North Bay Regional Center Presents Community Support Services: Behavioral Supports 2017 Mila DeWitt, Ph.D., BCBA Behavioral Consultant January Crane, MPA Training Manager

Training objectives Rights & Responsibilities of the Regional Center and Provider Client’s Rights Reasons why individuals with developmental disabilities often have behavioral challenges How the Regional Center access supports and services What to expect from the behavioral services provided

Rights & Responsibilities of NBRC & Providers Person Centered Planning re: Center for Medicaid/Medicare (CMS)/ Home and Community Based Services (HCBS) Final Rule http://www.dds.ca.gov/HCBS/ NBRC Service Policy: Purchase of Services NBRC Service Policy: Behavioral Analysis Services http://nbrc.net/about-us/transparencyaccountability/ Disability Rights- California: http://www.disabilityrightsca.org/pubs/506301Ch06.pdf

Clients rights Individual Program Plan (IPP) goals should maximize opportunities for the person to develop relationships, be part of community life, and increase control over his or her life, acquire increasingly positive roles in community life, and develop competencies to help accomplish these goals [Lanterman 4646.5(2)]. Clients and planning teams are expected first to identify employment options including creating plans that will maximize opportunities for clients to develop workforce skills that will maximize employment options. “Integrated competitive employment is intended to be the first option considered by planning teams for working age individuals, but individuals may choose goals other than integrated competitive employment.” [Lanterman 4869(a)(3)].

Why behavioral services? Regional Center clients have a right to increase independence have access to and strive to be a productive member of the community

Supporting Our Clients with Behavioral Services Why do individuals with developmental disabilities often have behavioral challenges? How does the regional center access supports and services? What to expect from behavioral services.

Behavioral Challenges Many individuals with developmental disabilities develop maladaptive behaviors such as Emotional Outbursts and Disruptive Behaviors Aggressive behaviors Self-injurious behaviors Inappropriate social behaviors and conversation And others

Why do individuals with developmental disabilities often have behavioral challenges? Behavior is Communication Limited Receptive and Expressive Communication Skills Leaning (or reinforcement) History Trauma (distressing, disturbing experience or physical injury) More Complex Cases: Psychiatric Disorders (disturbances in thoughts, moods, and/or behavior) Medical Conditions: Pain

What’s the Function? Behavior is Functional: The environment impacts behavior and behavior impacts the environment Reciprocal, functional relationship Environment includes, internal, “private events” (such as thoughts). Behavior is Purposeful Reinforced behaviors are repeated If a behavior is occurring then it is working somehow for the individual

What’s the Function? Behaviors that continue are behaviors that are “working” for the individual Behaviors are “telling” us that the individual needs something and this is the only way s/he knows how to get that need met The question is not: How do I manage hitting? The question is: Why is he hitting?

By changing the environment… Physical space/setting How can we help our clients reduce maladaptive behaviors and replace them with socially appropriate adaptive behaviors? By changing the environment… Physical space/setting Reactions to behaviors Interactions with others Schedule/activities Rule out medical causes!

Reminder… Many of our clients communicate and behave differently this is different than a “problem behavior” or a “maladaptive behavior.” Maladaptive behaviors are dysfunctional behaviors that disrupt daily living. They may cause harm to others or oneself. What’s an example of a different behavior that’s not a maladaptive behavior?

How does the regional center access supports and services? Hiring Behavioral Consultants to work with clients and their caregivers per NBRC procedure Title 17 Behavioral Analyst: BCBA (Service code 612) Associate Behavior Analyst: BCaBA(Service code 613) Behavior Management Assistant (Service code 615) Behavior Management Consultant (Service code 620)

How does the regional center access supports and services? (cont.) Types of Behavioral Services for Regional Center Clients: Parent Training Early Intensive Behavior Intervention (EIBI) & Behavioral Intervention Services (BIS) Comprehensive Behavior Services (CBS): Goals include skill building in several developmental domains and FERBS: Functionally Equivalent Replacement Behaviors. EIBS for autism is always a CBS. Focused Behavior Services (FBS): BIS, goals include usually 1 or 2 problem behaviors (maladaptive behaviors) and FERBS. Behavior Consulting in Facilities

BEHAVIOR CONSULTING IN FACILITIES Certain levels of Community Care Facilities, Intermediate Care Facilities and Day Treatment Facilities must have behavior consultation Facilities must contract with Behavior Analyst for these services Facilities should have Individual Behavior Support Plans for each client in the house Progress reports should include graphic displays of data

What to expect from behavioral services Regional Centers offer Applied Behavioral Analysis (ABA) Therapy What is ABA? Each individual is treated uniquely, since each person (and environment) is unique It is not a pre-set guide that is applied the same way to each consumer. Every type of behavior intervention must use positive, non-aversive interventions

What is Applied Behavior Analysis? ABA is a science devoted to the understanding and improvement of human behavior Scientific approach for discovering environmental variables that influence behavior Systematic approach for developing plans to improve behavior All decisions in an ABA program are data- driven Behavior analysts use direct observation, measurement, and functional analysis of the relations between environment and behavior

What to expect from behavioral services (cont.) A well-designed ABA Treatment plan should include: An Assessment: Current skill set Needs (developmental delays in skills and maladaptive behaviors) Interests/preferences/choices Family/residential setting

What to expect from behavioral services (cont.) A well-designed ABA Treatment plan should include (cont.): Goal Setting based on the factors above (included in the assessment) Direction and planning completed by a trained and certified behavioral professional The hours of services recommended & how much supervision is needed Goals focused on maximizing independence The expected outcome/Transition Plan : Long-range goal is to support clients until they reach a level of competency that facilitates discharge or exit from services. When appropriate, discharge will be recommended for clients and supported by a plan of transition or fade from services if needed. Discharge Plan: Discharge or exit may also be proposed in other situations such as failure to comply with providers’ policies and others. Crisis Plan: Included when behavior has potential harm to self or others

What to expect from behavioral services (cont.) A well-designed ABA Treatment plan should include (cont.): Instruction plans that separate specific skills into manageable tasks that build toward larger and more complex tasks Parents/Caregivers training and participation section with goals Ongoing adjustment by the behavioral therapist to adapt to the learner’s needs Frequent communication with Caregiver/Family to receive feedback, review progress, plan for upcoming needs and discuss changes in the treatment plan. (http://www.roi-mi.com/aba- therapy-applied-behavior-analysis ) Progress Reports: Objective measurement of progress with graphic displays

Summary Rights & Responsibilities of the RC and provider: Person Centered Planning Clients Rights: Informed Choice/Community Integration Reasons why folks with Developmental Disabilities exhibit challenging behaviors How to access supports and services: Policy vs Procedures, supports are linked to the client need based on Developmental Disability, Planning Team driven What to expect from behaviors services, specifically ABA.

Additional resources: To learn more about applied behavior analysis: Behavior Analyst Certification Board (BACB) https://bacb.com/ The California Association for Behavior Analysis, CalABA https://calaba.org/ Evidence-Based Practices (autism): CAPTAIN www.captain.ca.gov National Standards Project http://autismpdc.fpg.unc.edu/ The National Professional Developmental Center. http://www.nationalautismcenter.org/national-standards-project/