What Role for Inclusive Environments for AWD in relation to PBS? Positive Behavior Supports in Practice

Transcription

1 Functional Analysis and Positive Behavior Support for Adults with Disabilities: Part Three Positive Behavior Supports in Practice Keith Storey, Ph.D., BCBA D Graduate School of Education Touro University keith.storey@tu.edu What Role for Inclusive Environments for AWD in relation to PBS? It is extremely important that AWD be working and living in inclusive environments with appropriate supports. 1

2 1. Peers without disabilities as role models. 2. Access to the norms and expectations of the inclusive environment. Naturally occurring reinforcers and punishers in the inclusive environment. Preventative Procedures and Interventions Broader aspects of a person s life: It is important to look broadly at a person s life to evaluate factors to change for increasing desirable behavior in that AWD. This evaluation may include factors such as: 1. Changing schedules or routines. 2. Resolving physical or medical issues. 3. Increasing positive social contacts. 4. Meaningful work. 2

3 Preventative Behavioral Supports Why Focus Preventative (intervention before undesirable behavior occurs) Behavioral Supports? Makes life easier. Many inappropriate behaviors won t occur. Many mild inappropriate behaviors will decrease without a formal intervention. Appropriate behavior is likely to maintain without formal intervention. Number of formal programs to be carried out will be reduced. 5 Components That You Should Put in Place 1. Identify generic positive behaviors and reinforce them. What are the generic behaviors that you want people to do? Many AWD have low levels of reinforcement. Independence. Appropriate communication. Completing work and tasks. Following work and community rules. 2. Minimize reinforcement for undesirable behaviors. If AWD is getting reinforcement from others then change the behaviors of others or remove them if possible. 3. Give people (AWD) rules. 4. Minimize Discriminative Stimuli (Sd s) for undesirable behavior. A. Demands and/or confrontations are high probability for escalation. B. Boredom, downtime, etc. C. Increase variety, choice and selfcontrol. 5. Define system for undesirable behavior. A. Need rules for both AWD and staff to follow. 3

4 Positive Behavior Support Tips 1. Pay attention to good behavior (reinforce desirable behaviors). 2. As a general rule, ignore inappropriate attention getting behaviors when directed towards the staff (extinction), if you think that the function of the behavior is to get staff attention (Do not ignore when safety is at stake or if you think that the function is to get attention from others). 3. Use contingencies. Example: "As soon as you do A, then you can do B." A is what you want the AWD to do. B is the reinforcer. Do not confuse this with coaxing and bribing. This is connecting the behavior and the reinforcement. 4. Be consistent. Always follow through with what you say. Be prepared to abide by a rule and to enforce it. 5. Be cautious: Do not make contingencies which you can't enforce. 6. Do not change contingencies for your own convenience. Do not require more after the AWD has done what was agreed upon. 7. If you give a AWD a choice by asking "yes" or "no questions (e.g., do you want to work now?), then respect the AWD's decision. Don't ask a question in which the AWD has no choice. Instead tell the AWD what needs to be done (e.g., "It's time to go to work now."). 4

5 8. As a general rule, do not give the AWD eye contact or any attention when the AWD is engaging in inappropriate behavior (again, this is if you think that the function of the behavior is to get your attention). Do not talk about the inappropriate behavior in the presence of the AWD. 9. Always plan ahead and think of any potential problems. If you think ahead you'll be more prepared to deal with problems as they arise. 10. Before engaging in community or work activities with AWD, inform them of basic rules and contingencies which can help them remember what is expected of them. Be consistent and follow through with the rules. Basic Guidelines for Positive Behavior Supports 1. Identify positive behaviors (e.g., communication, task completion, social interaction, following requests, initiating behavior). 2. Identify effective reinforcers. 3. Deliver reinforcers for desireable behaviors. 4. Frequency of reinforcers should be reasonable high (from the perspective of the AWD). 5. Frequency of reinforcers should meet the needs of the individual AWD. 6. Minimize reinforcers for undesirable behaviors. 7. Be careful how you use your attention. 5

6 Comprehensive Interventions 8. You may ignore an inappropriate behavior, but do not ignore the message (e.g., function) behind the behavior). 9. Minimize environmental events that serve as cues that trigger or promote undesirable behavior. 1. Built from a functional assessment (you know the function of the behavior). 2. Focus on all the problem behaviors a AWD engages in. 3. Address all contexts where problem behaviors occur. 4. Address behavior problems throughout the AWD s day. 5. Focus on change in problem behaviors that is both substantive (meaningful) and durable. 7. Involve teaching new skills in addition to attending to the variables that will reduce problem behaviors. [Very important!] 6. Are consistent with the values, skills and resources of the implementers. 6

7 8. Build from a competing behavior model and provide the organizational framework for integrating an array of behavioral strategies: A. Setting event manipulations. B. Altering immediate antecedents. C. Teaching competing alternative behaviors. D. Managing consequences to both support adaptive behaviors and eliminate reinforcement of problem behaviors. Ecological Manipulations (e.g., Setting Event Manipulations) Broader aspects of a person s life. Involves: 1. Changing schedules/routines. 2. Resolving physical/medical issues. 3. Increasing social contacts. A. Setting Factors: Places. Persons. Activities. B. Task Related Factors: Many problem behaviors occur in task related situations, so that one s first interpretation is that the AWD is being non compliant. An alternative explanation is that there is something about the task that troubles the person. EX: By being aggressive the AWD gets out of something that they consider nonfunctional (or easy or boring or too difficult). Things to do to remediate problem: 1. Breaking the task down into smaller steps. 2. Giving the individual extra assistance on certain steps that may be more difficult. 3. Change in scheduling. 4. Change everything (or as much as possible). 7

8 C. Response Interruption: Prevents a problematic behavior from occurring by interrupting the behavior. 1. Prosthetic device. 2. Manual blocking. 3. Verbal cueing. D. Relaxation training. E. Physical exercise. F. Anger Control Training. G. Systematic desensitization: Immediate Antecedent Manipulations Involves procedures such as modifying task stimuli that are discriminative for disruptive behaviors or mixing easy and more difficult requests. 1. Removing discriminative stimuli for disruptive behavior (harsh voice from staff). 2. Stimulus change (if AWD does not like to change activities, change the prompt). 3. Stimulus fading (removing Sd or prompt, ex: close staff presence). 4. Stimulus interruption (stopping another person from approaching AWD). 8

9 Response/Skill Manipulations Pretask requests (also known as behavioral momentum) is a procedure designed for situations in which an adaptive pattern of responding competes with undesirable behaviors. Pretask requests are an antecedent strategy, in that the procedure is used to keep the undesirable behavior from occurring. Pretask requests can be effective in transitions, acquisition of skills, and breaking a chain of undesirable behaviors. Procedures which teach appropriate alternatives to disruptive behaviors. These response/skill manipulations are based upon two concepts: (a) build the instruction around the functions or accomplishments of behavior, not just the specific skill, and (b) sequence the instruction so that the full set of behaviors needed to achieve the function are taught together. Teaching new skills is one of the most powerful strategies that we have. 1. Teaching communication skills. 2. Teaching social interaction skills. 3. Systematic desensitization. 4. Relaxation techniques. Consequence Manipulations Procedures which follow the disruptive behaviors and are designed to decrease the occurrence of the disruptive behaviors. The concept behind consequence manipulations is that if a specific consequence can maintain a disruptive behavior, it should also be effective at building and maintaining an adaptive behavior, especially if there is a focus on functional equivalence. 1. Identifying and delivering effective positive reinforcers for appropriate behavior. 2. Manipulating reinforcement schedules. 3. Removing reinforcers for disruptive behaviors. 4. Goal setting. 9

10 Case Study Example One Margarita is a 30 something adult with a severe intellectual disability. She was living with her parents until recently, when they moved into an elder care situation, and it was no longer possible for Margarita to continue to live with them. Margarita has moved into a supported living situation, where she is living in a house (bought by Margarita s parents for her) with a roommate, Alma, who is without a disability. Alma lives in the house rent free and provides support to Margarita in the evenings (in the morning and on the weekends, Margarita receives support from a supported living agency). Margarita works five days a week at the city housing bureau, where she receives support from a supported employment agency job coach. She is doing well in her new living situation, except sometimes she engages in unusual behaviors such as yelling and waiving her arms, throwing herself into furniture, and dropping plates onto the kitchen floor to break them. Alma and the supported living staff are concerned as these behaviors have been increasing. 10

11 Fortunately, the supported living agency has contracted with Dr. Haymes, who has a strong background in applied behavior analysis and functional assessment. After performing a comprehensive functional assessment, Dr. Haymes hypothesized that Margarita was acting out in order to get attention from Alma and the supported living staff. Part of the functional assessment involved interviewing Margarita s parents. The parents shared that in the evenings and on weekends, when Margarita was living with them, they would often do activities together at home or in the community and often with a variety of friends. 1. What is the probably function(s) of the behavior? the function of Margarita s undesirable behavior is to get attention. 2. What would be a hypothesis for this behavior? A. When this happens (a description of specific setting and antecedent events associated with the problem behavior): When Margarita is at home and does not receive positive social interactions at least four times an hour from Alma or supported living staff 3. What data collection system would you use to measure this behavior? Frequency. B. The AWD does this (a description of the problem behavior): Margarita engages in undesirable (yelling and waiving her arms, throwing herself into furniture, and dropping plates onto the kitchen floor to break them) behavior C. In order to (a description of the possible function of the problem behavior): in order to get attention. 11

12 4. What would be a positive (e.g., functional) replacement behavior(s) that serve the same function as the challenging behavior? Positive attention getting skills. Because Margarita is nonverbal, develop an app for Margarita s smart phone and tablet, where Margarita had only to press an icon and a voice would say, Hi, I would like some attention and would like to do an activity with you. 5. What might be a logical intervention that might include these strategies: A. Setting event manipulations. Set up a system so that Alma s phone would vibrate every 30 minutes in the evenings and mornings during the work week, and throughout the day during the weekends, for the supported living staff. This vibration will serve as a prompt to alert staff to initiate, at that point in time, an interaction with Margarita or to make a positive comment if they were already engaged in an activity. B. Altering immediate antecedents. When staff see Margarita becoming agitated intervene immediately to pay attention and remind her to use relaxation and selfcalming skills. C. Teaching competing alternative behaviors. Teach relaxation and self calming skills. D. Managing consequences to both support adaptive behaviors and eliminate reinforcement of problem behaviors. Have Alma and staff ignore Margarita s undesirable behaviors when they occur. Have Alma and staff model the use of relaxation and self calming skills and praise Margarita when she uses them. 12

13 Case Study Example Two 6. What global interventions (e.g., lifestyle interventions) might be appropriate for this individual? Have Margarita join clubs and service organizations in which she is interested so that she develops friends and social networks outside of people who are paid to provide support to her. Keith is a 23 year old adult who has a diagnoses of ASD, Down Syndrome, and a Visual Impairment. Keith has limited verbal skills and prefers not to interact with others. He is works at a supported employment position where he does office work in a law firm such as delivering mail, prepping rooms for meetings, and doing copying. Keith finds working in a group or around other in close proximity to be difficult from a social standpoint. He becomes anxious and starts engaging in self stimulatory behavior such as rocking, twirling his hair, drumming his fingers on objects, and rolling his shoulders. Keith does not like to be have someone come up to him and suddenly be presented with tasks and told what to do. He often makes inappropriate remarks in these situations such as I won t do it or try and make me to the person presenting the task and demand. 13

14 Finally, Keith definitely does not like to be touched by others. For instance, if staff or coworkers put their hands on his shoulder he will drop to the floor and cry out She hurt me! If co workers touch him or brush up against him he says You re gross and other inappropriate remarks. 1. What is the probably function(s) of the behavior? 2. What would be a hypothesis for this behavior? A. When this happens (a description of specific setting and» antecedent events associated with the problem behavior): B. The AWD does this (a description of the problem behavior: C. In order to (a description of the possible function of the problem behavior): 3. What data collection system would you use to measure this behavior? 5. What might be a logical intervention that might include these strategies: A. Setting event manipulations. B. Altering immediate antecedents. 4. What would be a positive (e.g., functional) replacement behavior(s) that serve the same function as the challenging behavior? C. Teaching competing alternative behaviors. D. Managing consequences to both support adaptive behaviors and eliminate reinforcement of problem behaviors. 14

15 6. What global interventions (e.g., lifestyle interventions) might be appropriate for this individual? 15