Positive behavior support overview
- 1. Center for Excellence in Disabilities Positive Behavior Support Project Positive Behavior Support Overview TBI Conference Anastasia Riley, MBA CBIS
- 2. With a grant from the WV Bureau for Behavioral Health and Health Facilities 2 Center for Excellence in Disabilities Positive Behavior Support Project
- 3. A part of West Virginia University & WVU Health Sciences Center Center for Excellence in Disabilities Positive Behavior Support
- 4. Part of a National Network Center for Excellence in Disabilities Positive Behavior Support
- 5. WVU CED’s Role: • Education and training to University students in multiple disciplines to prepare a workforce that is able and willing to serve persons with disabilities • Technical assistance to individuals with disabilities and direct care providers who serve them to enhance their skillset and improve service quality • Gap filling direct services and supports in an effort to improve availability and acceptability of services for West Virginians • Dissemination of information about the status of disabilities services in West Virginia and the nation • Research activities conducted in collaboration with partners, to improve services and policies related to individuals with disabilities and their families. Center for Excellence in Disabilities Positive Behavior Support
- 6. About WVU CED • Serves individuals with disabilities across the life span in all 55 counties • 7 Programs • 4 Clinics • Approx. 90 Staff • Multiple state and federal partners Center for Excellence in Disabilities Positive Behavior Support
- 7. Become an Affiliate Looking for a way to be more connected to CED? Individuals can now sign up to be an Affiliate of the CED. Affiliates will: • Receive updates on CED news and events • Have opportunities to provide input regarding programs, services and research projects http://www.cedwvu.org/about-ced/become-an- affiliate/ Center for Excellence in Disabilities Positive Behavior Support
- 8. Session Goal Increase awareness and skills in the application of positive behavior support strategies. Center for Excellence in Disabilities Positive Behavior Support Project 7
- 9. Center for Excellence in Disabilities Positive Behavior Support Project Session Objectives • Identify the fundamental concepts of Positive Behavior Support. • Define and give three examples of “proactive strategies.” • Identify the functions of behavior. • Explain ways to improve quality of life. 8
- 10. What is PBS? Positive Behavior Support • Person-centered • Positive • Proactive • Data-driven Center for Excellence in Disabilities Positive Behavior Support Project
- 12. Positive Behavior Support is… • Proactively changing the environment to prevent problem behavior and set the person up for success • Finding the purpose or function of a problematic behavior • Finding replacement behaviors to serve that same function • Reinforcing replacement behaviors • Teaching in a strength-based way • Improving quality of life • Supporting the individual and helping them reach their full potential Center for Excellence in Disabilities Positive Behavior Support Project
- 13. ABCs of Behavior A – Antecedent (Triggers) What event causes the behavior to occur? B – Behavior (Target) What action we want to focus on and target? C – Consequence (Function) What does the person get or get away from as a result? Center for Excellence in Disabilities Positive Behavior Support Project
- 14. Center for Excellence in Disabilities Positive Behavior Support Project Our A-B-Cs are all connected…
- 15. Antecedents • Events that occur before a behavior • Slow Triggers - Things that create the beginnings of a “bad day” • Feeling sick • Being hungry • Feeling tired • Fast Triggers –The straw that breaks the camel’s back; the immediate things that set off the behavior • Loud noise • Difficult task • Not being able to do a task Center for Excellence in Disabilities Positive Behavior Support Project
- 16. Power Struggles A situation where a person who believes he or she is in control feels threatened by the perceived confrontational action of another person and responds negatively in an effort to regain control. Center for Excellence in Disabilities Positive Behavior Support Project
- 17. You Know It’s a Power Struggle When You Feel… • Provoked • You want to control another person • Challenged • Like saying, • “I’ll make you do it” • “You can’t get away with that” Center for Excellence in Disabilities Positive Behavior Support Project
- 18. How to Avoid a Power Struggle • Appear calm • Speak quietly and slowly • Sit down—don’t tower over the other person! • Non-threatening body language • Eye contact without staring • Be aware of triggers--theirs and yours • Offer choices, don’t give orders Center for Excellence in Disabilities Positive Behavior Support Project
- 19. How to Avoid a Power Struggle • Listen to gain trust • Try to put yourself in their shoes for the situation • Find something to agree about • Praise the good • Use humor appropriately • Make the person part of the solution Center for Excellence in Disabilities Positive Behavior Support Project
- 20. West Virginia University Center for Excellence in Disabilities Creating Proactive Strategies Based on the Antecedent • Proactive Strategy = A way to avoid or adjust to an antecedent to prevent the problem before it starts • Avoiding = If we can eliminate the trigger in real life why not • Adjusting = Calming techniques; ways to cope with the situation • Many of us figure out ways to avoid or adjust on our own but kids often need help in coming up with these ideas.
- 21. Examples: Proactive Strategies • Sunglasses or head phones • Using a different tone of voice • Always having snacks and water on you at all times • A reminder notebook or recording device • Checking out a situation in advance • A quiet relaxing space to go to calm down • Teaching relaxation methods • Sensory integration techniques Center for Excellence in Disabilities Positive Behavior Support Project
- 22. Center for Excellence in Disabilities Positive Behavior Support Project Activity: What is Calming to you? • Check mark √ the items that you find relaxing. • Cross out any items you find stressful. • Use the back to create a personalized calming strategies action plan.
- 23. Precursor Behaviors • Behaviors that signal a problem before it begins • Think about some thing you may do: • Pace • Certain expressions • Withdraw • Identify someone’s specific precursor behaviors to stop a target behavior before it happens • Redirection can be very effective when precursor behaviors are present Center for Excellence in Disabilities Positive Behavior Support Project
- 24. Behavior Behavior is anything and everything someone does. All behavior serves a purpose. Target behaviors - are behaviors we want to decrease and replace with more appropriate behaviors Replacement behaviors - are behaviors that we teach the client to engage in, rather than the problem behavior in order to meet the same function Center for Excellence in Disabilities Positive Behavior Support Project
- 25. Defining the Behavior • Operational Definitions: • Observable • Measureable • Pass the Dead Man’s Test (A dead man can’t do it) • Define: • Target Behavior • Ex: Physical Aggression: Hitting, kicking, spitting at another person • Replacement Behavior • Ex: Hit Pillow: Take a pillow and punch it So everybody sees it the same way Center for Excellence in Disabilities Positive Behavior Support Project
- 26. Behavior • What is the behavior telling us? • All problem behaviors are communicating something. • Does the person want attention? • Does the person want a break? • Does the person want an item/activity? • Does the person want sensory stimulation? Center for Excellence in Disabilities Positive Behavior Support Project
- 27. Consequences • What happens immediately after the target behavior. • What does a client get or get away from by performing a behavior? There is a consequence Naturally good or bad to EVERY behavior in life. Center for Excellence in Disabilities Positive Behavior Support Project
- 28. Functions of Behavior 4 Main Categories: • Sensory • Escape • Attention • Tangible Remember… SEAT Center for Excellence in Disabilities Positive Behavior Support Project
- 29. Center for Excellence in Disabilities Positive Behavior Support What potential functions are served by the behavior of smoking? SEAT at the Table • Sensory input from nicotine • Escape/delay from other activities (i.e., smoke breaks) • Attention from/socialization with others • Tangible access to a physical object If you have ever tried to quit, were all these functions successfully met by doing something else?
- 30. Functions of Behavior • What is the purpose or function of the behavior? • Can another more socially appropriate behavior serve the same function(s)? • We need to make the replacement behavior easy and accessible • We need to teach the person to use the replacement behavior Center for Excellence in Disabilities Positive Behavior Support Project
- 31. Center for Excellence in Disabilities Positive Behavior Support Project Challenging Behavior Desired Behavior “Aggression” “Disruption” “Elopement” “Following rules” “Being nice” “Working/playing /living independently” What the person does (behavior) + How the environment responds (functionally equivalent reinforcement)
- 32. Replacement Behaviors Need to… • Serve the same function as the problem behavior • Be taught when calm • Be easier than the problem behavior • Be reinforced more than the problem behavior • Fit the relevant context of the person’s life • It is also key to make old target behaviors irrelevant (not reinforced anymore) Center for Excellence in Disabilities Positive Behavior Support Project
- 33. Replacement Behavior Examples Original Behavior Replacement Behavior Function Being Met Self injury Scribbling heavily, rage drawing Sensory stimulation Screaming & yelling in public Joining a theatre group or talking to new people Social attention Hitting someone Walking away Escape from an undesired task Stealing an item Asking for the item on credit or saving up for it. Obtain a preferred item
- 34. How to Learn New Skills • Demonstrate and then let the person try • Practice • Break tasks down to one step at a time • Role Play • Scripting • Social Stories • Reminders like Visual Cues Center for Excellence in Disabilities Positive Behavior Support Project
- 35. Reinforcers • Are consequences that make the behavior more likely to occur • Are more than just a reward • They are also a motivator • Need to be constantly re-evaluated to make sure they are effective • Can change daily or based on satiation factors • Meet the function and beyond • Utilize current preferences / lifestyle Center for Excellence in Disabilities Positive Behavior Support Project
- 36. Token Economies • Give tokens as written transparently • Never take away earned tokens • Will create anger and loss of momentum • Offer a token mall or shop • Show progress toward goal to achieve greater success • Is also an ongoing positive reinforcer Center for Excellence in Disabilities Positive Behavior Support Project
- 37. Self Token Economy Chart
- 38. Center for Excellence in Disabilities Positive Behavior Support Project Building community involvement and inclusion • Use the person’s preferences and help them feel comfortable in a new situation. • Most people like to try new things w a friend for support • Creating opportunities – Look in the paper, on-line for a list of activities in the area – ask the person what interests them. • Job and volunteer opportunities • Generalized social support systems • Bowling league • Adult classes • Paint and Wine/Deserts
- 39. RESPECT-ing Rights • People with a disability have the same rights as people without a disability. • They have the same rights as any other American citizen. • Having a guardian does not mean they can take away certain rights. • Remember to put yourself in your client’s shoes to see if you would want someone telling you what to do. Center for Excellence in Disabilities Positive Behavior Support Project
- 40. Increasing Choice • Respect choice – We need to give a person as much control over their own lives as possible. • Increase opportunities for choice – Always ask the person what they want • Help with decision-making - Help the person weigh out the pros and cons of their options Center for Excellence in Disabilities Positive Behavior Support Project
- 41. Center for Excellence in Disabilities Positive Behavior Support Project Situation Option 1 Pros Cons Option 2 Pros Cons Option 3 Pros Cons Solution SODAS
- 42. Improving Quality of Life How can we help this person reach their full potential? How can we give them more choices and control over their life? How can we help them improve their relationships with other? Learn how to develop these relationships How do we help the person achieve more independence? Center for Excellence in Disabilities Positive Behavior Support Project
- 43. Center for Excellence in Disabilities Positive Behavior Support Project Mindfulness Exercise Mindfulness – Paying attention non-judgementally in the present moment. Benefits: • Improves Lifestyle • Reduces Stress • Emotional Resiliency • Slows Aging Techniques: • Progressive Relaxation • Having a mantra • Savoring http://appstudywvu.wi xsite.com/mindfulsteps wv/relaxationiphone
- 44. Center for Excellence in Disabilities Positive Behavior Support Project Savoring • Focus on sensory impressions in a moment-to- moment fashion • Take 10 minute walk; activities; convos; friends • Savor food – eat slowly and appreciatively • Mediterranean Diet alleviates depression • Rich in Veg, fish, complex carbs, legumes, nuts; low in red meat • “Rainbow Diet” – eating naturally colorful foods • Eat more Omega 3 (salmon, flaxseed, legumes) • Good diet = less prison fights (Johnson, 2012)
- 45. Center for Excellence in Disabilities Positive Behavior Support Project Gratitude Diary • Each day – write 3-5 things you likes • What happened to me? Why did it happen? • What did I do right? Why did I do that? • Write one thing you didn’t like • Ask yourself: And how is it also good, a blessing in disguise? • Find 2-3 ways it helps you
- 46. Center for Excellence in Disabilities Positive Behavior Support Project Aspects to Consider • Health • Choice / Control • Independence • Happiness / Optimism • Social Supports • Living Situation • Spiritual Beliefs • Resilience in Adversity • Confidence • Resources 46
- 47. Center for Excellence in Disabilities Positive Behavior Support Project Dreaming 47
- 48. Person Centered Planning • Person-centered planning is a process that uses creative facilitation tools to assist a focus person in developing a plan on how they wish to live or be in the future. Person Centered Planning is at the heart of Positive Behavior Support. Center for Excellence in Disabilities Positive Behavior Support Project
- 49. Assessment Tools to Facilitate Person-Centered Planning • Circles of Support • MAPs (Making Action Plans) • PATHs (Planning Alternative Tomorrows With Hope) The CED PBS Project has a free 2 day trainings available on Person Centered Planning. http://pbs.cedwvu.org/training.php Center for Excellence in Disabilities Positive Behavior Support Project
- 50. Center for Excellence in Disabilities Positive Behavior Support ProjectInclusion Press
- 51. Eight Questions of MAPs: 1) “What is a MAP”? 2) “What is person’s history or story?” 3) “What are your dreams?” 4) “What are your nightmares?” 5) “Who is the person?” 6) “What are the person’s strengths, gifts, and talents? 7) “What does the person need?” 8) “What is the plan of action?” 1997, Forest, O’Brien, Pearpoint, Snow, Inclusion Press Center for Excellence in Disabilities Positive Behavior Support Project
- 52. Example of a MAP- by Kathy Torsney
- 53. Activity: Mini Map Center for Excellence in Disabilities Positive Behavior Support Project
- 54. What is a PATH? • The PATH evolved from the MAPs process. It offers an extension of the MAPs steps by adding a more detailed plan of action. • The PATH breaks down the steps into separate action plans for 3 month; 6 months, and 1 year. It works by imagining the future focusing on the dream goals and thinking back in time on how you got there. Center for Excellence in Disabilities Positive Behavior Support Project
- 56. Example of a PATH Center for Excellence in Disabilities Positive Behavior Support Project
- 57. Hopes and Dreams • What are the person’s dreams? • How can we help them reach their dreams or at least the aspects of the dream that are most important to them? • Become a doctor = Work as patient aide at a hospital • Be Batman = Helping others - Volunteering • Mermaid = Go scuba diving • How can we give our clients opportunities to explore their interests? Center for Excellence in Disabilities Positive Behavior Support Project
- 58. PBS is: Positive Proactive Person Centered Teamwork Data- Driven Quality of Life Support Respect Center for Excellence in Disabilities Positive Behavior Support Project
- 59. References Smolkowski, K. School-wide Positive Behavior Interventions & Supports. Oregan Research Institute. http://homes.ori.org/~keiths/bibliography/behavior- schoolwide.html Cooper, B. (2013) 10 Simple Things you can do today to make you happier, backer by science. Buffersocial. https://blog.bufferapp.com/10-scientifically- proven-ways-to-make-yourself-happier 10 Ways to Boost your Happiness. Realbuzz.com. Healthy Active Living. http://www.realbuzz.com/articles/10-ways-to-boost-your- happiness/#pagination-top Johnson, D. L. (2012). How Positive Psychology Changes our Lives. Cross Country Education. Falvey, M.; Forest, M.; Pearpoint, J.; Rosenberg, R. (1997) All My Life’s a Circle Using the Tools: Circles, MAPS & PATHS. Inclusion Press. Inclusion Press. http://www.inclusion.com/ Center for Excellence in Disabilities Positive Behavior Support Project
- 60. Thank You! Questions? Comments? Anastasia Riley, MBA CBIS Behavior Specialist aheasley@hsc.wvu.edu 304-290-6229 Center for Excellence in Disabilities Positive Behavior Support Project