number 2 â€¢ january 1997 - institute for applied behavior analysis

I N S T I T U T E F O R A P P L I E D B E H A V I O R A N A L Y S I S

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

THE

N E W S L E T T E R

A quarterly publication dedicated to the advancement of positive practices in the field of challenging behaviorVolume II • Number 2 ISSN 1083-6187 • January 1997

C o n t e n t s

Severe and challenging Behavior:Counter-Intuitive Strategies for CrisisManagement Within a NonaversiveFramework ............................................. 1Editors’ Note ......................................... 2Quality Assurance: What Madeit Work for Us ........................................ 3Daily Life of a PersonWho is Disabled .................................... 7Commentary on aSpeech on the Daily Lifeof a Person Who is Disabled ............... 8Pen Pal Request ................................... 9Definition of a Problem Behavior ..... 18Procedural Protocols ......................... 19Alphabetical Index ofPrevious Issues .................................. 23Resources ........................................... 24

Continued on page 10

Severe and Challenging Behavior:Counter-Intuitive Strategies for CrisisManagement Within a NonaversiveFramework

Gary W. LaVigna and Thomas J. WillisInstitute for Applied Behavior Analysis, Los Angeles

Editors’ Note: The Multielement Model has evolved gradually over the years. Oneof the areas that has developed most dramatically has been that of reactivestrategies and emergency management of and for behavioral crises. While those ofyou who have attended our two-week training institutes and longitudinal trainingprograms would have received a copy of our monograph concerning EmergencyManagement Guidelines, we have totally revised that monograph and plan topublish it later this year as Challenging Behavior: Reactive Strategies andEmergency Management Within a Nonaversive Framework (Willis & LaVigna, inpress). The following article presents some of the material we discuss in themonograph and is based on a presentation Gary gave at the Positive ProgrammingConference sponsored by St. John of God in Dublin, Ireland, in April 1995.

Applied behavioral analysis has been very useful in the develop-

ment of positive approaches for supporting people with severe and

challenging behavior (LaVigna & Donnellan, 1986). In fact, the

nonaversive strategies that have been developed are based on the

same fundamental premise as the punitive strategies; that behavioris a function of its consequences, under certain conditions. In the

research that has been carried out in both the experimental analysis

of behavior and applied behavior analysis, we have not seen a single

piece of evidence, a single study, a single sentence that would

support a conclusion contrary to the following statement: If you

have a behavior that could be changedthrough the use of aversive contingen-cies, then it could also be changedthrough positive contingencies. Our con-fidence that this statement is true, yourbelief that behavior can be changedthrough positive strategies, as well aspunitive ones, has helped evolve the fieldof Positive Practices.

As that field developed, many of usbecame concerned that something wasbeing lost; something was missing inwhat we were doing. What was it? Theanswer is, “The PERSON.” When youthink about the thousands of behavioralstudies that were published beginning inthe 60’s through the 90’s, you probablyrecall those the graphs which showedsuch dramatic decreases in the TARGETbehaviors. The tragedy, however, is doyou remember anything about the PER-SON, the SUBJECTS? Probably not. Do

P O S I T I V E P R A C T I C E S • V O L U M E I I • N U M B E R 2 • J A N U A R Y 1 9 9 7

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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

Service to Employ PeopleJulia F. Shaull, LCSW, MSW

Director of Supported EmploymentStacy L. Daniels, MA

Asst. Director Supported EmploymentSusan Caraway

Manager - Los AngelesAyndrea LaVigna

Manager - Ventura CountyLeilah Sadd

Manager - North Los AngelesPatricia Speelman, MA

Manager - Orange County

Social/Community Integration andParticipation

Maryam Abedi, PhDDirector of Supported Living

Melissa ShapiroSupervisor - North Los Angeles

Ellen J. Lewis, PhDManager - Ventura County

Lori LeakSupervisor - Ventura County

Cheryl Stroll-Reisler, MAManager - Los Angeles

IABA - GeorgiaDiane Sabiston, MEd

Senior Manager - Georgia

Professional Training ServicesJohn Q. Marshall, Jr., MEd

Director of Professional Training ServicesSouth Carolina

AdministrationJay RavensComptroller

Robert H. SheltonDirector of Human Resourcesand Administrative Services

Copyright 1997 by:Institute for Applied Behavior Analysis

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

(310) 649-0499

All rights reserved. No portion of this newslettermay be reproduced by any means without theexpress written permission of the Institute for

Applied Behavior Analysis.

Positive Practices (ISSN 1083-6187) is aquarterly publication of the Institute for AppliedBehavior Analysis. Individual issues are $10.00

each. Subscriptions are $25.00 per year fordelivery within the US and $40.00 per year fordelivery outside of the US. For subscription

information, change of address or information onclassified advertisements contact: John Marshall;IABA; PO Box 5743; Greenville, SC 29606-5743

USA; (864) 271-4161.

Individuals wishing to contribute articles orletters to the publication are requested to contact

Gary LaVigna or Thomas Willis; IABA; 5777West Century Blvd. #675; Los Angeles, CA

90045 USA; (310) 649-0499.

Editors’ Note…In this issue of Positive Practices, we introduce in written form for the

first time, the concept of using certain counter-intuitive strategies toprevent behavioral crises and for get-ting behavioral crises under rapid andsafe control. These methods onlymake sense within the multielementapproach and we hope you find themboth interesting and provocative.Again, we invite questions and com-ments.

For our behavioral definition andsample protocols we have includedcontributions from Sue Hines, whocame over from New Zealand lastsummer to attend our eighth annualSummer Institute. Sue’s participationduring the Summer Institute was im-pressive and we are happy to includesome examples of her work here.

We are also very proud of RobertaHoffman, a strong self advocate, towhom we have the pleasure of pro-viding services. She was asked to present at last years Supported LifeConference in California and has agreed to let us publish a version of hertalk in this issue of Positive Practices.

Finally, we have included yet another example of a PSR application foryour information. This one was sub-mitted by Amy Taub, who partici-pated in the two-week training insti-tute we provided in Montana twoyears ago. The PSR system is gettinga lot of recognition from around theworld as a particularly applicableTotal Quality Management systemfor Human Service Agencies. Need-less to say, we are thrilled by thegrowing acceptance of the PSR andwill feature additional articles in thefuture illustrating its various applica-tions.

Enjoy!

Gary W. LaVigna andThomas J. WillisCo-editors

Gary W. LaVigna, PhDClinical Director

Thomas J. Willis, PhDAssociate Director


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Quality Assurance:What Made it Work For Us

Amy Taub, Quality Life Concepts, Inc., Great Falls, Montana

Editors’ Note: Amy Taub presented a version of this paper as part of a panelpresentation; “Periodic Service Review: The Results of Replicating a ManagementSystem” at the 1996 TASH Conference in New Orleans, Louisiana November 1996.

Introduction:A number of changes have occurred in our field over the last

several years that have caused service providers to become more

responsive and more accountable to the consumers of services that

we provide. One of the most exciting changes, that has certainly

produced challenges for all of us, is that consumers, advocates, and

families have learned to assert themselves. They now know what

services they want, how to get them, and often they are not willing

to “settle” for anything less! This has provided us the opportunity to

take a close look at the services we provide and scrutinize the quality

of services to determine if the expressed needs of consumers are

indeed being met. We are all becoming increasingly aware that

service provision is becoming more competitive, and if we are not

meeting consumer needs as they perceive them, consumers will go

elsewhere to get those services! Quality service provision is

imperative to survive in the current market.

How do you determine whether ser-vices are of the highest quality? Servicesare becoming increasingly comprehen-sive, i.e., we are now providing support toconsumers in a wider variety of areas, increative ways that involve more people inthe community, and are therefore increas-ingly more difficult to monitor. Ouragency determined that it was necessaryto develop a quality assurance system toassist us in monitoring what we weredoing and how we were doing it. Thegoal was to ensure that services beingdelivered truly met the needs of consum-ers and were consistent across all servicelocations.

Quality Life Concepts, Inc. is a pri-

vate nonprofit corporation located in GreatFalls, Montana that provides long-termcommunity living services for 110 indi-viduals with developmental disabilities,ages 14 through 96. Approximately 80people receive community living supportand habilitation services from our agency.Thirty-one people live in their own apart-ments or houses throughout the commu-nity and the remainder live among 12group homes. Simply stated, we supportmany people with varying needs in nu-merous locations throughout the commu-nity. Obviously, ensuring that theagency’s standards of quality service de-livery are being met throughout the de-partment is, at best, difficult.

Quality Assurance: WhereWe Were and What WeNeeded

When we set out to design a qualityassurance tool, our goal was to ensurethat services provided in all service loca-tions were high quality, individualizedservices based on consumer need, andthat they did not vary from location tolocation. What services looked likewould, of course, vary because of thevarying needs of persons served, but itwas imperative that the processes used todetermine needs, prioritize needs, andimplement supports to meet identifiedconsumer needs be the same across theentire department.

For many years, service quality var-ied across service locations — serviceswere not always driven by the needs ofpersons served — but rather by the vary-ing needs, experience levels, motivationallevels, and priorities of the staff workingin each service location. Services changedwhen staff (or their priorities) changed.There was no one way of ensuring consis-tency of anything! This posed a problemfor two reasons. It was important thatservices provided by this agency be basedon the needs of persons served — thatthey be consumer driven. It was alsoimportant that job duty performance ex-pectations of a position were the sameacross the entire department, regardlessof the service location where the jobduties were performed. We aimed toestablish clear standards of expectationin two areas: performance of job dutiesand consumer services, as well as to es-tablish a consistent measure whether thesestandards were being met. Additionally,we wanted to increase our ability to ad-dress a potential “hot spot,” to troubleshoot early, so the hot spot did not igniteand blaze!

We used a number of monitoring toolsto monitor portions of service implemen-tation: training book reviews (to monitorimplementation of Individual Support andHabilitation Plans; medical file reviewsto ensure that records were maintainedaccording to agency standards and thatconsumer medical needs were met; and,safety and cleanliness checklists to en-


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sure that facilities operated by the agencywere well maintained and met licensingstandards). We used a number of tools tomonitor a number of things but it was notworking well. The tools in place werecomplicated and very time consuming.More importantly, they did not tie every-

thing together in a way that made sense todirect service staff. Furthermore, moni-toring was not occurring frequentlyenough to trouble shoot early — to pro-vide additional staff support and trainingwhen the need first arose. It was evidentthat in order for service delivery to flowsmoothly, we needed a single compre-hensive system of quality assurance thatmet the following criteria: it must mea-sure both process and outcome in a widevariety of areas, tie all the pieces to-gether, be easy to use and understand.

What We Did and How WeGot There

In April 1995 the Community LivingServices Department (CLS) implementeda comprehensive quality assurance sys-tem developed by LaVigna, Willis, Shaull,Abedi and Sweitzer (1994) called thePeriodic Service Review (PSR). The useof this system has significantly affectedthe quality of services within the depart-ment. It has probably had more impactthan all the systems combined that havebeen implemented in the last 10 years.Significant change occurred immediatelyafter implementation, and continues tooccur 1-1/2 years later!

We felt that in order for a qualityassurance system to truly work; i.e., en-sure the consistent delivery of high qual-ity services, staff needed to have total

ownership of the design and initial imple-mentation. We took this beyond the com-monly touted idea of “some ownership”to encourage “buy-in”. When lookingback to the beginning, this is definitelythe most important aspect to our success-ful implementation of the PSR. Further-

more, it is important to under-stand that the PSR system is apositive system that delineatessuccesses and further opportu-nities for growth. It is not de-signed to be punitive to staff.

TimelineThe summaries offered be-

low paint a reasonable picture ofthe activities CLS engaged whileimplementing the PSR. Also

offered in this section are anecdotal com-ments that demonstrate some of the“growing pains” with which we werehaving to grapple.

February and March, 1995CLS formed a voluntary Task Force

to develop the system. The compositionof the Task Force included supervisors,resource consultants and, most impor-tantly, direct service staff. Serving as thefacilitator of the Task Force meetings,the CLS Director specified four broadareas that the PSR would address: Gen-eral Program Activities; Habilitation andSupport; Health/Safety; and, Staff De-velopment.

Described below are the five stepsthat the Task Force determined needed tooccur to implement the PSR:1. Standard development: The Task

Force defined ideal services in each ofthe above areas, i.e., identified broadareas that each section of the PSRwould include and then developedstandards that represented reasonableexpectations to achieve during the firstyear. An example would be to re-structure recreational activities thatincluded participating in communityactivities with non-handicapped peers;thereby, promoting community inclu-sion.

2. Methods of measurement: The TaskForce then determined methods ofmeasurement that reflected staff val-

ues of what they described as reason-able “first year” achievement expec-tations. Standards were specific; e.g.,the community inclusion activityspecified the number of activities permonth that would occur per personover a specified time.

It was also decided to samplerecords rather than review the recordsof all persons served in a service loca-tion. The Task Force opted to includetwo persons served, selected ran-domly, from each service location.Included in the monthly random se-lection were all persons served. Thistechnique decreased the possibility of“things sliding” because each personhad an equal chance of being moni-tored each month.

3. Staff review and comment: In lateMarch 1995, the PSR system was pre-sented to all CLS staff and they wereinvited and encouraged to make com-ments and participate in the develop-ment of standards. The Task Forcepresented and discussed each proposedstandard. Staff were given the oppor-tunity to comment and make sugges-tions; e.g., was each standard writtenclearly; was each standard fair; wouldthe method of measuring work?

4. Review Process: The Task Forceelected to have the reviews completedby peers, Consumer Training Spe-cialists (habilitation and support planconsultants to direct service staff),and the CLS Director. Monthly re-views across the year include peerreviews (eight times), ConsumerTraining specialist reviews (threetimes) and CLS Director review (onetime).

The review process itself had someinteresting side bars. During peerreviews staff from one service loca-tion spent time in another service lo-cation, sharing their successes, andoffering suggestions to each other.Staff voiced that they benefited im-mensely by this process.

Initially, some supervisory staffhad a tendency to use the review pro-cess punitively with their staff. Wehave had to provide continuous feed-back and training so that the tool istruly used to prompt growth — an

We took this beyond thecommonly touted idea of“some ownership” toencourage “buy-in.”


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“opportunity to improve” — not anopportunity to “beat people up”.

5. Feedback Process: The reviewershared with the service location su-pervisor the results and the supervisordiscussed the PSR scores with thestaff and developed a plan to improvethe score. The average departmentalscore was published in a graphed formon a monthly basis and posted in eachservice location. Individual servicelocation scores were not made public,and were shared only within the ser-vice location.

April, 1995Prior to PSR standards being devel-

oped, a number of ways to meet con-sumer-based outcomes were in placethroughout the department. The TaskForce members felt it was important tostandardize the methodology (process) toachieve the desired results (outcomes).Standardized methodology (as a directoutcome of the PSR development) imple-mented in April included:1. A summary section was added to the

preference assessment report (Indi-vidual Interest Inventory) that dis-cussed how the information from thisinventory was going to be incorpo-rated in this person’s life. For ex-ample, if a person’s inventory identi-fied that she liked basketball then thesummary would address how staffwere going to incorporate basketballin her life — possibly through joininga basketball league.

2. Preference assessments were requiredfor all individuals regardless of theirverbal abilities.

3. A standard format was established forall support objectives to be imple-mented. (A standard format existedfor habilitation (training) plans, butnot for support plans not involving theuse of formal program methodology.)

4. A “relief book” was put in all servicelocations that included protocols toeducate relief (substitute) employeesregarding basic household routine,preferences of persons served and id-iosyncrasies of persons served. Thisbook included photographs and currentinformation regarding all individualsreceiving services in the location.

5. A standardized format was establishedfor all working training record books.

6. A standard format was established forall working medical records books.

7. Written statements of the side effectsfor all medications administered atthat time were included in each medi-cation book.

8. A calendar of upcoming activities wasposted. It incorporated consumerchoice, in a format that is understand-able to the individuals receiving ser-vices in that location (pictures, stick-ers, representational objects, etc.).Protocols were written for consumersplan activities.

9. A list of allergies and special diets forpersons served were posted on therefrigerator in all service locations.

10.Medicaid cards and/or other healthinsurance information and cards wereto be kept in medical books.

11.Written procedures for caring for in-dividuals with incontinence were de-veloped.

12.Supported Living implemented addi-tional measures to ensure the safety ofpersons served living in their ownapartments - including monthly con-sumer demonstrations of evacuationprocedures and use ofemergency on-call pro-cedures, fire alarmchecks, and writtenemergency proceduresfor each person.In addition, each loca-

tion conducted a self-re-view to serve as a baseline.This baseline gave peoplean idea of what needed tooccur prior to the nextmonth’s review whichwould be performed bysomeone outside their ser-vice location. These scoreswere not submitted to the CLS Director.

May, 1995The Consumer Training Specialists

reviewed all service locations. The aver-age departmental score was 64 % and wewere delighted! (Self-review averagedabout 50%.) It was truly amazing to seewhat had been accomplished in abouttwo months. CLS had been struggling for

years to maintain consistent methodol-ogy across the department and we nowhad a way of achieving and maintainingour goal!

June, 1995Peer Review occurred across all ser-

vice locations. The CLS departmentalscore was 76%. This reflected a signifi-cant amount of work on the part of servicelocation personnel to get everythingimplemented to do well on the PSR.

July, 1995Peer Review occurred across all ser-

vice locations. The CLS departmentalscore was 75%.

July had previously been identified asthe time to evaluate the PSR process andmake any revisions. To accomplish thisappraisal of the system, the Task Forceattended service location staff meetingsand solicited comments and ideas fromstaff. Specifically, they asked for opin-ions about the tool, the process, and forsuggestions for revisions.

The Task Force met at the end of themonth to discuss the array of employeecomments they had received. Commentswere generally extremely positive as

people saw significant changes occur intheir service location and improvementwas evident.

However, staff had some concernsand many ideas to improve the process.Using this information the Task Forcerevised the tool. The significant revi-sions made by the Task Force are out-lined below:1. The Task Force considered the Ha-

CLS had been struggling foryears to maintain consistent

methodology across thedepartment and we now had a

way of achieving andmaintaining our goal!


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bilitation and Support section of thePSR as the most important. However,under the initial scoring system a ser-vice location could score well on allother sections and do poorly on theHabilitation and Support section andstill score 75%. Therefore, the TaskForce decided to weight this sectionto reflect its significance. The revisedPSR scores all items in this section asfive (5) points — all other items on thePSR are worth one (1) point. (Note:score is either one or five, not onethrough five.)

2. Employee competencies, previouslyincluded in all sections of the PSR,were placed in a separate section.

3. The employee accident/consumer ac-cident tracking standard was elimi-nated from the PSR since documenta-tion of accidents was not kept in theservice location. Staff felt that entirereview needed to happen in the ser-vice location. Further, accidents andfollow-up activities were being moni-tored by the departmental Safety Com-mittee and there was no need to dupli-cate this activity.

4. Many standard definitions were re-written in more specific language asstaff felt many standards needed clari-fication to eliminate as much reviewersubjectivity as possible.

5. The Task Force determined that each

service location needed a PSR “kit”.This kit contained everything neces-sary to conduct the PSR in the servicelocation and is outlined below:a. Instructions for completionb. The standards: Group Home, In-

tegrated Living and Senior DayProgram (Staff competencies arespecific)

c. Score sheetd. Safety checkliste. Cleanliness checklistf. Training book formatg. Medical book format

March, 1996 — Annual revision:The review process continued

throughout the year. In March, TaskForce members met with staff in all ser-vice locations to examine the process, theresults, and to solicit comments and ideasregarding what worked, what did notwork, and to gather suggestions for changein the PSR system. Comments wereagain exceptionally positive. Staff feltthat for the first time in years agencyexpectations in each area of performancewere clear and consistent. Staff also feltthat results clearly demonstrated that thePSR system had significantly improvedquality of service delivery — and that weshould continue using the system. Revi-sions were made in April that incorpo-rated staff input regarding the review

Figure 1: CLS Monthly PSR Scores

process, the feedback process and thePSR document. An annual revision pro-cess is necessary to keep up with newdevelopments and directions and to en-sure staff ownership of the system. Thisrevision process will continue to be com-pleted in the same manner — controlledby those responsible to implement thestandards — direct service staff.

ConclusionFigure 1 depicts the average PSR

scores from May 1995 to December 1996.Staff are excited about the changes theyhave seen within the department, and feelthat they designed a process that worked!Data clearly demonstrate that significantimprovement has occurred. It is criticalto understand that each revision occur-ring over the last year involved makingthe standards more difficult. Althoughthe average score held steady, what ittakes to attain that score has not!

QUALITY ASSURANCE HAS BE-COME A PART OF DAILY ACTIVI-TIES, DAILY DISCUSSION, AND ISAN INTEGRAL PART OF THE WAYWE DO BUSINESS — AND IT SHOWS!

References

LaVigna, G. W., Willis, T. J., Shaull, J. F., Abedi, M., &Sweitzer, M. (1994) The Periodic Service Review: Atotal quality assurance system for human services andeducation. Baltimore: Paul Brookes Publishing Co.


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Daily Life of a Person Who is DisabledRoberta Carol Hoffman

Editors’ Note: Earlier last year, Roberta Hoffman, one of the people to whom weprovide support services, approached Gary and asked him if IABA would helpdefray her expenses to attend the Supported Life Conference in the Fall of 1996 inSacramento, California. She was excited to go, since she had been invited toparticipate as a panel member to make a presentation on October 11th. Thisannual event is always a highlight in California. With presentations from bothconsumers and service providers, attendance usually exceeds 1,000 people. IABAwas more than happy to help Roberta attend. We also asked Roberta if we couldpublish an edited version of her talk here in the Newsletter. She agreed and alsoprepared some additional commentary, which we have appended at the end.Roberta took the opportunity of this address to publicly thank those people that shefelt have helped her over the years. It is our pleasure to give these thanks morepublic exposure and it is with our deep appreciation that she has seen fit to includeso many of us at IABA.

The people who sponsor the Annual Supported Life Conference ask everybody toevaluate each session they attend. On a five point scale, with “1” representing“unsatisfactory” and “5” representing “excellent,” those who attended Roberta’ssession rated it an average of 4.5 on the measure of “usefulness” and an average of4.7 on the measure of “quality.” We are all very proud of Roberta.

I am a person who has Autism. I am fully ambulatory. My

Autism is very mild. I can memorize addresses and phone numbers.

I can also memorize bus routes. I can take the bus to my mother’s

house and anywhere I please without any problems. I have a

disabled bus pass which enables me to ride for a reduced rate on all

Los Angeles County bus systems. I also ride Access Services too.

I am fully employed. I have a job as aCustomer Service Representative atBlockbuster Video. I also have a job as aclerical aide at a local wedding photostudio. I am in a program called STEP. Ihave been pleased with their service andespecially their job coaches.

I have a wonderful family and verygood parents. My family has been therethrough good and bad.

I have very good parents who are myconservators. They fight for me when Ifeel that my rights have been violated.They also help me with life’s problems.

My living situation has been good. Iam in a program called SCIP (SocialCommunity Integration and Participa-tion). I have been in this program forthree years. I have been pleased withtheir services, I still am. They help with

my monthly budget and cleaning aspectsof life’s daily occurrences.

Over the years I have been in severalprograms. My favorite programs that Iwas involved in were Life Steps Mobilityand Daily Life programs. I also had afavorite recreation program calledREACH ran by Matthew Richard Wa-ters. REACH taught me the ropes of thecommunity.

I like volunteering for the Jay NolanCenter’s Saturday Recreation Program. Iwas working for a friend of mine that hada group of children that were not commu-nity trained. These kids like to play at thepark, and do puzzles and arts and crafts.

I do volunteer work for the Associa-tion of Volleyball Players for the MillerLite Pro Beach Volleyball Tour that isheld in the United States. I also volunteer

for the Women’s Professional VolleyballAssociation and the Bud Light WorldLeague and four player association. I doa lot of work around the volleyball courtsand associate with the players.

I worked at several jobs before I startedat Blockbuster Entertainment. I likedonly three of them. I liked working forAthletes and Entertainers for Kids as avolunteer, because I would have a posi-tive impact on these children who wouldotherwise be involved in a gang as I speakright now! I did not want to see thesechildren in gangs, because most gangsare negative.

I held a volunteer job at TorranceMemorial Hospital which was OK, but Idid not like seeing people hurt. I held apositive attitude that kept the patientshappy. I gave them flowers that weredelivered to the front desk from localflorists. I did patient discharges and a lotof errands. I hate to say this, this job keptme BUSY from the day I started to theday I decided to leave the job.

I like working for the 1736 FamilyCrisis Center doing clerical work. Thisjob was great, because I was workingclose to the beach. I liked the officebuilding that I was in. I learned how togreet patients as well as other office du-ties.

I also liked working for Nissan MotorCorporation, because of me learning newskills in the Mail Center. I also had a lotof friends who taught me the ropes of thejob and how it is done. I got a lot ofexercise during my eight hour shift.

I also liked working for El CaminoCollege, because I like servicing the stu-dent population. I did a lot of filing andcomputer work.

I also added some volunteer work thatI like doing. I am volunteering for theTennis Association of Southern Califor-nia and the FIVB World Volleyballleague, also local race venues.

I get a lot of recognition from myservices to the communities of HermosaBeach/Manhattan Beach when they bothhost the volleyball tournaments. I alsoget lunch and tee-shirts and shorts forworking these tournaments.

For right now, I want to stay in Tor-rance and volunteer for the Pro-BeachVolleyball events. I do not want to move


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until later on in life. I am the kind ofperson that likes to stay put in one placefor a long time.

I would like to commend these pro-grams and the corresponding individualsthat helped me get to where I would wantto be in life.

I think that if you people were not hereon this earth today, helping me get towhere I want to be today, I would nothave any independence in life at all.

These particular individuals from thefollowing agencies are getting an awardfor helping me get to where I want to bein life, and especially for being there forme when I needed someone.

IABAJennifer Perekrest

Marcia JamesNancy Farber

Tamori WootenJanet FrancisCheryl Stroll

Susan CarawayHolly BaranDebra Yau

Carrie LenihanHallie Ben-Horin

Kerry SmithPeter DeMieriKathy DacusLisa Young

Chris PellaniMichelle Slater

Julia ShaullHeike BallmaierMelissa ShapiroGary LaVigna

LIFE STEPSVirginia FrancoDenise Smith

Anita MontoyaAnita BeardPaula Vick

Phil Pacheco

REACHMatt WatersHolly Starr

Julie N.

JAY NOLANPeggy Wade

Bodil S.Alicia E.Anne B.

SOCIAL VOCATIONALSERVICES

Neisha HurskinCharmaine Mathison

LisaVickie GarrettThom WilsonKathy Cullen

All of you people deserve a big thankyou for helping me through life’s dailyoccurrences!

Commentary on a Speech on the DailyLife of a Person Who is DisabledRoberta Carol Hoffman

I was asked a lot of questions regarding my life in general. I was

asked about my school career at Mira Costa High School and school

in general. I told the audience that I received good grades in school

and on my report cards. When I took the California State Proficiency

Exam, I scored a 98% point average and passed! I was one of the top

ten graduates of the class of 1987. I had good teachers that helped

me through school.

I was asked about how I go aboutgetting around Los Angeles County. Isaid that I take the Metro busses and theDial-a-Ride. I told people that heard myspeech that I like public transportation asopposed to driving because it is safer tobe on the bus. I told the people that it washard for me to use the busses at first but astime proceeded, it got easier. I had a

mobility trainer who was very nice andcaring.

I was asked about my jobs in the pastthe ones today. I told the audience that Ilike the ones that I hold today. I likeworking for Blockbuster Video becauseof the five free rentals per-week benefitthat I get. I was asked about the experi-ence with Blockbuster. I like it and it is

a positive learning experience for me. Ilike the people at BBV and how fun it is.I was also asked about my second job inLos Angeles. I told people that I plan toleave that job because of the distance thatit takes for me to get to work.

I also told them about the programthat helps people like me get jobs. I wasasked about my programs in the past andpresent. I liked Life Steps programs inthe past, and in the present, I like theSTEP and SCIP programs because theyteach clients about how to become inde-pendent in life.

Certain people asked me why I likevolunteering. I told them I am a commu-nity oriented person who like keeping outof trouble.

I was asked about my visit to theUCLA Neuropsychiatric Institute when Iwas four years old. I was going there forcertain tests. When these tests were doneI was being treated to lunch on the streetcalled Westwood Boulevard.

Certain people asked me about donat-ing blood and parts. I answered them andsaid the part about my niece Krissy hav-ing heart surgery at UCLA Medical Cen-


9

Gerri TaylorPO Box 751

Bega NSW 2550AUSTRALIA

19 December 1996

Gary LaVigna and Tom WillisIABA5777 West Century Blvd., Suite 675Los Angeles, CA 90045-5675UNITED STATES OF AMERICA

Dear Gary and Tom

Enclosed is a letter from a young womanwho would like to write to a person wholives in America. I wondered if you wouldbe able to publish her request in the IABANewsletter, please.

Many thanks.

Gerri Taylor

ter in Westwood. I told the people thatmy own stay at UCLA was good. I wastreated with respect and dignity and as aperson who is a patient.

I told them that my career in collegewas fun and sometimes a stressful learn-ing experience. I liked my counselor,Paul Coulton. He is very funny and veryhelpful. I was taking classes geared towarda degree in Business Administration. Theclasses that I took were hard and grueling.I needed tutoring in all my classes.

One guy from Bonnie MuntionsAgency asked me “How does it feel to

have Autism.” I said it has its ups anddowns. In general, it feels great all around.

A majority of the people in the roomwith me have children who have Autismand said that their child’s Autism is sosevere that I felt very sorry for them andwhat they go through on a daily basis. Ifelt the need to tell them that Autism isnot a hampering disability. IT IS NOTTO FEEL ASHAMED OF!! Some peopledo not understand how autism works andhas advantages. I told them that mine hasto deal with memorizing phone number,bus routes, addresses of my friends, and

certain agencies.I was asked what it was like to grow

up in a big family. I said in a word - FUN!My brothers took me places, for example,the Fire Station.

I was asked about my childhood a lot.I told the audience that it was great.When I was a newborn baby, by sistersdid not want to go to church on Sunday sothey took me behind the couch and hidway behind so that way my parentscouldn’t find us. It was funny when I toldthe audience. That started a big laugh atthe end.

Pen Pal RequestEditors’ Note: Gerri Taylor participated in the first two week training institute we held in Australia in 1993. That group willalways be special to us and Gerri is a special person even among special people. When Gary was in Australia last month, Gerrimentioned that she was working with someone who wanted a pen pal in the US. He suggested that they write a letter to theIABA Newsletter to see if there was any interest out there. There letters arrived and we publish them without editing below. Wehope that some of you respond or at least pass Ms. Wooding’s letter on to someone who might be interested in correspondingwith a pen pal in Australia.

2/43 Bega StreetBEGA NSW 2550

AUSTRALIA

My name is Celine Wooding, and I am 34years old. I live in my own flat in Bega, andI work at a place called Stitches and Printswhich is a sewing and screen printingbusiness.

I would like to write to someone fromAmerica, and one day I want to go toAmerica to visit.

Would someone in America like to writeback to me, please.

Celine Wooding


10

…giving our analysis a personcentered focus has helped usunderstand that what weoften call problem behavioralways serves some legitimatefunction for the person.

you remember why they did what theydid; was it even reported? Probably not.

Someplace, we lost sight of the mostimportant part of what we do and why wedo it; the PERSON. Yes, we have thetechnology to change behavior, but whyare we doing it, and do we have the right?WE believe we are doing what we do tohelp people improve the QUALITY oftheir lives.

As a result of these concerns, WE andothers; namely, you have endeavored toturn our focus toward the PEOPLE weserve. We have begun to ask why peopledo what they do; why they hurt them-selves and others. Most importantly, giv-ing our analysis a person-centered focushas helped us understand that what weoften call problem behavior always servessome legitimate function for the person.Additionally, this person-centered focushas resulted in looking beyond behavior;looking at valued/meaningful outcomesfor the people we serve.

A value-looking, values-based ap-proach to people with disabilities andchallenging behavior is not new. TheSocial Role Valorization movement hascaused us all to focus on helping thepeople we serve achieve valued and valu-able outcomes. Unfortunately, an artifactof this values-based approach for manyhas been the unnecessary rejection ofbehavioral technology.

Behavioral technology, however, canbe used in support of and in subordinationto values. As we have described else-where (LaVigna & Willis, 1996), our

values were strongly influenced byWolfensberger (1983). We value: com-munity presence and participation, inways that are age appropriate and valuedby society; autonomy and self-determi-nation, through the exercise of increas-ingly informed choice; continuous in-volvement in the ongoing process of be-coming; increasing independence and pro-ductivity to the point of economic self-sufficiency; and the opportunity to de-velop a full range of social relationships

and friendships.These values serve as a

foundation for the work wedo with the people byIABA. With these valuesin mind, we have devel-oped a model for support-ing people with challeng-ing behavior, which isaimed toward producingseveral outcomes (LaVigna& Willis, 1995). Where nec-essary, when it is a verydangerous behavior, one ofthe things we need to beconcerned about is getting

rapid results. So, speed and degree ofeffects is one of the outcomes we areinterested in producing. Second, we wantdurability. We want lasting change. Third,we want those changes to generalize toother settings, particularly to the commu-nity and the other natural settings thatothers have an opportunity to access andenjoy. We want to minimize the develop-ment of negative side effects. Accord-ingly, we track collateral behaviors. Wealso want to use strategies that have so-cial validity, that is, those strategies thatare acceptable to our client, our client’sfamily, support staff, and the community.

Finally, we need to demonstrate thatwhat we do has educational and clinicalvalidity. This means that as a result ofwhat we have done, we can show that theperson has a better quality of life; theperson is happier, has greater access,greater opportunity, greater control, etc.That is, we have achieved our valuedoutcomes. When we are designing oursupport strategies, it is this entire breadthof desired outcomes that we focus on. Noone of these dictates what we do at anygiven time. We discipline ourselves to

stay focused on the entire range of needs.To achieve all of these outcomes, we

begin with a person-centered assessmentaimed at understanding the meaning ofthe behavior (Willis & LaVigna, 1996a;b). This involves a broad look at theperson’s life situation and not just theimmediate antecedents and consequencesof their behavior, his or her skills, family,history, health, environments, etc. This isall in an effort to get a very board under-standing of the meaning of the behaviorfor that individual. On the basis of thisbroad understanding, we design a multi-element support plan. These plans in-clude proactive strategies, including eco-logical changes, positive programmingand focused support, designed to pro-duce changes over time and where nec-essary reactive strategies, to deal withsituations when they occur. The plan isthen implemented by a support team withmanagement systems effective enough toensure consistency (LaVigna, Willis,Shaull, Abedi & Sweitzer, 1994). This isthe multielement model that integratesour effort to produce the full range ofoutcomes, guided by the values describedabove (LaVigna & Willis, 1995).

One of the significant technical chal-lenges in working with people who dohave severe and challenging behavior isin dealing with crisis situations whenthey occur. The person is breaking win-dows now, the person is starting to bitehimself now, the person is throwing fur-niture at other people now, the person isbiting, kicking or scratching others now.It is relatively easy for us to agree to usestrictly positive, nonaversive strategiesin the proactive mode, but we tend to getmore challenged in coming up with strat-egies in the reactive mode that are equallypositive.

The multielement model can help lib-erate some very creative, equally posi-tive, reactive strategies. It provides ac-cess to reactive strategies that we previ-ously never thought we had. Using themultielement approach, we construct ourproactive plans to produce certain changesover time. Accordingly, when we areplanning what to do about a behaviorwhen it occurs, we are liberated fromneeding to address the issue of the future.Our sole agenda becomes situational man-

Continued from page 1


11

This provided a very effectivesituational managementstrategy when the target

behavior occurred and yet wasable to do so without producing

a counter-therapeutic effect.

agement. This gives us options that inother contexts might produce counter-therapeutic effects.

Here is one brief example of an earlyexperience of ours that led us to becomeaware of the new options that might beavailable to us in using the multielementapproach. We were asked to carry out anassessment for a man a number of yearsago who had a very serious form of self-injury. We’ll describe it, not to be disre-spectful to him, but for you to appreciatethe seriousness of the behavior and whypeople needed to do something when itwas occurring. When he got upset, hewould tug on his own lip to the pointwhere he had separated it from his face ona number of occasions, requiring surgicalreplacement. The doctor was saying thatwe could not let it happen anymore be-cause he did not know how many moretimes he could successfully sew his lipback into place. We carried out our as-sessment and we designed a multiele-ment plan. In terms of proactive strate-gies, there were 18 different things thatwe included, i.e., 18 different ecological,positive programming and focused sup-port strategies.

The question, of course, was whatwere we going to do when he startedtugging at his lip? In designing a supportplan, in many cases, we may need toanticipate some level of occurrence of thechallenging behavior. The best we couldcome up with to keep him safe when hestarted tugging at his lip was to put ourarms around him and hold him. You mightexpect that holding him was an aversiveevent. However, the problem was just theopposite, since being held in this mannerwas a reinforcing event. Perhaps some ofyou have worked with people for whombeing physically held and restrained is areinforcing event rather than an aversiveone. The position that this person put usin was that what we were doing to keephim physically safe was potentially rein-forcing the problem behavior. This couldhave produced a counter-therapeutic ef-fect, which would have made the behav-ior more likely to happen in the future.

Using the multielement model, thereis a certain logic in “holding him when heengages in self injurious behavior.” Thelogic is this: The reactive strategy is used

to get the most rapid and safest controlover the crisis situation. If this reactivestrategy has potentially reinforcing prop-erties, the counter-therapeutic effect canbe prevented by including certain otherstrategies in the proactive plan. Specifi-cally, these can include the independentand noncontingent availability of the eventused as a reactive strategy, supplied atsatiation levels. By taking these proac-tive steps, the reactive strategy merelygives us a very effective means of dealingwith the situation without producing acounter-therapeutic effect.

In the case at hand, to assure theproactive, noncontingent availability ofthe event, five minutes every half hourwas scheduled to assure that staff pro-vided him with a deep muscle massage.The reason for this is that we did not wanthis intense physical contact with staff tobe accessible to him only through theproblem behavior. We want you to bevery aware of this safety valve built intothe proactive plan. What happened overtime was that years later, he still has hislip. Further, because of the proactive plan,he no longer engages in any level of self-injurious behavior. What we see here is areactive strategy which was actually areinforcing event that, in addition to be-ing used as a reactive strategy, was pro-vided at other times on a noncontingentbasis. This provided avery effective situ-ational managementstrategy when the tar-get behavior occurredand yet was able to doso without producinga counter-therapeuticeffect. What we havelearned is that the mul-tielement model allowsthese kinds of options.

We want to discusshow we address thisneed for managementstrategies in situationsthat might be consid-ered to be of a crisis nature. This isimportant since many of you are workingwith people whose behaviors can occur atcrisis levels, where health and/or safetyare at immediate and serious risk. Thereare many reactive strategies that we could

employ that are not particularly counter-intuitive or which are perhaps more ap-propriate for more innocuous non-crisisproblem behavior, which we discuss infull elsewhere (Willis and LaVigna, inpress). What we thought would be a goodfocus for this paper is to discuss strate-gies that may seem extremely strange,until you have become fluent in using themultielement model. Your first reactionwhen we mention some of these strate-gies will be “that sounds absolutelycrazy.” That is what we mean by counter-intuitive; at first glance they just do notseem to make sense.

Since the best crisis management strat-egy is one that prevents crises to beginwith, we’ll start with some counter-intui-tive strategies for preventing crises andthen we’ll turn to some counter-intuitivestrategies that are remarkably effective ingetting rapid control over crises whenthey are actually occurring.

Preventing BehavioralCrises

Let’s begin with some counter-intui-tive strategies for preventing or avoidingcrises. Remember that the context for thisdiscussion is rooted in thinking aboutthose people whose behaviors can esca-late to crisis levels.

Introducing and Maintaining a HighDensity of Noncontingent Reinforce-ment. One counter-intuitive strategy forpreventing behavioral crises is introduc-ing and maintaining a high density ofnoncontingent reinforcement. This is


12

…the greatest reason formaintaining a high-density ofnoncontingent reinforcement isits impact on the quality of lifeof the individual.

worth considering because what we dointuitively if a problem behavior occursis to cancel all activities that we feelmight inadvertently reinforce the prob-lem behavior. He had an extreme tempertantrum this afternoon! He broke furni-ture! He hurt somebody! We better can-cel our going downtown to dinner plans

because we wouldn’t want to reinforcethe problem behavior.

Consider this, however. Have you everhad this experience as a parent? It is lateSaturday afternoon, your sweet, ador-able, angelic child comes up, saying some-thing to you and because of nothing hav-ing to do with that child or what that childdid, you snap and snarl and are mean tothat child. Even as you are acting in thishorrible parenting way, you are saying toyourself “she doesn’t deserve this.” Youknow your behavior has something to dowith something having nothing to do withthe child. The child is totally innocentand you are not able to convince yourselfthat she deserves the way you are actingtowards her. How many of you, then,realizing this is uncalled for behavior onyour part, canceled that evening’s plans,called up your friends and said: “Sorry, Ican’t go to the movie today.” “I know wewere supposed to come over for dinnertonight but I’m afraid that if I go over andenjoy myself, I am going to inadvertentlyreinforce this terrible parenting behav-ior.” None of you did that. Why didn’tyou become a terrible parent? That is,why wasn’t your problem behavior rein-forced and strengthened. For two rea-sons; first, the reinforcing event was nota contingent event. It is not as if “I’mgoing out to dinner tonight because I wasmean to my child.” Second, there was a

delay between the event that happened inthe afternoon (your behavior) and the(reinforcing) event that happened in theevening.

We know that for reinforcement tostrengthen behavior; it has to be immedi-ate and contingent. As long as there is asufficient delay and/or if there is no con-

tingency relationship,then we shouldn’t haveto worry about goingahead with an indepen-dently scheduled, non-contingent reinforce-ment. Such a reinforc-ing event should notstrengthen problem be-havior, even if the be-havior occurred earlierin the day.

There are many rea-sons for maintaining a

high-density of noncontingent reinforce-ment. Consider this; a high density ofreinforcement may be a setting event forthe low rate of challenging behavior,whereas a low density of reinforcementmay be a setting event for a higher rate ofproblem behavior. So, by initiating, or byintroducing, a high density of reinforce-ment, we are creating a pervasive settingevent which by itself should reduce thelevel of challenging behavior and behav-ioral crises.

Furthermore, when we cancel theevening’s plans because we are afraidthat the problem behavior is going toreinforced, we introduce an aversiveevent; namely, the withdrawal of a rein-forcing activity or reinforcing event. Thiswithdrawal itself can trigger a crisis situ-ation. Rather than acting in a way whichminimizes the likelihood of a crisis, whenwe cancel that evening’s event becauseof a problem behavior, we immediatelyhave done something that makes a crisismore likely, not just because a low den-sity of reinforcement is a setting event fora higher probability of challenging be-havior, but also because the withdrawalof the reinforcing event itself is a typetwo punisher and can very likely elicit aproblem behavior.

Perhaps the greatest reason for main-taining a high-density of noncontingentreinforcement is its impact on the quality

of life of the individual. Consider thequality of life of the people we serve whoalso have challenging behaviors. At best,it does not approximate ours at its worst.Surely, setting the conditions for a low-density of reinforcement does not im-prove a person’s quality of life. If one ofour goals is to give people a better qualityof life, one of the most direct ways ofdoing this is to introduce a higher densityof noncontingent reinforcement that justimproves the quality of life generally. Itis our contention that in whatever we aredoing to support a person, we should beable to demonstrate that the person isexperiencing a higher density of rein-forcement than before we got involved. Ahigh density of reinforcement should benoncontingently available to a personbefore we even consider any contingen-cies in which the person has to earn rein-forcement. We don’t have to earn mostour pleasures in life; then, why shouldthey?

Consider this example. We were work-ing recently with a 14 year-old girl whomwe had just helped move home after be-ing in a 24-hour residential school, whereshe had been for the previous four years.She moved home on her parents initiativebecause what they were using in the 24-hour facility, among other things, was arestraint procedure. Now that she hadgotten to be an old and big 14-year-old asopposed to a young and small 10-year-old, the kind of restraint procedure theywere using was leading to injury. Further,it was no longer acceptable to the fundingeducational authority.

She came home and we established amultielement support plan. One of thethings we knew about her was that shehad very poor impulse control and, forthat and a variety of other reasons, werecommended that we introduce andmaintain a high level of noncontingentreinforcement, independent of what shedid or didn’t do. One of the things she didright from the very beginning was to notgo to school every day. When she wouldstay home from school, how would wespend the day? We didn’t insist that shestay home as you might with a typicalchild. You might say, “If you don’t go toschool today, then you can’t go out andplay.” With her, we got out of the house;


13

…introducing and maintaininga high density of noncontingentreinforcement can help prevent

behavioral crisis.

we went into the community; we did avariety of things, including on one occa-sion stopping and buying a snack.

The question to us could be “weren’twe concerned that we would be reinforc-ing her refusal to go to school?” That’s alegitimate question to ask. We had reasonto think that we would not be differen-tially reinforcing that behavior becausecommunity access was something shewas enjoying every day anyhow, buyingsnacks in the community was somethingshe was enjoying every day anyhow.These were not contingent events. Fur-ther, we knew that when she got to school,she really enjoyed the activities that werethere and even though we might be out inthe community doing things, what shewas not getting access to were some ofthe activities she really enjoyed at school.It may be a high density of reinforcementshould she choose not to go to school, butwe believed it would be an even higherone if she chose to go.

Part of the monitoring system here isnot just to determine whether or not wewere avoiding severe property destruc-tion and aggressive behavior, her targetbehaviors. Obviously one of the thingswe were also tracking in our evaluationsystem was time spent in school. Sureenough, over time she spent more andmore time in school. Obviously thisneeded to be tracked and we needed toplan these things with care, based on allthe information that we had gathered inour assessment process.

To summarize, introducing and main-taining a high density of noncontingentreinforcement can help prevent behav-ioral crises. The avoidance of a behav-ioral crisis can be made more likely sincea high density of reinforcement is a set-ting event for a lower probability of prob-lem behavior. Further, not canceling areinforcing event avoids an aversive eventwhich itself can increase the likelihood oftarget behavior and/or escalation to abehavioral crisis. This recommendationalso normalizes the density of reinforce-ment experienced by the people we sup-port by providing a density closer to thenorm and by removing artificial contin-gencies. This recognizes that most of ourday-to-day reinforcers are also noncon-tingent. Possible counter-therapeutic ef-

fects can be prevented by assuring thenoncontingency of the reinforcing events,making sure to schedule their occurrenceindependent of the occurrence of targetbehavior. Other concerns about counter-therapeutic effects can also be addressedthrough the proactive plan in a multiele-ment approach.

Avoiding Natural Consequences.Another counter-intuitive strategy forpreventing a behavioral crisis is to avoidsome natural consequences. This sugges-tion may sound strange to many of you. Itmay even be objectionable for peoplewho take an explicitly values-based ap-proach who may rely heavily on naturalconsequences to promote the quality ofthe lives of the people they serve. But, wefeel there are a number of good reasonsfor avoiding SOME naturally occurringconsequences. Consider this, if the natu-ral consequence is aversive for the per-son, it may escalate the person’s behaviorto a potentially crisis level. In addition,consider that the natural consequence canitself lead to further exclusion and de-valuation. When natural consequenceshave the potential for causing crisis levelescalation, and when they further stigma-tize the person, we suggest that maybe weshould avoid the natural consequence.

Here is an example of the problem.We were supporting a woman in her joband we knew she was on the verge ofgetting fired. Her manager was not happywith her work. Hefound her lazy, disre-spectful, and unrespon-sive. This was not asheltered workshop.This was a real job situ-ation. We knew it wascoming. It was a natu-ral consequence to herbehavior. At the sametime we knew enoughabout her to know thatif she was fired, that experience would belikely to cycle her into a two-week periodof hell where she may have had to behospitalized in a psychiatric unit.

What did we do in this case? Wetalked to her. We established that fromher point of view she was not happy withher job. From her point of view, shewould rather look for a different job. We

established with her that she did not havemuch time to do that, given that she hadthis other job that she didn’t like. Oursuggestion to her was the following: “Whydon’t you resign? Why don’t you just goin this afternoon and quit?” She said,“That’s a terrific idea. I wish I had thoughtof that.” We did a little role play with herabout how she should submit her resigna-tion. She went in and she quit. Fortu-nately, her boss didn’t say, “You can’tquit. You’re fired.” She had a chance toavoid being fired with our guidance. Thisis counter-intuitive since many of uswould say “Let her experience the natu-ral consequence. That is how she’lllearn.”

The proponents of natural conse-quences argue that the people we servehave the right to these consequences andthat we devalue them by not providingthem. They ask, “What is wrong withnatural consequences? I experienced themand I turned out OK.” If there is one thingthat characterizes the people we are dis-cussing today, it is they are not going tolearn from their natural consequences. Ifthey were going to learn from naturalconsequences, this newsletter wouldn’texist. We’d be working in a differentfield. We’re talking about people whocharacteristically have not and will notlearn from natural consequences. It seemsto us that the proponents of natural conse-quences are arguing two points. First,

they seem to be saying that the people weserve would be OK today if people wouldhave “just used natural consequences fromthe get go.” Second, they seem to besaying that parents and teachers FAILEDto use natural consequences, and that iswhy their adult children misbehave. Thatis just not the case. Parents and teachersusually began trying natural conse-


14

quences. That didn’t work so they got alittle more contrived in what they did.That didn’t work so they called in a con-sultant and it got even more contrived. Asthey got more and more contrived, theyprobably got more and more punitive andmore and more segregated and isolated.So, by the time that child was an adult;she was in a strict program, isolated andsegregated from the rest of society.

For the past fifty plus years, all of ushave been striving to liberate the peoplewe serve from the degradation, isolationand abuse they experienced in segregatedplaces. The proponents of natural conse-quences seem to be saying, “Now thatthey have been liberated, lets use naturalconsequences to manage their behavior.”It seems that they are suggesting that wego back to “square one;” back to theineffective things that were tried by par-ents and teachers when their children andstudents were very young. Unfortunately,it seems to us that this would be juststarting the “cycle of escalation” all overagain.

We caution you, be careful of naturalconsequences and avoid them where theymay lead to crisis situations or to furtherexclusion and/or devaluation. In anyevent, don’t expect the occurrence ofnatural consequences to be an effectiveteaching strategy for the people we areconcerned about. It’s the people who don’thave severe and challenging behaviorwho may have learned from natural con-sequences, not the people whom we areconcerned about here.

Don’t Ignore Behavior Under Cer-tain Conditions. How many people haveheard of Guido Sarducci? Guido Sarducciestablished a 20 minute university inwhich he teaches in twenty minutes whatthe typical college student remembersfive years after they have graduated fromcollege. His idea is why teach all thatother stuff if all they are going to remem-ber is 20 minutes worth of information.That is all he teaches them to begin with.So in Economics 101, he teaches “supplyand demand” because that is all we re-member from Economics 101 five yearsafter we have graduated.

What do we remember from our In-troduction to Behavior Modificationcourse? What we remember is that when

a person acts inappropriately, that weshould ignore. How many of you haveever heard this phrase? Ignore her; she isdoing that for attention. We’ll bet youthat this phrase was not used with refer-ence to a peer or a colleague, but that itwas used with reference to one of ourclients.

How many of you really believe thereis something to the idea that aberrantbehaviors communicate legitimate mes-sages? Most of us do. If that is true, whatis worse than to advise somebody to ig-nore the behavior? What you would besaying functionally is to ignore their ef-forts to communicate. What happens ifyou ignore a person’s communication?The person’s behavior escalates.

We have talked about precursor be-haviors before; you know, those minorbehavior problems, those low levels ofagitation that may signal that the personis preparing to engage in something seri-ous. These precursors might be under-stood as the whispers of behavior. Be-cause of what we remember from theSarducci school, we ignore them. Conse-quently, what are we requiring of theperson? It seems to us that we are requir-ing that the person not whisper to us, butshout at us; and it is the “shout” we thencall severe and challenging behavior.

The consultant you are likely to hireoff the street for advice on what to do withproblem behavior is likely to say ignoreit. However, if you want to avoid crises,good advice may be don’t ignore it. Butthere are some qualifications to this ad-vice. In the first place, ignoring doesn’talways equate to extinction and it is reallythe extinction event that causes the esca-lation (the opposite effect we look for in areactive strategy in a multielement ap-proach). Table 1 provides definitions ofextinction and ignoring and correspond-ing examples of when ignoring repre-sents extinction and when it doesn’t.

Don’t Punish. Our final counter-in-tuitive strategy for preventing behavioralcrises is don’t punish. We have workedwith a number of large service deliveryagencies over the past twenty or so years.During that time, we have seen two verylarge agencies simply abandon punish-ment altogether after our training; over-night, by fiat. No more punishment al-

Definitions:Extinction - The withholding of apreviously available reinforcer.Ignoring - Continuing with whatyou were doing as if the behaviorhad not occurred.

Example #1: When ignoring isextinction.

Scenario - A teacher has beenreprimanding the student andsending her to the vice-principal’soffice whenever she uses profanityin the classroom. He observes thatthe behavior is getting worse andnot better and concludes thatcontrary to his intentions he hasbeen reinforcing this behavior. Forone thing, the student seems toenjoy getting the teacher upset.Secondly, the student seems to likemissing class. Accordingly, theteacher plans to start ignoring thisbehavior, thereby withholding thepreviously available reinforcers.Immediate likely effect onbehavior - Escalation.Advice when using amultielement approach - Don’tignore.

Example #2: When ignoring is notextinction.

Scenario - During class time, anine-year-old student challengedwith problems associated withautism, frequently holds his openhand between his eyes and thelights on the ceiling and moves hishand back and forth. The teacherbelieves that it is the visualstimulation that is reinforcing thestereotypic behavior. She decidesto ignore it when it occurs andsimply continue with herinstructional program as if it hadnot occurred.Immediate likely effect onbehavior - Ignoring the behaviorwill not escalate it and continuingwith the instructional program maynaturally redirect the student toengage in the instructional activity.Advice when using amultielement approach - Sinceignoring the behavior will not leadto an escalation in the behavior,this may be an option to consider.However, other reactive strategiesmay be necessary to get rapid andsafe control over the situation.

Table 1 - Extinction and Ignoring


15

In the context of situationalmanagement, punishment can

escalate the situation, producingthe opposite effect that we look

for in a reactive strategy…

lowed! You might expect that once thepunishment was stopped so quickly, therewould be a tremendous “recovery afterpunishment” phenomenon; you mightexpect that all of a sudden high rates ofchallenging behavior would begin to oc-cur. Yet when these agencies said “nomore punishment allowed” the overalllevel of behavior problems decreasedimmediately and what remained wereless serious problems.

Consider why that may be. A personacts in a way that is considered inappro-priate. Let’s say there is a low level pun-isher available, loss of tokens, loss ofprivileges, cancellation of an event, etc.The person reacts to that with some agi-tation, some acting out, which gets an-other level of punishment. Now we mightprovide for an over correction procedureor some kind of time out procedure. Let’ssay the person is not so happy about theover correction procedure or doesn’t wantto be escorted to the time out room, andnow starts to physically resist the effort toput them into that situation. What hap-pens is that now staff are having to usephysical management, restraint and othervery extreme aversive procedures in or-der to finally control the behavior. Whileit is true that if you do not punish that veryfirst behavior in the sequence, that be-havior may increase in its frequency,what we may have avoided are the moreserious behavior problems, the behav-ioral crises that result purely from our useof punishment.

One way to avoid crises are to elimi-nate punishment from our support plans.This is counter-intuitive since we think ofpunishment as a strategy for suppressingproblem behavior. The suppressive ef-fects of punishment, however, are futureeffects. In the context of situational man-agement, punishment can escalate thesituation, producing the opposite effectthat we look for in a reactive strategy in amultielement approach. We have alsodiscussed how introducing and maintain-ing a high density of noncontingent rein-forcement, being very careful with ouruse of natural consequences, and not ig-noring behavior under certain circum-stances, while counter-intuitive, may alsobe very helpful in preventing behavioralcrises. But what about the crisis that you

can’t prevent? What about 2 o’clock Sat-urday afternoon when he starts to breakevery piece of furniture in the house?What can you do?

Resolving BehavioralCrises

Diversion to a Reinforcing or Com-pelling Event or Activity. Let us intro-duce you to two counter-intuitive strate-gies for resolving behavioral crises. Thefirst is diversion to a powerfully reinforc-ing or compelling event or activity. Thatis, when the person is starting to act up,divert him or her with the most powerfulreinforcing or compelling activity or eventyou can identify. For example, in theprevious case of the person who wasengaging in the lip pulling behavior, ourholding him was an inadvertent reinforc-ing event. We didn’t design it to be rein-forcing, but it certainly had the potentialto produce a counter-therapeutic effect.As you may recall, to prevent this, we hadto balance this reactive strategy by in-cluding certain features in our proactiveplan.

Let us point out the intuitive part ofthis approach. What is intuitive is that ifyou introduce a dra-matically reinforcingor compelling activityor event, it is not sur-prising that it can di-vert the person fromwhatever he is doing.What is counter-intui-tive about it is that thiswould appear to resultin the potential rein-forcement of the prob-lem behavior. This isthe part that is counter-intuitive and appears, therefore, to con-traindicate it as a useful reactive strategy.

If we didn’t have the multielementmodel, there would be no hope of usingthis strategy as part of a rational supportplan. With the multielement model, how-ever, what we end up with is a proactiveplan that compensates for the potentialcounter-therapeutic effects of the reac-tive strategy, leaving us with a reactivestrategy that doesn’t produce any un-

wanted changes over time but rather givesus a very effective way of dealing with acrisis situation when it occurs.

We want to give you a further ex-ample of this. In one of our trainingprograms, We were guiding a teacherwho had selected one of her students toprovide a focus for her practicum assign-ments. Her recommended proactive planincluded, among other things, changingher curriculum and reorganizing her edu-cational space so it was less distracting.In terms of positive programming, herinstructional staff were teaching her touse a picture communication board withwhich, for example, she could point to apicture of a glass of water if she wanted todrink something and she could ask to goto the girls’ room, ask for a magazine, andask for break time by pointing to associ-ated pictures. They were also teachingher the relaxation response, that is thatwhen she was getting upset, to take a deepbreath, hold it and relax. As a focusedsupport strategy to produce rapid changein her problem behavior, they also haddesigned a particular schedule of rein-forcement.

Then the question came up: “What dowe do when she engages in the targetbehavior of screaming and scratching her

own face?” Staff wanted to continue touse “corner time out,” but we pointed outto them that this appeared to be an inef-fective reactive strategy insofar as theyhad been using it with little results. Theywere still getting an average of 40 min-utes a day of the screaming and scratch-ing behavior after 18 months of trying tosolve this problem. We invited them to goback to their assessment information andidentify, if they could, a behavior that


16

When you know what theperson wants, it is obvious thatthe quickest way to get him to

stop asking for it is to give it tohim. Capitulation!

was reinforcing or compelling enoughthat it would interrupt almost anything.What they realized was that if they handedher a magazine, what she “needed” to dowas open it and take the staples out. At themoment, that seemed to override every-thing else in her life. So the recommenda-tion was that the minute staff saw thetantrum coming, they should hand her amagazine.

You would be concernedabout two things in followingsuch advice. First, you wouldbe concerned that you wouldjust be reinforcing tantrumbehavior and increasing itsfuture occurrence. The otherthing you would be concernedabout is that she would be withher magazines all day long andwouldn’t participate in anyeducational activities. So tomake a long story short, theresults were that from day oneno day had more than five minutes ofscreaming and tantrums, representing animmediate and significant reduction induration. We also tracked her on-taskeducational time. That also started in-creasing from day one. There was nevera reduction in time spent in productiveeducation. Further, the frequency of tan-trums gradually decreased and by the endof the school year tantrums were no longeroccurring. Therefore, it was no longernecessary for staff to hand her a magazineas a reactive strategy, since, with theelimination of the target behavior, a reac-tive strategy was no longer necessary.The last report we had was that it hadbeen two years since there had been anytantrums.

Notice the safety valves included inthe support plan. She could ask for amagazine using the communication board.Therefore, having a tantrum was not theonly way to get access to a magazine.Further, in the play area, where she was atleast twice a day, was a stack of maga-zines, with which she could do anythingshe wanted. Such safety valves (i.e., in-dependent, noncontingent access) allowusing reinforcing and/or compelling ac-tivities and events to divert a person andinterrupt a problem behavior, perhapseven problem behavior occurring at a

crisis level, as a reactive strategy, withoutproducing a counter-therapeutic effect.

Strategic Capitulation. Last, and per-haps most counter-intuitive of all reac-tive strategies is what we call strategiccapitulation. Many times we know whatthe message is. We know what the personis asking for. We know what the personwants. When you know what the personwants, it is obvious that the quickest way

to get him to stop asking for it is to giveit to him. Capitulation!

Let us give you a very dramatic ex-ample of this involving a man on whosebehalf we provided some consultation(LaVigna, Patterson, Willis, & Johnson,in preparation). His behaviors were quiteserious. His aggression was so severe thathis staff were often out on disability leavedue to the injuries they had incurred. Hisself-injury was so severe because of hisbanging his head into the corners of wallsand furniture; they were afraid he wasgoing to be permanently blind, suffersevere neurological damage or possiblyeven kill himself. After a year of using anonaversive approach, he was still con-sidered to be an extreme risk to himself,so much so that the clinical supervisorthought contingent shock was necessary.

To make sure that they had their strat-egy right; they brought in an independentbehavioral consultant with excellent cre-dentials. After he did his assessment, heconcluded the following: In spite of thefact that “state of the art” nonaversiveprocedures had been used, he concludedthat this person remained a serious dan-ger to himself and others. He suggestedthat not only were staff ethically justifiedin using contingent shock to treat thisbehavior, they were ethically required to

use contingent shock to treat this behav-ior because this person has the right toeffective treatment.

We were also asked to carry out anindependent assessment. We concludedquite differently and felt that his behaviorserved a very obvious function. One ofhis precursor behaviors was to say “ba baba ba,” along with a backward swayingmotion of his hand as he turned away

from you. We also asked thestaff, “In your experience, isthere anything you can do whenhe is hitting you or hurting him-self that if you do it he stops?”Their answer was “Yes, whenwe walk away he stops.” Weconcluded that the meaning ofthe behavior was “Leave mealone!”

The clinical supervisor hadtold them not to walk away orback off when target behavioroccurred, since that would (nega-

tively) reinforce the problem behavior. Infact, outside of the context of a well-balanced multielement support plan,counter-therapeutic effects, i.e., the rein-forcement and strengthening of the targetbehavior, might very well have been theresult. However, in this case, we recom-mended that capitulation be used as areactive strategy as a strategic element ina comprehensive multielement plan.Along with the reactive use of capitula-tion we also recommended a variety ofproactive environmental, positive pro-gramming, and focused support strate-gies, which among other things involvedteaching him to tolerate performing non-preferred activities, teaching him to tol-erate the presence of others, and teachinghim to access the community. What weasked staff to do when he started hittingthem or himself was to turn and walkaway. The end result was that from thatday forward, injuries stopped occurring.Staff were not longer hurt. He was nolonger hurt. Further, beyond the dramaticreductions in the rate and severity of hisself injury and aggression, his quality oflife was also greatly improved.

We want to give you some guidelinesfor using capitulation strategically as areactive strategy for target behavior toavoid escalation to crisis levels and/or


17

getting a crisis under rapid and safe con-trol (Willis & LaVigna, in press). In theseguidelines you will also see some advicefor using some of the other counter-intui-tive strategies.1. If you are going to use capitulation,

the earlier you use it the better. Ide-ally, this would even be in response toprecursor behavior.

2. Whether the reinforcement that youhave identified as operative is posi-tive or negative, it should be madefreely available to the person, simplyfor the asking.

3. Have a fully developed proactive planwhich, among other things, is aimedat: a) improving the person’s overallquality of life; b) giving the personmore control over her or his life; c)teaching the person how to communi-cate; d) teaching the person how tocope; e) preventing negative side ef-fects of reactive strategies; and f) reduc-ing the need for any reactive strategiesby using focused support strategies.

4. Design an adequate and accurate data

Manager of supportedliving services for adults

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depends on experience.Mail or fax resume, with

salary history, to:

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Fax: +1 (310) 649-3109

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“We the People,ALL the People”

To receive a 1997Call for Participation please call the

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29 W. Susquehanna Avenue, Suite 210Baltimore, MD 21204

system to measure effects on bothtarget behavior and relevant collateralbehavior.

5. Address social validity issues, includ-ing obtaining the collaboration andconsent of the individual and all thosewho will be effected by the capitula-tion.The toughest part of using counter-

intuitive strategies to avoid and/or re-solve crises is the social validity of thosestrategies. As effective as strategies suchas these may be in establishing rapid andsafe control in a crisis situation, gettingpeople to accept them can sometimes bedifficult. There may be many reasons forthis resistance but we believe that one ofthem is that these strategies do not meetone of the needs that the use of punish-ment often meets so well. Whether pun-ishment sufficiently changes the person’sbehavior or not, the use of punishmentmeets our own emotional needs in manysituations. Recognizing and dealing withthis issue may end up being the biggestchallenge in adopting a strictly nonaver-

sive approach. Certainly, our experiencetells us that counter-intuitive strategiessuch as we have described here can pre-vent behavioral crises or get them underrapid and safe control within a strictlynonaversive, multielement approach.

References

LaVigna, G. W., & Donnellan, A. M. (1986). Alternativesto punishment: Solving behavior problems withnonaversive strategies. New York: Irvington.

LaVigna, G. W., Patterson, J., Willis, T. J., & Johnson, J.(in preparation). Outcome measurement in a case ofsevere self-injury and aggression using nonaversiveprocedures. In T. J. Willis & G. W. LaVigna (Eds.),Case Studies in Nonaversive Behavioral Support.Baltimore: Paul H. Brookes Publishing Co.

LaVigna, G. W., & Willis, T. J. (1995). Challengingbehavior: A model for breaking the barriers to socialand community integration. Positive Practices, 1(1),1, 8-15.

Willis, T. J., & LaVigna, G. W., (1996a). Behavioralassessment: an overview. Positive Practices, 1(2), 1,8-15.

Willis, T. J., & LaVigna, G. W., (1996b). Behavioralassessment: an overview part 2. Positive Practices,1(3), 1, 11-19.

LaVigna, G. W., & Willis, T. J. (1996). Behavioraltechnology in support of values. Positive Practices,1(4), 1, 7-16.

LaVigna, G. W., Willis, T. J., Shaull, J. F., Abedi, M., &Sweitzer, M. (1994). The Periodic Service Review: Atotal quality assurance system for human services andeducation. Baltimore: Paul Brookes H. Publishing Co.

Willis, T. J., & LaVigna, G. W. (in press). Challengingbehavior: Crisis management guidelines. Los Angeles:Institute for Applied Behavior Analysis.

Wolfensberger, W. (1983). Social role valorization: Aproposed new term for the principle of normalization.Mental Retardation, 21, 234-239.

IABA Manager WantedIABA Manager WantedIABA Manager WantedIABA Manager WantedIABA Manager Wanted


18

Description and Operational Definitionof Problem Behavior

Sue Hines, Allied Health, Templeton Centre, Christchurch, New Zealand

Editors’ Note: The following definition was excerpted from the BehavioralAssessment Report and Recommended Support Plan written by Sue Hines as herpracticum assignment for the 1996 Summer Institute in Los Angeles. We thought itwas worth providing as an example, since it clearly describes a problem that whenfirst referred, was much more ambiguous and vague. Part of a good assessment isto take a referral problem that may initially be unclear and to help provide someclarity and focus for the support plan. The problem that was initially referred hadto do with “John Doe’s” “noncompliance” and “resistance” at work which in thepast had been so bad as to lead to his being fired. We believe that Sue did a verygood job in developing a description of the problem which allowed definition andfocus. We hope you find this example useful. You may also want to know that thesample protocols provided elsewhere in this newsletter were also excerpted fromSue’s practicum assignment for the Summer Institute.

Verbal Defiance/ResistanceA. Topography. Two intensities of ver-

bal defiance/resistance have beenidentified.1. Use of profanity, e.g., “You f—

ing do it,” or use of other commonswear words. Exception to occur-rence would be the use of profan-ity following an immediate shock,fright, injury to himself, and/or inreply to the use of profanity orabusive threat when being ad-dressed.

2. Muttering, e.g., “You do it,” “Yousure about that,” but repetitive withincreasing volume, that is articu-latory and audible from a distanceof five feet away.

B. Cycle. For the purpose of recordingan occurrence, verbal defiance/resis-tance is considered to have begun(onset) upon his first utterance of pro-fanity or upon repeated phrases ofresistance without any interim state-ment, such as the examples above(note articulations must be under-stood). The episode would be consid-ered as over when all topographieshave been absent for five minutes(offset).

C. Course. This behavior is typicallypreceded by one or more known pre-

cursors (i.e., actions on the part ofJohn that precede or signal the likeli-hood of the behavior). Some precur-sors typically manifested by John in-clude inarticulate muttering and/or adelay in engaging in assigned activity(Target Behavior #2). The degree andspeed of escalation depends on theactivity he is requested to perform andthe verbal interaction/style of the otherperson. The behavior ceases on John’scompletion of necessary task. It is

noteworthy to mention that followingan episode of verbal resistance whethermild or aggressive/severe, John willemerge from the incident calm andinteractive, bearing no obvious carryover effect to the next interaction/task.

Figure 1 illustrates a typical epi-sode where at work John has broomand is meant to be engaged in sweep-ing, but has faltered, become disen-gaged. Job coach: “Time to do yoursweeping, John.” (No sweeping orfurther interruption to sweep occurs.)

D. Strength.1. Rate. This target behavior is re-

ported to occur between one totwo times daily at work and isestimated to occur up to hourly athome.

2. Severity. As indicated elsewherein this report, the occurrence ofverbal defiance/resistance has pe-riods of escalation in rate and inseverity. There are two scenarios:a. Incident ends when activity

changes.b. Rate of occurrence and sever-

ity coupled together has re-sulted in job loss.

Task InterruptionA. Topography This behavior is that

which is characterized by John’s dis-engagement from performance of theassigned task or activity, prior to its

Figure 1 - Typical episode

MILD John (inarticulate muttering)a fewexchangesoccur Job Coach “on with your sweeping, now John.”

TYPICAL John “You do it. (articulate muttering)multipleexchangesoccur Job Coach “John, keep on with your sweeping.”

EXTREME John “You f---ing do it.” (profanity)

➔➔

➔➔


19

satisfactory completion for a periodexceeding 30 seconds. Excludedwould be naturally occurring distrac-tions such as movement of the forkliftin his immediate work area, not ex-ceeding off-task behavior intervalnaturally expected and also when heis responding to a request reasonableto that effect, e.g., filling carry outcalls, moving aside for customers orat the request of others, etc.

B. Cycle. For the purpose of recordingtask interruption it is considered tohave begun (onset) with the lack ofinitiation or cessation of John’s en-gagement in uncompleted, assignedtask, it is to be considered to haveoccurred following 30 continuous sec-onds of disengagement or lack of ini-tiation. It may or may not be associ-ated with target behavior #1 - verbalresistance/defiance. The incident isconsidered to be over (offset) whenJohn is actively reengaged in on-taskbehavior characterized by physicalmovement conversant with necessaryaction to perform task. It may bedisplayed several times for varying du-rations of inactivity during a single task.

C. Course. This behavior is typicallyidentified by periods where John ap-pears immobile, “spaced out,” staringinto space or engaged in off-task ac-tivity such as repetitive banging of astick or tapping of fingers and/or ob-jects during a time interval in whichhe has been requested to carry out atask or occurs as an interruption toassigned task which maybe associ-ated with verbal defiance/resistance,i.e., target behavior #1.

D. Strength.1. Rate. This target behavior occurs

frequently to the level of severalinterruptions during virtually ev-ery assigned task. It would bebeneficial to collect further data inthis area to establish formal base-lines.

2. Severity. Task interruption hasbeen a major contributing factor inJohn’s previous employment dis-missal as continuance of task in-terruption means task completionand standard of performance arejeopardized.

Procedural Protocol - Task Interruption:Self-DirectionSue Hines, Allied Health, Templeton Centre, Christchurch, New Zealand

Editors’ Note: While we have been providing sample protocols in each issue of thisNewsletter, and plan to continue doing so, a question is often asked as to thedifference in the level of detail provided in the Behavioral Assessment Report andRecommended Support Plan and in a “procedural protocol.” While generally, thelevel of detail in a recommended support plan should be sufficient to enable abehavior specialist to write a detailed, step by step checklist that staff can followwhen they implement the procedure, the protocol itself should be of sufficient detailas to not require any interpretation. The protocol and/or checklist should be sooperationalized that anyone responsible could follow it with accuracy andprocedural reliability, i.e., fidelity. Nevertheless, we often provide a level of detailfor one or two of the strategies in a Recommended Support Plan, to provide anexample for the behavior specialist as to the level of detail we think is important forstaff training and for consistency in implementation. Sue Hines did an outstandingjob in completing her practicum assignment for the 1996 Summer Institute in LosAngeles. Her recommended support plan had sufficient detail to allow a behaviorspecialist to pick up the ball to write detailed behavioral protocols, with one or tworecommendations illustrating the level of detail that a protocol should have. Hersample protocol was also well done. To show the relationship betweenrecommendation and protocol, we have excerpted two of the procedures sherecommended. One that is already at a protocol level of detail (the latter) and onethat would require such detail (the former). We have also attached the sampleprotocol that she developed as part of her Summer Institute practicum assignment,which was attached to the Behavioral Assessment Report and RecommendedSupport Plan.

In the protocol, it might be interesting for you to notice the way progress issupposed to be tracked for teaching this particular functionally equivalent skill.Sue’s analysis was that John Doe’s Task Interruption behavior partly served therole of eliciting the prompting he needed to complete a task. To reduce this promptdependency, she thought it would be helpful to teach him to be prompted back orremain on task with a “beeper” which he could use as a self reminder to keepworking. As you can see, progress is to be measured by tracking the hoped forincreases that would be observed in the time from Mr. Doe’s start of the task andwhen task interruption is first observed, given the onset definition described in thedescription of behavior provided elsewhere in this Newsletter.

Introduction:The following is an excerpt from the

Behavioral Assessment Report and Rec-ommended Support Plan. These recom-mendations were among a number thatwere made for positive programming.They are followed by a detailed protocoldeveloped for one. Such protocols areused for staff training.

Functionally Equivalent Skills.People engage in seriously challenging

behaviors for perfectly legitimate rea-sons. They use these behaviors to com-municate important messages, to assertthemselves, to manage unpleasant emo-tions, to escape unpleasant events, and togain access to events and activities. Onestrategy for helping people overcome theirchallenging behaviors is to provide themwith alternative ways of achieving thesame objectives, alternative ways of sat-


20

isfying their needs. These alternativesare defined as functionally equivalentskills because they achieve the same goalas the challenging behavior. In the fol-lowing paragraphs, a functionally equiva-lent skill and method for the teaching itare described: as John’s target behaviorscome under control, introduction of fur-ther instruction in this area is imperative.For example John also needs to develop afunctional way of communicating “I wantsome help please.”

However, my immediate focus is thatJohn requires the development of theability to reengage himself once distractedfrom the assigned task, without the needto rely on others to keep himself engagedin an activity through to completion. Forthe purpose of initial instruction, the ac-tivity will be sweeping. To develop thisself-reliance, the following plan is sug-gested.

Equipment: This procedure requiresthe provision of an electronic beeperwhich is able to be set at predeterminedintervals ranging from one minute apartand longer, and that will emit a beep orshort series of beeps which is not relianton being turned off or reset after eachemission. The period of duration needsto be able to extend to a minimum of 15minutes e.g., one minute elapses: beep;one minute: beep; one minute: beep, etc.This should be fixed to enable it to beworn on the wrist like a bracelet or aroundthe neck like a necklace. Also, a stop-watch is needed for the job coach.

John will be taught through a series ofinstructional tools such as imagery androle play instruction prior to actual imple-mentation.1. Imagery - using photos or picture rep-

resentation of sequence of events. GetJohn to relay meaning, expectation ateach step.

2. Role play - involving modeling byJohn to display his comprehension ofthe prompt (i.e., the beep) and theexpectation.

3. Actual Implementation - The aim isthat when John is distracted fromsweeping the external stimuli beepwill provide him an effective prompt,rather than the job coach. Ultimatelythis will lead to increased duration of

on-task behavior during sweeping, upto a period of 15 minutes duration.NB* - Each time John exceeds his

previous record he should immediatelybe allowed to change activity through theprompt sequence described in the proce-dural protocol.

Following negotiation with managerand co-worker (Brad), reinforcer for 3consecutive periods exceeding averagecould be an arrangement for a quick rideon a pallet on the fork lift. (Similar toactivity other workers are seen to engagein during its use). This could be providedat end of John’s shift or during his breaktime.

Functionally Related Skills. Thereare many other behaviors that if learnedby the person, may have a direct impacton the person’s behavior. For example, aperson who is taught the difference be-tween edible and inedible substances maystop eating inedible substances; a personwho is taught to make his own snacksmay stop stealing food. The purpose ofthis category of strategies, again, is toempower the person; to give the persongreater skills. The following paragraphsdescribe a strategy for teaching a func-tionally related skill to John.

In addition to this skill, thought shouldbe given to providing John with opportu-nity to be involved in ongoing personaleffectiveness training in the near future.Although not a clear antecedent for John’sbehavior problems, the inability to pre-dict and keep track of the course of hisday may play a significant part in helpinghim solve his problems. Thus, any effortthat helps John better predict the eventsof his life may also reduce the likelihoodof protest behaviors, and behaviors cuedby anxiety associated with the “unknown”or lack of predictability. In an effort toincrease his ability to predict and trackdaily events, an Activity Sequence Boardis suggested, and the following recom-mendations are presented:

Step 1. For each activity or event thatmight occur during John’s work day, takea passport size photograph showing himengaging in some portion of that activity(e.g., sweeping outside). These picturesshould be laminated since they would behandled frequently. Attach a small dot ofVelcro to the reverse side of each picture.

Step 2. In partnership with John de-velop a work schedule in 15 minute slots,arrange these pictures in an ordered se-quence similar to John’s daily scheduleon a clipboard in the break room or hislocker. They should be hung on the boardfrom top to bottom, with the point closestto the top representing the first activity ofthe day. Each activity of the day shouldbe fully represented. (This may requiremultiple pictures as we need to assigntasks into 15 minute intervals). Initially,schedule only two hours at a time, e.g.,8:30 to 10:30 and as John develops theskill proficiency increase by an hour at atime.

Step 3. At the beginning of each day,the sequence of activities for the dayshould be reviewed with John. The pic-tures representing each activity should beselected, and he should be included inplacing the activity pictures on the se-quence board according to required jobrequirements. Tables 1 and 2 on page 21depict examples of how an activity se-quence board may look.

Step 4.a. Prior to the initiation of each daily

activity, John should approach the“Activity Sequence Board,” or al-ternatively the job coach could takethe clip board to him. Staff shouldcommunicate to John that it is timeto check the board, e.g., “OK John,let’s see what we have to do next,”or “Let’s go see what is on yourschedule board.”

b. Once he arrives at the board, heshould be shown the picture repre-senting the next activity. At thesame time, he should be instructed“John, it is time to ___________ .”

c. John should be required to ver-bally acknowledge the time andactivity he needs to do.

d. John should be socially praised foreach element of this rather com-plex chain: going to the pictureboard, acknowledging the time andpicture associated with the nextactivity, going to the area wherethe activity is to take place, andinitiating the scheduled activity.

e. Initially, staff may need to prompteach part of this chain. However,it needs to be remembered that the


21

goal is for John to proceed to andwith the activity independently. Itis important, therefore, that staffdo not teach in such a way thatverbal and/or gestural correctionsbecome permanent members of thebehavioral chain. Consequently,special attention will need to begiven to procedures for fadingprompts. Perhaps a hook for hisactivity chart could be available ina discrete area of each of his rou-tine tasks areas thus allowing forthe introduction of self monitor-ing.

Step 5. At the completion of eachdaily activity, John should return to the“Activity Sequence Board.” At that time,he should be instructed to sign off theactivity and remove the picture to signalthe completion of the task. Again, thisactivity may need to be prompted.

Step 6. Initially, it may be necessaryto employ some form of tangible rein-forcement for each element of the abovedescribed chain. These should be fadedand replaced with social praise. Subse-quently, social reinforcement should befaded, but not completely removed. To-ken reinforcement should be consideredin this regard. Tokens for complete ac-tivities could be placed on the sequenceboard, with exchange occurring at theend of the pictured work day.

Step 7. As you know, daily schedules

seldom remain unchanged during a day.They often change as function of weather,staffing patterns, and work need. In aneffort to reduce the impact of these events,and to help John better predict the courseof the day, the Activity Sequence Boardshould be employed. When a daily eventis changed unexpectedly, the proceduresdescribed in “STEP 4” should be carriedout. Basically, the picture of the newactivity should be substituted for the ac-tivity that will not be carried out.

Step 8. It may be advisable to make aversion of the Activity Sequence Board,for John’s bedroom notice board at home.That includes activities John performs athome or is expected to from the time hisalarm goes off in the morning until hislights go off at night. This would requirea seven day format and perhaps timeschedules that can be altered. He mayrequire his father’s assistance to arrangehis schedule.

Step 9. The process of reviewing theActivity Sequence Board should be madeincreasingly longer. For example, re-viewing might proceed according to thefollowing schedule:a. before every activityb. before every two activitiesc. in the morning, at noon, and before

dinnerd. in the morning, and at noone. in the morning, or as on task behavior

improves is altered to new baselines

Protocol:Consumer’s Name: John DoeProtocol Name: Task Interruption: Self-DirectionDate Initiated: September 1, 1996

General Recommendations1. Intervals: 4x daily, Mon.-Fri.

This procedure will be carried outthroughout the duration of sweepingtask (which has been broken down sothat it involves sweeping four sepa-rate areas, i.e., 4 separate trials) forthe purpose of instruction - imageryand role play.

2x sessions of four intervals/trialseach should be integrated into John’swork day, e.g., prior to commence-ment and prior to re-commencementfollowing his morning break.Changes: Date:Changes: Date:

2. Monitoring Systems:Job coach will monitor progress in

narrative form using the progress sheetand record time on-task duration foreach interval/trial (once implemented)on task duration sheet.

Reliability checks are scheduledprior to John’s advancement to nextinstructional level, involving JobCoach supervisor observation and con-sensus of readiness.

Following implementation, reli-

John Doe'sCompletionSignature

CoachNote TimeCompleted

0900 Activity ListS.G.

NB: RemovePicture whenjob completed

0905 Sweep ShopFront

0920 1 Carton ofCans

0935 Sweep LeftSide of Shop

0950 1 Carton ofCans

Packet for completed

tasks

1005 Sweep rightSide of Shop

10.20 Break

Table 2 - Example of Work Schedule

0700 AlarmGet Up

0715 Breakfast

0745 Shave

0800 Teeth Cleaning

0830 Catch Bus

Toothpaste

Table 1 - Example of Home Schedule

Packet forcompleted

tasks


22

ability will be on an incidental basis,i.e., observation by supervisor duringregular support visits of a minimumof once every two weeks.

An example of the on-task dura-tion record to be developed followingbaseline monitoring is represented inFigure 1.

3. Reinforcers:When John exceeds his RECORD

duration of on-task “sweeping” (jobcoach stop watch), job coach will in-terject, “Gee, you worked hard onthat. Let’s take a quick break and geta snack. ‘______’ will finish thissection of sweeping.”

When John exceeds average line 3consecutive times, delayed reinforcerof having a quick ride on a pallet onthe fork lift may be worth investigat-ing.

Imagery Instruction

1. Staff need to take a series of photo-graphs as follows:a. One picture of Activity Board set

up indicating sweeping activityb. Two Pictures of John Doe putting

beeper onc. Two pictures of John Doe stand-

ing with broom, not sweepingd. Four picture of beeper device add

noise implication “beep”e. Five pictures of John Doe sweep-

ingf. One picture of John Doe finishing

sweeping2. Arrange these in the sequence of indi-

cating that when “beep” is emittedthen John needs to get on with hissweeping.

3. Talk with John about each picture.Let him explain what is happening,that is, “beep” signals time to get onwith your sweeping until area clean.

4. Let John arrange pictures whilst tell-ing you what is happening.

5. Make narrative note of John’sprogress, recognition of events, ex-pectation when beep is heard (that is,that he gets on with sweeping). Whenjob coach is sure that John under-stands the process STEP managershould then observe the instruction ifthere is consensus that John is under-standing the process. Then instruc-tion will proceed to Role Play Instruc-tion.

Role-Play Instruction

1. Have John arrange imagery cues insequence, get him to explain conceptof BEEP as a cue for him to get onwith the job.

2. Proceed to getting John to demon-strate the actions that accompany eachof imagery cards.

3. Set the stage: as you move through thesteps, if John halters in expected step,interject with showing him the corre-sponding imagery cue.

4. Continue with role play instructionuntil job coach is satisfied that Johnunderstands the relationship of theaudible beep to on-task behavior. Atthis stage, seek consensus of readi-

ness through attendance of Supervi-sor, Lisa, at an instructional session,prior to proceeding to on job imple-mentation.

Work Implementation

Equipment: Activity schedule,beeper, stop watch (indicating sweep-ing), small snack or other treat available.1. To determine average of time John

engages in requested activity, redi-recting himself within 5 seconds ofemission of “beep.” Over 12 discretetrials, time John from time of initialengagement until 30 seconds sinceemission of beep and non-engage-ment.

Then calculate average by addingtime in seconds together then divid-ing by 12.

Using this equation, set this timeinterval as the (criterion) record forwhich you want John to exceed.Once this is established, then proceedwith procedure as indicated throughimagery and role play sequence. Withthe stop watch, job coach will monitorduration of John’s on-task activity.a. When criterion interval is exceeded

next time John stops immediatelyinterject “Gee, you worked hardon that. Let’s take a break and geta snack. ‘______’ will finish thissection of sweeping for you.”

or

b. If John is disengaged from activ-ity, “beep” has sounded, 5 secondshas passed and he remains disen-gaged then stop John “Gee youhave worked hard on that, let’stake a break and when we’ve fin-ished we’ll come back to finishthis section of sweeping.”The procedure will continue as set

in imagery and role play instruction.However, the on-task duration untilhe exceeds the criterion is slightlylonger. Verbal script for achieving ornon-achieving remains unchanged.Continue adjusting the criterion asdescribed above until John has ex-tended his on-task duration/self redi-rection to the required level for taskcompletion.Table 3 - Progress Record - John

1 2 3 4 5 6

MINUTES

* RECORD

* NEW RECORD

NB: 3 CONSECUTIVE PAST AVERAGE. TIME TO CALCULATE NEW AVERAGE.

Figure 1. - Example of “on-task”duration record

Goal: Self Re-Direction/Task Interruption

Date/Time Signature


23

Make your plans now toattend the

Ninth AnnualTwo Week Summer Institute

on

Assessment &Analysis of Severe &Challenging Behavior

July 20 - August 2, 1997Los Angeles, California

For a complete description of thecourse, registration procedure and

fees, contact:

John Q. Marshall, Jr.Director of Professional Training Services

Institute for Applied Behavior AnalysisPO Box 5743

Greenville, SC 29606-5743 USATelephone: +1 (864) 271-4161

Fax: +1 (864) 271-4162Toll Free (US & Canada): (800) 457-5575

Internet: [email protected]

Alphabetical Index of Articles in Volume I(October 1995 through October 1996)

Back Issues Are Available for $10 per Issue

A Person Centered Approachto Supporting People withSevere Reputations ............. Vol I Num 1 .......... Oct 95 .......... p 16

Behavioral Assessment:An Overview Part 1 .............. Vol I Num 2 .......... Jan 96 ............ p 1

Behavioral Assessment:An Overview Part 2 .............. Vol I Num 3 .......... Apr 96 ............ p 1

Behavioral Technology inSupport of Values ................ Vol I Num 4 .......... Jul 96 ............. p 1

Challenging Behavior: A Model for Breakingthe Barriers to Social and CommunityIntegration ............................ Vol I Num 1 .......... Oct 95 ............ p 1

Definition of a Problem Behavior(Aggression) ......................... Vol I Num 1 .......... Oct 95 .......... p 18

Definition of a Problem Behavior(Anxiety Outbursts) .............. Vol II Num 1 ......... Oct 96 .......... p 15

Definition of a Problem Behavior(Defiance) ............................. Vol I Num 4 .......... Jul 96 ........... p 17

Definition of a Problem Behavior(InappropriateInteractions) ......................... Vol I Num 3 .......... Apr 96 .......... p 20

Definition of a Problem Behavior(UnexplainedPossession) .......................... Vol I Num 2 .......... Jan 96 .......... p 16

Motivational Analysis ........... Vol II Num 1 ......... Oct 96 ............ p 1

Positive Programming: AnOrganizational Response toChallenging Behavior ........... Vol I Num 1 .......... Oct 95 ............ p 3

Procedural Protocols - BehavioralEscalation ............................. Vol I Num 4 .......... Jul 96 ........... p 18

Procedural Protocols -Interactional Style ................ Vol I Num 2 .......... Jan 96 .......... p 17

Procedural Protocols -Interpersonal Style ............... Vol I Num 1 .......... Oct 95 .......... p 21

Procedural Protocols -Learning to Tolerate and Copewith Denial ............................ Vol II Num 1 ......... Oct 96 .......... p 17

Procedural Protocols -Transition .............................. Vol I Num 3 .......... Apr 96 .......... p 21

Profiles in Courage .............. Vol II Num 1 ......... Oct 96 .......... p 21

Psychometric Characteristics ofEvaluation Instruments forBehavioral Assessment Reportsand Intervention Plans ......... Vol II Num 1 ......... Oct 96 ............ p 3

Quality Monitoring atChurch Parade ..................... Vol I Num 4 .......... Jul 96 ............. p 3

Resource Focus: CompetencyBased Training ..................... Vol I Num 4 .......... Jul 96 ........... p 22

The Behavior Intervention SupportTeam Program: AddressingChallenging Behavior of Peoplewith and Intellectual Disability inVictoria, Australia ................. Vol I Num 2 .......... Jan 96 ............ p 3

The Development of a StatewideBehavior Resource in theState of Montana .................. Vol I Num 3 .......... Apr 96 ............ p 3


24

ResourcesTraining Calendar

Alternatives to Punishment: Solving BehaviorProblems with Nonaversive StrategiesG.W. LaVigna & A.M. Donnellan

“(This book) provides a comprehensive treatmentof alternatives to punishment in dealing with behaviorproblems evidenced by human beings at various levelsof development and in various circumstances. Basedupon their own extensive observations and athoroughgoing analysis of relevant experimental studies,(the authors) have put together a document that is atonce a teaching instrument, a summary of research, andan argument for the use of positive reinforcement in thetreatment of inadequate or undesired behavior… alandmark volume which should forever lay the ghost thataversive methods (even the ubiquitous ‘time out’) needto be applied to the delinquent, the retarded, or thenormal ‘learner,’ whether in the home, the school, theclinic, or other situations.” — Fred S. Keller (From thePreface to Alternatives to Punishment) - paper, $19.50/ISBN 0-8290-1245-1

The Behavior Assessment GuideT.J. Willis, G.W. LaVigna & A.M. Donnellan

The Behavior Assessment Guide provides theuser with a comprehensive set of data gathering andrecords abstraction forms to facilitate the assessmentand functional analysis of a person’s challenging behaviorand the generation of nonaversive behavioral supportplans. 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. Fassbender

As individuals with special educational anddevelopmental needs are increasingly being integratedinto the community, responding to their challengingbehavior in a dignified and appropriate manner becomes

essential. In this volume, the authors argue against theuse of punishment, and instead advocate the use ofalternative strategies. The positive programming modeldescribed in this volume is a gradual educational processfor behavior change, based on a functional analysis ofproblems, that involves systematic instruction in moreeffective ways of behaving. The work provides anoverview of nonaversive behavioral technology anddemonstrates how specific techniques change behaviorthrough positive means. The extensive examples andillustrative material make the book a particularly usefulresource for the field.-paper, $17.95/ISBN 8077-2911-6.

Social Skills Training for Psychiatric PatientsR.P. Liberman, W.J. DeRisi, & K.T. Mueser

This guide to the application of social skills trainingwith psychiatric patients systematically provides clinicianswith the ingredients necessary to start and run their ownsocial skills groups. Case examples, transcripts of socialskills training sessions and exercises aid the reader inapplying the training methods.-paper, $28.95/ISBN 0-08-034694-4

The Role of Positive Programming InBehavioral TreatmentG.W. LaVigna, T.J. Willis, & A.M. Donnellan

This chapter describes the role of positiveprogramming in supporting people with severe andchallenging behavior. After discussing the need forpositive programming within a framework based onoutcome needs, variations of this strategy are delineated.Then, assessment and analysis are described as criticalfor comprehensive, positive, and effective support. Acase study of severe aggression is presented to illustratethe process of assessment and analysis, the supportsthat follow from this process, and the long term results ofthis 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. Sweitzer

Evolving from more than a decade of work at IABA,this book provides the tools needed to enhance andmaintain high quality service delivery. Translating theprinciples of organizational behavior management andtotal quality management into concrete policies andprocedures, the Periodic Service Review (PSR) acts asboth an instrument and a system. As an instrument, thePSR provides easy to follow score sheets to assess staffperformance and the quality of services provided. As asystem, it guides managers step-by-step through 4interrelated elements — performance standards,performance monitoring, performance feedback, andsystematic training — to offer an ongoing process forensuring staff consistency and a high level of quality forservices and programs. Practical examples show howthe PSR is applied to group home, supported living,classroom, and supported employment settings, and thehelpful appendices provide numerous tables and chartsthat can easily be tailored to a variety of programs. -$37.95/ISBN 1-55766-142-1

Add for Shipping to US Addresses:1st book (min.) $4.00 Each add’l book $0.75

Add for Shipping to International Addresses:1st book (min.) $6.00 Each add’l book $1.00

Mail check or company purchase order to:Institute for Applied Behavior Analysis

PO Box 5743Greenville, SC 29606-5743 USA

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

Foreign orders must be made in U.S. currency bybank draft or international money order.

(Prices are subject to change without notice.)

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 BehaviorChallenges

This is a 6 module video training program thatteaches viewers IABA’s person centered multielementmodel for developing nonaversive support plans forpeople with challenging behavior. Two text books,lecture notes and pre/post tests are included. $1,250.00

Staff Supervision and Management Strategies forQuality Assurance

This is a 4 module video training program basedon The Periodic Service Review: A Total QualityAssurance System for Human Services and Education.Viewers will learn concrete strategies to ensure that thehighest quality services are being provided by theiragency/school. Text book, lecture notes and participantexercises are included. $750.00

For more information, contact:

John Q. Marshall, Jr.Director of Professional Training ServicesInstitute for Applied Behavior Analysis


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

and Emergency Management. AssuringStaff Consistency Through the PeriodicService Review: A Quality Managementand Outcome Evaluation System is a 1 dayseminar that teaches participants a staffmanagement system that ensures theagency/school is providing quality services.

March, 1997 - US Seminars (Greenville,SC; Seattle, WA; San Francisco, CA;Vancouver, WA)

April, 1997 - US Seminars (Pittsburgh, PA;New Orleans, LA; Tampa, FL; Gainesville,FL; Atlanta, GA)

May, 1997 - Belfast, Northern Ireland

1997 TASH Conference“We the People, ALL the People”

Boston • December 10-13, 1997

Other venues will be arranged and announced at alater date. For detailed, current information on anyseminar, contact:

John Q. Marshall, Jr.Institute for Applied Behavior Analysis


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

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

In Australia - Jeffrey McCubbery (0354) 395 305

Assessment and Analysis of Severeand Challenging BehaviorGary W. LaVigna & Thomas J. Willis

This competency-based trainingpracticum provides participants with theclinical skills required to design andimplement person-centered multielementnonaversive support plans.Los Angeles • July, 1997Melbourne • September, 1997

IABA International Conference toAdvance Positive Practices in the Fieldof Challenging Behavior

Enrollment l imited to previousparticipants in IABA’s Two Week Instituteand Longitudinal Training.London • February, 1997

Positive Approaches to SolvingBehavior Challenges and The PeriodicService ReviewGary W. LaVigna & Thomas J. Willis

Positive Approaches… are 2, 3 & 4 dayseminars that present IABA’s multielementmodel for providing person centerednonaversive behavioral supports to peoplewith challenging behavior. These seminarscover Basic Principles of NonaversiveBehavior Support, Behavioral Assessment

Printed Resources Available from IABA

number 2 â€¢ january 1997 - institute for applied behavior analysis

Documents