1. October 21, 2009 Shannon Dorsey, Ph.D. University of Washington, School of Medicine Division of Public Behavioral Health and Justice Policy Behavior Management: Skills you can Use…TOMORROW

2. Goals for Today How to define the problem and its positive opposite Strategies to increase positive behavior Strategies to decrease unwanted behavior Considering the nuanced aspects of attention Strategies to teach the above strategies Basically, a lot of strategies. The end. 2

3. Behavior Management Strategies Basics from the range of evidence-based parenting programs  Parent-child Interaction Therapy  Incredible Years  Triple P  Helping the Noncompliant Child Not teaching an intervention model but techniques from the underlying principles  Makes sense that all have so much in common, all derived from the Hanf model

4. Who you Work With… Common across all behavioral interventions: the Caregiver is your main partner If the caregiver isn’t engaged in the work—behavioral change won’t happen For foster parents, you have a second partner, the caseworker

5. Skill Number 1: Defining the Problem And…it’s Opposite

6. First Things First: Define the Problem Behavior We can’t fix what we don’t know REALLY, REALLY well. Make it behavioral What does it look like? What does it sound like? Examples What are some examples of behavioral problems? What are some examples of loosey goosey somethings or others?

7. The Difference Between the Two Behavioral Problems Not listening to directions Destroying property Touching a sibling’s private parts Hitting other kids and adults Having temper tantrums Loosey Goosey Somethings Bad attitude Being disrespectful Acting suspicious Acting immature

8. First Things First: Define the Problem Behavior What would the opposite of the problem be? Make it behavioral What would it look like? What would it sound like? Not listening to directions Destroying property Touching a sibling’s private parts Hitting other kids and adults Having temper tantrums

9. First Things First: Define the Problem Behavior Get the Specifics of the Behavioral Problem:  How frequently does it happen?  For how long has it been happening?  How intense is the behavior? KEY: Your plan will look very different, depending on these factors If you don’t know, worth taking the time to find out  Tracking

10. Examples of Differences in Freq., Duration, and Intensity Stealing change from an unlocked car one time vs. a 1-year history of stealing jewelry and wallets Tantrums once a week vs. 2-3 times a day Sexualized behavior: covert masturbation vs. overt masturbation and touching a sibling Firesetting: happened once, inappropriate access to matches for a 9 y.o. vs. intentional fire setting over a year by a 14 y.o.

11. Skill Number 2: Learn all you can about what surrounds the behavior What’s the context than maintains the problem? Where can we intervene?

12. Learn all that you can about it Functional Behavioral Analysis Basically…  What happened right before the problem behavior?  Then what happened?  What did you do?  What did he do?  Then what did you do?  And what did he do?  And after that, what happened, what did you do?  Tell me another time it happened. (repeat)

13. Great Functional Behavior Analysis Resource All behaviors serve a function Can take some time to understand the function, and how the behavior is maintained What are people’s responses to the child’s behavior? How can the responses be modified so the inapprop. behavior doesn’t “payoff?”

14. What are we looking for? B ehavior C onsequences A ntecedents What happens right before the behavior, what happens right after?

15. Group Exercise What do you know so far?

16. Skill Number 3: Focus on Increasing the Positive Opposite Using reinforcement and attention to increase the absence of the problem

17. Reinforcement You have the positive opposite defined; What are your options for increasing the positive opposite? All evidence-based parenting programs start with positives first Many times, a focus on improving the relationship and praise and rewards first Praise  Labeled and Specific Rewards  Creativity in Rewards

18. Praise Label the positive behavior Give it RIGHT AFTER the behavior is displayed No handshake-slap praise undoing  “you did a great job cleaning up your dishes after dinner, why can’t you do that every night?” Key is how you TEACH it and how you USE it  Not just “yeah yeah we all use praise”  Specific focus on the positive opposite: Praise as a tool  Model  Role Play  Homework (Praise for each time you see it over the next week)  Follow up

19. Rewards What are free or low cost rewards? What are creative, out of the box rewards that are motivating?  Ice cream for breakfast example Can rewards be things that kids receive already, but now are earned?  This can be challenging—make sure doesn’t turn into privilege removal, b/c then it isn’t a reward Can tokens be used? How often do rewards need to be given?  Depends on frequency, duration and intensity (Skill #1)  Depends on age

20. Rewards When the positive opposite is the absence of the problem behavior, and not so much actively doing something else….what’s the interval for the reward?  Depends on frequency, duration and intensity (skill #1) AND what you know about the problem behavior (skill #2) Does the child need to have completely DO the positive opposite, or just make steps towards it?  Depends on frequency, duration and intensity (skill #1)

21. Rewards: Shaping Behavior Does the behavior have a few parts? Can you reward steps toward the appropriate behavior, parts of the desired behavior? How do you present a rewards plan?  Off Road Parenting Example  What do you notice about how it is introduced?

22. Skill Number 4: Using Selective Attention to your Advantage Only Works once Praise and Rewards are in Place

23. The Power of Attention

24. Ignoring Eye contact Facial expression Body language (including blushing!) In many cases, the ignorer needs to occupy themselves in another activity  Home-related task  Shift attention to another child Ignoring STOPS as soon as the child moves toward the positive opposite behavior

25. Skill 5: Consequences When Rewards and Selective Attention Aren’t Enough

26. Consequences Vary based on age Time out Privilege removal Work chores Younger the child, apply as soon as possible after the problem behavior Spending less time here, b/c if we do the others well, less need for consequences

27. Skill #6: How to Teach Skills This is just as, or more, important as the other skills

28. UP and OUT of your Chair Talking about how to deal with difficult behaviors or do something new doesn’t tend to lead to success or make people feel capable Peanut Butter & Jelly Example

29. Practicing: UP and OUT of your Chair Talking about how to deal with difficult behaviors or do something new doesn’t tend to lead to success or make people feel capable Steps Model: You demonstrate the new skill, have caregiver realistically play the child/adolescent Discuss Practice: Now you play the child Talk about homework and plan Problem solve loopholes (if appropriate)

30. Practicing: UP and OUT of your Chair (cont.) Can do a 2-takes practice to get buy in, if you think the caregiver is escalating the child Take 1: Parent engages in power struggle, accidentally reinforces Take 2: Parent does NOT engage in the power struggle, watches the role of attention You play the parent, have ACTUAL parent, who is playing the child, give you feedback

31. Bringing it all Together Case Application

32. What we want to avoid….(the problem behavior!)

33. The Positive Opposite! What family, child do you have in mind? What can do you from Skills 1 & 2 in the next week? What would be your next step, for Skill 3?

34. Questions? Thank you. dorsey2@u.washington.edu