Positive Behavior Support and Functional Assessment. Day 3 Webinar & Onsite

Transcription

1 Positive Behavior Support and Functional Assessment Day 3 Webinar & Onsite Stephanie Benson, MA Positive Behavior Support and Functional Assessment Day 3 Webinar 1

2 Webinar Agenda 9:00-9:15 Introductions 9:15-9:25 Brief PBS Review 9:25-9:45 Overview of Behavioral Principles 9:45-10:30 Overview of Functional Assessment 10:30-11:00 Start Developing a Plan Brief PBS Review 2

3 Implementing Multi-Tiered Systems of Support Positive Behavior Support Tertiary Stage Individualized PBS Plans Integrated with Other Positive Supports (PCP, Trauma-Informed Care, DBT, Etc.) Plans Are Monitored- Data-Based Decision Making Teams Monitor Progress of Each Person Positive Behavior Support Secondary Stage Early Intervention and Data Monitoring Additional Supports for Key Social Skills Function-Based Decisions Simple Interventions Mental Health and Wellness Interventions Universal Stage Teach and Encourage Communication Predictable and Proactive Settings Encourage and Reinforce Social Skills Consensus-Based Team Focus Emphasis on Using Data For Decisions 3

4 Opportunities for choice making Promoting physical and social wellness Development of pre-service and in-service training covering areas related to preventing challenging behavior Sufficient prompts and reinforcement for communicating Creating positive environments Access to high quality medical, dental, and mental health services Access to individualized and valued social networks Overview of Behavioral Principles 4

5 Behavior 1. Behavior changes due to changes in the environment 2. Effective management procedures are based on consideration of the relationship between environment and behavior Behavioral Principles Positive Reinforcement Negative Reinforcement *Punishment (Positive and Negative) (see note on previous slide) Extinction 5

6 Reinforcement: anything that increases the likelihood that a behavior will occur again Positive Reinforcement Negative Reinforcement Positive Reinforcement ADDING something to increase the likelihood that the behavior will occur again EXAMPLES Praising someone for a job well done Offering a token or ticket a person can accumulate to buy prizes Offering 15 extra minutes of computer time for completing chores 6

7 Negative Reinforcement TAKING AWAY something to increase the likelihood that the behavior will occur again EXAMPLES Taking away a chore for appropriate behavior Allowing someone to take a short break from work after giving a break card Hunger removed after eating something Turning off your alarm clock Punishment Punishment: when a behavior is followed by a consequence that decreases the behavior s future rate of occurrence NOT punishment just because someone views the consequence/event as unpleasant the behavior must decrease How is punishment different from negative reinforcement? 7

8 Extinction Extinction: when a previously reinforced behavior is no longer reinforced and the rate of occurrence decreases Extinction burst: After first implementing extinction, usually consisting of a sudden and temporary increase in how often the behavior occurs, followed by the eventual decrease and extinction of the targeted behavior. Behavioral Principles Positive Reinforcement Negative Reinforcement *Punishment (Positive and Negative) *Any forms of punishment procedures (i.e., aversive or deprivation procedures) are prohibited procedures and may not be used as a substitute for adequate staffing, as punishment, or for staff convenience under 245D Extinction 8

9 Operational Definitions An operational definition is an accurate and detailed description of the behavior to be measured. How the behavior is defined may differ given the purposes for measuring it. Operational Definitions q Objective q Measureable q Observable q Clear q Unambiguous q A bystander could identify it q Complete q Identify the limits of the behavior q Differentiate occurrences from non-occurrences 9

10 ICI Operational Definitions to Assist with Staff Entry of Incident Reports Can be helpful for uniform/standardized reporting and data analysis Handout and will be available on mnpsp.org Can be modified for your agency Does not override required incident reports for DHS, your agency policies, or other policies, procedures, or regulations A Functional Approach 10

11 Functional Approach A functional approach to assessment assumes that individuals behave in adaptive ways to ongoing changes in their environment. Factors within the environment Factors Within the Individual Interaction between individual and environmental factors Challenging Behavior as an Adaptive Strategy 11

12 2 Basic Functions Problem Behavior Pos Reinf Obtain/Get Something Escape/ Avoid Something Neg Reinf Stimulation/ Sensory Social Tangible/ Activity From Adult Peer Only 2 Basic Functions Problem Behavior Pos Reinf Obtain/Get Something Escape/ Avoid Something Neg Reinf Stimulation/ Sensory Social Tangible/ Activity Adult Peer From 12

13 Only 2 Basic Functions Problem Behavior Pos Reinf Obtain/Get Something Escape/ Avoid Something Neg Reinf Stimulation/ Sensory Social Tangible/ Activity Adult Peer From Only 2 Basic Functions Problem Behavior Pos Reinf Obtain/Get Something Escape/ Avoid Something Neg Reinf Stimulation/ Sensory Social Tangible/ Activity Adult Peer From 13

14 Only 2 Basic Functions Problem Behavior Pos Reinf Obtain/Get Something Escape/ Avoid Something Neg Reinf Stimulation/ Sensory Social Tangible/ Activity Adult Peer From Socially Motivated Non- Socially Motivated 14

15 Seeking/Obtain Avoiding/Escaping Attention Tangibles/ Activities Sensory Making others laugh Intimidating others or staff Slow transitions between activities because he has to stop and chat Working for a token (can of pop) Wants to have free time Acting very irritable because s/he hasn t eaten yet today Hand-flapping Looking away whenever a co-worker asks a question. Acting up at the beginning of a work activity to go home for the day Intimidating staff because s/he doesn t want to go on an outing. Wants to be kicked out of the room because it s too noisy Won t take medicine because of the way it makes him/her feel Three Sources of Assessment Data Indirect Assessments Interviews Rating Scales Checklists Direct Observation ABC Recording Data Collection Functional Analysis Direct manipulation of environmental variables 15

16 Indirect Assessment Indirect Assessments: Rating Scales and Checklists PROS Can be quick to give to multiple raters Requires less time and effort for the interventionist than direct observation Assists with interpretation of the information obtained through direct observation CONS Interpretation of the items by the respondent can be subjective Provides less precision in identifying potential functions of behavior than direct observation Information obtained via indirect assessment should be validated through direct observation 16

17 Examples of Rating Scales, Checklists, and Interviews Motivation Assessment Scale (MAS) Functional Assessment Screening Tool (FAST) Positive Environment Checklist Functional Behavior Assessment Interview (FBAI) Direct Observation: ABC Recording 17

18 ABC s of Behavior What does ABC stand for? Antecedent-Behavior-Consequence Also includes setting events Identifies the how the behavior interacts with the environment ABC Recording: Setting Events Setting Events = Slow Triggers Things that may influence the likelihood of a behavior being set off later in the presence of an antecedent 18

19 Types of Setting Events Physiological Type Cognitive/Emotional Examples Pain or discomfort from illness of medication Fatigue Argument with friends/family Physical Environment Social Activity Loud noises, Lack of light, too much light Presented a difficult task Change in the routine Temperature of the environment too hot/cold Surprise visits Staff Changes Experienced long wait time Medication Changes Slept more/less than usual Signs of illness Aggressed upon by another person Chaotic environment 19

20 ABC Recording: Antecedent Antecedent = Fast Triggers Events that immediately precede the occurrence of the target behavior Presence of certain adults/peers Being told no Changes in routine Transitions Presentation of tasks Termination of preferred activities Given feedback about behavior or performance ABC Recording: Behavior Your operationally defined behavior (the one you want to change) Document the specific behavior 20

21 ABC Recording: Consequence What event immediately followed the behavior? Given a redirection Peers laughing Stern look/glare Avoiding task Talking to peers Getting something that was requested Engaging in activity Example ABC Analysis Chart 21

22 Minimizing Disadvantages in Observations Conduct observations on several different occasions. This will allow issues such as reactivity to decrease and provide more observation opportunities Conduct observations across a variety of settings and situations. Creates opportunity to observe the behavior under a number of different conditions Have people in the person's daily environment collect data. Reduces reactivity that can be created by an outside observer. Select an appropriate tool and personalize it. A non- standardized tool can be modified to increase the likelihood that it will be used. Functional Analysis 22

23 Functional Analysis In a functional analysis, there are several possible conditions that may present different consequences for behavior (Iwata, Dorsey, Slifer, Bauman, & Richman, 1994). The following are examples of "standard" conditions that are sometimes implemented in a functional analysis: Attention Tangible Escape Free play Alone Attention- The goal of this condition is to determine whether attention is positively reinforcing challenging behavior. The assessor sits near the individual but is engaged in another activity (e.g., reading a magazine). Whenever any challenging behaviors occur, the assessor turns to the individual and gives them a mild reprimand or statement of concern (such as "don't do that"). He/she then turns away again and only provides attention or social interaction when the challenging behavior re-occurs. 23

24 Tangible- The goal of this condition is to determine whether attention is positively reinforcing problem behavior A highly preferred activity is identified When the session begins, the item is removed from the learner after they have interacted with it. Upon each occurrence of problem behavior, the item is returned for a period of time (e.g., 30 seconds) Then, once again removed. Behavior maintained by positive reinforcement, is more likely to occur at a high rate Escape -The purpose of this condition is to determine whether the problem behavior is maintained by negative reinforcement in the form of escape from the instructional tasks. A series of tasks are presented Tasks are based on current academic/vocational goals identified before the assessment as "difficult" but not impossible to complete. After problem behavior, the task is removed and a brief break is provided. 24

25 Developing a Plan Where Next? After you have collected data, you analyze and look for patterns! Identify the level of behavior How often it occurs How long Look for maintaining consequences! 25

26 Why know function? We can modify setting events so the likelihood of challenging behavior is REDUCED We can remove triggers, or use prevention strategies that will offset triggers Alter consequences to limit their reinforcing effect on the target behavior Develop a Plan Antecedent Desired Behavior Problem Behavior Alternate behavior Natural Consequence Maintaining Consequence 26

27 Develop a Plan Antecedent Problem Behavior Maintaining Consequence Develop a Plan Antecedent Problem Behavior Alternate behavior Maintaining Consequence 27

28 Develop a Plan Desired Behavior Natural Consequence Antecedent Problem Behavior Alternate behavior Maintaining Consequence and Function Questions? 28

29 Upcoming Dates PBS Webinars/Training Days Day 3- Monday 2/12/2018 Day 4- Friday 3/9/2018 Day 5- Monday 4/30/2018 Day 6- Monday 6/11/2018 End of Webinar 29

30 Positive Behavior Support and Functional Assessment Day 3 Onsite Onsite Agenda 11:00-11:15 Break After Webinar 11:15-11:25 Introductions 11:25-11:30 Therap Update 11:30-12:00 ABC (Activity) 12:00-1:00 Lunch 1:00-2:15 Measurement and the Importance of Operational Definitions (Activity) 2:15-2:30 Break 2:30-3:30 Introduction to Graphing in Excel 3:30-3:45 Functions of Behavior (Activity) 3:45-4:00 Like-Learn-Change 30

31 Introductions Therap Update 31

32 ABC Analysis Activity ABC Analysis Activity ABC Analysis Chart 32

33 ABC Analysis Activity Antecedent-Behavior-Consequence Antecedent: events that happen immediately before the target behavior Behavior: the target behavior Consequence: events that happen immediately after the target behavior ABC Analysis Activity ABC Analysis Video 1 33

34 ABC Analysis Activity Share-out What was the antecedent? What was the consequence? What do you think is the function of the target behavior? ABC Analysis Activity ABC Analysis Video 2 34

35 ABC Analysis Activity Share-out What was the antecedent? What was the consequence? What do you think is the function of the target behavior? ABC Analysis Activity ABC Analysis Video 3 35

36 ABC Analysis Activity Share-out What was the antecedent? What was the consequence? What do you think is the function of the target behavior? How could you use this tool in your agency? LUNCH See you back at 1:00pm 36

37 Agenda after Lunch 12:00-1:00 Lunch 1:00-2:15 Measurement and the Importance of Operational Definitions (Activity) 2:15-2:30 Break 2:30-3:30 Introduction to Graphing in Excel 3:30-3:45 Functions of Behavior (Activity) 3:45-4:00 Like-Learn-Change Measurement and the Importance of Operational Definitions (Activity) 37

38 Ways to Measure Behavior Frequency Recording number of times a behavior occurs Interval Recording whether a behavior occurs during intervals of specified time period Time Sampling whether a behavior occurs at the end of an interval during a specified time period Duration Recording the length of a time a behavior occurs Latency Recording the amount of time it takes for a student to begin the targeted behavior Frequency Recording EACH occurrence The behavior must have a discrete beginning and ending The behavior must occur at a relatively low frequency The observer must be able to record every occurrence of the behavior What types of behaviors might be appropriate for EVENT recording and what might not? 38

39 Practice Frequency Recording: Video Challenging Behavior- Toothbrushing refusal What went wrong? 39

40 Importance of Operational Definitions Ensure everyone counts the same behaviors Helps with consistency of consequences for individual Eliminates subjectivity Operational Definitions Taking a generic behavior (aggression) and describing it in an objective manner Hitting with hand; kicking with feet We can see it and count it! 40

41 Operational Definitions q Objective q Measureable q Observable q Clear q Unambiguous q A bystander could identify it q Complete q Identify the limits of the behavior q Differentiate occurrences from non-occurrences Operational Definition Practice With the person next to you try to write an operational definition for the behavior we observed in the video. Refusal: Examples: Non-examples: 41

42 Frequency Recording: Take 2 Challenging Behavior- Toothbrushing Refusal Interval Recording Divide the time into EQUAL intervals The shorter the interval, the more accurate the data 42

43 Interval recording Includes Partial Interval Whole Interval Time Sampling Partial Interval Recording the occurrence or non-occurrence of a behavior at any time during a time interval. Advantages Most useful with high rates of behavior. Can provide an estimate of frequency and duration of behavior and of performance across time intervals. 43

44 Partial Interval Recording Video SIB example Partial Interval Recording: Video Operational Definition: Person engages in or attempts to engage in behavior that produces or has the potential to produce tissue damage or pain (e.g., picking skin, biting arms, hitting head, cutting skin). Examples: Non-Examples: 44

45 Partial Interval Recording Video SIB example Whole Interval ENTIRE Interval Advantages Most useful with high rates of behavior. Can provide an estimate of frequency and duration of behavior and of performance across time intervals. 45

46 Momentary Time Sampling END of the interval Can be intervals of minutes or seconds Duration and Latency Both emphasize measures of time rather than frequency of behavior Duration how long the student engages in the behavior Latency how long it takes the student to engage in the behavior 46

47 Latency Recording Measures the time between the antecedent and the initiation of the behavior Duration Recording The behavior must have a beginning and an end Record Average duration used when the behavior occurs regularly. Teacher measures length of the time consumed in each occurrence and then finds the average duration for that day. Total duration measures how long a student engages in a behavior during a limited time period 47

48 Introduction to Graphing in Xcel Purpose of Graphs To organize data To inform goals To aid in communication between case managers, family, staff, etc. 48

49 What to report? Frequency recording: Rate (e.g., frequency self-injury per minute) Number of occurrences (e.g.., frequency of verbal aggression in 20 minutes) Interval recording: Number of intervals (e.g., 10 second intervals containing on-task behavior) if intervals are constant Percentage of intervals over an observation period (e.g., percentage of intervals without disruption ) What to report? Duration: Number of seconds/minutes/hours (e.g., duration of eloping (in seconds)) Latency: Number of seconds/minutes/hours (e.g., latency between antecedent and onset of behavior (in minutes)) 49

50 Walk through graphing example Guide to Graphing in Excel 50

51 Functions of Behavior (Activity) Guess that Function! Different areas of the room are labeled with a common function of behavior. Escape Attention of staff/peer Gain attention of staff/peer Escape Tangible/ Task Demands Gain Tangible Escape Sensory input Gain Sensory Input After hearing the scenario, move to the area of the room you think displays the function of the challenging behavior. 51

52 Guess that Function! Joy spends much of her time alone in her room. While alone in her room, Joy often engages in challenging behavior. After Joy engages in challenging behavior her staff come into her room and ask Joy what is wrong. Joy usually stops engaging in the challenging behavior once staff enter talk to her. Guess that Function! Hassan rarely engages in challenging behavior when few demands are asked of him and he is allowed to work at his own pace. 52

53 Guess that Function! Franklin engages in challenging behavior when he is in loud environments or when he is in large crowds of people. Guess that Function! When Luella is told she needs to turn off her favorite show, she will engage in challenging behavior. Staff often respond by negotiating with Luella for 5 more minutes of television time. 53

54 Guess that Function! When Chantelle engages in challenging behavior staff often respond by giving Chantelle access to her favorite weighted blanket which they feel helps her to calm down. Guess that Function! Maia engages in challenging behavior during dinner time when all of her room mates are together at the table asking her questions about her day. Staff often respond by allowing Maia to eat dinner by herself. 54

55 Contact Information Stephanie Benson Stephanie Benson, MA Institute On Community Integration, University Of Minnesota, Minneapolis MN Contact Information Jessica Simacek, PhD Rachel Freeman, PhD Erin Watts Julie Kramme 55

56 Preparation of this [presentation/report] was supported, in part, by cooperative agreement JPK%50470 from the Minnesota Department of Human Services. The University of Minnesota undertaking projects under government sponsorship are encouraged to express freely their findings and Conclusions. Points of view or opinions do not, therefore necessarily represent official MN DHS policy. 56