Presentation on theme: "Introduction to Positive Behavior Support"— Presentation transcript:
1 Introduction to Positive Behavior Support Geunyeong Pyo, Ph.D. Clinical Coordinator for Psychological Services IL Dept of Human Services Division of Developmental Disabilities
2 Purpose of the CourseTo provide an introduction to Positive Behavior Support (PBS)To review some basic concepts of behavior analysisTo introduce the basics of a functional assessmentTo introduce basic concepts of designing a PBS plan
3 Positive Behavior Support Based on applied behavior analysisResponse to the 1997 amendments to the Individuals with Disabilities Education ActEvolved to improve and extend comprehensive interventions for individuals with severe problem behaviorsSystemic and individualized strategies for achieving outcomes and preventing problem behaviors
4 Positive Behavior Support Respect for all citizens’ rightsTreating all people with respect and dignityPerson-centered supports and servicesPrevent abuse and neglect
6 ABC Model Antecedent: You see a coworker when you arrive at work Behavior: You say “hello”Consequence: Coworker says “hello” back to you
7 Behavior Behavior is everything a person does. “Behavior” refers to all behaviors, not just problem behaviors.Behaviors that can be observedBehaviors that can be heard/seenPeople can agree something happenedBehaviors that can be measured
8 Behavior Kate is angry vs. Kate hit Mark Mary is depressed vs. Mary is cryingRyan is anxious vs. Ryan is pacingSue is listening vs. Sue is looking atthe speaker
9 Behavior“Jack has a personality issue. He can tell you what to do when somebody annoys him (such as take a deep breath, count 1-2-3), however, he chooses to be aggressive instead of using the knowledge.”
10 BehaviorGroup Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner whether your description was about a behavior.
11 Behavior Rely on your Eyes and Ears. Take-home-message:Rely on your Eyes and Ears.Do not rely on what you are thinking!!!
12 ABC Model of PBSAntecedent Behavior Consequence
13 Why Do We Engage in Behaviors? People are likely to engage in behaviors that work.You see a coworker when you arrive at workYou say “hello”Coworker says “hello” back to youPeople are less likely to engage in behaviors that do not work.Coworker did not say “hello” to you.
14 Principles of Behaviors Almost all human behavior is learnedAll behaviors occur for a reason.No behaviors occur “out of blue.”Behaviors continue to occur because they are effective.Behaviors stop occurring because they are ineffective.
15 Consequences Events occurring after the behavior Consequences can be good or badGet what you wantGet away from you don’t likePeople leave you aloneGet a scolding from otherslose something valuable
16 Consequences Reinforcement Consequences increase the probability of the behavior.PunishmentConsequences decrease the probability of the behavior.
17 ReinforcementPositive Reinforcement increases behavior by the addition of a desirable event when the behavior occurs.PraiseEdiblesMoneyNegative Reinforcement increases behavior by the removal of an aversive event when the behavior occurs.Excuse from choresEscape from a crowdStops pain
18 PunishmentPositive Punishment decreases behavior by the addition of an aversive event when the behavior occurs.Verbal reprimandIncreased workNegative Punishment decreases behavior by removing a desirable event.Time outRemoving Privileges, fines
19 Negative Reinforcement vs. Punishment Negative reinforcement increases behavior by the removal of a negative experiencePunishment always decreases behavior
20 + - Summary Table + Reinforcement: Increases behavior by adding something good.+ Punishment:Decreases behavior by adding something bad.-- Reinforcement:Increases behavior by taking away something bad.- Punishment: Decreases behavior by taking away something good.
21 Misuse of Reinforcement Laura lives in a group home with three other people. At supper time, all four persons go to the table. When a staff member begins giving one of Laura’s peers a serving of food before serving Laura, Laura begins to scream and pull her own hair. The staff member then quickly gives Laura a food serving, and Laura calms down.Jefferson has a supported job in a printing company, in which he does several job tasks. When he is given the task of folding mailing fliers, which he knows how to do, he always tears the flies. When he begins the tear the fliers, that task is removed from him.
22 Misuse of Reinforcement Former president Nixon and Henry Kissinger were sitting in the Oval Office discussing policy matters. King Timahoe, Nixon’s Irish setter, came in and began chewing on the rug. The president commanded him to stop. King Timahoe kept right on chewing. The president commanded again. More chewing. Finally, Nixon opened his desk drawer, took out a dog biscuit and gave it to King Timahoe. “Mr. President,” said Kissinger, “you have taught that dog to chew the rug.” (Based on Roberts & Santogrossi, 1976)
23 Misuse of Reinforcement “Our young daughter had adopted a stray cat. To my distress, he began to use the back of our new sofa as a scratching post. ‘Don’t worry,’ my husband reassured me. ‘I’ll have him trained in no time.’ I watched for several days as my husband patiently ‘trained’ our new pet. Whenever the cat scratched, my husband deposited him outdoors to teach him a lesson. The cat learned quickly. For the next 16 years, whenever he wanted to go outside, he scratched the back of the sofa.” (Reported in Behavior Analysis Digest, March, 1990).
25 Types of ReinforcersA Primary Reinforcer has an intrinsic reinforcing value; only temporarily lose ots effectiveness through satiation; e.g. food, drinkA conditioned reinforcer originally has no reinforcing value, but became a reinforcer after being paired with a primary reinforcer; e.g., money, token, stickerA back up reinforcer is paired with a conditioned reinforcer to make it effective.
26 Reinforcers The only way we can tell is by its effect on behavior !! No single item or event is reinforcing to everyoneA reinforcer for an individual can be a punisher for another individual.The strength of an item or event to serve as reinforcer can vary with time, circumstances, satiation level, and deprivation level.The only way we can tell is by its effect on behavior !!
27 Misuse of Reinforcement “Our young daughter had adopted a stray cat. To my distress, he began to use the back of our new sofa as a scratching post. ‘Don’t worry,’ my husband reassured me. ‘I’ll have him trained in no time.’ I watched for several days as my husband patiently ‘trained’ our new pet. Whenever the cat scratched, my husband deposited him outdoors to teach him a lesson (Your intention). The cat learned quickly. For the next 16 years, whenever he wanted to go outside, he scratched the back of the sofa (Actual result).”Lesson: You have to think like the cat !!!
28 Identifying Possible Reinforcers Ask him/herObserve what s/he chooses when free to do soCheck records to see what’s worked in the pastTry different thingsMeasure the effects on the behavior
29 Punishers Verbal reprimand Planned ignoring Extinction Response interruptionTime outRemoving a privilegeSuspension from work
30 Punishment To stop a problem behavior immediately to prevent harm To teach alternative positive behaviorImmediate effectThe effect does not last.should be used when the side effects of punishment are clearly outweighed by the potential benefits.
31 Side Effects of Punishment Reactive aggressionAdaptationAvoidance of the person/setting delivering punishmentSuppression of behaviors similar to the target behavior but appropriateTeaches the person to use punishment to others
32 PunishmentAn informed consent is required from the guardian and/or the individual.A detailed behavior program is required to specify how to use punishment (to avoid an abuse).Punishment should be combined with replacement procedures and preventative procedures—it should be therapeutic
33 Identifying Possible Punishers One person’s punisher may be another’s reinforcer.The only way we can tell is by its effect on behavior.Measure the effects on the behavior
34 Example of an erroneous punisher “Our young daughter had adopted a stray cat. To my distress, he began to use the back of our new sofa as a scratching post. ‘Don’t worry,’ my husband reassured me. ‘I’ll have him trained in no time.’ I watched for several days as my husband patiently ‘trained’ our new pet. Whenever the cat scratched, my husband deposited him outdoors to teach him a lesson. The cat learned quickly. For the next 16 years, whenever he wanted to go outside, he scratched the back of the sofa.” (Reported in Behavior Analysis Digest, March, 1990).
35 Factors affect the effectiveness of punishers AdaptationA punisher may lose its effectiveness if it was delivered frequently in a short period of time.Conditioned punisherSaying “No!” will lose its effectiveness if it is not paired with another punisher.
36 Factors affect the effectiveness of reinforcers/punishers ContingencyA reinforcer/punisher should be delivered contingent to the target behaviorImmediacyA reinforcer/punisher should be provided immediately following the target behavior.
37 Example of erroneous contingency Former president Nixon and Henry Kissinger were sitting in the Oval Office discussing policy matters. King Timahoe, Nixon’s Irish setter, came in and began chewing on the rug. The president commanded him to stop. King Timahoe kept right on chewing. The president commanded again. More chewing. Finally, Nixon opened his desk drawer, took out a dog biscuit and gave it to King Timahoe. “Mr. President,” said Kissinger, “you have taught that dog to chew the rug.”
38 ConsequencesGroup Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner what might be the consequences for the behavior.
39 ABC Model of PBSAntecedent Behavior Consequence
40 AntecedentsAn antecedent is a stimulus that precedes a behavior and makes it more likely that the behavior will occurWhen and where did the behavior occurredWhat happened before the behavior occurredWho was present when the behavior occurred
41 Examples of Antecedents Tom tends to engage in self-injury behavior more often when Jane, a staff member, works on the shift, because she typically reinforces the behavior with attention.Luke, a 7-year-old boy with Autism exhibited challenging behaviors at school and home. It appeared that much of Luck’s schoolwork was too difficult for him.
45 Antecedent: Biological Factors Fatigue, pain, physical discomfortMedical problemsMedication side effectsChanges in habits of eating, sleeping, bowel movement
46 Antecedent: Environmental Factors Physical environmentloud, crowded environmentSpace arrangementRoutinesMorning and evening grooming schedulesEvening activities (too much or too little)Snack timeSchedule for chores
47 Antecedent: Environmental Factors WorkshopNot much to do, boring, too much workIt is important to communicate between the staff at home and at workshopIf problem behaviors occur mainly at the workshop, or at home, it is an environmental issue.
48 Antecedent: Human Factors StaffAge, sex, race of the staffPersonality of the staffDo not get involved in power struggleDo not take individual’s behavior personallyTry to understand the individual’s perspective
49 Antecedent: Human Factors ResidentsDifferent habitsLanguage (the way they say things)Dynamics among the residentsOther individual’s psychopathology
50 Antecedent: Human Factors FamilyChanges in family situationIllness and death in the familyFrequency of contactVisit schedulesHow much the family is involved and how they communicate with the staff and the individual
51 Communication Positive communication Negative communication Great work!Thanks for helping me.You look really good today!Typical social talk:How are you?Good to see youNegative communicationStop that!You know better than thatDon’t let me see you do that again!I said “NO!”Sit down and be quiet now!
52 Communication See from the individual’s perspective Examine how they take what you are sayingAsk the individual to repeat what they have heard.Talk to them in an appropriate way for the individual’s age
53 Communication Make yourself clear and simple Many if’s and uncertainties are confusing.Woman’s vs. man’s way of saying thingsGiving a lecture is often not usefulListen to them and validate their feelings
54 Attention Need for attention is a basic human need “Nobody cares” is not a good feelingRemember---you are his/her familyGive them a lot of attention----for positive behaviors.
55 AntecedentsGroup Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner what could be the antecedent for the behavior.
56 “Best Practices Approach” …. Look at the good/bad things in the environment ….problem behavior cannot be treated in a problem environment
57 “Best Practices Approach” Do something when things are going well.Address problems before they escalateProvide antecedents and positive reinforcing consequences for desirable behaviorRemove or change antecedents that come before problem behavior
59 Behavior Support Plan BSP is a treatment plan. BSP provides guidelines for staff behavior to manage the individual’s behaviorBSP is an education plan—it teaches appropriate, alternative behaviors, not just attempt to suppress the problem behaviorBSP is to help the individual to meet his/her needs in a positive way.
60 Components of a BSP Target behaviors Functional assessment Data collectionIntervention strategiesPreventive measuresReplacement behavior training
61 Target Behaviors Behaviors that we wish to reduce or eliminate: Physical aggressionSelf-injurious behaviorNail bitingProperty destructionVerbal aggressionSpittingElopement
62 Target Behavior Kate is angry vs. Kate hit Mark Mary is depressed vs. Mary is cryingRyan is anxious vs. Ryan is pacingSue is listening vs. Sue is looking atthe speaker
64 Examples of Operational Definition 1. Inappropriate sexual behavior:Touching female staff in private places (i.e. breasts), touching peers genitals, getting in bed with peers, exposing self to peers2. Elopement:Leaving the immediate area without permission resulting in a break in supervision
65 Target Behaviors Should be defined by operational definition Target one specific behavior at a timeTarget a behavior that is a really problem.Staff training is important—one of the major reasons of failure
66 Components of a BSP Target behaviors Functional assessment Data collectionIntervention strategiesPreventive measuresReplacement behavior training
67 Functional Assessment A diagnostic procedure for behaviorsTo understand the function of behavior—what does the individual achieve by exhibiting the behaviorTo find out the relationship of antecedent –behavior—consequencebased on data (no speculation)!!
68 Reasons for Collecting Data Data provides objective information on why the behavior is occurringPeople see things differently.Memory does not necessarily tell the truth.An individual may behave differently depends on a situation, a person, time of the day etc.
69 Data collectionIndirect assessment using questionnaires, interview methodsDirect assessment: Data gathering through direct observation
70 Interview for indirect Assessment What are the problem behaviors?When a behavior is most and least likely to occurIn what situation the behavior is likely to occurWhat events predict that the behavior will not occur?Who was there when the behavior occurred and what did he/she did?How did others react to the behavior?What are the consequences that appear to maintain the behavior?
71 Questionnaires for indirect assessment Functional Analysis Screening Tool (FAST) Iwata, 1996Functional Assessment Interview Form (FAI) O’Neil, R.E., et al., 1990Antecedent-Behavior-Consequence AnalysisQuestions About Behavior Function (QABF) Vollmer & Matson, 1996
72 Example of Functional Assessment Functional Assessment: The Questions About Behavior Function (QABF) was reviewed. Results indicated that physical aggression is maintained by escape. QABF scores were (endorsements and occurrence ratings):Target BehaviorAttentionEscapeNon-socialPhysicalTangiblesP Aggression (PA)0-02-41-2
73 Direct Assessment Data gathering through direct observation Data should be collected based on an operational definition.Data should be reliable and valid.Inter-rater reliabilityDon’t rely on your memory—make a record immediately.
74 Data Data should be collected based on an operational definition. Data should be reliable and valid.Inter-rater reliabilityDon’t rely on your memory—make a record immediately.
77 Data Frequency Recording Interval Recording Duration Recording The number of times an uniform eventInterval RecordingRecording an non-uniform behaviorDuration RecordingHow long the behavior lasts when it does occurIntensity Measures
78 Data Analysis Components of the descriptive analysis Frequency of behavior over timepatterns and trends analysisIt is nearly impossible to get an accurate representation of the data using numbers on a chartData needs to be plotted on a graph to analyze the trends.The trends in the data are more important than any single data point.
80 Functional Assessment and Data Collection Group Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner how you would do functional assessment and data collection.
81 Components of a Behavior Support Plan (BSP) Target behaviorsData collectionFunctional assessmentIntervention strategiesReplacement behavior trainingPreventive measures
82 Intervention Procedures 1. To respond to the problem behaviors in ways that will not maintain the behavior2. Based on the results of the functional assessment
83 Interventions Procedures Example) For attention maintained behaviorUse Planned ignoring for the negative attention-seeking behaviorVerbal reprimands/directives to stop behavior, reassuring/reasoning with person are not recommended
85 Verbal Reprimand A verbal command to stop a given behavior. “Stop!” “No!”Verbal reprimands should be brief, firm and to the point.Do not yell or show frustration, anxiety, fear
86 RedirectionAn attempt to shift an individual’s attention away from his or her issue and onto an appropriate task“Here, let’s get back to work.”“Finish brushing your hair.”“What is that a picture of in your magazine?”“Is that a new shirt you’re wearing? I like it.”
87 Planned IgnoringWithholding desired social attention following inappropriate behavior display while still maintaining appropriate supervision.ex) Staff member showing no reaction after being cursed at or called a name.Used only when safe and appropriateDo not ignore dangerous behavior
88 ExtinctionWithdrawing the positive consequences that was reinforcing the behavior
89 Misuse of Reinforcement Former president Nixon and Henry Kissinger were sitting in the Oval Office discussing policy matters. King Timahoe, Nixon’s Irish setter, came in and began chewing on the rug. The president commanded him to stop. King Timahoe kept right on chewing. The president commanded again. More chewing. Finally, Nixon opened his desk drawer, took out a dog biscuit and gave it to King Timahoe. “Mr. President,” said Kissinger, “you have taught that dog to chew the rug.” (Based on Roberts & Santogrossi, 1976)
90 Extinction CurveWhen a behavior is under extinction, it increases first, then gradually drops offBe persistent.Everybody should be on the same page (every person, setting, including family)Extinction procedures cannot treat dangerous behaviors
91 Response Blocking Physically block an attempt to engage in a behavior. This is done by intercepting the blow without holding onto the individual in anyway.Stepping between two individualsPlacing pillow between his or her head and floorPlacing arm out to absorb an SIB blow from making contact
92 Response Interruption Response interruption is utilized when a block has been ineffective.Response interruption involves brief and intermittent physical guidance.e.g., Physically interrupt a behavior and then guide his/her hands to a more appropriate activity.
93 Nonexclusionary Time-out (NETO) NETO involves removing an individual from an otherwise reinforcing situation until he or she is calm.This technique is also referred to as Non-exclusionary Required Relaxation or, simply, Required RelaxationDuring NETO, the individual always remains in the same room.Specific rules apply and must be followed as written.When to useFor how longRelease time
94 Exclusionary Time-out (ETO) restrictive This technique is also referred to as Exclusionary Required Relaxation (ERR)Removing an individual from the room of an otherwise reinforcing situation.An individual is never left unsupervised in this instance.Specific rules apply and must be followed as written.When to useFor how longRelease time
95 Guidelines for Selecting Interventions Which intervention corresponds to the function of the behavior?Which intervention is least likely to produce negative side effects?Which is the least intrusive and most likely to produce positive changes?Which intervention teaches alternative positive behavior?For which intervention is there the most system-wide support?
96 Guidelines for Selecting Interventions The behavior program must ensure that there is no reinforcement for engaging in the problem behaviorRewards provided for the appropriate behavior will be equal to or exceed the rewards for engaging in the challenging behavior.
97 Case ExampleTom’s roommate likes to listen to music at night. Tom gets really angry when his roommate turns on music at bedtime. His roommate would not change his habit. Tom smashed his roommate’s CD player and they got into a fist-fight.
98 Replacement BehaviorTarget behavior serves a purpose (fulfilling practical or psychological needs)Replacement behavior provides an alternative means for achieving the same purpose as the target behaviorThe focus should be on teaching the person to access the same reinforcers appropriately
99 Replacement Behavior Don’t just take the behavior away. What maintains problem behavior can maintain appropriate behavior if you know what the function of the behavior isTeach skills that will replace the problem behavior
100 Replacement Behavior For behavior maintained by escape Evaluate task/activity and determine aversive qualitiesModify task or alter environmentTeach functional communication skillsEscape cardDesensitization when situation cannot be avoided
101 Replacement Behavior For behavior maintained by attention Provide attention for alternative positive behaviorsSocial skills trainingTeach communication skillsUse behavior contracting and token systems
102 Replacement Behavior For aggressive behaviors Communication training Relaxation trainingAnger managementSelf-control
103 Replacement Behaviors For behavior maintained by tangiblesProvide tangibles for alternative positive behaviorsUse behavior contracting and token systemsFunctional communication training for tangibles
104 Interventions and Replacement Behavior Group Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner what intervention methods and replacement behaviors you would use to stop the behavior.
105 Preventive Strategies Do not wait until things are going bad!! Do something when things are going well!!
106 Prevention Strategies Get to know the individualBased on the results of functional assessmentUse a BSP from the beginningUnderstand their disabilities—it may not a “personality” issueBuild up a positive relationship
107 Prevention Strategies Manipulate the environment to reduce the chances of negative behaviorsModify task, materials, instructions, routinesSchedule time with preferred person or access to desired object/eventProvide more frequent attention/reinforcement (for positive behaviors)
108 Prevention Strategies To avoid crowds and loud noiseschange the route of getting in and outDifferent schedule for groomingProblems around family contact:Discuss with family about a regular contact schedule (incorporated into BSP)Struggles around choresstructure the setting and daily routine as much as possible
109 Prevention Strategies Group Activity 1. Describe the most recent behavior of an individual you are supervising. 2. Discuss with your partner what you could do to prevent the behavior.
110 Writing a BSP Spell out various components of the plan Be specific and concreteAssign responsibility for implementationDevelop a checklist to correspond with each componentDevelop scripts specifying responses
111 Implementing BSPThe Behavior Plan must be carried out as written!!!
112 Evaluation of BSP Baseline Intervention Rate of Behavior Days 100 80 2030401009080706050BaselineIntervention
113 Obstacles to a successful BSP Inadequate functional assessmentBehavior not well definedInadequate measurement/data collectionFailure to consider other issues (e.g., environmental, medical, psychiatric)
114 Obstacles to a successful BSP Inadequate intervention methodIneffective method to stop the behaviorInadequate detailed procedure (how to do it)No replacement behavior
115 Obstacles to a successful BSP Inadequate system-wide supportNo man-powerNo collaborative work between the settingsNo support from family
116 Obstacles to a successful BSP Poor writingThe plans do not have all the component to help staff implement the programVague and abstractFailure to adequately monitor implementation or change the plan
117 Obstacles to a successful BSP The plans are not carried out in the way the plans are writtenLack of skills by those implementing the planInadequate staff training
118 Staff TrainingIt is essential that staff are trained to perform the BSP competentlyThe only way to ensure they can is not to have them describe the program to you, but to have them demonstrate.Staff training is not complete until staff demonstrate they can competently do the skill.
119 Staff TrainingThe more consistently staff implement the program, the better the result will be.Ongoing monitoring is essential, because staff will drift.Periodic retraining will be necessary to collect data and implement behavior programs
120 Steps in Staff Training Describe what to doProvide a written description of what to doShow staff what to doObserve as staff practice what to do and give feedbackRepeat Steps 3 and 4 until staff do the work skill correctly
121 Summary Respect for all citizens’ rights Treating all people with respect and dignityThere is a reason for a behavior.Pay attention to individual’s needsFocus on preventing rather than correcting problemsBSP is not to discipline the individual.Consider what it would be like to be on the receiving end of the BSP
122 Summary Know the individual. Set reasonable objectives Teach more acceptable replacement behaviors that serve the same function as the inappropriate behaviorModify the environmentTrain staff for success of BSPMonitor and follow up on staff Implementation
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