Positive Approaches to Challenging Behaviors by Stacie J. Lane-O’Brien, MSW

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Positive ApproachesPositive Approachesto Challenging Behaviorsto Challenging Behaviors

by

Stacie J. Lane-O’Brien, MSW

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Stacie

• Stacie– Over 20 years experience with individuals

with behavioral support needs– Behavior Support Consultant– Certified CPI instructor– All different levels of provider agency for 16

years.

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OverviewDay 1

• Overview of binder• Positive Behavioral Supports• Antecedent Strategies (Basic supports needed for

success)• Behavioral Assessment

– A-B-Cs– Classes of Reinforcement

• Hypothesized Function• Matching supports with the function• Managing Crisis• Preparing for Day 2

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Common Practice vs. PBSTraditional

Discipline:

Focused on the topography of problem behavior

Positive Behavior Support:

Focused on cause of problem behavior

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Common Practice vs. PBS

Traditional Discipline:

Eliminate inappropriate behavior


Increase appropriate and adaptive response

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Common Practice vs. PBSTraditional

Discipline:

Goal was to stop

problem behavior, through the use of random rewards or punishment


PBS reduces reinforcement for problem behavior, and provides reinforcement for appropriate behavior

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Sees problem behavior as a problem


Sees (destructive) behavior as communication and/or a lack of skills

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Behavior Modification


Applied Behavior Analysis (ABA)

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Observer or Object of Offensive Acts and police officer of problem behavior


Investigator of Environmental Influences and provider of preferred possibilities

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Applied Behavior Analysis

• ABA asks “Why do behaviors occur?”

• Behavior that persists serves some function.

• Persistent behavior is communicating information about the function.

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Antecedent StrategiesBasic Supports Needed for Success

History and Psychosocial Stressors:

• Medical concerns

• Diagnosis

• Past life events

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Antecedent Strategies Basic Supports Needed for Success

Environmental Considerations:• Home environment • Work/School environment• Roommates• Staff interactions

– The first question is not what to do when Joe hits, but, what can I do to prevent Joe from wanting to hit in the first place? The second question is what do we do when he does hit his head.

– Changing staff responses vs. focusing on the changing the other person’s behavior

• Current rights restrictions• Routine and schedules

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Triggers/Antecedent

• Events or situations that routinely precipitate challenges for the person

• Problems that have yet to be solved

• Identifying triggers can make problem behaviors highly predictable

• Examples

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Setting events?

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• Understand transitions are hard, and have patience!

• Watch out for the honeymoon period!• Remember: Behavior Change takes time!• Watch out for certain “rules” being established

the first few days. • Staff Training:

– Train staff prior to working with the person.– Anticipate additional trainings that may be

needed.

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Does the behavior need to change?

• Is it destructive behavior?- Is it dangerous to the person?- Is it dangerous to others?- Is there property destruction?

• Is it a problem behavior?- Is it preventing the person from advancing to more

independent opportunities? (will a change in the behavior help the person in reaching short and long term goals?)

- Is the behavior a disruption to the program?- Is the behavior jeopardizing the person’s placement?

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Define the Behavior

In order to address a challenging behavior, we need to define what a behavior is:• Observable

• Measurable

• Inter-observer Agreement

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Non-behavioral term

(Emotional)

Behavioral definition

(Descriptive)

Rude –Speaks when others are talking–Calls people names (e.g., idiot)

Controlling

Bi-polar

Rigid

Lazy

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• Behavior occurs in settings.

• It is important to know what happens before and after a behavior so we might know how the environment may be related to the behavior.

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immediate antecent as well as setting events

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Specific things in the environment (Stimuli)

A-B-Cs:• What happens before the behavior

occurs (A or antecedent)?

• What is the behavior (B)?

• What happens after the behavior occurs (C or consequence)?

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A-B-C

A. Late for important meeting at work

B. Drive fast to get to work

C. Get speeding ticket

Antecedent

Behavior

Consequence

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A-B-C

A. Teacher gives math seat work.

B. Sally draws pictures instead of completing math work.

C. Sally spends recess completing math work.

Antecedent

Behavior

Consequence

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reword B. Not a behavior. does not pass the dead mans test

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A-B-C

A. Dinner is announced by staff.

B. Jeremy bangs his head on the arm chair.

C. Jeremy is instructed that he has 5 minutes to “get it together” and get to the table.

Antecedent

Behavior

Consequence

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A-B-C Worksheet(Training Binder: section 5, page 11)

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Name Daily Behavior RecordDate (Training binder: section 5, page 7)

Time of Day How often? What activity was involved?What behavior

occurred?What did you do

about the behavior?

Morning6:00-6:30 am6:30-7:00 am7:00-7:30 am7:30-8:00 am8:00-8:30 am≈≈≈≈≈≈≈≈≈5:30-6:00 pmEvening6:00-6:30 pm6:30-7:00 pm7:00-7:30 pm7:30-8:00 pm8:00-8:30 pm8:30-9:00 pm9:00-9:30 pm9:30-10:00 pm

____________

__________________________________________________

≈≈≈≈≈≈≈≈≈

__________

__________________________________________________________________________________________

Data is collected throughout the day

≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈≈

≈≈≈≈≈≈≈≈≈≈≈≈≈

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This record will help us understand the times and situations in which problems occur. Here is a sample entry:

Time of Day How often? What activity was involved What behavior occurred? What did you do about the behavior?

3:30-4:00 pm __________ Picking up toys Refused to pick up, screamed, bit hand

Gave up, picked up toys myself

A B C

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Antecedents & Consequences

Caveats to A-B-Cs:• C maintains, but A is predictive• C is often misunderstood (the

consequence could have happened years ago)

• Pulling A-B-Cs from records

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Behaviors continue to occur for one of two reasons:

• To gain something that is desired–Positive reinforcement

• To avoid something that is aversive–Negative reinforcement

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Positive Reinforcement

Major gain categories – Positive Reinforcement:

• To gain attention

• To gain access to preferred items and activities

• To increase stimulation

Make coffee in the morning.

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Negative Reinforcement

Major avoidance categories – Negative Reinforcement:

• To avoid attention

• To avoid/escape aversive items and activities (e.g. work)

• To decrease stimulation

Take an aspirin to get rid of a headache.

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Sensory Integration

Definition of Sensory Integration:

• The ability of the central nervous system to organize and process input from different sensory channels to make an adaptive response.

• We are bombarded with a variety of sensations throughout or day. Some catch our attention and some we disregard. This is because we have a working sensory integration system.

• People with developmental disabilities, and especially those with brain damage, tend to have major problems handling the many sensations that other people without processing problems take for granted. They may become Sensory Defensive.

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Sensory Defensiveness

Sensory inventory examples – does the person:1. Layer clothing?2. Resist grooming?3. Try to handle or touch everyone or everything?4. Persistently put hand in pants or pant pockets? 5. Display self-injurious behavior?6. Lose balance easily?7. Become upset with changes in room arrangements?8. Display self-stimulatory behaviors? 9. Bite, hit, kick, pinch, etc.?

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Sensory Defensiveness

Example activities to address Sensory Defensiveness:1. Wilbarger Protocol2. Lotions and rubs3. Ball pits4. Swinging5. Hugs6. Therapy balls7. Jumping8. Others?

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Calvin & Hobbs

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Positive

Something is

Added

Negative

Something is

Removed

Reinforcement

Punishment

Behavior

Behavior

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Positive

Something is

Added

Negative

Something is

Removed

Reinforcement

Punishment

Behavior

Behavior

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Positive/Negative

• This is the next step in evaluating the influences of the behavior

Running your A-B-C through this process

• Why is this important?

It tells you what not to do, as well as what you should do.

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Positive/Negative

A. Math seat work given by teacher.


C. Sally spends recess completing math work and chatting with the teacher.

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Positive/Negative

A. Math seat work given by teacher.


C. Sally spends recess completing math work and does not have to go to the playground where Jimmy the bully often targets her.

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Positive/Negative



C. Jeremy is instructed that he has 5 minutes to get it together and get to the table, and gets to finish the level on his video game.

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Positive/Negative



C. Susan, the staff member Jeremy really likes, persuades Jeremy to come out and sit by her.

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Positive/Negative



C. Jeremy is assured that he will not have to “try” any veggies.

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Why the Function is so Important

• “Time-out” is a common consequence.

• What if negative reinforcement is desired and we use time-out?

• What if positive reinforcement (Attention) is desired and we provide a lecture about how wrong the behavior is, and then we have to apologize, etc.

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Behavior Modification?

• Kid throws a tantrum at school.

• Time-out was not effective.

• Consequences now include loss of recess and no computer time at home after school, because time-out was not an effective consequence.

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A-B-C Worksheet(Training binder: section 5, page 11)

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Function

• Doing a functional assessment of the problem behavior will help you identify the function. (section 5, page 1)

• The environmental event maintaining behavior (Function) must be identified.

• You can then create a support that addresses the identified function.

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• Identify the function of problem behavior.

• Teach recognizable communicative response to produce a specific outcome.

• Reinforcement for problem behavior is placed on extinction.

• Communication replaces problem behavior because they serve the same function.

Functional Communication Training (FCT) Carr and Durand (1985)

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Replacement Behavior

Let’s teach Jim another way that he can get the attention he needs:• Jim currently uses head-banging.

• What other behavior might work?

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Selecting Communication

Topographies to consider:• Verbal: I need your help.

• Visual cue: picture card of staff

• Sign: Anyone have a sign for a attention?

• Assistive technology (microswitch)

• Gesture

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The communication must:• Match function

• Be efficient (easy to do)

• Be effective (result in reinforcement)

• Problem behavior on extinction

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Must be efficient:• Do they know how?

• Can they easily do it?

• Is it dependable?

• Is it understandable?

• Is it easier to bang head?

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Must be effective:• Result in desired reinforcement

• Provide immediate result

• During teaching, many opportunities may be needed!

• Shaping

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Head-Banging

Alternative

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A-B-C Worksheet plus Behavior Support (Training binder: section 5, page ??)

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A-B-C Worksheet plus Behavior Support (Training binder: section 5, page ??)

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Managing Crisis Situations

Bell Curve

0

-

-

-

+

+

+

0

Integratedexperience

Mild

Moderate

Severe

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Staff Responses:

• Don’t take it personally!

• Be supportive and collaborative vs. authoritative.

• “Acceptance is different than approval.”

• Introduce video clip.

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• Knowing what to do in a crisis situation decreases staff fear and anxiety, injuries, and ultimately decreases staff turnover.

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• Crisis Prevention Institute (CPI)

• Non-Violent Crisis Intervention– Learn to set limits with challenging consumers.– Learn to address challenging/confrontational

questions from a consumer.– Learn to avoid or reduce power struggles.

• Care, Welfare, Safety and Security

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OverviewDay 2

• Preventing Challenging Behaviors by Enhancing Quality of Life

• The training process• Managing participants and questions• Transitioning between topics• Groups teaching a portion of the class together• Your Organizational Plan• List Serve, PBS website and how to access• Monthly/quarterly instructor conference calls.• Post test• Certificates for passing course and becoming a certified

trainer

Prepare for Day 2• Teaching a portion of the class in groups (15 min

each) – Traditional Discipline vs. Positive Behavioral Supports

– Teaching the A-B-Cs of Behavior

– Teaching classes of Reinforcement, including an explanation about punishment.

– Teaching how to decide on a replacement behavior and what your new response to a challenging behavior will be.

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AgendaDay 2

• Preventing Challenging Behaviors by Enhancing Quality of Life

• The training process• Managing participants and questions• Transitioning between topics• Groups teaching a portion of the class together• Your Organizational Plan• List Serve and how to access• Monthly/quarterly instructor conference calls.• Post test• Certificates for passing course and becoming a certified

trainer

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Encouraging Encouraging Desirable Desirable

Behavior by Behavior by Improving Improving

Quality of LifeQuality of Life

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The Focus on Function

• We tend to focus on problem behavior!

• What if we focus on supporting a person in a way that helps them enjoy a quality of life that makes problem behavior unnecessary and irrelevant.

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Preference/Choice/CommunicationAssessments

-Preference assessment sec.5, pg. 19

• Assess a person’s ability to access their preferences, rather than to look at which conditions evoke problem behavior.

• By making this a focus, you can avoid most problem behaviors before there is a reason for them to occur.

• Be a provider of preferred possibilities!

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Preventing Challenging Behaviors by Enhancing Quality of Life

• Realizing Hopes, Dreams and Wishes

• Does the person believe or feel he or she is living a meaningful life?

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Sometimes We Have Silly Rules:

• I have seen many silly rules.

• Silly rules take away from a person’s Quality of Life.

• They interfere with:– Self-determination– Choice– Self-direction

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Preventing Challenging Behaviorsby Enhancing Quality of Life

In Work and Day Programs:

• I can’t use the telephone at the workshop without written permission from my staff, even if I want to call for a pizza.

• I work at a sheltered workshop and I can’t go anywhere for lunch.

• If I have something in my lunch that I don’t like, I can’t give it away.

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In My Own Home:

• I can’t eat or sleep in the living room.

• I can’t sleep in the TV room.

• I have to eat meals at a certain time.

• We have to be in bed by 9 pm.

• I can’t sleep in on weekends.

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Preventing Challenging Behaviorsby Enhancing Quality of Life

In My Service Delivery:

• You have to work your way out of the group home by proving that you can live like they want you to live.

• I can’t go out to eat with my case manager.

• I can’t buy pop or anything for my direct care staff.

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Preventing Challenging Behaviors by

Enhancing Quality of Life

In My Relationships:

• I have to get permission from staff to date.

• I can’t have time with friends or family when I want because staff have to go with me.

• I want to date this girl but wherever the girl goes, staff goes. I want to take her to a ball game, but the staff doesn’t want to go to the game so I can’t take her.

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Preventing Challenging Behaviors

by Enhancing Quality of Life

In My Personal Time & Preferences:

• If I want to go somewhere, everyone in the house has to want to go there too.

• You can only smoke when staff will go outside with you even if it is your lunch time.

• “We don’t have a say in making the rules!”

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Preventing Challenging Behaviors

by Enhancing Quality of Life

No Silly Rules!

• Just say no to “Silly Rules!”

• Many “good intentions” behind “Silly Rules.”

• We see people do things that are NOT in their best interests all the time.

• Push common sense, respect, and dignity!

The Training Process

TrainingProcess

Training

SituationalApplications

Formal refreshers

Policy discussions

Reviews

Practice

Training

• Explain (Lecture)- keep it short- vary the format to keep people engaged- use examples – your own experiences and real

life examples- use visual aids – videos, cartoons, etc.

• Demonstrate (Activity) -always show the participants first/give them an example.

• Participate (Practice)-have them do the exercise or give their own examples.

• Revisit Explanation-check in and make sure everyone understands. Answer any questions they may have.

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Situational Applications

Address unique situations that occur by tailoring your approach within the framework of PBS

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Refreshers

Schedule formal PBS refresher training sessions every 6-12 months.

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Policy Discussions

• Review of agency policy in relation to the concepts being taught today using PBS.

• Change policies (any silly rules?)

- if not in alignment with PBS

- to use consistent language with PBS

• Review of policies with staff

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Reviews

• Review of PBS concepts at staff meetings

• Review and analysis of incident reports with staff

• Review of interventions being used and if they are affective.

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Practice

• Role play how staff are using each specific intervention

• Demonstrate the use of schedules, sensory interventions, de-escalation techniques, and others.

• Role play presence, tone of voice, cadence, volume

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

…and back to Training

TrainingProcess

Training


Formal refreshers

Policy discussions

Reviews

Practice

Managing Questions• Information seeking questions – open up to the group.

Don’t be afraid to say “I don’t know. I can find out and get back to you.”

• Validation questions – not really questions. Careful about passing judgement. You don’t have all the information. Let participant reach his/her own conclusion.

• Choice Questions – 2-3 answers the participant is unsure of. Deflect the question back to the participant. Will usually come up with own answer.

• Challenging Questions – nonproductive. Power struggle. Put back into that person’s lap. “how would you handle that?”

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The Inattentive Participant• Make friendly eye contact with the person.• Use proximity control – move closer to the person

while continuing to talk to the group.• Involve the person in an active way – ask them to

help you out with something.• Confront the person in private if the above hasn’t

worked.• As a last resort, give the person the choice of

staying or leaving if they cannot refrain from disrupting the group.

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Transitioning Between Topics

• Ensure that the material flows together

• Bridge between one topic and another. Explain how and why.

• For example: “Now that we are sure we have addressed all of the person’s basic support needs, we now need to determine if the behavior is something that we really need to change.”

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Group Presentations• Teaching a portion of the class in groups (15 min

each) – Traditional Discipline vs. Positive Behavioral Supports

– Teaching the A-B-Cs of Behavior

– Teaching classes of Reinforcement, including an explanation about punishment.

– Teaching how to decide on a replacement behavior and what your new response to a challenging behavior will be.

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Organizational Plan(Section 4,Page 1)

• Organizations get together in a group

• Fill out the Organizational Action Planning Form.

• Share with the group when finished.

• Ask if you have questions.

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Supports

• List Serve [email protected]

• PBS web site: http://www.uihealthcare.org/ucedd/self-advocacy/money-follows-the-person/

• Quarterly Instructor Conference Calls if requested.

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mailto:[email protected]

http://www.uihealthcare.org/ucedd/self-advocacy/money-follows-the-person/

http://www.uihealthcare.org/ucedd/self-advocacy/money-follows-the-person/

Positive Approaches to Challenging Behaviors by Stacie J. Lane-O’Brien, MSW

Documents

destructive behavior

behavior change

persistent behavior

cause of problem behavior

applied behavior analysis

common practice

pbstraditional discipline

problem behaviors