Implementing Positive Behavior Support...
Transcript of Implementing Positive Behavior Support...
1
Implementing Positive Behavior Support Plans
Slide 1
The purpose of this segment is to describe how positive behavior support plans are implemented
and how teams can evaluate the planning process to ensure that the interventions selected are a
good fit for the child, her family, and the rest of her team.
Slide 2
In this segment, you will learn how to move from brainstorming interventions together as a team
to the process of implementing and monitoring the positive behavior support plan.
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Slide 3
We will discuss what needs to be considered when implementing the plan and how the plan is
evaluated over time.
Slide 4
At the end of the segment on building positive behavior support plans, we described a way to
brainstorm ideas for interventions based on the functional behavioral assessment.
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Slide 5
We showed how this collaboration process involved taking the hypothesis statement the team
developed and encouraging all team members to share ideas for possible setting event
antecedent, social skills, and consequence interventions.
Slide 6
In the previous segment, we introduced John, a boy with a diagnosis of emotional and behavioral
disorder. John engaged in problem behavior in order to escape from non-preferred tasks.
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Slide 7
This figure reviews the interventions that John and his team chose after the brainstorming
session. The team discussed all of the ideas that were generated and together, as a team,
interventions were selected that the team felt were the best choice for John and his family.
Slide 8
There are a number of issues that a team like John’s will need to consider when implementing
new interventions.
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Slide 9
First, each child is unique. Problem behaviors can be minor and repetitive in nature or very
dangerous to the child or others.
Slide 10
The intensity of problem behaviors and, therefore, the complexity of positive behavior support
planning is on a continuum from simple to more complex.
Slide 11
A team may only need a brief functional behavioral assessment followed by a brainstorming
session that results in one or two simple interventions that are implemented for a child who is
loud and tends to interrupt others.
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Slide 12
In other situations, it may be difficult to clearly identify the function maintaining problem
behavior. A child may shout and curse in class to escape from academic tasks but at home she
may shout and curse at her brother and his friends in order to get their attention. A plan may need
to include sets of interventions to address the different functions maintaining problem behaviors.
Slide 13
When implementing a positive behavior support plan, the team will decide how often to meet
and how much time will be needed in order to implement and monitor the interventions based on
each child’s problem behavior.
Slide 14
The next important consideration is to implement interventions in way that takes into account the
entire family system including relationships among family members, the types of routines
important to the family, and the unique cultural characteristics within the home.
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Slide 15
It can be helpful for the entire family to review and clarify the expectations within the home.
This includes identifying the positive social behaviors that all family members agree are
important for their family.
Slide 16
The team may discuss how the entire family currently participates in routines, chores, and other
important family interactions and how the principles of positive behavior support could be used
to prevent and reduce conflicts across different family members.
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Slide 17
For instance, in John’s brainstorming session, one intervention included reviewing the daily
schedule before and after school.
Slide 18
John and his mother identified a time period that works best to review the daily schedule.
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Slide 19
During the team discussion, John shared that his family tends to eat together as a family at
breakfast and again when the children come home from school.
Slide 20
John’s mother meets them in the kitchen for an afternoon snack after school. This family routine
is relatively problem-free and most interactions between family members are positive during
breakfast and after-school snack time.
Slide 21
The breakfast and morning routine may be the best time period to add in a review of John’s daily
schedule.
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Slide 22
In fact, John’s mother might decide to use this schedule review process with John’s younger
brother as well so that it becomes part of the family’s everyday routine, one that encourages
predictability and choice making, two types of interventions that tend to decrease problem
behavior.
Slide 23
Interaction patterns among family members should be considered during the planning process. If
a child’s mother and father tend to communicate with the child differently, they may need to talk
about how they can become more consistent.
Slide 24
An important goal of the positive behavior support process is to help a child live successfully
within his community. The outcomes expected from wraparound planning and positive behavior
support include increasing a child’s community engagement.
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Slide 25
The natural supports that were discussed in wraparound planning are reviewed at this stage in the
positive behavior support planning process. As new interventions are being implemented, new
connections need to be made with individuals who provide natural supports to the child and
family.
Slide 26
Natural supports include people and resources in the community that help support families as
friends, and caring community members.
Slide 27
The team considers how interventions can be implemented with the direct support and
involvement of individuals who live within the community. Natural supports also may be needed
to provide other family members with support.
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Slide 28
An example of a natural support strategy could involve identifying an adult mentor from a
community program, within the extended family, or as part of a family’s larger social network.
Slide 29
A child living in a single parent household may benefit from a mentor who will become a
positive adult male role model in the child’s life.
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Slide 30
Another type of natural support may be associated with a local spiritual organization. The local
church often provides a place where families can go to receive social and emotional support.
Individuals associated with sports teams, scouts, and other organizations may become part of the
wraparound team to help build natural supports for a child and family.
Slide 31
Families experiencing chronic or ongoing stressors related to a child’s problem behavior may
need assistance in dealing with the negative emotions associated with these behaviors. The team
needs to consider the social and emotional needs, not just for the child, but for her entire family.
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Slide 32
A series of new studies are currently exploring how families and teachers can overcome negative
beliefs that may impede an individual’s progress in trying new ways to address their child’s
problem behavior.
Slide 33
These studies focus on identifying current thought patterns that may make it difficult to focus on
more positive strategies, and teaching new ways to reframe what parents or others are thinking
during problematic events.
Slide 34
Additional interventions for supporting the child’s family members may be added at this time to
ensure that everyone in the family receives the social and emotional supports necessary for a
successful positive behavior support plan.
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Slide 35
Counseling, cognitive behavior therapy, meditation and relaxation sessions, and other therapies
for specific family members may be needed to provide the supports necessary for a child’s plan
to be successful.
Slide 36
Share a unique routine that your family has at home and how it is related to your cultural values.
Describe an example of a natural support used in a wraparound plan you participated in – How
was this natural support identified? What kind of negative thought patterns can make it difficult
for parents to support their children?
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Slide 37
The last issue to consider while moving forward with a positive behavior support plan is the
degree to which each of the interventions selected are a good fit, not just for the child and family,
but for any individual who will be implementing the interventions. The positive behavior support
plan should fit the values of the individuals who will implement the plan.
Slide 38
For instance, in some cultures, the father is considered the head of the household making all
important decisions on behalf of the family. Interventions that focus on empowering a child to
make his own decisions may create an internal sense of conflict and tension for the family since
the head of the household is supposed to make these types of decisions.
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Slide 39
The interventions selected must fit the skill level of the individuals implementing the plan. If
team members are expected to implement interventions that are complex and no information is
given to them about how to implement these more complicated strategies, the positive behavior
support plan will not be implemented.
Slide 40
Finally, the resources necessary for implementing a positive behavior support plan must be
available for the interventions to be successful.
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Slide 41
Creating an elaborate or expensive strategy for reinforcing a child for positive behavior may
appear logical but is unlikely to be effective and will be filed away and not used if there are no
funds to implement costly interventions.
Slide 42
Let’s stop for a Knowledge Check. Please identify whether the following statement is true or
false: The following are the only types of interventions used in a positive behavior support plan:
Setting event, antecedent, teaching new skills, and consequence interventions.
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Slide 43
How did you respond? This statement is False. Interventions may be needed to support the social
and emotional needs of other family members.
Slide 44
In the next section of this segment, we will describe how positive behavior support plans can be
implemented in an effective manner.
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Slide 45
The wraparound or person-centered planning and positive behavior support process described in
these segments are based on the International Association for Positive Behavior Support
Standards. These standards outline the key features of an evidence-based positive behavior
support plan.
Slide 46
Have you worked with a wraparound team that uses national standards for wraparound
implementation? How do you know when a wraparound planning session is implemented with
high standards? Are there other evidence-based practices you are familiar with that introduces
standards of practice?
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Slide 47
As you know, an effective positive behavior support plan results in decreases in problem
behavior, increases in academic, social, and communication skills, and positive lifestyle changes.
Slide 48
In addition to varying in size and complexity, effective behavior support plans focus on specific
routines and settings where problem behaviors occur.
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Slide 49
Multiple interventions are often needed to address the different elements of the hypothesis
statement including setting events, antecedents, teaching skills to replace problem behavior, and
consequence interventions.
Slide 50
The way in which a plan is written and recorded varies based on the complexity of the plan and
how the team is working together. A written positive behavior support plan is meant to provide
guidelines for the team to follow.
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Slide 51
Written positive behavior support plans include the identifying information about the child and
reasons for the plan as well as a description of the problem behaviors.
Slide 52
Here is the next Knowledge Check. Select the item that is the best example of a clear and
objective definition for problem behavior:
A. Irritating And Defiant Behavior
B. Disruptive Behavior That Interrupts Conversation
C. Crumpling Homework And Throwing It In The Garbage Bin
D. Throwing A Temper Tantrum
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Slide 53
How did you respond? The answer is C: Crumpling Homework And Throwing It In The Garbage
Bin.
Slide 54
The escalating pattern of problem behaviors for a child should be listed in the positive behavior
support plan for all problem behaviors that are maintained by the same function. Interventions
are implemented across the relevant home, school, and community settings, wherever the team
feels interventions are needed.
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Slide 55
It is helpful to include a summary of the hypothesis statement in the written plan to show team
members the link between the interventions and why problem behaviors are occurring. The team
should describe each intervention in detail. This helps make sure everyone is clear about what
strategies are being implemented.
Slide 56
A crisis plan can be helpful since problem behaviors may still occur and a consistent response
will interrupt the escalation of problem behaviors from minor to more intense.
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Slide 57
A crisis plan outlines what team members will do when serious problem behaviors occur.
Another helpful tool is to summarize the positive behavior support plan as a quick one-page
review.
Slide 58
The implementation plan is the process used to document the actions taken to put the positive
behavior support plan in place. Teams use an implementation plan to keep track of the steps
needed to move from the discussion in meetings into practice.
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Slide 59
At each wraparound, person-centered, and positive behavior support plan meeting, the team
makes a list of the steps needed to complete important tasks. The people responsible for each
task are documented and the intended due date for each task is recorded.
Slide 60
This implementation plan starts with the first meeting the team schedules and is meant to create a
laundry list of all the major activities, who is responsible for completing the activity, and by what
date. When the team reaches the implementation stage, each step is broken down to establish
what is needed to get the intervention started.
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Slide 61
For instance, during the functional behavioral assessment, the team may have recorded the time
it takes before a child who engages in problem behavior to get attention starts to misbehave.
Slide 62
Imagine that a team has observed that the child they are supporting will behave appropriately
when left alone with no interaction from adults or peers for no more than 6 minutes before she
starts pounding on the table and throwing items at other children.
Slide 63
The implementation plan will include making a list of each step the parent will take to prompt
the child to initiate play with her older sister or herself. The prompt will always occur before the
first six minutes that the child is alone to avoid problem behavior occurring.
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Slide 64
The child’s parent may need someone with experience to demonstrate how the communication
intervention works. Part of the implementation plan for this child will be to schedule a time for
the child’s PBS Facilitator to demonstrate to the girl’s mother how to implement the
intervention.
Slide 65
The next time the routine occurs, the girl’s mother takes the lead prompting her child to
communicate. Afterwards, the PBS Facilitator and the girl’s mother talk about what is working
well and how the intervention could be improved. Over time, the girl’s mother says she feels
confident that she can implement the intervention by herself.
Slide 66
The tool used to document how well each person does teaching communication is referred to as
fidelity of implementation. Fidelity of implementation means that something is implemented in
the way it was originally intended.
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Slide 67
Fidelity can be monitored in different ways. An observer may document each step that was
completed while watching the intervention being implemented or a rating scale for someone to
self-evaluate his performance can be created. In some cases, products that were completed
during the intervention can be counted.
Slide 68
In the story about the child seeking attention from her family, the PBS Facilitator and the girl’s
mother choose a direct observation approach using the fidelity tool in this figure. The mother
uses the tool when she is observing the PBS Facilitator and then they reverse roles when the
mother implements the intervention.
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Slide 69
Each time the PBS Facilitator observes the communication intervention, she puts a checkmark by
the steps that the mother successfully completes.
Slide 70
Together, the girl’s mother and the PBS Facilitator use this tool when they discuss the progress
being made implementing the intervention.
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Slide 71
As you can see from this story, the fidelity of implementation tool assists the team in many ways
and is considered an important part of the positive behavior support plan. It helps ensure
accuracy, provides guidance, and is used to improve the intervention.
Slide 72
Fidelity of implementation provides evidence that the interventions are implemented and this
makes it more likely that positive outcomes that are observed by the team are due to the
interventions implemented and not some other variable. This tool also provides evidence that the
interventions are a good fit for the child and his team.
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Slide 73
Fidelity of implementation is one type of evaluation that occurs as part of monitoring a positive
behavior support plan. Let’s talk about the types of tools used to evaluate plans in more detail.
Slide 74
Each problem behavior that is addressed in the positive behavior support plan is measured by the
team before the key interventions are implemented.
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Slide 75
This is referred to as a baseline measure. In Andrew’s graph from the first segment, you see the
incidents of problem behavior labeled on the left side on the vertical line and the days the
problem behaviors occurred are plotted on the horizontal line.
Slide 76
On the right side of the graph on the vertical line you see the incidents of the replacement
behavior used during school days. An important outcome measure that is evaluated by the team
is the extent to which problem behaviors decrease and the new replacement skill increases.
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Slide 77
Surveys are often completed by the child, his family, and his team after the positive behavior
support plan is implemented. These surveys focus on a variety of issues including how well the
plan fits the values, skills, and resources for those implementing interventions.
Slide 78
Other surveys may ask the child and her team whether quality of life has improved due to the
interventions for both the child and her family. The team should review each of the domains that
were addressed in the wraparound and person-centered plan since the new interventions being
implemented will have an impact on one or more of these domains.
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Slide 79
For example, a self-management intervention implemented at home and school will contribute to
a child’s self-determination. Self-determination refers to a person's ability to control his or her
own destiny. A self-management plan may also impact productivity if the plan is linked to
academic goals.
Slide 80
The team needs to evaluate how well a child’s life domains are being addressed across any
evidence-based practices that are implemented that may impact the child’s quality of life.
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Slide 81
For this Discussion Topic, please discuss the following questions: Are there any other evidence-
based practices that may need to be considered in addition to wraparound or person-centered
planning and positive behavior support? How might a team evaluate the impact of trauma
informed therapy or cognitive behavior therapy on a child’s quality of life domains?
Slide 82
Here is the next Knowledge Check: Select the best definition of an implementation plan as it
applies to positive behavior support interventions:
A. Provides The Team With Lists Of Actions, People Responsible, and Due Dates
B. Provides Evidence That The Interventions Are Implemented In The Manner Intended
C. Provides A Quick One-Page Summary Of Interventions
D. Refers To Treatment Integrity
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Slide 83
The answer is A. An implementation plan provides the team with a list of actions, people
responsible, and due dates.
Slide 84
Now let’s listen to a story that shows the major features that are assessed when a child engages in
problem behavior.
Slide 85
Michael is a five-year old boy who was adopted by his parents when he was one year old.
Michael loves his family and anything to do with robots…
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Slide 86
...or better yet, robot aliens! Michael was diagnosed with Autism and intellectual and
developmental disabilities. He was transitioning to a new kindergarten class at the time of this
story.
Slide 87
He lives with his mother and father, three siblings, and two older siblings in a rural area of
northern Kansas.
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Slide 88
Michael engaged in property destruction including pushing lamps onto the ground and pounding
on tables and walls. Sometimes, Michael threw household items like plates on the floor and
stomped on them, causing them to break. Michael also engaged in self-injury by banging his
head on walls or other objects.
Slide 89
Before the positive behavior support plan was implemented, Michael’s mother was really
worried about Michael’s behavior. She felt very depressed and powerless to help her son.
Michael would have a good day maybe once every three to six weeks. Evenings after dinner
were described as the worst time of the day.
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Slide 90
Michael and his team started the person-centered planning process and moved quickly to the
functional behavioral assessment. The team used the information gathered to brainstorm ideas
and the facilitator made sure everyone knew how to implement the main interventions.
Slide 91
Michael’s person-centered planning goals included focusing on his transition to kindergarten and
spending more time in the community engaging in new activities. The team decided to work on
increasing communication, decreasing problem behaviors, and introducing Michael to new
community events.
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Slide 92
The team decided to focus on the evening routine since that was the most stressful time for
Michael and his family. The team identified the hypothesis statement described in this figure.
Michael engaged in self-injury and property destruction to obtain favorite items and activities.
He had a number of setting events that increased the likelihood of problem behaviors including
allergies, headaches, loud and noisy settings, and situations that were unpredictable.
Slide 93
As a Discussion Topic, take some time to read the interventions that the team identified with
Michael. What other interventions might be considered by the team? Are there other new skills
that would be helpful for Michael to learn that would help replace the problem behavior?
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Slide 94
Michael’s team created a plan to make sure all of the interventions were implemented.
Michael’s mother asked for direct training and support to implement the new communication
intervention.
Slide 95
Before starting the interventions, the team reviewed Michael’s preferences and dislikes and used
this as a starting point for the picture schedule.
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Slide 96
In the evening, Michael learned to bring his mother and father pictures to show them the
activities and items he wanted.
Slide 97
Michael’s mom and dad worked really hard to make sure the communication process was more
effective for Michael than engaging in problem behavior. If Michael used his picture
communication sign to ask for a grilled cheese sandwich, his father would go make it, even if it
was right after dinner.
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Slide 98
Michael’s mother and the positive behavior support facilitator created a one page summary of the
positive behavior support plan. This review was helpful in the evening to remind Michael’s
mother and father about the key features of the intervention when they were really busy.
Slide 99
Michael’s mother documented events when her child engaged in self-injury, the most serious
problem behavior. You can see that Michael’s problem behaviors decreased once his
interventions were implemented. However, his behaviors did increase on several occasions due
to unexpected setting events. Michael experienced two severe allergic reactions leading to a big
increase in problem behaviors on the days he was feeling ill.
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Slide 100
Michael’s mother and the entire team was excited to see the increase in the number of times
Michael brought a picture to his mother or father to communicate what he wanted. As the
replacement behaviors increased, problem behaviors decreased.
Slide 101
All of Michael’s team members filled out a survey that evaluated how well the positive behavior
support plan fit the values, skills, and resources of the team. They also completed a survey that
included questions about whether changes in quality of life occurred both for Michael and his
family due to the interventions that were implemented. These surveys showed that the team felt
the plan had been very effective
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Slide 102
Michael’s mother reported during a follow-up meeting that focused on Michael’s quality of life
domains that the family was able to go to the county fair together for the first time.
Slide 103
The family decided to try a new community outing to the county fair on a Tuesday night when
the fairgrounds tended to be less crowded. Michael used his pictures to communicate at the fair
and ended up having a great time. Overall, Michael’s mother reported that life had changed for
the better. Michael only had bad days once in a while instead of every day.
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Slide 104
Before finishing this segment, please identify whether this statement is true or false: The team
should review the wraparound or person-centered plan when starting the positive behavior
support plan interventions to review natural supports and assess how quality of life domains will
be impacted.
Slide 105
How did you respond? This statement is true.
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Slide 106
You have now completed the Implementing Positive Behavior Support Plans Using Data-based
Decisions segment.
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