welcome to the pennsylvania dual diagnosis direct support ......curse words and cutting of the...

Welcome to the Pennsylvania Dual Diagnosis Direct Support Curriculum training on Functional Behavioral Assessment and Behavior Support Planning.

The Commonwealth of Pennsylvania’s Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Developmental Programs (ODP) have undertaken a joint initiative to address the needs of people who have an intellectual disability as well as mental health challenges. People who have both of these challenges are commonly referred to as those who have Dual Diagnosis. For the purpose of this training, Dual Diagnosis is not referring to co-occurring mental health challenges and substance abuse or dependence, although people can have substance abuse or dependence issues as well as a Dual Diagnosis of an intellectual disability and mental health challenges. The curriculum was designed for Direct Supporters, Supports Coordinators and others who work in either the intellectual disability field or the mental health field. The ultimate goal of this training curriculum is to provide information that can aid in the understanding of the struggles and the triumphs of those you support or will support. This curriculum was designed to demonstrate the complexity of Dual Diagnosis and the factors that need to be considered to best support those with whom you come into contact. The Pennsylvania Dual Diagnosis Direct Support Curriculum was also designed to demonstrate that all people in this world, regardless of their challenges, are much more alike than they are different.

Live Training Version

• The information presented to you today is to increase your awareness. It is not intended to replace medical advice. If you believe you or someone you support have these conditions or concerns, please seek the advice of a physician.


By the end of this training, you will:

•Understand the purpose of a Functional Behavioral Assessment, or FBA •Understand why it is important to rule out other medical and environmental reasons for challenging behaviors •Understand the importance of documentation, sharing information and consistency of staff responses •Understand the importance of the behavior support plan for the person and supporters


• Behavior is an observable and measurable act of a person. Behavior can be seen directly by others. Being angry is not a behavior. The observable and measurable things a person actually does that leads you to conclude a person is angry is the behavior. Examples of behavior that lead to the conclusion that a person is angry include: cursing at you, smashing windows and hitting and/or spitting on you.


• Form is the way a behavior looks. It is what we actually observe. It is a detailed description of the behavior we see or hear occurring. Some examples of challenging behavior are: punching the windows, yelling out curse words and cutting of the wrist.

• Function is the purpose of the behavior. It is the reason why a behavior

happens or continues to happen. Some examples of behavioral function are: to avoid a task, to get attention, or to escape a request.

• For example: Jerry biting his wrist is the behavioral form or what the behavior looks like so that he could get his staff’s attention, which is the function or reason why he bit his wrist.

• Understanding form and function is necessary in order to help Behavior Specialists obtain data and communicate in a way that helps make the information you are providing more relevant.


• The slide you are viewing shows some examples of behaviors that have a specific form, but have several different possible functions. The Functional Behavioral Assessment process looks to uncover the functionality of challenging behaviors. If a challenging behavior serves multiple functions, then it is important to address each function. Each function is then addressed with interventions that target each and every function of that challenging behavior in order to successfully reduce the challenging behavior from occurring. For example, on this slide the person yells in the lunch room in order to leave the area. At home, the person yells to get attention from a supporter. Behavior planning would be used to develop strategies that can aid the person in getting attention at home and also for escaping the lunchroom or coping with being in the lunchroom without the need for yelling.


• Positive Behavioral Support is proactive, respectful and eliminates the need for punishments and the overuse of negative consequences. The goal of Positive Behavioral Supports is to understand WHY a challenging behavior continues to occur rather than just simply attempting to eliminate the behavior. Positive Behavioral Support focuses on recognizing the person’s needs, desires, likes and strengths and identifying positive ways for the person to meet those needs. Behavioral support, education and social supports are combined to generate environments that allow people to succeed.


• In order for Positive Behavioral Support to be effective, we must first assume several things in order to allow ourselves the ability to have a positive perspective about the person. Without a positive perspective on the person we support, we are likely to fail. If we believe that the person cannot change, they won’t. Having a positive perspective leads us to 5 primary assumptions in the development of Positive Behavioral Supports:

• Assumption 1: There is no place for ridicule or humiliation of individuals with disabilities in the process of managing behavioral challenges. This means that we do not tease, taunt, put down, reprimand, scold, or punish people with our words and actions because of their behavioral challenges.

• Assumption 2: Inappropriate and challenging behaviors are learned and predictable. This means that, with careful observation, data collection and the input of all team members, especially direct supporters, we can uncover WHY someone engages in challenging behavior, as well as the conditions, situations, triggers and other factors that lead to the behavior.

• Assumption 3: A person’s challenging behavior is his/her best effort to be successful. This means that the person who is exhibiting challenging behaviors, uses skills that they have learned to get their wants and needs met. Sometimes challenging behavior also stems from a behavior or routine that was once considered appropriate. Now, however, the behavior is no longer needed in a changing environment, or people that are unfamiliar with a particular behavior simply do not understand the behavior in the context of the person’s current environment. Here is an example of this concept.

• John is 26 year old gentleman with a diagnosis of Autism Spectrum Disorder. John is non-verbal but utilizes his own personally created version of sign-language. John is also fairly good at non-verbally


communicating his wants and needs to others. John continues to take his shoes off before entering his new Community Living Arrangement and leaves them on the walkway and the lawn. When his supporters have attempted to bring his shoes into the home, John can become aggressive, often fighting with his supporters and grabbing his shoes so he can throw them back outside. During this time, John will also pull items from hall closets and throw items out from under the sink cabinet. John continues to demonstrate this behavior almost daily and it has progressed to where John will throw his shoes on the roof, in the street and down the sewer. John refuses to have his shoes in the house. John’s supporters have purchased him a bin with a lid to keep his shoes outside, but he continues to remain agitated and will bite himself. John’s supporters do not know WHY John is having such challenging behaviors revolving around his shoes.

• John’s Behavior Specialist contacted John’s mother to ask specific questions about routines regarding his shoes when he used to live at home with his family. John’s mother reported “Oh! Johnny was always told to leave his shoes on the front porch because he tends to have pretty smelly shoes. I always asked him to leave them on the porch so I could deodorize them and then I would bring them into the house! Sometimes he would go in the closet or under the sink and even do it himself!”

This case example shows how a person’s past routine, when changed, can sometimes lead to significant challenges when we do not take the time to ask questions and look into a person’s history. It is important to understand why a behavior occurs if we want to change it. John’s supporters began replicating the routine John had when he lived at home with his family and all of John’s behavioral challenges ended. John’s behavioral challenges at his CLA was his best effort to be successful and his best effort to do what he had been taught for years by his mother.

Assumption 4: A person’s behavior is not what defines that person. This means that frequently, a person who is behaving in a challenging way may be labeled as manipulative, sociopathic, attention-seeking, violent, or dangerous. Labeling someone based on his or her behavior results in wrongly defining the person. For example, a person labeled as manipulative is treated very differently by others than a person who is not labeled as being manipulative. Pretend for a moment that you just met me today for the first time. You may already be making personal judgments about me based on negative things that you had heard or read about me. What if someone you work with had told you that I’m untrustworthy or manipulative. Would it impact how you view me? If many people told you the same thing about me, would it change how you reacted to me even more? What if the information was in documentation you read about me? How would it impact this training for you? Would you find yourself ignoring what I am saying because of how I have been labeled?

• Assuming that a person’s behavior is simply who that person is, leads us to stop trying to best support a person. If we assume that the person has some severe character flaw, then we may assume they are incapable of changing. If we assume someone is incapable of changing, we treat the person that way. If we treat the person as though he or she will never change the behavior, then that person is less likely to change that behavior.

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Assumption 5: The mere presence of others influences a person’s behavior. We must consider that, many times, a person’s behavior, both positive and challenging, may be in response to us. Consider this: have you ever been at a party, meeting or some other event when someone you dislike, who you may have had past negative experiences with, shows up? How does the presence of that person change your behavior? Maybe you become a bit annoyed, nervous, less outgoing, or more guarded about what you say or do around them? What about when you are around your best friends or people you really love and trust? Are you more outgoing; more willing to open up? What if you were out on the town with friends, having a great time and your supervisor shows up in the same place just by coincidence? Would this suddenly change how you are behaving? • Most of us have been trained through life experiences how to alter our

behavior in response to our environment. Many of those we support have learned the same lesson. We cannot forget that WE impact the behavior of others and how we behave will impact how others respond to us. This assumption is very important when it comes to Positive Behavioral Support. Positive Behavioral Support is about looking at the behavior of the person being supported AND the behavior of the supporters. In order to help someone express his or her wants and needs in a more positive way, we may need to change some of our OWN behavior.

• Think about relationships that have defined you as a person. Has there been someone in your life you consider your teacher, mentor, role model; a person who impacted your life and has helped you become a better person? Think about how that person may have changed your life. Now, think about this: What if YOU can be that person for someone you support? What if YOU can be that teacher, that mentor, that role model?

• Positive Behavioral Support focuses on the functional rather than the topographical analysis of behavior. This means that WHY someone is engaging in a certain behavior is much more important than WHAT the behavior is and how many times it occurs.

• For example: If Timmy hits himself 45 times a month based on the behavioral data collected, it only tells us that Timmy hit himself 45 times. Without additional functional data, we haven’t learned about WHY Timmy hits himself. If we are not focusing on WHY Timmy hits himself, then we will have difficulty creating effective ways, or interventions, to reduce his self-hitting behavior.

• Functional analysis of behavior, or the WHY of what someone does, is the way to begin a Functional Behavioral Assessment


• The Behavior Specialist Consultant should work with the team to complete a Functional Behavioral Assessment prior to the drafting of a Behavior Support Plan. A Behavior Specialist Consultant is an individual who meets the educational and experience related criteria authorizing them to be a Behavioral Support provider based on the waiver and managed care organizations that they may contract with. Experience and level of education requirements may vary depending on who the Behavior Support Specialist contracts with to conduct such services.

• A Functional Behavioral Assessment is conducted when a person or a team feel that Behavioral Support may be needed in order to assist a person in reducing, modifying or understanding a person’s challenging behavior. A Functional Behavioral Assessment should be conducted prior to the development of a Behavior Support Plan. Functional Behavioral Assessments may need to be conducted more than once, and depending upon changes in a person’s behavior, environmental conditions, and physical or psychiatric concerns.

• The purpose of a Functional Behavioral Assessment is to help understand WHY someone does something. For instance, if Suzy is becoming physically aggressive towards peers and supporters, the purpose of the Functional Behavioral Assessment is to discover WHY Suzy is becoming aggressive.

• It may take some time to gather enough information to make a clinical judgement about the function of the behavior in order to develop the Functional Behavioral Assessment .

• Without determining the function of behavior, we may inadvertently reinforce inappropriate behaviors with our current responses and interventions. Through the Functional Behavioral Assessment process, assessing why a person engages in challenging behavior can assist us in


learning how to respond without reinforcing the challenging behavior.

• A good Functional Behavioral Assessment includes all of the information on this slide. The more historical and current information a Behavior Specialist can obtain about a person, the better the Functional Behavioral Assessment will be. A Functional Behavioral Assessment should be more than just filling out brief questionnaires and brief assessment tools. A strong Functional Behavioral Assessment incorporates information from a wide variety of sources.

• Examples of information needed to conduct a good Functional Behavioral Assessment include:

• Record reviews of as much historical and current information as possible

• Interviews with the person AND their supporters, especially direct supporters and family

• Completion of assessment measures such as the Motivation Assessment Scale, or the Questions About Behavioral Functioning.

• Direct and indirect observation of the person in various environments • Collection of data that the Behavior Specialist clinically judges to be

important for the development of the Functional Behavioral Assessment.

• Data should include, if known, the antecedent or what happened before the behavior, and the date, time, place, severity, and duration of the behavior.

• Although the Behavior Specialist will be the one writing the Functional Behavioral Assessment, supporters, family, team members and the person themselves all play an important role in helping generate the best Functional Behavioral Assessment possible. Supporters MUST take an active role in assisting the Behavior Specialist in the collection of data and obtaining of records, and be willing to take part in interviews with the Behavior Specialist. If team members are unwilling to assist in this process, it will severely impact the quality and comprehensiveness of the Functional Behavioral Assessment and, most likely, the effectiveness of the Behavior Support Plan.


• In order to accurately assess the function of a behavior, the TEAM should

work to obtain the information outlined on this slide, which includes any and all historical documentation on the individual from:

•Family •Schools the individual attended •Past providers •Individual Support Plans or ISPs •Individual Education Plans or IEPs •Past and current medical records from attending and specialty physicians •Past and current psychiatric records, including medication history •Past psychiatric hospitalization records •Past medical hospitalizations •Past Behavior Support Plans, Plans of Support or Social, Emotional, Environmental Protocols

Basically, any information on the individual that was documented throughout his or her entire lifetime should be included.

A thorough biopsychosocial evaluation is KEY to understanding who a person is and why he or she may engage in challenging behaviors. Remember: MANY TIMES, CHALLENGING BEHAVIORS WHICH SERVED AN IMPORTANT FUNCTION HISTORICALLY ARE NO LONGER RELEVANT OR USEFUL.


• There are limitations to what a Behavior Specialist may do. It is not uncommon for medical health issues, medication side effects or pain related issues to manifest themselves as behaviors. Behavioral intervention cannot remedy ongoing medical concerns, so it is important to rule out other issues as previously mentioned before proceeding with an evaluation by a Behavior Specialist.

• Some suggested preventative and proactive measures that

supporters can assist in are: • Scheduling of full physical and dental exams and completion

of consults, recommended assessments and medical testing • Discussing the possibility of obtaining genetic testing to rule-

out a genetic syndrome and other organic concerns with the person’s physician

• Obtaining neurological assessment and testing to rule-out possible neurological concerns that may be associated to behavioral challenges such as aggression and self-injurious behaviors

• Sometimes the function of someone’s behavior can be very clear and may not be related to medical concerns. However, if a person is non-verbal or has limited communication around pain and illness, is medically compromised, has a multitude of medications or medical conditions, has a history of poor medical care or if no function of the behavior is clear, ruling out medical concerns is VITAL.

• There will be times where medical concerns are not the FULL

CAUSE of a person’s challenging behavior but their medical concerns do help CONTRIBUTE to the challenging behavior. Our primary focus is attempting to enhance a person’s overall quality of life mentally, spiritually, socially AND physically. You may find that a person continues to be challenging even if medical concerns are addressed. The important question to remember is: has the person become even slightly LESS challenging since addressing their medical concerns? If the answer is yes, then progress is being made to address behavioral challenges.


• If a person is demonstrating difficulties due to a possible psychiatric concern, behavioral intervention alone may not be able to fully support the needs of the person. For example, it is unlikely that behavioral support could successfully eliminate auditory hallucinations, manic episodes or suicidal ideation if any of these are symptoms of a psychiatric diagnosis. However, by collaborating with other mental health practitioners, a Behavior Specialist can assist in the development of environmental strategies and interventions that may help reduce the total impact of the person’s psychiatric symptoms. The Behavior Specialist may also be able to identify environmental triggers. For example, supporters telling a person “No”, loud noises or being in crowds, may all trigger exacerbation of psychiatric symptoms. Once triggers have been identified, the Behavior Specialist may be able to provide strategies and recommendations to reduce or eliminate environmental triggers, and provide strategies that may help the person cope with their psychiatric symptoms more successfully.

• To assist you in understanding how a Behavior Specialist can help in relation to a person experiencing psychiatric symptoms, here is a case example:

• Aaron is a 35 year old male who has a diagnosis of mild intellectual disability and schizophrenia. Aaron is currently receiving psychotropic medication management by his psychiatrist. Aaron also receives Behavioral Support.


Aaron’s Behavior Specialist works closely with Aaron, his psychiatrist and his team to track increases and decreases in psychiatric symptoms. Based on the detailed data that Aaron’s Behavior Specialist collected, Aaron’s psychiatrist was able to make several successful adjustments to his psychotropic medication. Aaron’s Behavior Specialist also taught Aaron several skills that have helped both Aaron and his team to better track and cope with his symptoms. Aaron’s Behavior Specialist encouraged the team to purchase Aaron a pair of high quality headphones and an IPod filled with music Aaron enjoys. When Aaron is experiencing auditory hallucinations, he will put on his headphones and play the music loud, as it helps him ignore the auditory hallucinations. Aaron’s Behavior Specialist also discovered, based on data collected, that Aaron’s symptoms appeared more frequently and intensely during times when Aaron was alone or bored. Aaron’s Behavior Specialist worked with Aaron and his team to develop a daily schedule that kept Aaron engaged and physically active. These strategies all contributed to a much better quality of life for Aaron.

• This case example demonstrates how a Behavior Specialist may be able to assist the team in regard to psychiatric symptomology. However, it is important for you to know that a Behavior Specialist’s primary goal is to assess and develop support planning related to challenging BEHAVIOR. NOT all challenging behaviors are symptoms of mental illness. If a team is requesting the assistance of a Behavior Specialist due to concerns associated with psychiatric conditions, the team should make this clear to the Behavior Specialist, as this information may alter how the Behavior Specialist conceptualizes, assesses and approaches the case.

• There may also be times in which a comprehensive Functional Behavioral Assessment uncovers the fact that perhaps a person does NOT have symptoms of a psychiatric diagnosis, but rather a behavioral concern that has been misdiagnosed. A Behavior Specialist can be important in determining if a person’s challenges are strictly behavioral, or perhaps associated with an undiagnosed or misdiagnosed psychiatric concern. There have been situations in which the diligent assessment and support of a Behavior Specialist has been able to assist in demonstrating that a person does not have a psychiatric concern and that person was successfully withdrawn from psychotropic medications and psychiatric treatment.

• The formal process of Functional Behavioral Assessment is an attempt to discover, based on the information obtained through documentation of behavior, observation, interviews and assessment measures, WHY a person does what they do.

• The Functional Behavioral Assessment may also find that there are several

reasons that a person engages in a challenging behavior. The Functional Behavioral Assessment attempts to explain each of the reasons and begins to formulate a plan for the Behavior Specialist to address these concerns. The Functional Behavioral Assessment can also be utilized to see if Behavioral Support is even needed.


• The Functional Behavioral Assessment should lead to the collection of a wide variety of information about the person. This slide contains examples of information that can be collected during a Functional Behavioral Assessment that can be used in the development of a Behavior Support Plan. A successful Behavior Support Plan should include as much of the information contained above as possible.


There are certain components that a Behavior Support Plan should include in order to maximize the effectiveness of the plan. The next few slides will discuss what these components are: • A Behavior Support Plan should include background information pertaining to

the person, including, but not limited to, family history, previous living situations, medical information, psychiatric and physical health diagnoses, historical behavioral information, and current medications.

• A Behavior Support Plan should include objectives or goals that are clearly stated and support why the plan is needed. An example of an objective in a Behavior Support Plan would be: Danny will reduce physical aggression to 0 incidents over a 3 month period. Another example would be: Carol will reduce self-injurious behaviors to less than 5 incidents a month over a 6 month period.

• A Behavior Support Plan should also provide a clear description of the target behaviors which are being addressed in the plan. These descriptions should be very specific to the person’s behavior. For example: physical aggression could be defined as: hitting, kicking or biting housemates. Self-injurious behavior could be defined as: biting a wrist or forearm. Property destruction could be defined as: flipping over the kitchen table. The most important thing to remember is that the target behavior is clearly defined based upon what the behavior REALLY LOOKS LIKE when the person engages in it. The more specific you can be, the better.

• Examples of general terms such as aggression, agitation, non-compliance or irritability should always be avoided because using these terms does not provide supporters with enough information to successfully track the behavior. It also leaves the target behavior open for interpretation. For example, some supporters might consider an act aggressive that other supporters might not consider aggressive, which would lead to unreliability in the interpretation of the behavioral data.


A Behavior Support Plan should also include setting events, antecedents, interventions, replacement behaviors, consequences or reinforcers, data collection and crisis and emergency planning. We will be discussing each of these on the next several slides.


• Setting events are the situations and conditions that increase the likelihood that a person will become triggered to engage in a challenging behavior. Examples of setting events include, but are not limited to physical illness, physical pain, psychiatric symptoms, life dissatisfaction, chronic stress, sleep disruptions, or reactions to medications.

• Think about when you are feeling sick. Do you respond differently to requests or demands when you are feeling sick compared to when you are feeling great? Would a person have less frustration tolerance when they are depressed compared to when they are not depressed? The answer is yes!

• Setting events affect how a person will respond to situations by temporarily increasing or decreasing reinforcers in the environment. For instance, an activity a person usually enjoys may not be as reinforcing right before the holidays or before a much more positively or negatively anticipated event such as a doctor’s appointment or a vacation. Math class may be difficult for a student who has a learning disability, but on most days the student copes well. However, on days when this student has a bad headache, the understanding of math problems may be more difficult than usual. Setting events can occur immediately before a problem behavior or days in advance. Some setting events are obvious while others may be more difficult to identify.

• For many of the individuals we support, a setting event may be the anniversary date of the passing of a loved one. The anniversary date of the death of a parent or sibling may cause the person difficulty every year. Setting events can be social, such as arguments; physiological, such as illness; or environmental, such as noisy or crowded rooms.

• A Behavior Support Plan should communicate the presence of already known or newly discovered setting events and how, if possible, to address them.

• The handout provided with this training in the Resource Section offers additional information about setting events as well as conditions and situations that supporters should consider when helping a Behavior Specialist


develop a Behavior Support Plan.

• Events that directly precede and serve as a "trigger" for a problem behavior are called antecedents. Antecedents serve as cues signaling when a behavior will be reinforced. A substitute supporter can sometimes be an antecedent for a problem behavior. In this situation, the presence of someone other than the person’s routine supporter signals that yelling, cursing, lying, manipulation and off task behavior in general, will be reinforced, allowing the person to escape from the demands of their routine.

• Antecedents can be related to the physical setting, materials, time of day or social situations. Examples of common antecedents include verbal requests, criticism, teasing, the absence of attention, and the presence or absence of specific people, materials, or events. The difference between an antecedent and a setting event is that setting events increase the likelihood that an antecedent will trigger problem behavior.

• A Behavior Support Plan should communicate the presence of already known or newly discovered antecedents and how to address them.

• The handout provided with this training in the Resource Section offers additional information about antecedents as well as conditions and situations that supporters should consider when helping a Behavior Specialist develop a Behavior Support Plan.


• A good Behavior Plan includes strategies to remove or reduce identified antecedents related to challenging behaviors, and includes strategies to make a challenging behavior unnecessary in specific situations. The Behavior Plan should also provide strategies to assist in the performance of replacement behavior. This means that the plan and Behavior Plan training from the Behavior Specialist should teach both the person and the person’s supporters how to help, remind, or encourage the use of the replacement behavior. This should also include how supporters should respond to the person when he or she successfully uses the replacement behavior.


Once we have identified what the person is trying to communicate, we need to look for a more positive way for the person to have their need met WITHOUT engaging in the challenging behavior. This is where the development of replacement behaviors comes in. Both the teaching and maintaining of replacement behavior is the responsibility of the Behavior Specialist and ALL supporters. It is impossible to see behavioral change unless all team members are unified and consistent in the encouragement and maintenance of replacement behaviors. This includes responding quickly and positively when a person uses the replacement behavior instead of resorting to their typically challenging behavior. The Behavior Specialist, with help from the person and the team, will need to identify a functionally equivalent replacement behavior. This means that the replacement behavior will help the person get what they want or need, or will help the person communicate the same way in which the challenging behavior did, only in a more positive, safer and less challenging way. When developing replacement behaviors, the team and the Behavior Specialist should consider:

• Is the replacement behavior effective and efficient for the person to use?

• How difficult is it for the person to perform the replacement

behavior (physically and/or cognitively)?


Consequence strategies are the behavioral planning that involves consistent, ongoing, active involvement by the entire team. The goal of consequence strategies is for every supporter to reinforce the use of replacement behaviors and withhold reinforcement for the challenging behaviors. This means that supporters respond faster to replacement behaviors and slower or not at all to challenging behaviors. The goal is for the person to learn, through experience, that the use of the replacement behavior will get he or she what they want or need and the challenging behavior won’t. If supporters still respond to challenging behavior or don’t respond positively to replacement behavior, the challenging behavior will continue….possibly forever. In order to be effective, Behavior Support is a team effort and it involves all supporters to be actively engaged in the process. Reinforcement is anything that is done following a behavior that increases the likelihood of the behavior happening again. For example, if every time a child screams, the mother gives the child candy to be quiet, it is very likely that the child learns that screaming equals getting a candy. It is very important that you, as a supporter, take a good, hard look at how you may be reinforcing challenging behaviors. How you respond to a behavior is as important as the behavior itself in terms of attempting to reduce it. Sometimes natural consequences do occur, and the person engaging in challenging behavior should be allowed to experience those consequences. While we must do everything we can to ensure a person’s health and safety, sometimes natural consequences should not be diverted by supporters as the person will find your interference itself


reinforcing.

The following is an example of a person who recognizes the consequences of her behavior: Joan is a 34 year old female with a history of physical aggression and property destruction. Joan has recently been punching her supporters and threatening neighborhood children. Police had responded several times due to Joan’s threats towards children, and each time her supporters were able to convince the police officers not to arrest Joan. Today, Joan began threatening neighborhood children, as well as throwing large rocks and bricks at the children. She struck a child with a rock on the back of the head causing bleeding. The police responded to the assault and again Joan’s supporters attempted to convince police officers not to arrest Joan. Joan was taken into custody and arraigned. Joan was shocked that she was arrested for her actions. After she was released, she was asked if she learned anything from her experience. She replied “Throwing rocks is taking it too far. I can’t throw rocks anymore”.

Although this is a simple, yet actual case example, it is important that we provide those we support with the realistic consequences of challenging behavior. Sometimes educating people about what can occur if they continue certain behaviors may help the person modify their behavior, although sometimes it seems that even severe consequences are insufficient to motivate the person to change. The aim of consequence strategies in Behavior Support is finding what motivates a challenging behavior and how to stop motivating the challenge and start motivating more positive and socially acceptable behaviors.

• Behavior Support cannot progress without the collection of data on target behaviors. Data collection is necessary in order to determine a person’s baseline behavior, which is an assessment of a person’s general behavioral pattern in their environments.

• Data collection is also vital to evaluate the effectiveness of Behavior

Support strategies and interventions. In order to measure the effectiveness of a Behavior Support Plan, supporters must take an active role in data collection. Of course, if the person is no longer having challenging behaviors, you would assume it was effective. However, data collection can also show us what really made the behavioral change. Many times, behavioral changes occur in tiny increments that most people might not notice right away. The purpose of data collection is to be able to see even small changes, and strategize on how to adjust behavioral supports and interventions.

• Data collection should focus on the frequency of challenging behaviors

but, more importantly, it should continue to look at the functionality of challenging behaviors that continue to occur. This is best documented by Antecedent-Behavior-Consequence, or ABC, charting and is encouraged to be used as part of the data collection procedures used by supporters. A-B-C charting provides strong information regarding both frequency and information that can help understand the function of the challenging behavior as well. An example of an A-B-C chart is included with your handouts in the Resource Section.


• This slide provides an example of Antecedent-Behavior-Consequence or ABC data. The behavioral data is beginning to show us a possible behavioral pattern. John may be connecting throwing the table to being able to go home. If John wants to go home, we can expect more tables to be thrown more frequently in the coming months.

• So how do we stop this behavior? Based on what little we know in this example, we don’t yet have a good answer. But we do know what the targeted behavior is. If John wants to go home, he knows what to do to be sent home.


• A crisis plan included within a person’s Behavior Plan should include instructions to supporters on how to manage a crisis which is SPECIFIC to the INDIVIDUAL. Broad and general, or “cookie cutter” crisis directives, may cause an exacerbation of the crisis and other challenging behaviors in many individuals. Again, we cannot stress enough that crisis planning should be individualized to the person, the person’s environment and the person’s specific behavioral challenges.

• Debriefing should occur as soon as possible after a crisis, involving

everyone who was present during the crisis. Debriefing looks at what happened before, during and after a crisis and how to reduce the chances of the same situation occurring again. Debriefings will ultimately increase everyone’s understanding of an individual’s behavior…including the INDIVIDUAL! Additional information on debriefing is found in the Crisis Supports and Debriefing Dual Diagnosis Curriculum training module.


• Behavioral support is a tedious and ongoing process. Behavioral change does not happen overnight. It can be a slow and gradual process. Sometimes there may be rapid progress, followed by the person returning to the challenging behavior. Behavioral Support is about hanging in there, never quitting and continuing to stick to or modify the strategies in the Behavior Support Plan.

• Behavior planning also involves other strategies that can help augment behavioral support. Some of these strategies are listed on this slide and include:

• Teaching and modeling effective coping skills • Building strong relationships between yourself and individuals • Letting the individual know you are listening and willing to help • Helping obtain communication assessments and adaptations • Providing communication assistance by using the individual’s means of

communication, such as an electronic talker or a Picture Exchange Communication System or PECS


• Moving a step beyond skill instruction, lifestyle interventions relate closely to global hypotheses of behavior and work to improve general quality of life factors such as gaining friends, having choices, participating in more activities and making decisions. Lifestyle interventions are the responsibility of all supporters to advocate for, and are based on the premise that if people are satisfied with their lives and have their needs met, then problem behaviors may be reduced. Poor quality of life may contribute to frustration and unhappiness, which in turn may lead to challenging behaviors. By promoting an “Everyday Life” we inch closer to making many challenging behaviors unnecessary and aid in the reduction of setting events that make challenging behaviors more likely to occur.


• Your perspective is important and invaluable to understanding the person and their behavior, and, of course, the circumstances surrounding the behavior. Remember to talk about the behavior, not make judgments about the person or their disability. Recognize that working with challenging behavior is difficult and it’s OK to need or ask for help. Forget past failures and focus on current and future successes. Also remember that behavioral change requires systematic instruction and delivers slow gradual improvement. Behavioral changes seldom happen overnight.


• Challenging behavior has gotten the person where they wanted to go more times than not. When it doesn’t work, the person is shocked and angry, and keeps engaging in the challenging behavior waiting for it to work again.

• Behavioral Support is about getting the person to see a new, more effective way of doing things, since the old way is not working any more.


Congratulations, you have successfully completed the Functional Behavioral Assessment and Behavior Support Planning training.

Thank you for your participation in this training!


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