The Power of Positive Behavior Supports

September 14, 2007September 14, 2007

Presenters:Presenters:Courtney McEuin, Psy.D.Courtney McEuin, Psy.D.

Kristin Shaner, M.Ed.Kristin Shaner, M.Ed.Belinda Powell, B.S.Belinda Powell, B.S.

Part 1: Overview and Key ElementsPart 1: Overview and Key Elements Kristin Shaner, M.Ed.Kristin Shaner, M.Ed.

Part 2: Selected Outcome Studies of PBSPart 2: Selected Outcome Studies of PBS Belinda Powell, B.S.Belinda Powell, B.S.

Part 3: Implementation and ChallengesPart 3: Implementation and Challenges Courtney McEuin, Psy.D.Courtney McEuin, Psy.D.

The PBS PhilosophyThe PBS Philosophy PBS is an approach to supporting individuals PBS is an approach to supporting individuals

that primarily emphasizes:that primarily emphasizes: Improving contexts (e.g., living environments, Improving contexts (e.g., living environments,

classroom), andclassroom), and Expanding personal competencies (e.g., Skill Expanding personal competencies (e.g., Skill

building).building).

Improving these aspects for individuals will:Improving these aspects for individuals will: Keep the primary purpose of supports the goal; i.e., Keep the primary purpose of supports the goal; i.e.,

helping the individual reach their highest potential in helping the individual reach their highest potential in learning and living; andlearning and living; and

Reduce many “problem” behaviors that are a result of Reduce many “problem” behaviors that are a result of context (school, room, playground) and person context (school, room, playground) and person variablesvariables

PROBLEM/REACTIVE FOCUSPROBLEM/REACTIVE FOCUS

Inadequate communication skills

Reactions: IgnoreReinforce Restrain etc

Problem behaviors:Self-harm or harm to others, Aggression, Passivity, withdrawal,Noncompliance, etc

Inadequate ability to entertain self

Lack of self-determination.Choice-making, andControl over the environment

Environment has too much/too little sensory stimulation

Schedules, expectations, and limits are inconsistent, chaotic, or confusing

Boredom

Lack of responsiveness by caregivers: personal care or social interaction

Insufficiently addressedinformation concerning Mental/medical

health, preferences, history, etc

Consequence-based (reactive) interventions

Lacks task-specific skills

Improved communication skills Less Problem behaviors:less need for Reactive interventions

Ability to self-entertain

The individual takes an active role in choice making

Environment has best sensory stimulation

Schedules, expectations, and limits are Clear and consistent

Available engaging experiences

Responsive caregivers

Gains task- or situation-specific abilities

Optimal medical/mental health, preferences accommodated

Improved functioning Quality of life Progress toward higher goals

(ALSO RESULTS IN)

POSITIVE BEHAVIOR SUPPORTS FOCUS

What does this mean?What does this mean? The shift in focus is: The shift in focus is:

Less on deficits and problems of the Less on deficits and problems of the individual as an endpoint, andindividual as an endpoint, and

More on building strengths, More on building strengths, competencies, preferences, learning, competencies, preferences, learning, and beneficial life experiences.and beneficial life experiences.

Lessening deficits, pathologies, or Lessening deficits, pathologies, or problems is not enough in itself. The problems is not enough in itself. The questions would follow: So now what? questions would follow: So now what? How is this person’s life better?How is this person’s life better?

Examples of the Shift In FocusExamples of the Shift In Focus

Client A engages in self-harming behavior. PBS Client A engages in self-harming behavior. PBS questions: Is this individual’s daily life stimulating questions: Is this individual’s daily life stimulating enough? What is going on when he/she does not engage enough? What is going on when he/she does not engage in self-harm? Why reduce self-harming behavior?in self-harm? Why reduce self-harming behavior?

Client B constantly tries to get out of a room. PBS Client B constantly tries to get out of a room. PBS questions: When is it ok for him/her to leave the room? questions: When is it ok for him/her to leave the room? Can the room be made more appealing? Is the Can the room be made more appealing? Is the environment beneficial to the individual or is it an agency environment beneficial to the individual or is it an agency preference?preference?

Client C loves going out to eat but grabs at things and Client C loves going out to eat but grabs at things and makes a mess in public. PBS questions: What kind of makes a mess in public. PBS questions: What kind of learning experiences would best enable him/her to be learning experiences would best enable him/her to be more successful while dining in public?more successful while dining in public?

The Problem With Problem Behaviors:The Problem With Problem Behaviors:

Often, “problem” behaviors are the last resort for getting results from Often, “problem” behaviors are the last resort for getting results from the surrounding environment. We label them “problems”, but they the surrounding environment. We label them “problems”, but they work somehow for the individual. work somehow for the individual.

If the problem behaviors are reduced, everyone else feels better.If the problem behaviors are reduced, everyone else feels better.

However, that does not mean the individual is better off if he/she However, that does not mean the individual is better off if he/she does not have an equally (or more) effective replacement behavior does not have an equally (or more) effective replacement behavior taught, learned, used, and responded to by others.taught, learned, used, and responded to by others.

Learned Helplessness- when exhibiting acting out behaviors do not Learned Helplessness- when exhibiting acting out behaviors do not result in desired outcomes, can result in passivity or appear as result in desired outcomes, can result in passivity or appear as “contentment”.“contentment”.

Key TermsKey Terms Positive Behavior- Behaviors that exhibit Positive Behavior- Behaviors that exhibit

competencies, are socially appealing or competencies, are socially appealing or inclusive, and are beneficial to the individual’s inclusive, and are beneficial to the individual’s progress and well-beingprogress and well-being

Supports- help, training and provided learning Supports- help, training and provided learning experiences to address individualized needs or experiences to address individualized needs or desires (support does not mean control or desires (support does not mean control or management)management)

Normalization/Inclusion- Helping the individual to Normalization/Inclusion- Helping the individual to experience life as similar as possible to experience life as similar as possible to members of the larger communitymembers of the larger community

More Key TermsMore Key Terms Person-Centered Planning: The needs of Person-Centered Planning: The needs of

the individual determines the array of the individual determines the array of services provided.services provided.

Self-determination: Choice and decision-Self-determination: Choice and decision-making, problem-solving, personal goal making, problem-solving, personal goal setting, self-management, self-instruction, setting, self-management, self-instruction, self-advocacy, etc. In other words, the self-advocacy, etc. In other words, the individual becomes as much the causal individual becomes as much the causal agent in his own life as is possible, within agent in his own life as is possible, within responsible care parameters. responsible care parameters.

More Key TermsMore Key Terms

Quality of Life indicators: examples are Quality of Life indicators: examples are improvements in peer relationships, improvements in peer relationships, communication, skill sets, participation in communication, skill sets, participation in preferred activities, and self-determination. preferred activities, and self-determination. Should be tracked and measured empirically.Should be tracked and measured empirically.

““Problem behavior is of note to the extent that it Problem behavior is of note to the extent that it interferes with achieving positive results with interferes with achieving positive results with respect to these…(Quality of Life) variables” respect to these…(Quality of Life) variables” (Carr et al, 2002) (Carr et al, 2002)

More Key TermsMore Key Terms Life Span Perspective: modifying supports Life Span Perspective: modifying supports

according to changing developmental and according to changing developmental and lifespan circumstanceslifespan circumstances

Ecological Validity: interventions result in Ecological Validity: interventions result in changes in real-life and environments.changes in real-life and environments.

Stakeholder participation and social validity: Stakeholder participation and social validity: wide inclusion of participants in the identification wide inclusion of participants in the identification of goals and methodsof goals and methods

Systems change: improve the living and learning Systems change: improve the living and learning contexts surrounding the individual to see lasting contexts surrounding the individual to see lasting change for the betterchange for the better

Emphasis on Prevention: anticipate needs and Emphasis on Prevention: anticipate needs and optimal structure of environment to prevent optimal structure of environment to prevent problems instead of reacting to problems after problems instead of reacting to problems after they occur.they occur.

Multiple methods of information collection for Multiple methods of information collection for integrated case formulation: data recording, integrated case formulation: data recording, questionnaires, interviews, historical information, questionnaires, interviews, historical information, testing, self-report, trials, interdisciplinary input.testing, self-report, trials, interdisciplinary input.

Molar assessments: looking at larger groups or Molar assessments: looking at larger groups or contexts, e.g, behavior patterns common across contexts, e.g, behavior patterns common across multiple individuals in a given setting or time multiple individuals in a given setting or time frame.frame.

In A Nutshell:In A Nutshell:

Focus on supporting the individual’s progress Focus on supporting the individual’s progress toward desired outcomes, expanding their toward desired outcomes, expanding their competencies and opportunities.competencies and opportunities.

““Problem” behaviors must be considered within Problem” behaviors must be considered within the context of relevance to goal progress and the context of relevance to goal progress and structural changes needed in the environment. structural changes needed in the environment. Functional behavioral assessment will give clues Functional behavioral assessment will give clues to the context or competency variables that need to the context or competency variables that need to be addressed.to be addressed. Functional Analysis: involves systematically Functional Analysis: involves systematically

manipulating consequences to verify their impact on manipulating consequences to verify their impact on behavior. behavior.

Outcome StudiesOutcome Studies

Carr et al. (1999)Carr et al. (1999)

A Research Synthesis requested by the US A Research Synthesis requested by the US Department of Education: Office of Special Department of Education: Office of Special Education ProgramsEducation Programs PBS is widely applicable to individuals with PBS is widely applicable to individuals with

serious behavior problemsserious behavior problems PBS was effective in reducing problem PBS was effective in reducing problem

behaviors in one-half to two-thirds of casesbehaviors in one-half to two-thirds of cases When PBS interventions are based on a When PBS interventions are based on a

previous functional assessment, success previous functional assessment, success rates almost doubledrates almost doubled

Clarke et al. (2002)Clarke et al. (2002)

A Hillsborough County Public School System A Hillsborough County Public School System Tampa, Florida Case StudyTampa, Florida Case Study

A female middle school student with serious A female middle school student with serious behavior problems behavior problems A PBS Intervention AppliedA PBS Intervention Applied

the student’s problem behavior in the the student’s problem behavior in the classroom decreased from an average of classroom decreased from an average of 75% to 31%. 75% to 31%.

A PBS Intervention Applied cont’dA PBS Intervention Applied cont’d• The student increased her level of The student increased her level of

engagement in school activities from engagement in school activities from 12% to 80%.12% to 80%.

• The percentage of days that the The percentage of days that the student’s affect was rated as positive student’s affect was rated as positive (e.g. happiness) increased from 26% (e.g. happiness) increased from 26% to 42%to 42%

Carryover Effects following the PBSCarryover Effects following the PBS

Intervention:Intervention: Problem behavior further decreased to 29%Problem behavior further decreased to 29% The engagement level increased to 85%The engagement level increased to 85% The percentage of days that the student’s The percentage of days that the student’s

affect was rated as positive decreased to affect was rated as positive decreased to 33%33%

Dunlap et al. (2001)Dunlap et al. (2001) A study of two mothers and their children who were A study of two mothers and their children who were

diagnosed with autism diagnosed with autism Looked at the parents’ use of functional assessment Looked at the parents’ use of functional assessment

and PBS proceduresand PBS procedures Successful use of the functional assessment Successful use of the functional assessment

checklist leads to:checklist leads to:– decreased problem behaviors (i.e. hitting the door decreased problem behaviors (i.e. hitting the door

with an object)with an object)– increased replacement behaviors (i.e. knocking on increased replacement behaviors (i.e. knocking on

the door)the door)

Horner (2000)Horner (2000)

Study consisted of 530 middle school studentsStudy consisted of 530 middle school students Implementation of PBS school wide resulted in a 47% Implementation of PBS school wide resulted in a 47%

annual reduction in the number of office discipline annual reduction in the number of office discipline referralsreferrals

Future direction – PBS is more than just a tool to Future direction – PBS is more than just a tool to reduce disruptive behavior; it is a technology for reduce disruptive behavior; it is a technology for engineering the individuals environment for engineering the individuals environment for productivity and safetyproductivity and safety

Smith-Bird and Turnbull (2005)Smith-Bird and Turnbull (2005)

A research synthesis of four research A research synthesis of four research studies with a PBS and family componentsstudies with a PBS and family components Linked PBS to Family Quality-of-Life Linked PBS to Family Quality-of-Life

Domains and IndicatorsDomains and Indicators REMINDER:REMINDER: PBS is an approach that PBS is an approach that

measures Quality of Life Indicatorsmeasures Quality of Life Indicators

Quality of Life Quality of Life DomainsDomains1.1. Family InteractionFamily Interaction

2. Parenting2. Parenting

3. Emotional Well-Being3. Emotional Well-Being

4. Physical/Material 4. Physical/Material Well-BeingWell-Being

5. Disability-Related 5. Disability-Related SupportSupport

Quality of Life Quality of Life IndicatorsIndicators1. Family enjoys time together1. Family enjoys time together

2. Family members help 2. Family members help children with schoolworkchildren with schoolwork

3. Family has necessary 3. Family has necessary supports to handle life supports to handle life stressstress

4. Family members feel safe 4. Family members feel safe in their communityin their community

5. Family members with 5. Family members with special needs have the special needs have the necessary supports to necessary supports to develop friendships.develop friendships.

Prior to applying a PBS intervention:Prior to applying a PBS intervention:• Individuals exhibited problem behavior that Individuals exhibited problem behavior that

interfered with ability to learn in a classroom interfered with ability to learn in a classroom environmentenvironment

• Individuals exhibited problem behavior that Individuals exhibited problem behavior that interfered with daily living at home interfered with daily living at home

• Caregivers had unexpressed feelings about the Caregivers had unexpressed feelings about the individuals’ problem behaviorsindividuals’ problem behaviors

• Caregivers felt anger directed toward the individual Caregivers felt anger directed toward the individual with the problem behaviorwith the problem behavior

A PBS Intervention Applied:A PBS Intervention Applied:• Caregivers begin expressing emotions Caregivers begin expressing emotions

regarding the individual’s problem behaviorregarding the individual’s problem behavior• Caregivers became more involved in the Caregivers became more involved in the

individual’s PBS plan by offering support individual’s PBS plan by offering support and suggestionsand suggestions

• Caregivers start to gain hope that the Caregivers start to gain hope that the individual’s behavior will improveindividual’s behavior will improve

Carryover Effects Following the PBS Carryover Effects Following the PBS Intervention:Intervention:• Individuals showed improved Individuals showed improved

communication and less tantrumscommunication and less tantrums• Level of aggressive behavior decreased to Level of aggressive behavior decreased to

a more tolerable levela more tolerable level

Implementation of PBS Implementation of PBS ProgramsPrograms

The Implementation ModelThe Implementation Model

There is no one definitive modelThere is no one definitive model There are many ways to implement PBS There are many ways to implement PBS

PlansPlans Models must take into account current Models must take into account current

organizational structure, characteristics of organizational structure, characteristics of the individual, living environment, level of the individual, living environment, level of family involvement, and staff expertise.family involvement, and staff expertise.

Barriers to ImplementationBarriers to Implementation

Continued focus on problem behaviorsContinued focus on problem behaviors Lack of understanding of criteria used to Lack of understanding of criteria used to

design PBS Plans or Insufficient design PBS Plans or Insufficient knowledge of proceduresknowledge of procedures

Recommended elementsRecommended elements

Person-centered planningPerson-centered planning

- Keeps the focus on supporting lifestyle - Keeps the focus on supporting lifestyle change vs. behavior changechange vs. behavior change

Team-based approachTeam-based approach

- Promotes shared responsibility for - Promotes shared responsibility for changechange

Behavior GuidelinesBehavior Guidelines

To facilitate pro-social behaviorsTo facilitate pro-social behaviors To address infrequent, non-harmful, To address infrequent, non-harmful,

maladaptive behaviormaladaptive behavior To address behaviors that may stigmatizeTo address behaviors that may stigmatize

Developing a PBS PlanDeveloping a PBS Plan

Identify the Goals of InterventionIdentify the Goals of Intervention

-Strengths and needs, team members to -Strengths and needs, team members to be involved in BS, situations and settings be involved in BS, situations and settings which require intervention.which require intervention.

Developing a PBS PlanDeveloping a PBS Plan

Gather InformationGather Information

- Description of the problem behavior.- Description of the problem behavior.

- Events, times, and situations that might - Events, times, and situations that might predict the behavior. predict the behavior.

- What might maintain the behavior?- What might maintain the behavior?

- Direct observation of the behavior.- Direct observation of the behavior.

Developing a HypothesisDeveloping a Hypothesis

Analyze patterns of behavior.Analyze patterns of behavior. Identify circumstances in which behavior Identify circumstances in which behavior

of concerns is most or least likely to occur.of concerns is most or least likely to occur. What does the individual gain or avoid by What does the individual gain or avoid by

initiating the behavior?initiating the behavior?

Designing PB Support PlanDesigning PB Support Plan

Clearly describes behavior of concern, Clearly describes behavior of concern, outlines goals of intervention and identifies outlines goals of intervention and identifies patterns of behavior that serve a function.patterns of behavior that serve a function.

Modifies social and physical environment Modifies social and physical environment to increase positive behavior.to increase positive behavior.

Teaches and reinforces specific behaviors.Teaches and reinforces specific behaviors. Includes crisis management procedures to Includes crisis management procedures to

ensure safety.ensure safety.

Implementing the PlanImplementing the Plan

Provide resources and training to ensure Provide resources and training to ensure effective implementation.effective implementation.

Create an action plan which includes Create an action plan which includes method of monitoring the program and a method of monitoring the program and a timeline of goal achievement.timeline of goal achievement.

Evaluating the Effectiveness Evaluating the Effectiveness of the Planof the Plan

Decrease in problem behavior.Decrease in problem behavior. Increase in appropriate behavior.Increase in appropriate behavior. Generalization and maintenance of Generalization and maintenance of

behavior change.behavior change. Goal achievement.Goal achievement.

VignettesVignettes

Questions and AnswersQuestions and Answers

Thank You!Thank You!