisciplinary team consists of4 - 7 individuals, working in a ser-vice for 100 - 400 people. Clearly,there are insufficient resources toprovide individualized service re-sponses. In an alternative model, akeyworker is empowered to ini-tiate and coordinate the delivery ofbehavioral assessments and behav-ioral support services. Since thereare many more potentialkeyworkers than multidisciplinaryteam members in any organization,there is less likely to be a poor fitbetween service needs and serviceresources.

3. In-service training versus out-of-service training. Given that a ser-vice opts for a model of staff train-ing in which expertise is widelyshared, the next decision is whetherto send staff to accredited coursesoutside the service, or whether toopt for in-service training. The St.John of God Order has had experi-ence of sending staff away for ac-credited staff training. It found thattoo often staff returned to the orga-nization only to be frustrated by thedifficulty of initiating new ap-

The ultimate objective is toelicit improvements in the

person’s quality of life andto overcome barriers tocommunity integration.


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proaches when the structures andethos of the organization had re-mained unchanged. In many cases,the staff member left, and the ex-pertise flowed to another organization.

4. Integrated or aggregated concep-tual framework. The fourth deci-sion is whether to promote a singlemodel of intervention or whether topromote a diversity of perspectivesand models for working. The ad-vantage of the latter approach isthat it fosters the creativity andstimulation that staff need to if theyare to work towards delivering aquality service. On the other hand,an integrated model means that allstaff are speaking a common lan-guage, and are using a commonconceptual framework. The disad-vantage of this is that the singlemodel might restrict the flow ofideas, or become an institutionalprocess itself.

Our organization has decided thatthe multielement model introducedto us by LaVigna and Willis (1995)through a longitudinal training pro-gram in 1993, which we refer to asthe Positive Programming model,is comprehensive enough to en-compass other ideas and models ofintervention. For example, we havefound that the model is consistentin practice with most aspects ofGentle Teaching (McGee,Menolascino, Hobbs & Mensouek,1987), despite conceptual diver-gence (Jones, McCaughey &

Connell, 1991). Both approachesrepresent the application of nonav-ersive behavioral principles withinthe context of social role valoriza-tion and quality of life outcomes.

The Callan Institute ForPositive Programs

Our organizational response has beento opt for in-service staff training in thePositive Programming model. The pur-pose is to promote and maintain digni-fied, valued lifestyles in the communityfor people with challenging behaviors,thereby minimizing the need for segre-gated specialized units. With this pur-pose, the Callan Institute has embarkedon a program of training a wide range ofboth frontline and resource staff mem-bers to become behavioral consultantsworking from the model of positiveprogramming.

In addition to staff training, the CallanInstitute promotes the use of a supervi-sory system known as the Periodic Ser-vice Review (LaVigna et al., 1994) toensure consistency of program imple-mentation and to set additional perfor-mance standards. Because it is con-stantly monitoring implementation, theCallan Institute is uniquely placed tosupport individualized service deliveryand to advise the organization on im-proving the infrastructure necessary toachieve the full potential of the people itserves.

Staff Training in PositiveProgramming

To date a total of 52 staff membersfrom St. John of God services havereceived training in positive program-ming. These staff come from a varietyof professional backgrounds (nursing,psychology, social work, teaching, com-munity facilitator). The majority (53%)work with people with severe learningdisabilities. More recently, however,positive programs have been introducedto people who do not have learningdisabilities, but who receive serviceswithin other parts of the St. John of Godservices. These include schools and resi-dential settings for children with emo-tional difficulties, a high dependencyunit for adults with mental health diffi-culties, and a residential service for eld-erly people with senile dementia.

Staff were selected by their directorsin each center. They were chosen be-cause they were strategically placed todevelop positive programs as an inte-gral part of the organization’s practice.They come from all levels of responsi-bility, including director of service, unitsupervisor, resource team member andstaff member. The largest group workin the large residential centers, reflect-ing the fact that it is here that the highestconcentrations of people with challeng-ing behaviors live.

Each of the staff who received thetraining have provided comprehensivebehavioral assessment and multielementbehavior support plans to at least oneclient. In some cases, staff have beenable to provide positive programs tosecond, third and fourth clients. To date,we have found that staff on resourceteams or at unit supervisor level havebeen best positioned within the organi-zation to provide the service to addi-tional clients. The factors that enhancethis appear to include a capacity to orga-nize a team to support the interventionplan, so that tasks can be and delegatedand time can be made available forprogram development and report writing.

Following the process established byLaVigna and Willis in our initial train-

Intervention discontinued

Target behavior increased

Target behavior unchanged

Moderate improvement

Significant improvement

Total Number

Percentof

Baseline

After3

Months

After12

Months

After24

MonthsOutcome

-

120+

80 - 120

30 - 80

0 - 30

N

0

1

7

16

25

%

0

2

14

33

51

N

3

0

0

2

18

%

13

0

0

9.5

78.2

N

1

0

1

1

13

%

6

0

6

6

81

49 23 16

Table 1:Outcomes ofPositivePrograminterventionsafter 3, 12and 24months


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ing, each staff member is trained towrite a behavioral assessment report,support plan and quarterly progress re-port. On completion of the training,participants continue to submit quar-terly progress reports. These are re-viewed by a review committee which isdrawn from the original course mem-bers. Each participant has an opportu-nity take a turn as a reviewer. Invari-ably, they find that this role furtherassists the development of their ownprogramming skills. The Callan Insti-tute coordinates this process and alsocollects follow up data for each behav-ioral assessment report submitted. Out-come data is available at 3, 12 and 24month intervals. To date, three monthlydata is available for 49 individuals.These data are presented in Table 1.

Table 1 shows that 12 months afterintervention, more than 78% of thepeople who received positive programsachieved significant improvements intheir behavior. In some of these casesthe intervention was so successful thatthe intervention was terminated, andthe behavioral consultant withdrew fromproviding active services. Usually, theconsultant provided a maintenance plan,and in some cases monitored ongoingdata collection. After 12 months, inter-vention plans with two clients weresuccessfully terminated. After 24months, interventions with 5 clients(31%) were successfully terminated.

These results need to be interpreted inthe context of the following facts:

• The wide range of staff train-ing backgrounds. Staff variedconsiderably in the extent towhich the values and methodscould assimilate into their ex-isting concepts and practices.

• The wide range of settings inwhich interventions wereimplemented. Not all settingshad experience with individualprogramming and many set-tings had exceptionally lowstaff to client ratios and clientgroups with multiple behav-ioral challenges.

• The wide range of staff roles.There was significant varia-tion in the extent to which thebehavioral consultant couldcommit him or herself to theprovision of behavioralconsultancy services. In somesettings the consultant’s nor-mal role and responsibilitieswere altered to accommodatepositive programming. In themajority of cases the provisionof positive programs was anadditional responsibility.

• As there is no control group, itis not possible to infer a causalrelationship between positiveprograms and the behavioralchanges summarized in Table1. However, as mentionedabove, many of these clientshad presented with severe chal-lenging behaviors for manyyears.

Sixteen clients hadclear dual diagnoses.Table 2 shows the out-come data from these cli-ents across a range oftimes frames since intro-duction of the interven-tion plans.

As Table 2 shows, 75%of people who have dualdiagnoses have achievedsignificant improvementsin their target behaviors.This result is not signifi-

cantly different from the results for thegroup as a whole. The presence of adual diagnosis did not impede behav-ioral progress, even though the diagno-sis remained unchanged.

Organizational BenefitsThe introduction of Positive Program-

ming has been associated with clearbenefits for our consumers. In addition,the organization has benefited in at leastthree ways:1. The population of people with chal-

lenging behaviors. As mentionedabove, our survey of challengingbehaviors in our service found thata total of 224 people showed severechallenging behavior in a one monthperiod, using Oliver et al.’s (1987)criterion of tissue damage to selfand others. One year after the es-tablishment of the Callan Institute,56 (25%) were receiving or hadreceived Positive Programming(see Figure 3).

Training of new behavioral con-sultants will continue. On this ba-sis, it is no longer unrealistic toproject that effective, nonaversivesupport plans will be available toevery person within the Order’sservices who presents with a chal-lenging behavior. We are currentlyinvolved in research to assess theimpact of these programs on qual-ity of life.

2. Trained behavioral consultants: Anadditional benefit for the organiza-tion is that there are now 52 trained

Intervention discontinued

Target behavior increased

Target behavior unchanged

Moderate improvement

Significant improvement

Total Number

Percentof

BaselineOutcome

-

120+

80 - 120

30 - 80

0 - 30

N

2

0

0

2

12

%

12.5

0

0

12.5

75

16

1,447 people with a learning disability 224 people with

very severe challenging behaviors

25% receive Positive

Programs

Figure 3: Number of people with severechallenging behavior receiving PositiveProgramming to date

Table 2: Outcome data after threemonths for clients who have a dualdiagnosis.


8

behavioral consultants strategicallyplaced across the Order’s services.The direct benefit of this is thatthese consultants can establish Posi-tive Programming to additional ser-vice users. Some behavioral con-sultants have been able to providePositive Programming to as manyas eight people with challengingbehaviors. The indirect benefit ofthis is the improvement in servicesfor other clients who are not indirect receipt of Positive Program-ming. Many of the ecological strat-egies designed to improve qualityof life of the person and to fit betterwith the needs and characteristicsof the person often have benefitsfor all service users within that set-ting. The introduction of an effec-tive functional skills teaching ethos,or a reward culture has similar ben-efits across a client group. Simi-larly, a staff decision to respond tochallenging behaviors by active lis-tening, can have a powerful effecton the ways that staff attend to theclient group as a whole. Our re-search program is also addressingthe kinds of supports staff need toadopt positive ways of working withclients.

3. Service organization: As men-tioned above, the Callan Institutealso promotes the use of a supervi-sory system known as the PeriodicService Review (LaVigna et al.,1994). This requires a staff groupto identify and operationalize itsperformance standards. Perfor-mance standards are then activelyand objectively monitored, withregular, visual feedback on progressgiven to the staff team. Of the 49Positive Programming interventionplans already implemented, 30 hadalso implemented a Periodic Ser-vice Review. Because the PeriodicService Review ensures the imple-mentation of generic performancestandards as well as performancestandards specific to the delivery ofbehavioral intervention, there arequantifiable gains in quality of ser-vice. Further, since the Periodic

Service Review ensures mainte-nance of performance standardsover time, it is likely that the be-havioral improvements reportedabove will also be maintained.

References

Dunne, T.P. (1994) Challenging behavior: “and there’smore...” Clinical Psychology Forum, 67, 25-27.

Emerson, E. and Emerson C. (1987) Barriers to theeffective implementation habilitative behavioralprograms in an institutional setting. MentalRetardation, 25, 101-106.

Emerson, E., Toogood, A., Mansell, J., Barrett, S., Bell,C., Cummings, R., McCool, C. (1987) Challengingbehavior and community services: 1. Introductionand overview. Mental Handicap, 15, 166-169.

Felce, D., Saxby, H., de Kock, U., Repp, A., Ager, A.,and Blunden, R. (1987) To what behaviors doattending adults respond? A replication. AmericanJournal of Mental Deficiency, 91, 496-504.

Jones R.S.P., McCaughey, R.E. and Connell, E.M.(1991) The philosophy and practice of GentleTeaching: Implications for mental handicap services.The Irish Journal of Psychology, 12, 1-16.

Krauss, M.W. and Seltzer, M.M. (1987) Communityresidences for persons with developmentaldisabilities: Here to stay. Baltimore: Paul BrookesPublishing Co.

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McClean B. and Ryan D., (1995) Factors affecting theuse of nonaversive methods by staff who work withpeople with severe challenging behaviors.(Unpublished manuscript).

McClean, B. and Walsh, P. (1995) The identification ofservice users with challenging behaviors across alarge service for people with learning disabilities.(Unpublished manuscript).

McGee, J.J., Menolascino F.J., Hobbs, D.C. andMensouek, P.E. (1987) Gentle teaching: Anonaversive approach to helping persons with mentalretardation. New York: Human Sciences Press.

Newman I. and Emerson, E. (1991) Specialized treatmentunits for people with challenging behaviors. MentalHandicap, 19, 113-119.

Oliver, C., Murphy, G.H. and Corbett, J.A. (1987) SelfInjurious behavior in people with mental handicap:a total population study. Journal of Mental DeficiencyResearch, 31, 147-62.

Quine, L. and Pahl, J. (1985) Examining the causes ofstress in families with mentally handicapped children.British Journal of Social Work 154, 501-17.

Schalock, R.L, Harper, R.S. and Genung, T. (1981)Community integration of mentally retarded adults:community placement and program success.American Journal of Mental Deficiency, 85, 478-88.

Willis, T.J. and LaVigna G.W. (1992) A-B-C IncidentAnalysis. Los Angeles: Institute for AppliedBehavior Analysis.

Continued from page 1sure says that a support plan has clini-cal/educational validity if, as a resultand through the process of bringing thebehavior itself under control, the personhas a better quality of life, that theperson has such things as more access,opportunity, choice and control, com-petencies and nurturing, caring and mu-tually gratifying relationships.

This complex array of critical out-comes makes it unlikely that any onestrategy will produce all the desiredresults. Rather, full results are likely torequire multielement support planswhose various components, in combi-nation, address the full range of out-come requirements.

Support Plans

Proactive StrategiesThe components of our multielement

support plan are illustrated in Figure 1.The first major distinction within amultielement support plan is betweenproactive strategies and reactive strat-egies. Proactive strategies are thosedesigned to produce changes over time.Reactive strategies, on the other hand,are those designed to manage the be-havior at the time it occurs. Includedwithin the category of proactive strate-gies are ecological changes, positiveprogramming, and focused support.These three categories of proactive strat-egies, and their intended contributionsto outcomes, are described below:

Ecological Changes. As the ABATask Force report on “the right to effec-tive treatment” acknowledges (VanHouten et al., 1988), behaviors occurwithin a context and often are a functionof the person’s physical, interpersonaland programmatic environment. Envi-ronmental or setting events and charac-teristics (i.e., the ecological context forbehavior) provide an important area ofanalysis and offer significant opportu-nities for change as part of a supportplan. For instance, some challengingbehaviors could be a reaction to thecrowded or noisy conditions in which a


9

produce an immediate improvement inbehavior. For example, while mostindividuals might show improvementin moving from an institutional settinginto the community, some might showan increase in challenging behavior.Such an environmental change mightstill be pursued, however, if it is in anormal home environment that the per-son can learn, through positive pro-gramming, to be successful and enjoyliving in a real home. If such a goal has

validity, and if such a goal is mostrealistically achievable with a change inenvironment, the transitional increasein challenging behavior may have to beaddressed with appropriate focused sup-port and reactive strategies.

There are other ways in which eco-logical changes may have to be bal-anced with other elements of the frame-work. For example, it is often true thatgiving the person increased choice andcontrol over their day to day life is anecessary change in the interpersonaland programmatic environments. How-ever, it may be that the person exerciseschoices primarily to avoid participatingin most activities and/or to avoid learn-ing new skills. If the right to choosewere taken as an absolute, the personmay end up not having the best qualityof life. It is important for support staffto acknowledge their responsibility toteach the person how to make increas-ingly informed choices. How are sup-port staff to balance their responsibilityto respect the right of the person tochoose and their responsibility to teachthe person new skills and to teach them

to make increasingly informed choices?The following anecdote shows how onesupport team struck this balance.

A young, adult man with the chal-lenges associated with autism engagedin frequent self injurious behavior. As-sessment and analysis disclosed thatmost of this behavior was his way ofsaying “no,” his way of saying that hedidn’t want to do what he was beingasked to do. Accordingly, his supportstaff developed a positive program to

teach him how to say “no” byholding up a wooden symbol. Theinstructional program was suc-cessful and self injury was avoidedby staff backing off from their re-quest whenever he held up thesymbol. The quandary that theyfound themselves in, however, wasthat, in this fashion, he avoidedmost opportunities to learn newskills, even a recreational skillsuch as ping pong and the like.Whenever staff would begin in-struction, he would “choose” notto participate by holding up his

signal.In response to these circumstances,

staff then developed another positiveprogram to teach coping and tolerancefor this activity. They initially withheldthe availability of the wooden “escape”symbol for a few seconds. This delaywas not long enough to provoke anepisode of self injury, but it did allowsome initial seconds of instruction.When the symbol was available andheld up by the person, staff respondedby terminating the activity. Very gradu-ally, the availability of the symbol wasdelayed for increasingly longer periodsof time, still with self injury beingavoided. This continued until the avail-ability of the symbol was being delayedfor a five minute period of instruction.This was accomplished while still avoid-ing self injury.

At this point, the symbol was madeavailable from the beginning of instruc-tion. It was observed that this youngman would tolerate 30 seconds of pingpong instruction before he asked to stop,using his wooden symbol. Staff alwayscomplied with this request by terminat-

person must work, or could be a reflec-tion of simple boredom. If this is thecase, then the challenging behavior maybe impacted by simple ecologicalchanges in which crowding and noiseare reduced and the environment is mademore exciting. Some examples of eco-logical changes include changing theperson’s setting (Horner, 1980); chang-ing the number and quality of interac-tions (Egel, Richman & Koegel, 1981;Strain, 1983); changing the instructionalmethods that are being used(Koegel, Dunlap & Dyer, 1980;Winterling & Dunlap, 1987);changing instructional goals; and/or removing or controlling envi-ronmental pollutants such asnoise or crowding (Adams, Tallon& Stangle, 1980; Rago, Parker &Cleland, 1978). Generally speak-ing, ecological changes attemptto “smooth the fit” between theperson and his or her environ-ment by modifying the environ-ment (Rhodes, 1967).

Behavior challenges may re-flect a poor match, i.e., a conflict be-tween the person’s needs, characteris-tics and aspirations and that person’sphysical, interpersonal and program-matic environments. Resolution of thoseconflicts may require a change in thoseenvironments. For example, if the as-sessment concludes that the challeng-ing behavior is a reaction to a barren andunstimulating living environment, itmay ultimately be necessary for thatperson to have a home that providesmore stimulation.

This may take some time, however.In the meantime, while a more suitableliving arrangement is being pursued,strategies may be needed to reduce ormanage the challenging behavior in thecurrent location. Focused support strat-egies are designed to meet this need.The person may be reinforced for theabsence or lesser occurrence of the prob-lem; antecedents that set off the behav-ior may be eliminated to reduce thelikelihood of the behavior (i.e., ante-cedent control strategies may be em-ployed); etc.

Ecological changes do not always

It is important for supportstaff to acknowledge theirresponsibility to teach the

person how to makeincreasingly informed

choices.


10

ing the instructional session. However,for any session that lasted for 30 sec-onds or less, they terminated the sessionwith a sincere “...Nice game. Let’s playagain tomorrow.” For any session thatlasted for more than 30 seconds, theyterminated the session with “...Nicegame. Let’s play again tomorrow. Whydon’t we go get a snack.” Through thisdifferential reinforcement, and with agradual increase in the criterion for

reinforcement, this young man eventu-ally got to the point where he couldvolley back and forth a 100 times, suc-cessfully, missing no more frequentlythan his opponent. More to the point, hebegan to seek staff out with the pingpong paddles in an effort to get them toplay with him.

This example provides one illustra-tion of how staff balanced the importantecological strategy of increasing a

person’s choice and control with a posi-tive program teaching tolerance forlearning a new recreational skill. Thiswas accomplished in such a way thatchallenging behavior was brought un-der control while enriching the person’squality of life, by giving him a newrecreational skill that he now has theopportunity to enjoy on a regular basis.The model reminds us that ecologicalstrategies hold a position of primacy in

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SUPPORT PLAN

SITUATIONALMANAGEMENT

FOCUSEDSUPPORT

POSITIVEPROGRAMMING

ECOLOGICALCHANGES

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ASSESSMENT

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Figure 1: A Multielement Modelfor Breaking the Barriers to Social and Community Integration


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our support plans, but that these strate-gies may need to be balanced by theother strategies to produce outcomesthat have the highest clinical/educationalvalidity, that is, result in the best qualityof life possible for the person.

Positive Programming. If Ecologi-cal changes can be described as changesin the environmental context, to smooththe fit between the environment and theindividual, positive programming canbe described as changes in the person’sskills to deal better with the environ-ment. Positive programming is definedas systematic instruction designed togive the individual greater skills andcompetencies which will contribute tosocial integration (LaVigna, Willis andDonnellan, 1989). There are four varia-tions of positive programming involv-ing the development of general, func-tionally equivalent, functionally relatedand coping/tolerance skills.

General skill development across thedomestic, vocational, recreational, andgeneral community domains facilitatesthe reduction of challenging behaviorby increasing the person’s repertoire ofsocially acceptable responses. “Theincrease in more adaptive and sociallyadequate behaviors will no doubt resultin a concurrent decrease in maladaptivebehaviors” (Lovaas & Favell, 1987, p.312) (e.g., Wong et al., 1987). Theopportunity to learn and engage in awide variety of activities thereby pro-vides a fundamental basis for other in-structional efforts.

Challenging behavior occurs in cer-tain situations because they can serveuseful functions (Carr & Durand, 1985;Durand, 1990). What is much needed isan analysis of these functions and theincorporation of positive programmingwhich teaches functionally equivalentbut more socially acceptable responses,or responses that are otherwise func-tionally related to the identified rein-forcers. (Donnellan, Mirenda, Mesaros,and Fassbender, 1984; Favell,McGimsey & Schell, 1982).

Along with ecological change, posi-tive programming has the primary goalof producing durable, generalized out-comes, with good social and clinical/

educational validity. In contrast withecological change, positive program-ming involves systematic instructionwhile the former has to do with avail-ability and opportunity. For example,ecological change could involve havingaccess to a kitchen in one’s home, hav-ing choices about what to do and havinga day planner in which to schedule one’sday. Positive programming might in-clude teaching the person how to cooka meal independently, teaching the per-son how to make choices and teachingthe person how to use a dayplanner to schedule a fullday of interesting and de-sirable activities.

LaVigna, Willis andDonnellan (1989) describein more detail the differentvariations of positive pro-gramming. We believe thatamong the most importantfunctionally related skillsis the ability to cope withand tolerate naturally occurring aver-sive events. This last category of posi-tive programming deserves to be high-lighted because it is often overlooked insupport plans and because of its criticalneed for anyone who is living a full lifein the real world.

Life’s texture includes being told suchthings as “later,” “no,” and “good-bye.”It includes such things as failure, frus-tration, criticism, being teased, beingsick and performing nonpreferred tasks.While we would want to help anybodyfind a set of life circumstances thatkeeps these naturally occurring eventsto a minimum, anybody who has a life,has these experiences.

The rub is that these events are oftenthe antecedents to challenging behav-ior. Ecologically, we may try to mini-mize them and it may be important toteach the person to learn how to com-municate the key messages that let usknow what she or he wants or what he orshe is upset about. For truly durableoutcomes, however, and for the bestquality of life possible, support staffmay need to take the responsibility tosystematically teach the person how tocope with and tolerate these events, and

not just rely on the sink or swim ap-proach or rely on the natural conse-quences to teach life’s lessons. If theindividuals we are concerned about wereso able to learn from natural conse-quences, such an elaborate frameworkfor addressing their behavior challengeswould not be necessary. In fact, theirserious behavior challenges probablywould not even have developed.

Focused Support. Ecologicalchanges, depending on their difficulty,may take time to arrange, and positive

programming may require some timebefore new skills and competencies aremastered. It may therefore be necessaryto include focused support strategiesfor more rapid effects. Hence the inclu-sion of these strategies in our approach(see Figure 1).

There are alternatives to punishmentin addition to differential schedules ofreinforcement which can produce thisrapid effect (LaVigna and Donnellan,1986). These include, but are not lim-ited to, certain antecedent and instruc-tional control strategies (Touchette etal., 1985; Touchette, 1983; Carr,Newsom, & Binkoff, 1976) and stimu-lus satiation Rast, Johnston, Drum, &Conrin, 1981; Ayllon, 1963). A com-prehensive support plan could also in-clude nonbehavioral strategies such asneurophysiological techniques, medi-cation adjustments, and dietary changes.

Within the multielement model, thepurpose of a focused support strategy isto produce the most rapid effects pos-sible, to reduce the risks associated withthe behavior and to reduce the need forreactive strategies. The model empha-sizes the use of nonaversive focusedsupport strategies, since punishment

There are alternatives topunishment in addition to

differential schedules ofreinforcement…


12

brings a greater risk of negative sideeffects and itself may detract signifi-cantly from the person’s quality of life.Further, the use of some punishmentprocedures may preclude the personfrom having access to certain environ-ments, because of the relative lack of

social validity of such strategies.The use of nonaversive strategies is

also dictated by the outcome require-ment of speed and degree of effects,which is the primary reason for usingfocused support strategies. Punishment,by definition, is an after-the-fact proce-dure. The behavior occurs and then thepunishing consequence is provided. Incontrast, stimulus satiation and ante-cedent control may, conceptually andprocedurally, preclude the occurrenceof the challenging behavior altogether(LaVigna & Donnellan, 1986). Sched-ules of reinforcement may furtherstrengthen the ability of a support planto avoid or minimize the occurrence ofchallenging behavior.

For those support staff who favor anemphasis on an ecological approach tochallenging behavior and who have astrong appreciation for the individual’srights and dignity, there may be an aver-sion to using focused support strategies,since such strategies are often artificialand contrived. There may also be anaversion to any procedure, such as aschedule of reinforcement, that is soblatantly “behavioral.” This is of sig-nificant concern, since such strategiesmay be necessary for rapid control andnecessary to keep the person and others

free from the risks associated with thechallenging behavior, including the riskof further exclusion. This “anti technol-ogy” sentiment may be understoodwithin the context of a history in whichmany believe “behavior modification”has been used with a behavior, program

or research focus rather thana focus on the person andher or his quality of life.However, this frameworkproposes to harness behav-ioral technology toward theend of supporting humanvalues and dignity. (See thediscussion of clinical/edu-cational validity elsewherein this article.)

A person who is physi-cally challenged may needa physical prosthesis, suchas a wheelchair, to gain in-dependence and full com-

munity access. Support staff wouldadvocate for the individual’s right to thewheelchair, even though it may repre-sent an “artificial” means by which theperson would have mobility in the com-munity, and may in fact elicit negativeattention from the community. Simi-larly, a person who is behaviorally chal-lenged may need a behavioral prosthe-sis, such as a formal schedule of rein-forcement, to gain temporary controlover behavior and to enjoy full commu-nity presence and participation, as morepermanent solutions are being sought.This would suggest that support staffshould be equally comfortable in advo-cating for the individual’s right to theschedule of reinforcement, if needed,even though it may represent an “artifi-cial” means of behavior control, andmay in fact elicit negative attention fromthe community.

To summarize, proactive supportstrategies are those designed to producechanges over time and to improve theperson’s overall quality of life. Al-though there is some inter relatednessand overlap, our model delineates threecategories of proactive strategies, (eco-logical changes, positive programmingand focused support), each of whichmakes its own contribution to a com-

plex array of desired outcomes. Whileproactive support strategies are includedto produce changes over time, reactivestrategies are included for the narrowbut important purpose of situationalmanagement.

Reactive StrategiesThe need for situational management

is unavoidable when you are supportinga person whose behavior can be chal-lenging. For those support staff whohave been resistant to using strictly non-punitive strategies, it may be partly be-cause many advocates of a nonaversiveapproach have not explicitly describedwhat to do when a challenging behavioroccurs.

Generally, nonaversive strategies cre-ate a reactive vacuum. Ecological strat-egies, positive programming and fo-cused support strategies do not describewhat to do when a behavior occurs; theyare proactive, not reactive. Punish-ment, in contrast, is by definition areactive strategy and prescribes exactlyhow to react when the behavior occurs.Given this critical need, in lieu of othersuggestions, it is no wonder that somepeople have held on to their use ofpunishment.

As shown in Figure 1, the multiele-ment model calls for the explicit inclu-sion of reactive strategies as a compo-nent of a support plan. The outcomerequirement that is being addressed by areactive strategy is a subset of speed anddegree of effects. While the proactivestrategies address speed and degree ofeffects over time, reactive strategiesaddress the speed and degree with whichindividual episodes of behavior can bebrought under control, with the leastamount of risk of injury to the person, tosupport staff and to others in the envi-ronment. The role of a reactive strategyis not to produce changes in the future,but rather to keep people safe in the hereand now.

The model’s liberation of reactivestrategies from the need to produce fu-ture effects allows more options for therapid resolution of an episode of behav-ior than more traditional approacheshave provided. This is because the

…a person who isbehaviorally challengedmay need a behavioralprosthesis… to enjoy fullcommunity presence andparticipation.


13

reactive strategy is planned within thecontext of a powerful proactive planthat does focus on the future. If we haveecological changes on track, if we areactively engaged in positive program-ming, and if we have our focused sup-port strategies in place, it is less likelythat the reactive strategy will produce acounter therapeutic effect. The follow-ing anecdote illustrates this point.

A classroom student was engaging intantrums, which included disruptivescreaming and scratching herself, anaverage of 40 minutes a day, despite theuse of a corner time-out procedure forthe previous year and a half. Based ona thorough assessment, a comprehen-sive support plan was designed. Forexample, ecological changes includedan improved curriculum and a rear-ranged classroom. Positive program-ming included teaching her a relax-ation response and to communicate us-ing a communication board, with whichshe could ask to get a drink of water orto go to the bathroom, ask for a break,ask for a magazine, ask for assistance,etc. Focused support included a differ-ential reinforcement schedule of lowrates of responding. However, ratherthan continuing to use the corner timeout procedure as a reactive strategy, atthe earliest sign of a tantrum or a knownprecursor to tantrums, she was handeda magazine. This was selected becausesupport staff knew that when she hadphysical access to a magazine, she com-pulsively and immediately stopped what-ever she was doing, even tantrums, andremoved the staples from the middle ofthe magazine. Once she completed theremoval of the staples, it was quite easyto redirect her back to her educationalactivities.

From a traditional perspective, such areactive strategy would be criticized forits potentially counter therapeutic ef-fects. The fear would be that handingher a magazine, with which she engagesin a high probability behavior, as a reac-tion to her challenging behavior, wouldreinforce and strengthen tantrums. Theframework allows the inclusion of suchstrategies, however, relying on a fullydeveloped proactive plan to overcome

the potential counter therapeutic effectsof the reactive strategy, that might oc-cur without the context of the proactivestrategies.

In the example, what actually hap-pened was that with the initiation of thefull multielement plan, tantrums wereimmediately reduced to an average ofless than five minutes a day, a directresult of the effectiveness of the reac-tive strategy to rapidly establish controlover each episode and to prevent itscontinuation and escalation. Further,her time on-task, engaging in produc-tive instructional activities graduallyincreased and the daily rate of tantrumsgradually decreased. It has now beenmore than two years since any tantrumshave occurred.

We believe that certain reactive strat-egies, which are in many ways, counter-intuitive, such as the one describedabove, may contribute rapid and safeways of resolving individual episodesof challenging behavior, if certain guide-lines are followed (Willis and LaVigna,in press). This may represent a novelcontribution of the proposed multiele-ment model to the field. It also repre-sents a new area of much needed re-search, to enable us to understand howmultielement plans oper-ate and to investigate theirpossible synergistic capa-bilities.

AssessmentThe components of this

multielement model,which provides for bothproactive and reactivestrategies, is dictated by afocus on all six outcomerequirements. The designof many of these compo-nents requires specific informationwhich only can be gathered through acomprehensive assessment, includingthe possible influence that neurologi-cal, medical or other organic variablesmay have on the challenging behaviorand its meaning to the person, i.e., thefunction it serves or the message it con-veys. The purpose of an assessment

process is to determine this meaning.One strategy for this person centered

approach to assessment is to use per-sonal profiling and positive futures plan-ning (Mount & Zwernik, 1988;Patterson, Mount, & Tham, 1988;O’Brien & Lovett, 1992). We havefound futures planning to be particu-larly useful as a way of understandinghow the person’s ecology may be af-fecting behavior and what ecologicalchanges may be helpful in trying tosupport the person.

Personal profiling and positive fu-tures planning is a two step processdesigned to provide an understandingof a person’s life and what they haveexperienced from their point of viewand to develop a plan that helps themreach their goals and aspirations for thefuture. As is the multielement model,this approach is based on five quality oflife values: (1) presence and participa-tion in the community; (2) fulfillingvalued roles and gaining social respect;(3) maintaining satisfying personal re-lationships with friends and family; (4)expressing personal preferences andmaking choices; and (5) gaining skillsand competencies. Participating in the

process are the focus person and the“stakeholders” in that person’s life, i.e.,a circle of support that includes family,friends, past and present support staff,and/or any others that may be able tomake a contribution. If this processdoes not provide a sufficient under-standing of the behavior and its mean-ing for the person, a specific process of

We have found futuresplanning to be particularly

useful as a way ofunderstanding how the

person’s ecology may beaffecting behavior…


14

behavioral assessment and functionalanalysis should be employed.

The fundamental role of behavioralassessment and functional analysis inproviding behavioral services representsa hallmark in the field of applied behav-

ior analysis (Kanfer & Saslow, 1969;Schwartz, Goldiamond & Howe, 1975).Assessment methods, information, andmaterials are considered to have utilityif they have been demonstrated to con-tribute to beneficial outcomes (Hayes,Nelson & Jarrett, 1987). More specifi-cally, the utility of assessment is de-fined insofar as it bears relevance fordeveloping a support plan (Hayes,Nelson & Jarrett, 1989). Utility re-search is in its infancy in the area ofchallenging behavior (Ballmaier, 1992).

As shown in Figure 1, our frameworkprovides for three aspects of assessmentas having possible utility. The first ofthese is the method or process of assess-ment. Traditionally, the treatment ofchallenging behavior has relied almostexclusively on direct, naturalistic ob-servation. Increasingly, however, in-terviewing, records review and analogsituations are being utilized (Durand,1990; Iwata, Dorsey, Slifer, Bauman, &Richman, 1982; O’Neill, Horner, Albin,Storey, & Sprague, 1990; Willis,LaVigna, & Donnellan, 1991). Thesecond aspect of assessment that bearson utility is the information gathered bythe assessment process (Ballmaier,1992). Some content may seem to haveobvious utility, for example, knowingthe controlling antecedents. Other in-

formation may still be of questionablevalue to some practitioners, for example,knowing the history of the person and ofthe specific challenging behavior. Fi-nally, the framework reminds us thatassessment materials and devices are

subject to exploration fortheir possible utility, that is,their contribution to the de-velopment of effective sup-port plans (Ballmaier, 1992;Durand, 1990; O’Neill,Horner, Albin, Storey, &Sprague, 1990; Willis,LaVigna, & Donnellan,1993).

MediationAn inclusive framework

for breaking the barriers tointegration caused by chal-

lenging behavior must also address avariety of mediator issues (Durand &Kishi, 1987; LaVigna, Willis, Shaull,Abedi, and Sweitzer, 1994). Hencetheir inclusion as illustrated in Figure 1.No support plan, regardless of its com-prehensiveness and elegance, will pro-duce the desired outcomes, unless it isfully and consistently implemented. Ourmodel delineates a number of dimen-sions that relate to this issue. Firstly,three categories of social change agentsare identified who may participate onthe support team. These include natu-ral mediators such as parent, siblings,regular education teachers, supervisorsat work, and others whose relationshipto the person is a natural one and hasnothing to do with the person’s disabil-ity or challenging behavior. Also in-cluded are professional staff whose re-lationship to the person is a function oftheir disability, such as special educa-tion teachers, job coaches, and domes-tic and community living support staff.Finally, included would be specializedstaff whose relationship to the person isa function of the challenging behavior.These might include the behavior con-sultant, the one-to-one support staff, orothers who are involved specificallybecause of the challenging behavior.

Secondly, the model delineates three

aspects of training, as they may relate tothe three categories of mediators. Theseinclude teaching the general skills thatsuch support people may need to sup-port the person, teaching the specificskills that are necessary to implementthe procedures incorporated into theplan and quality assurance systems toassure full compliance with the supportplan. Such quality assurance systemsinclude clear and operational defini-tions of what exactly needs to be done,socially valid monitoring of implemen-tation, feedback based on the results ofmonitoring to improve and maintainfull and consistent implementation, andoutcome evaluation (LaVigna, Willis,Shaull, Abedi & Sweitzer, 1994).

We may also need to consider what isreasonable to expect of a person provid-ing support, particularly parents or par-ent surrogates, regardless of training.Some support strategies may be so in-volved or some situations so deterio-rated that they require professional oreven specialized staff. For this reason,we have developed an intensive supportapproach that allows the provision ofspecialized services without placing theperson in a more restrictive setting orother “challenging behavior unit”(Donnellan, LaVigna, Zambito &Thvedt, 1985).

ConclusionBy design and definition, good re-

search isolates independent and depen-dent variables and seeks to determinethe effect of the former on the latter.The variables not under study are re-moved or otherwise controlled. In starkcontrast, while individual elements maybe based on a specific study or group ofstudies, a person centered support planhas an array of elements, is based on acomprehensive assessment, and is aimedat producing a broad range of outcomes.We suggest that because this broad con-text is often lacking, research findingsmay be misinterpreted and misapplied.Additionally, we suspect that the nar-row interpretation of research findingshas led to practices that many outsidethe field have perceived as an overuse,

No support plan, regardlessof its comprehensivenessand elegance, will producethe desired outcomes, unlessit is fully and consistentlyimplemented.


15

misuse and, in some cases, abuse of thepunishment technology.

The model we have proposed is aframework for generating research ques-tions, for discussing research findings,and for incorporating those findings intomultielement, comprehensive, personcentered support plans. It also providesa model for guiding behavior analystsin understanding the difference betweena person centered support plan and theexperimental investigation of isolatedvariables. If our strength has been in thelatter, our weakness may be in theformer. By adopting a model such asthe one proposed here, we can onlyenhance the field of applied behavioranalysis.

The multielement model is funda-mentally derived from the outcomesdesired when supporting a person whohas the reputation of having challeng-ing behavior. Speed and degree of ef-fects has received most of the focus inthe field, but this is only one of theoutcomes that require our attention. Theothers include the durability and gener-alization of effects, minimizing nega-tive side effects, social validity, that is,the acceptability of our strategies to theindividual receiving treatment, to his orher family, to support staff, and to thecommunity, and clinical/educationalvalidity.

In this way, the proposed frameworkprovides a values base for addressingchallenging behavior. Effectiveness isultimately measured by clinical/educa-tional validity, that is, by the effects ofthe support plan on the person’s qualityof life, on the person’s increased inde-pendence and competence, social andcommunity presence and participation,productivity, personal empowermentand choice, and relationships and sup-port network (O’Brien, & O’Brien,1991). It is to these valued outcomesthat this Multielement model is dedi-cated.

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A Person Centered Approach toSupporting People with SevereReputationsGlenn Metlen, Ann Majure and Cheryl Stroll-Reisler

Editors’ Note: In the following column, you will have the opportunity to meettwo members of the IABA family. Glenn Metlen is a consumer of our servicesand Ann Majure is a Manager of supported living services in Ventura,California. Cheryl Stroll-Reisler assisted in developing Glenn’s supportstrategies and is a Manager of supported living services in Los Angeles. Thispaper was originally presented jointly by them at the 1994 Supported LifeConference in Sacramento California.

ANN:How do you support people so they

can live in and be a part of the commu-nity, have friends and acquaintances intheir lives, and have work and leisureactivities they enjoy and find meaning-ful? Most of us know the answer to thisgenerally - we focus on and respond tothe needs and desires of each individualperson. Many of us use tools such as“personal futures planning,” “circles ofsupport,” “lifestyle inventories,”“MAPS” to help us come to know some-one who needs our help to succeed inthe community. These tools have helpedus move away from the old deficit modelof understanding a person. Most of usno longer define people by what theycannot do or by some negative charac-teristic described in great detail in everyIPP the person has ever had. We nowknow to look for capacity, for positiveattributes, and to help the person buildon these. We know that the most impor-tant person to have involved in planningand deciding what supports are neededis the person who will be using thesupports. We know to listen to peopleand regard their wishes when it comesto where they will live, with whom theywill live, what kind of job they want,with whom they want to spend leisuretime, etc. But what do we as paid staffdo when we have listened and respondedto all of a person’s choices and prefer-ences and the person still has issues

which jeopardize his or her living in thecommunity? What happens whensomeone’s choice is impossible to pro-vide or even illegal? What about thepeople who have many abilities andpositive attributes but also have beenvery wounded by the service system?Some of these people have learned tocope with the injustices of their lives byengaging in behaviors which present adanger to themselves or others or be-haviors which the community simplywill not tolerate?

What about these people, the oneswho have the most “severe reputations?”They are often the people who never geta chance to live in the community be-cause they are considered “not ready”or they get sent back to more restrictivesettings after a short stay because theirbehavior was considered too difficult tobe “handled” in the community. Theseare the people we want to address. Wewant to share with you some of the toolswe use to help people with “severereputations” succeed in living in andbeing a part of the community.

One of the tools we use has developeda bad reputation lately - behavioral tech-nology. It’s sort of politically incorrectthese days to admit that we use or be-lieve in the value of behavior technol-ogy as a part of the supports we providefor people. We may reject and abhor theuse of aversive behavioral techniques(restraints, behavior controlling drugs,isolation, noxious substances, etc.) and

recognize them for the abusive, dehu-manizing things they are. But even thenonaversive techniques such as posi-tive reinforcement and positive pro-gramming have been seen as control-ling and denying individuals their rightto self-determination. “Natural conse-quences” are supposed to be the bestteacher and reinforcer. We want toshare with you the story of someonewhose needs required that we use arange of supports, including behavioraltechnology, and how he and we to-gether designed a support plan whichwe all feel accommodates his particularneeds and helps him succeed in thecommunity.

The best person to begin to tell youabout all this is the person who receivesthe supports. We are very pleased thatGlenn Metlen has agreed to talk with usabout his life and the things he feels areimportant to him.

GLENN:Hi, my name is Glenn Metlen. I’m

here today to talk to you about some ofthe things that have helped me live thekind of life I want to live and do thethings I want to do.

Over the years, I have been describedin many ways, some not too flattering.I’m someone a lot of people may de-scribe as having a challenging reputa-tion. I also am someone who lives in myown apartment. I have a job at RossClothing. I play the piano. I enjoyreading and writing. I like to eat out.

There have been times in my life,though, when these were not the thingsabout me that people spent a lot of timetalking about. They were too busy talk-ing about things like “aggression,” “in-tolerance,” “perseveration,” and a wholelist of other negative things. Becausesome people looked mostly at the nega-tive things, I had to live in institutionsand group homes for 12 years.

In 1990, I was able to move into myown apartment in West L.A. I reallyenjoy living there. I like paying my ownbills and deciding what to do and how todo it. I enjoy learning how to cook thefoods I like. I enjoy going to concerts


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and going to the library.The people I work with at IABA lis-

ten to me and try to respond to the thingsI tell them are important to me. Forexample, they helped me organize myapartment so it’s clean, orderly, andquiet. They helped me find a roommatewho is not disabled. They are nice to meand listen to me when I need to talk.They talk to me about things that worryme, like crossing busy streets, approach-ing cats and dogs, or just saying “no” topeople on the street who ask me formoney.

Just talking about the things that worryme helps a lot. But there are times whenI need something more to help me copewith the things that worry me. My staffand I have come up with some otherpretty creative things I want to tell youabout. One of the most important thingsI use is my “Almanac of Solutions.” Iuse this when I feel anxious about some-thing. My support staff and I havethought about all the situations that havecaused me to get anxious in the past andways I can handle the situation so Idon’t have to worry about it over andover. I have all these situations andsolutions written down in a book. WhenI feel anxious, I can just look in myAlmanac and read about a solution. Forexample, sometimes I get anxious whenmy support staff are late. I can look inmy Almanac and read what I can dountil my staff get there. I can play mypiano. I can call the IABA office andtalk to someone there. Then I don’thave to get too worried while I wait formy staff.

My weekly planner is another thing Iuse that helps me cope. My supportstaff write down all the things I havescheduled for the week. When I start toworry, I can look at my schedule, and itreminds me what’s going to happen onwhich days. If something happens tochange my plans, I can change it on myweekly planner. Then my support staffand I can discuss anything about thechange that bothers me and how tohandle it.

I also have what some people call“formal behavior programs.” They helpme avoid doing some of the things that

might cause me serious problems in thecommunity - like aggression and prop-erty destruction. I get a reward everyday that I don’t have one of these behav-iors. Recently, my support staff askedme if I thought I still needed theseprograms, and I told them that I did. Itold them that I liked signing my cardevery night to get my reinforcement.

All of these things I’ve talked aboutare important to me and help me live inthe community. I like it when my sup-port staff ask me what I need from them.That way, when I change, my supportscan change too.

ANN:Glenn has described the things that

help him cope with life in the commu-nity. Some of these things you may seeas just common sense. For example,most of us would like to live in a neat,clean apartment and be around nicepeople who will listen to us when weneed to talk about something. Thesethings may be important to many of us,but to Glenn they are critical to his beingable to cope with the stresses he finds inthe community and are essential to hiswell-being and safety. We have learnedhow critical they are by spending thetime to really come to know Glenn as aperson. We refer to these types ofthings as environmental or ecologicalstrategies.

Just addressing the environmentalthings Glenn needs is not enough toassure that he can cope with everythingthe community throws his way. Hisalmanac, his written schedule, his wayof using his staff to problem-solve cameabout because we tried to look at Glennas a unique human being and designstrategies based on how he best learnedand coped. These were all things thatwe and Glenn together decided helpedhim deal with anxiety and cope withthings in the community. These typesof strategies fall into the category ofwhat we call “positive programming”or ways of teaching and interacting withsomeone to help them develop new orbetter ways of dealing with life. ForGlenn these strategies are just as essen-

GLENN’S SUPPORT STRATEGIES

I. ECOLOGICAL ORENVIRONMENTAL STRATEGIES(These involve planned changesdesigned to improve the matchbetween glenn and his environ-ment. Environment can includepeople, places, and things.)• living in an apartment with a

nondisabled roommate• living in a quiet neighborhood• having opportunities to partici-

pate in vigorous exercise• having staff who help Glenn talk

through solutions to problems(e.g., “Columbo Method”)

• using a written weekly plannerto know “what is expected”

• using a personalized “Almanacof Solutions”

II. POSITIVE PROGRAMMING(This involves opportunities andinstruction which promotedevelopment of a rich repertoire ofappropriate behaviors that areincompatible with Glenn’sundesired behavior.)• expanding general vocabulary• learning how to say STOP, I

DON’T WANT TO, NO, etc.• general social skills training• personal effectiveness training• positive self-talk/optimistic

thinking• relaxation training• journal writing• discussion time

III. FOCUSED SUPPORTSTRATEGIES(These involve ways of helpingGlenn gain rapid control overthose behaviors which place himand others at imminent risk. Theyare used only in conjunction withenvironmental and positiveprogramming strategies.)• Antecedent Control Strategies

(eliminating the “cues” for theproblem behavior and increas-ing the “cues” for the absence ofthe problem behavior):- Interactions should beindicative of respect and dignity.- Provide additional support inlarge groups and crowds.- Don’t express concern whenGlenn is anxious. Stay neutral.- Always have access to abathroom.- Avoid arguing or threateningGlenn with consequences.- Do not ignore Glenn.

• Differential Reinforcement ofOther Behavior with Progres-sively Increasing Reinforcement(DROP):- Glenn receives a tangiblereward each day for theabsence of agitation, aggres-sion, and property destruction.


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tial to his success as having the rightapartment, the right roommate, and theright staff.

Environmental strategies and posi-tive programming are both part of themultielement model we employ in us-ing behavioral technology in support ofpeople who have challenging reputa-tions. In fact, most of the things we dofall into these two types of support.Yes, we may also use some of the moretraditionally recognized behavior tech-niques, like contingent reinforcement,as Glenn described to you. We use thisnot to exercise control over a person butto help the person learn to control urgeswithin themselves which will put themor others in some type of jeopardy.

We do not use these techniques todeny a person their right to self-expres-sion, but to help the person learn whatsociety will and will not allow them toexpress. (Sometimes natural conse-quences can be very dangerous for aperson with a severe reputation if thoseconsequences result in jail, return to aninstitution, or worse.)

We have found that to support people

with challenging reputations, it is es-sential that we truly use a person-cen-tered approach. We must come to knoweach person and learn with them what ittakes to help them succeed. This is notjust a surface understanding, but anunderstanding that comes from spend-ing time with people, asking them whatthey really want and/or need. It is anunderstanding that comes from carefulanalysis of what we learn from the peopleand how they best learn and communi-cate. We then look at the range ofnonaversive technologies and makeavailable to the person any we jointlyfeel will help him or her be more suc-cessful, more able to fully participateand enjoy the community.

When we look at nonaversive behav-ioral technology or any other strategy ortheory we use when we develop sup-ports for someone, we try to alwayskeep in mind that our application of anyof this is a product of our values, con-sciously or unconsciously. We at IABAhave spent a lot of time over the pastyear looking closely at our values, bothas an organization and as individual

spitting on another person (i.e.,projection of saliva from themouth such that it makes con-tact with another person); and,

2. Major Aggression: This isdefined as any response to-ward another person whichcould cause significant physi-cal injury or pain. Some spe-cific examples of major ag-gression include hitting (i.e.,striking another person withan open hand or closed fistsuch that the contact is audibleand/or results in movement ofthe person’s body), buttingwith her head (i.e., contact ofthe head to the body of anothersuch that the person’s body ismoved even slightly), biting(i.e., any contact of teeth to abody part of another person),kicking (i.e., any contact of afoot to the body of another,

Behavioral Definition of a ProblemBehaviorEditors’ note: In each issue of this newsletter we plan to have a column whichaddresses a technical issue in writing a behavioral assessment report. Typically,this will include an excerpt from an actual report. In this issue, we show how thedescription of the behavior and the operational definition should includeseparate descriptions of the topography, cycle, course, and strength (e.g., rate,duration, latency, and/or severity) of the target behavior. Since the coursedescription cross references to the Antecedent Analysis, we have included thissection of the report as well.

Description of Behavior and Operational Definition ofAggression.A. Topography. Two intensities of aggression have been defined:

1. Minor Aggression: This is defined as any response toward another personwhich causes, or is unlikely to cause anything more than, minor physicalinjury or pain, such as poking (i.e., thrusting finger or knuckle into the bodyof another such that the skin and/or clothing of another are depressed),pinching (i.e., grasping the skin of another between a finger and thumb orbetween fingers and the palm such that a fold of skin can be observed), or

practitioners within the organization.Examination of values is a lifelong pro-cess that we believe is essential forthose of us in this work. So, when wecome together with someone who needsour support, we always look for theways of support which are the leastintrusive and the most respectful of theindividual. Even when we and the per-son we support decide that some type offormal behavioral strategy is needed,we always try to keep sight of the factthat it is the people who implement thisstrategy who are the most importantingredient. Our relationships with thepeople we support are not just “nice tohave.” It is through relationship that weget to know someone well enough toread the cues and know what to do. It isthrough relationship that we begin tosee the person, not as just a client orconsumer, but as a valued, unique hu-man being.

We see our business as offering peopleopportunities. Nonaversive behavioraltechnology is just one means of expand-ing those opportunities for some people.


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with the exception of contactas part of organized games),and/or scratching (i.e., contactof the fingernails to the bodyof another such that a depres-sion is made at the time ofcontact, and/or a mark is ob-served on the surface of theskin). Major Aggression mayalso include attempts to strikea person with an item in herhand, such as a pencil or athumbtack.

B. Cycle. For the purposes of count-ing the number of times aggressionoccurs, an episode of aggressionbegins (i.e., onset criterion) withthe first occurrence or appearanceof any one or combination of theabove topographies. An episode ofaggression ends (i.e., offset crite-rion) when 60 seconds have goneby without any of the above topog-raphies.

C. Course. While Sally’s aggressionhas been reported to occur withoutwarning, typically it is preceded byone or more known precursors (i.e.,actions on the part of Sally thatprecede or signal the likelihood ofa problem behavior). Some pre-cursors manifested by Sally includefalling on the floor, burping andspitting, refusal to do something,demanding that someone do some-thing for her, throwing, shreddingand/or breaking clothing, furnitureor other objects, and general yell-ing and tantrum behavior. Precur-sors may also include pouting andsaying that she is not feeling well.

While aggression may appear tooccur suddenly, more typically itresults within the context of an epi-sode where she is getting visiblymore and more upset, as indicatedby her precursor behavior. Forexample, on her most recent homevisit, she got into a verbal battlewith her parents at bedtime aboutwho was going to make her bed.Earlier in the day she had becomeupset about something and had re-moved her sheets and blankets fromher bed and tossed them away. Sally

was demanding of her mom “youmake-up and fix” and mom wasequally insistent in saying “no, youmake the bed or sleep as it is.”After some back and forth of thiskind, with voices becoming louderand louder, and after emotions be-coming more and more raised andthe interaction escalated, Sally be-gan to yell and then to hit out at hermother. At this point her mom anddad had to physically move her intoher bedroom and shut the door.There then proceeded to be a periodof about an hour and a half of gen-eral yelling and tantrumming andproperty destruction in the bedroom,before Sally was able to calm down.

Such episodes were described asnot typical of her behavior at home,although an episode with a courseof such as this was not uncommonat school. On the other hand, thestaff at school described anothertypical pattern that was muchquicker in developing. As an ex-ample, they described the time whenthe buzzer went off in the class-room and she was “told to stopdrawing,” at which point she startedthrowing things, and then began tohit the staff person. While precur-sor behavior still occurred, the es-calation to aggression was muchquicker in this situation, and a sig-nificant number of episodes aredescribed as being on this faster track.

However, it was also acknowl-edged by both parents and staff thatthe degree and speed of escalationvery much depended on what washappening to her at the time andhow she was being treated by theperson or people with whom shewas having the interaction. Theinteraction of antecedents withSally’s behavior and those that aremore or less likely to produce asignificant and rapid escalation aredescribed below in the AntecedentAnalysis section of this report.

D. Strength.• Rate. As described above, until

recently, Sally was said not todisplay significant amounts of

aggression at home. The cur-rent rates at her residentialschool, at the time of the as-sessment, were zero to fourminor incidents a day, with anaverage occurrence of .75 epi-sodes a day, i.e., an average ofthree episodes every four days,with most of these occurring inthe residence, and zero to sevenmajor incidents a day, with anaverage of 1.25 episodes a day.Most of these major episodesare reported to occur in theschool environment.

• Severity. As indicated, an epi-sode of aggression could beover quite quickly or continuefor an extended period of time.While it could be over after aperiod of only 90 seconds, epi-sodes of more than an hourwere not uncommon, althoughsuch extended episodes are lessfrequent at the present time.Very rarely, an episode couldlast for a half day. The mostcommon topographies werereported to be pinches andscratches and when she is re-ally upset, the school reportsthat it requires three people tophysically control her. On theother hand, there is typicallyonly one person on at a time inthe residence, and they ex-pressed their confidence inbeing able to manage Sally,even if an episode of aggres-sion occurred. The highernumber of incidents of majoraggression in the school, andthe greater number of peoplerequired to manage her there,adds importance to the clearestunderstanding possible of howdifferent interactional styleseffect Sally’s behavior. Fi-nally, while it is not typicalthat actual injury occurs to aperson as a result of Sally’saggression, on separate occa-sions, it has caused a bruised(possibly cracked) ribs, a blackeye, and a bloody nose.


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Antecedent AnalysisBased on a review of records kept by

staff and based on in depth interviews ofstaff and parents, an antecedent analy-sis disclosed a number of events associ-ated with a higher likelihood of aggres-sion and a number of events associatedwith a lower likelihood. As with virtu-ally all antecedent analyses, no eventswere identified that would allow a pre-diction of occurrence or non occurrenceof aggression with 100% accuracy. Thistypical lack of a perfect relationshipbetween antecedents and behavior ex-plains some of the difficulty that mayhave been experienced in previous at-tempts to understand the meaning ofSally’s aggression.

However, there was one set of ante-cedents generally recognized for theirstrong relationship to Sally’s refusal tocomply with a request, the most com-mon precursor associated with aggres-sion, occurring in more than 85% of theepisodes involving this target behavior.Since Sally’s refusal to do a task is arecognized and frequent precursor toaggression, antecedents to task refusalcan also be considered as antecedents toaggression, as they initiate a behavioralchain that can escalate to aggression.Specifically, it was generally recognizedthat she is more likely to refuse what isbeing asked of her if: the request ismade as a way of getting her attention,especially when she is being distractedby surrounding stimulation; if the adultis speaking fast to her; if the adult isusing a demanding, cold, unfriendlyand impersonal tone; if the adult is ask-ing her do certain known, non preferredtasks, such as working on her sightwords out of the context in which thosewords are used functionally; if the adultis making the request without offeringany choice, without providing a friendlyexplanation or without offering a sym-pathetic ear for the need to do the task;and making the request in an authorita-tive manner.

These antecedents are well known toincrease the likelihood of Sally’s re-fusal to do a task or participate in orterminate an activity. There are also a

number of antecedents associated withthe higher likelihood of refusal escalat-ing to property destruction, tantrumbehavior and the other precursor behav-ior, and for the incident to continueescalating to aggression. They mayalso directly initiate precursor behaviorby themselves, and subsequent escala-tion to aggression. Finally, on very rareoccasion, they may provoke aggressionoutright, without any precursor behavior.

These high probability antecedentconditions include responding to herrefusal to comply with a repetition ofthe request in the manner describedabove; moving into closer proximity toSally, in response to her refusal; at-tempting to physically restrain her be-cause she appears to be about to engagein aggression; physically “escorting” ordirecting Sally to another area, as aconsequence for refusal to comply or asa consequence for another behavior;directing Sally to stop an activity, as aconsequence for a behavior, such as theday she was told to get off the swingbecause she was spitting and burping;having her lose a reinforcer as a conse-quence for a behavior; categoricallydenying her something that she has askedfor, without a friendly and sympatheticear and active listening; and/or con-fronting her with a hostile tone andstance.

From the above analysis, it is alsopossible to identify those events associ-ated with the low likelihood of aggres-sion and the precursor behavior that canlead to aggression. These include, firstof all, the antecedents associated with ahigher likelihood that she will complywith a request. Specifically:1. Making sure you have her attention

before the request is made, espe-cially when she is being distractedby surrounding stimulation.

2. Speaking slowly to her when mak-ing the request.

3. Making the request using clear,concise and simple language.

4. Using a friendly and warm tonethat communicates a firm, personalexpectation of cooperation, ratherthan a demand for compliance.

5. Designing lesson plans so that non

preferred tasks are taught in themost natural and functional con-text possible.

6. Making the request within the con-text of a choice with legitimateoptions, both of which would beacceptable, making it a win-winsituation for everybody. An ex-ample of a win-win choice wouldbe one in which the teacher wantsSally to work on math but givesSally the choice as to whether shewants to work on the computer orthe calculator; for example, “It istime for math, which do you wantto work on first, the calculator orthe computer?” (Win-lose choicesshould be avoided, such as “Youcan either start your math or I willgo into the other room and leaveyou alone.”

7. If a choice is not possible, at leastproviding a friendly explanationand offering a sympathetic ear forthe need to do the task.

8. Making the request in an egalitar-ian, as opposed to an authoritativemanner.

The following antecedent conditionsmake it less likely that refusal, if itoccurs, will escalate to aggression, thatother precursors will occur and/or esca-late to aggression, and/or that aggres-sion will occur without any precursors:1. Responding to her refusal to com-

ply with a repetition of the request,but with special care to use themanner described above;

2. Continuing the interaction with nochange or threatened change inproximity, in response to her re-fusal or as a consequence for an-other behavior; rather than movinginto closer proximity to Sally orphysically leaving the area she is inor threatening to do so;

3. Developing a support plan for ad-dressing her refusing to complyand her other identified behaviorproblems using one or more of theprocedures based on establishednonaversive technology, in order to:a. avoid physically “escorting”

or directing Sally to anotherarea, as a consequence for re-


21

fusal to comply or as a conse-quence for another behavior;

b. avoid the use of physical re-straint;

c. avoid directing Sally to stop anactivity, as a consequence fora behavior;

d. avoid the removal of a rein-forcer as a consequence for abehavior; and,

e. avoid aversive consequences,generally, for problem behavior.

4. Offering a friendly and sympatheticear and actively listening when it isnecessary to categorically deny hersomething that she has asked for orthat you know she wants; and,

5. Using an open, friendly, warm and

non hostile, non confrontationaltone and stance when interactingwith her.

In addition to these relatively imme-diate antecedents, which lead to a higheror lower probability of occurrence foraggression and its precursors, there arealso a number of setting events thateffect the likelihood of these behaviors.One of these is Sally’s physical health atthe time. That is, when she is sick orotherwise not feeling physically well,she is even more likely to respond to thehigh probability antecedents with ag-gression or its precursor behaviors.During these times, it would be espe-cially important to employ the anteced-ents associated with a low probability

of problems, as described above. Simi-larly, staff described how it is relativelyeasy to determine by her manner if Sallyis in a good mood, or if she got up on thewrong side of bed. Her being in a badmood is also a setting event for aggres-sion and its precursors. Staff report,however, that the use of humor and aneasy going manner works quite well inbreaking her out of her mood, givingthem greater confidence that they canthen proceed with the regular businessof the day. To push ahead with businessas usual when Sally is in a bad mood oris not feeling well, increases the chancesthat aggression and its precursors willoccur.

Procedural Protocols -Interpersonal StyleEditors’ Note: A Procedural Protocol is a written “recipe” describing how animportant part of a support plan should be carried out. Perhaps one of themajor reasons that plans are carried out “inconsistently” is the lack of a cleardescription of what needs to be done. Procedural Protocols can take manyforms. What is common to all is a description of what to do, when to do it, andwho is to do it. A protocol may be as simple as a statement of “do’s anddon’ts.” It may be a simple description of how support staff should carry out asimple Differential Reinforcement Program. The steps of a procedural protocolshould not be in a long, drawn-out paragraph format. Rather, the steps shouldbe seen as “visual bites” (bullets of information) that grab the person’sattention.

In the following column, we present two sample procedural protocols, toillustrate how different protocols can be written. These protocols, and the oneswe will publish in this column in the future, can be added to the reader’s libraryof protocols for future reference and adaptation as the need arises. In this case,the protocols were developed as part of Sally’s support plan. Excerpts from herassessment report appear elsewhere in this newsletter.

Key Elements:1. Obtain Sally’s attention before be-

ginning to talk to her. (This isparticularly important when she isbeing distracted by surroundingstimuli.)

2. Speak slowly.3. Use clear, concise and simple lan-

guage.4. Use a friendly, warm, engaging tone

of voice.5. Convey openness nonverbally, us-

ing body language and gestures.6. Use nonauthoritarian interactional

style.7. Convey respect for Sally as an ac-

tive teenager.8. Avoid using a bossy, confronta-

tional, demanding manner.9. When making a request, communi-

cate a firm, personal expectation ofcooperation.

10. When a choice is not possible, atleast provide a friendly explana-tion and offer a sympathetic ear forthe need to do the task.

11. Specific scripts should be usedwhen: 1) Making requests to per-form nonpreferred activities, 2)Denying her something and/or say-ing no, 3) She must delay gratifica-tion, 4) Interrupting a reinforcingactivity, 5) Disagreeing with her,

Protocol #1Name: Sally MelliorDate Protocol Developed: June 14,

1993Protocol Name: Ecological Strate-

gies - Interpersonal StyleMaterials: NoneSchedule: During all interactions

with Sally.General Statement: When working

with Sally, a key to continued successover time is to always use simple, clear,concise language that is spoken slowly.The tone of the interaction must befriendly and warm, but with a definiteexpectation of cooperation. The styleshould be that engaged in with anyfriendly teenager. This format offriendly, warm, firm, nonauthoritarianinteraction is key to success in workingwith her.


22

6) Confronting her about misbe-havior.

CommentsWhen things are going well, it may be

relatively easy to adopt the interactionalstyle described. However, it is evenmore important to follow the aboveguidelines when things seem to be get-ting off track and you find yourselfgetting upset with Sally.

Protocol #2Name: Sally MelliorDate Protocol Developed: June 14,

1993Protocol Name: Script - Denial and

Saying NoMaterials: NoneSchedule: Whenever you must deny

her something she is asking for and shebecomes the slightest bit upset or oppo-sitional.

Responsible Person: Everybodywho interacts with Sally

General Statement: There are anumber of antecedent control strategiesthat may act to preclude the occurrenceof Sally’s targeted behaviors. These aredescribed in her assessment report, withwhich everybody should be familiar.Eventually, perhaps after a year of suc-cess, the gradual fading of strict adher-ence to some of these antecedents canoccur. The fading process will be initi-ated very carefully. In addition to goinga long period of time without aggres-sion and its precursors, the most impor-tant indicator that fading can begin willbe when the goals and objectives of thepositive programs have been met.

Scripts have been developed to giveyou crystal clear guidelines on what tosay and how to say it for those situationsthat are known to have a tendency foreliciting aggression and its precursors.In addition to providing the words, thesescripts include directions to use thosestyles of interaction that are known towork best for her.

Script:General:

1. Obtain Sally’s attention before be-ginning to talk to her. (This isparticularly important when she isbeing distracted by surroundingstimuli.)

2. Speak slowly.3. Use clear, concise and simple lan-

guage.4. Use a friendly, warm, engaging tone

of voice.5. Convey openness nonverbally, us-

ing body language and gestures.6. Use nonauthoritarian interactional

style.7. Convey respect for Sally as an ac-

tive teenager.8. Avoid using a bossy, confronta-

tional, demanding manner.Specific:

1. Spend time applying active listen-ing protocol until it is clear to herthat you understand what she wants.a. Determine her message and

provide a sympathetic ear.b. You should then put what you

understand Sally to be sayinginto you own words, in orderto verify with her your under-standing of what she is feeling.

c. During this listening and veri-fying process, DO NOT evalu-ate, give an opinion, advise,analyze or question.Example: Sally says, “I don’twant to go shopping in Dad’scar. I want to go in Jane’s car.Dad says, “It sounds like youdon’t want to ride in my carand you want to ride in Jane’scar.”

2. Monitor your progress during theactive listening process, i.e., trackthings to determine if Sally is be-ginning to calm down or to escalate.a. Verbal Indications: For ex-

ample, voice is closer to nor-mal volume and pace.

b. Nonverbal Indications: Forexample, Sally begins to lookcalmer, physically more re-laxed, less tense.

3. Review with Sally the issuesbrought up during active listening,using slow, clear, concise, andsimple language, e.g., “Let me makesure I understand everything… Isthere anything I missed?”

4. Listen for Sally’s indication thatshe has been heard.

5. Keeping a warm, friendly attitude,ask Sally if you can now relate toher your reason for saying no, e.g.,“Sally, I’ve listened to you, nowwill you listen to me? Can I tell youwhat I think?”

6. Try to get Sally to a “neutral” envi-ronment, e.g., “Sally, would it beO.K. with you if we went to sitdown over here and continue totalk about this?”

7. After gaining Sally’s acceptance,go to the “neutral” place and haveher listen to your explanation, re-membering to make sure you con-tinue to hold her attention, and youare not being authoritarian. E.g., “Ifeel it would be better to take mycar because Jane’s car has no gas.We will have more time to shop, ifwe take my car. Do you under-stand?” Or... “I feel __________because _____________. Do youunderstand?”

8. Enter into a negotiation process.E.g., “What do you think we shoulddo to fix this situation, Sally?”

9. Provide Sally, with some optionsthat would be acceptable to youboth. E.g., “Can we take my carnow and Jane’s car later?” Or...“How about doing this or this in-stead of that?”

CommentsIt is important to remember that if you

have gotten into a situation involvingdenial, and if Sally seems upset about it,as soon as possible, the forward motionof the activity should be stopped andthis script should be played out with asmuch time as it takes. Having reachedan understanding, the regularly sched-uled activity can then proceed.


23

Supported EmploymentJulie Shaull, Diane Sabiston, Chris PellaniThis is a 2 day workshop that provides participantswith all of the “nuts and bolts” of providing qualitysupported employment services to people withchallenging needs.March, 1996 - Great Britain Seminars (London,

Manchester, Edinburgh)

Dual DiagnosisRobert Sovner, MDThis 1 day seminar will examine current diagnostictrends and medication issues of people that have adual diagnosis.March 18, 1996 - Los Angeles

Seminars and workshops are available for in-house presentation and local sponsorship. Fordetailed information on any seminar, contact:

John Q. Marshall, Jr., Seminar CoordinatorInstitute for Applied Behavior Analysis

PO Box 5743Greenville, SC 29606-5743 USA

Telephone: (864) 271-4161-Fax: (864) 271-4162Internet: [email protected]

Toll Free (USA and Canada): (800) 457-5575

or in Australia - Jeffrey McCubbery (054) 416 344or in England - Cherry Connell (01562) 747 881

or in Auckland, New ZealandRay Murray (09) 623 8899 ext. 8681

or in Christchurch, New ZealandRebekah McCullough (03) 379 3980

Multimedia Training Programs

Competency Based Training ProgramThis is a systematic, criterion-referenced, self-instructional multimedia course for staff developmentthat is customized to your agency. It is being used byadult service agencies and schools in Australia, GreatBritain, Spain and the US. $1,500.00

For more information on the CBT, contact:Diane Sabiston

Institute for Applied Behavior AnalysisPO Box 30726

Savannah, GA 31410-0726 USATelephone: (912) 898-0390 • Fax: (912) 898-8077

Positive Approaches to Solving BehaviorChallengesThis is a 6 module video training program that teachesviewers IABA's person centered multielement modelfor developing nonaversive support plans for peoplewith challenging behavior. Two text books, lecturenotes and pre/post tests are included. $1,250.00

Staff Supervision and Management Strategiesfor Quality AssuranceThis is a 4 module video training program based onThe Periodic Service Review: A Total Quality AssuranceSystem for Human Services and Education. Viewerswill learn concrete strategies to ensure that the highestquality services are being provided by their agency/school. Text book, lecture notes and participantexercises are included. $750.00

For more information, contact:



Telephone: (864) 271-4161 • Fax: (864) 271-4162

Assessment and Analysis of Severe andChallenging BehaviorGary W. LaVigna, PhD & Thomas J. Willis, PhDThis competency-based training practicum providesparticipants with the clinical skills required to designa multielement nonaversive support plan.Australia • Bendigo, Vic • November 5-17, 1995USA • Los Angeles, Ca. • July 28-August 10, 1996England • November, 1996

Positive Approaches to Solving BehaviorChallenges and The Periodic Service ReviewGary W. LaVigna, PhD or Thomas J. Willis, PhDPositive Approaches… is a 2 day seminar thatpresents IABA's multielement model for providingperson centered nonaversive behavioral supportsto people with challenging behavior. The PeriodicService Review is a 1 day seminar that teachesparticipants a staff management system that ensuresthe agency/school is providing quality services.October/November, 1995 - Australian Seminars

(Sydney, Canberra, Brisbane, Adelaide,Hobart, Melbourne)

November, 1995 - New Zealand Seminars(Auckland, Christchurch)

January, 1996 - US Seminars (Florida, US VirginIslands)

February, 1996 - US Seminars (Virginia)March, 1996 - US Seminars (New Jersey, Ohio)June, 1996 - Australian Seminars (Melbourne,

Perth, Darwin); Oslo, Norway; Belfast,Ireland; London, England; Cardiff, Wales

October/November, 1996 - Great Britain Seminars(London, Taunton, Manchester,Birmingham, Sheffield, Edinburgh)

Other venues will be arranged and announcedat a later date.

ResourcesTraining Calendar

Printed Resources Available from IABAAlternatives to Punishment: Solving BehaviorProblems with Nonaversive StrategiesG.W. LaVigna and A.M. Donnellan“(This book) provides a comprehensive treatment ofalternatives to punishment in dealing with behaviorproblems evidenced by human beings at various levelsof development and in various circumstances. Basedupon their own extensive observations and a thorough-going analysis of relevant experimental studies, (theauthors) have put together a document that is at oncea teaching instrument, a summary of research, and anargument for the use of positive reinforcement in thetreatment of inadequate or undesired behavior… alandmark volume which should forever lay the ghostthat aversive methods (even the ubiquitous ‘time out’)need to be applied to the delinquent, the retarded, orthe normal ‘learner,’ whether in the home, the school,the clinic, or other situations.” — Fred S. Keller (Fromthe Preface to Alternatives to Punishment) - paper,$19.50/ISBN 0-8290-1245-1

The Behavior Assessment GuideT.J. Willis, G.W. LaVigna and A.M. DonnellanThe Behavior Assessment Guide provides the userwith a comprehensive set of data gathering and recordsabstraction forms to facilitate the assessment andfunctional analysis of a client’s behavior problems andthe generation of nonaversive behavioral interventionplans. Permission has been granted by the authors toreproduce the forms for professional use. -spiral, $21.00

Progress Without Punishment: EffectiveApproaches for Learners with Behavior ProblemsA.M. Donnellan, G.W. LaVigna, N. Negri-Schoultz, L.FassbenderAs individuals with special educational anddevelopmental needs are increasingly being integratedinto the community, responding to their problem

behaviors in a dignified and appropriate mannerbecomes essential. In this volume, the authors argueagainst the use of punishment, and instead advocatethe use of alternative intervention procedures. Thepositive programming model described in this volumeis a gradual educational process for behavior change,based on a functional analysis of problems, that involvessystematic instruction in more effective ways ofbehaving. The work provides an overview ofnonaversive behavioral technology and demonstrateshow specific techniques change behavior throughpositive means. The extensive examples and illustrativematerial make the book a particularly useful resourcefor the field. - paper, $17.95/ISBN 8077-2911-6.

Social Skills Training for Psychiatric PatientsR.P. Liberman, W.J. DeRisi, K.T. MueserThis guide to the application of social skills trainingwith psychiatric patients systematically providesclinicians with the ingredients necessary to start andrun their own social skills groups. Case examples,transcripts of social skills training sessions andexercises aid the reader in applying the trainingmethods.-paper, $25.95/ISBN 0-08-034694-4

The Role of Positive Programming In BehavioralTreatmentG.W. LaVigna, T.J. Willis, A.M. DonnellanThis chapter describes the role of positive programmingin the treatment of the severe behavior. After discussingthe need for positive programming within a frameworkfor research and treatment based on outcome needs,variations of this strategy are delineated. Then,assessment and analysis are described as critical forcomprehensive, positive, and effective support. A casestudy of severe aggression is presented to illustratethe process of assessment and analysis, the supportsthat follow from this process, and the long term resultsof this approach. - spiral, $5.00

The Periodic Service Review: A Total QualityAssurance System for Human Services &EducationG.W. LaVigna, T.J. Willis, J.F. Shaull, M. Abedi, M.SweitzerEvolving from more than a decade of work at IABA, thisbook provides the tools needed to enhance and maintainhigh quality service delivery. Translating the principlesof effective management into concrete policies andprocedures, the Periodic Service Review (PSR) actsas both an instrument and a system. As an instrument,the PSR provides easy to follow score sheets toassess staff performance and the quality of servicesprovided. As a system, it guides managers step-by-step through 4 interrelated elements — performancestandards, performance monitoring, performancefeedback, and systematic training — to offer an ongoingprocess for ensuring staff consistency and a high levelof quality for services and programs. Practical examplesshow how the PSR is applied to group home, supportedliving, classroom, and supported employment settings,and the helpful appendices provide numerous tablesand charts that can easily be tailored to a variety ofprograms. - $36.00/ISBN 1-55766-142-1

Add for Shipping and Handling:1st book (min.) $3.00 Each add’l book $0.50

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July 28 – August 10, 1996Los Angeles, California

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