Collaboration Can Change Lives: Supporting Families of Young Children with Challenging Behavior Through PBS Lise Fox, U. of South Florida Rochelle Lentini, U. of South Florida www.challengingbehavior.org www.csefel.uiuc.edu Research on PBS Effective for all ages of individuals with disabilities 2-50 years. Effective for diverse groups of individuals with challenges: mental retardation, oppositional defiant disorder, autism, emotional behavioral disorders, children at risk, etc. PBS is the only comprehensive and evidence-based approach to address problem behavior within a variety of natural settings. 2 What Does PBS Mean in “Simple Terms”? “A set of tools that has allowed children to more fully participate and succeed in every day life.” John Father of Josh and Brendan 3 “If a child doesn’t know how to read, we teach.” “If a child doesn’t know how to swim, we teach.” “If a child doesn’t know how to multiply, we teach.” “If a child doesn’t know how to drive, we teach.” “If a child doesn’t know how to behave, we……..... ……….teach?………punish?” “Why can’t we finish the last sentence as automatically as we do the others?” Tom Herner (NASDE President ) Counterpoint 1998, p.2) 4 Old Way General intervention for all behavior problems Intervention is reactive Focus on behavior reduction Quick Fix New Way Intervention matched to purpose of the behavior Intervention is proactive Focus on teaching new skills Long term interventions 5 Before Positive Behavior Support (PBS) Frustrate 1. To cause to have no effect 2. To prevent from achieving a goal or gratifying a desire Methods Used Before PBS Family Stayed Home Restricted Access within the home Physical Restraint Food as a Distraction/Reward Spanking Constant Vigil 7 Process of Positive Behavior Support Step 1: Establishing a team and identifying goals Step 2: Gathering information (functional assessment) Step 3: Developing hypotheses (best guess) Step 4: Designing behavior support plans Step 5: Implementing, monitoring, evaluating outcomes and refining plan 8 Potential Team Members Parents/Family (may include a grandparent, sibling, aunt or uncle…) Teacher Assisting Teacher/Paraprofessional Therapists Administrative Staff Program Consultant/Resource Professional Other 9 Process of Positive Behavior Support Step 1: Establishing a team and identifying goals Step 2: Gathering information (functional assessment) Step 3: Developing hypotheses (best guess) Step 4: Designing behavior support plans Step 5: Implementing, monitoring, evaluating outcomes and refining plan 10 Step 2: Gathering Info (Functional Assessment) A process for developing an understanding of a person’s challenging behavior and, in particular, how the behavior is governed by environmental events. 11 Dimensions of Communication Every communicative behavior can be described by the form and function. Form: the behavior used to communicate Function: the reason or purpose of the communicative behavior 12 Functional Assessment Observe the child in target routines and settings Collect data on child behavior, looking for situations that trigger problem behavior AND that are linked with appropriate behavior Interview persons most familiar with the child Review records 13 Before PBS-Entering Library Before PBS-Computer Chaos Process of Positive Behavior Support Step 1: Establishing a team and identifying goals Step 2: Gathering information (functional assessment) Step 3: Developing hypotheses (best guess) Step 4: Designing behavior support plans Step 5: Implementing, monitoring, evaluating outcomes and refining plan. 16 Brendan’s Triggers, Behaviors, Responses, & Function Triggers Walking to car from house Walking from car to public place Demand is placed to go to next “activity” Behaviors TANTRUMS: cries then Sometimes allowed to yells and screams, continue what he was doing throws self onto ground, a bit longer sometimes throws Verbal coaxing objects Physically helped after a bit of his tantrum Change in routine Function: Setting Event: Tired/late afternoon Responses Avoid/prolong transition Hypothesis Statement Brendan is likely to tantrum (prolonged whining, crying, screaming, and dropping to the ground) and then sometimes will throw an object when someone places a demand to go somewhere. When he tantrums and/or throws objects, he is sometimes allowed to continue playing or the transition of going somewhere is prolonged. This results in temporarily escaping the transition or delaying “going somewhere”. 18 Process of Positive Behavior Support Step 1: Establishing a team and identifying goals Step 2: Gathering information (functional assessment) Step 3: Developing hypotheses (best guess) Step 4: Designing behavior support plans Step 5: Implementing, monitoring, evaluating outcomes and refining plan. 19 Support Plan Behavior Hypotheses - Purpose of the behavior, your best guess about why the behavior occurs Prevention Strategies - Ways to make events and interactions that predict problem behavior easier for the child to manage Replacement Skills - Skills to teach throughout the day to replace the problem behavior Responses - What adults will do when the problem behavior occurs 20 Brendan’s Preventions, New Skills & New Responses Preventions Give him predictability with mini schedule Count down/timer to give him time to process and get ready for the next activity (safety signal) “Going Places” social story New Skills Say “I don’t want to” Follow schedule Go places and stay with adult (transition successfully) Ask “Where are we going?” with prompting New Responses To Problem Behavior: Praise brother and other parent Validate his feelings Prompt to “use your words” and give him words Give choices (“Would you like to walk by-yourself or hold hands?”, “Do you want to take Thomas or Gordon?”) Remind him of transition by saying “It’s time to go…..” and physically help (without “feelings”) and praise once he transitions. To New Skill: Give him highly desired items to reinforce successful transitions (juice, Thomas the Train) Praise for successful transitions Behavior Support Plan Development Develop plan using plain language Develop mini-plans for difficult routines Make sure plan will fit with routines/activities/values of family/teaching staff Develop action plan of who will produce what components needed to implement the plan Design components that are easy to use, easy to remember Plan must accommodate competing demands on teaching staff/family 22 Process of Positive Behavior Support Step 1: Establishing a team and identifying goals Step 2: Gathering information (functional assessment) Step 3: Developing hypotheses (best guess) Step 4: Designing behavior support plans Step 5: Implementing, monitoring, evaluating outcomes and refining plan. 23 After PBS-Computer Play SUPPORTS Social Story My Potty Book Visual of Sequenced Step After PBS-Computer Turn-Taking SUPPORTS Timer Turn Cue Card After PBS-I’m All Done with the Computer SUPPORTS First/Then First Then computer book Timer “If a child doesn’t know how to read, we teach.” “If a child doesn’t know how to swim, we teach.” “If a child doesn’t know how to multiply, we teach.” “If a child doesn’t know how to drive, we teach.” “If a child doesn’t know how to behave, we……..... ……….teach?………punish?” “Why can’t we finish the last sentence as automatically as we do the others?” Tom Herner (NASDE President ) Counterpoint 1998, p.2) 27 Before PBS-Entering Library With PBS-”We Go to the Library!” SUPPORTS Social Story Cue Cards Mini-Schedule Going to the Library Written by Mommy for Brendan 2003 Today is a special day. Today I am going to the library! I can borrow books at the library. Getting books is fun! I can walk to the library. No running at the library. I hold hands with Mommy or Daddy when I walk to the library. First, I walk pass the sliding doors. Then, it is time to whisper. The library is a quiet place. Mommy and Daddy are happy when I use my calm, quiet voice. I can whisper and get books at the library. I like the library! First, I quietly play with the beads. I can play with the beads for a little while. Then, I stop and get books. I will know it is almost time to get books when Mommy or Daddy say 2 more minutes. 1. Play with beads 2. Choose books Sometimes it is hard to talk quietly in a whisper and to use walking feet; but I can try to follow the library rules. The library rules are: Whisper Walk I’m all done with the beads. Wow, look at all those books! I can find cool books and take them to my house. Let’s show the librarian which books I want to take home. I wait my turn to show the librarian the books that I want to borrow. When it is my turn, I give the librarian my books and my library card. I can say, “I want to borrow these books please.” I’m all done at the library. That was fun! It is time to go. Let’s go to the van. I can hold my books and walk to the van. I love my new books! I can carry my new books to the van. I hold hands with Mommy or Daddy. I am happy when I read my new books. First, I sit in my car seat. Then, I can read my new book. LIFE WITH PBS 41 1 2 Turn off T.V. 3 Clean up 4 Bath 6 5 Brush Teeth Pajamas 7 Story Time 8 Pray Bedtime Mini Schedule Everyone can go to circle and sit on their picture. I can sit nicely and look at the teacher. I can also listen with my ears and try to do what the teacher says. Sometimes it is hard for me to sit. But I can look at my “sit picture” and try to remember to sit, like all my friends, nicely on my picture. If I get up off my picture, it is hard for my friends to see and have fun. When we are in circle, I need to have nice hands And try to keep my hands to myself. “What do we do in circle?” First the teacher points to me, then I can answer with words. First Then When the class sings, I can sing. When the class dances, I can dance. The Circle Rules are: I sit on my picture. I look at the teacher. I listen, then do. I have nice hands. Circle is fun when we all try to follow the rules. Be Aware of … Time PBS is a difficult concept the first round Differing skills and/or approaches Possible baggage Varying adult learning styles Fear of change Competing factors Data collection may be “scary” You’re an “outsider” in a family’s home 53 Families and PBS Factors that influence: –“Buy-in” –Motivation –Enthusiasm –Health/Abilities –Time –Resources –Ability to “change” –Ability to be consistent –Resilience/Stress level –Organizational skills –Educational level –Ability to think “outside-the-box” –PBS knowledge 54