Challenging Behavior in Natural Settings: PBS: What the Research Says

1. Challenging Behavior in Natural Settings: PBS: What the Research Says Kathryn Hoover, Ph.D. Radford University, Radford, VA April 30, 2008

2. Introductions and Overview • First, who I am • Next, who are you? • Overview • Rationale for addressing challenging behavior • Discussion/Definition of terms found in the research • Research based steps to Positive Behavior Support with group work to practice each step in the process I hope one of you will provide us with a case study so we can apply these strategies to real life situations. Please remember to respect the confidentiality of the child and family (no identifying information), and to describe objectively what the behavior looks like—just what can be seen, try not to interpret yet. Hoover, 2008

3. What Children Need (and Seek) • Children need to be able to predict and control as much as they can in their world • How do infants control parent behavior (when hungry, tired, dirty diaper, frightened, etc.—what do they do? And what do parents do?). Children become adults. • Did you make your own decision to come to this workshop? How important is the control of your life to you? It is important to children, too! • To be predictable, the environment needs to be consistent, and provide structure and choices within limits • Research shows that teachers respond more predictably to challenging behavior than appropriate (Jolivette, Stichter & McCormick, 2002; Nielsen & McEvoy, 2004)—given that, how do you think a child who needs predictability is more likely to act if they need predictability: appropriately or ? Hoover, 2008

4. Why is it important to address challenging behavior? • What children risk if they take challenging behaviors to day care, preschool, school: • Rejection by peers (and by programs!) • Negative interactions (relationships) with teachers: sets children up for negative relationships in future • Probable negative impact on family and family relationships (for all members) • Risk of later substance abuse, delinquency, unemployment, etc. (Powell, Fixsen, Dunlap, Smith & Fox, 2007) • What can we do? • Positive Behavior Supports in all environments (focus time and attention on prevention of challenging behavior: how to do it) (Boulware, Schwartz & McBride, 1999). Hoover, 2008

5. First, Some Definitions • PBS Terminology Handout • Terms you will hear as we discuss PBS and FBA: • PBS: Positive Behavior Support/s • FBA (Functional Behavior Assessment) • Challenging Behavior: (why not ‘misbehavior’?) • Environment (includes surroundings, people, things) • Antecedent events or triggers • Consequences • Positive Reinforcement (reinforcers) • Punishment • Function of a Behavior • Attention, escape, tangible, sensory Hoover, 2008

6. Just a few more Definitions • Replacement Behavior (communication included) • Altering antecedents (environment) • Family-Centered Intervention: COLLABORATION • Contextual fit: any plan to address challenging behavior must fit into the needs of the child AND the family, and the abilities and comfort in implementing the plan of family members; and fit into the routines and daily work of the family • Shared decision-making and responsibility • Why is this crucial? • Research shows that families can learn to conduct FBA’s and implement Behavior Intervention Plans (Tyrell, Horn & Freeman, 2006) Hoover, 2008

7. OK, now let’s get to it! • Prevention of Challenging Behavior at Home or in a Program (child care, classroom): • Focus on Teaching Social Skills to Prevent Problem Behavior • First, identify the social behaviors that you want the child to learn (communication is a social behavior) • Then, Teach those behaviors: all adults use the same language: “’We say please when we want’ (a toy)” • Respond consistently to appropriate prosocial behavior –give the child feedback so she knows how she is doing (remember, if we are only consistent when we ‘punish’ they will seek punishment when they need predictability) Hoover, 2008

8. Instruction in Discipline • First, set up a few simple rules (pick your battles): state what the child is to do (not what she is to not do) • Example: “Toys are for playing” “Hands stay on your own body” “Feet stay on the floor” “Walking feet in the hall” • Next, decide how you will respond to the child when a rule is ‘broken’ (natural fit, not punishment for children under 18 months-2 years, do-able, and all commit to do it) • TEACH the desired behavior, don’t just expect the child to learn it without instruction • Then ALWAYS respond as planned when a child breaks a rule (act, do not react: not in anger); explain why the consequence is being delivered, and how to avoid in future: “If you throw a toy, the toy is gone for now. Are you all done? Then show (or tell) me ‘all done.’” Hoover, 2008

9. What if it doesn’t work? FBA • Basic Steps of FBA (based on Boulware, et al., 1999) • Identify the problem (define the behavior) • Gather information: observations, checklists, interviews • Brainstorm possible functions and possible solutions • Make a plan • Implement the plan • Evaluate the results • Steps of FBA Handout 1 • Does anyone have a situation you would like to share with the group? Then you will do this as small groups for another child: real life or case study Hoover, 2008

10. Steps of FBA: Identify the Problem • Identify the Problem • With family, decide what the problem is: sometimes clear (aggression) sometimes not clear (tantrums at ‘unpredictable’ times: transitions/change or “No” etc.) • Helps to identify when it occurs, with whom, and what it looks like (tantrum: what does it mean?) • Very important also to know when the behavior DOES NOT occur! • So with our case study: • What is the problem? What does it look like? • When does it occur? With whom? (with what?) • When does it NOT occur? • Now, with your handout 1, get in groups and do as small group (10 minutes) Hoover, 2008

11. Next Step: Gather Information & Hypothesis • Gather Information • Interviews (formal or informal) with family, other care givers, (bus driver, etc. for school setting) • Motivational Assessment Scale: MAS (handout is old version): several who interact with child complete • Observation: ABC chart (handout) • Antecedent—what happened before behavior • Behavior (describe what you see) • Consequence—what happened after, which is probably reinforcing the behavior, to keep it effective • The Consequence often then becomes the Antecedent for the next cycle of ABC Hoover, 2008

12. Gathering Information and Hypothesis • Also need to ask: • How does the child communicate? All behavior communicates—is lack of appropriate communication a major factor in the behavior? • What predicts the behavior? • Hypothesis: • When _________ happens (antecedent), the child ________________ (behavior) in order to get ________________(consequence); therefore the function of the behavior is _________________. For our case study child, can we hypothesize? So now, with FBA Handout 2: complete—10 min. Hoover, 2008

13. Step 3: Make a Plan • The Purposes of the Plan are: • A. Prevent the challenging behavior; • B. Help the child be successful in the situation; • C. TEACH a REPLACEMENT (appropriate) behavior which will serve the same function (achieve same goal); and • D. what will you do if the behavior still occurs (sometimes called ‘crisis intervention plan’) Hoover, 2008

14. A) Prevent the Behavior (most important!) • First, Look at the environment: what are the antecedents (triggers) and can any of them be changed so the behavior is reduced? Can you: • Change the room arrangement; amount of materials, location • Adapt the schedule (are you rushing the child when he needs more time for an activity? Do you plan nap time after outside?) • Modify activities or tasks: is it too hard? Too easy? Boring? • Provide cues for the child: transition cues: verbal, visual, model • Ignore inappropriate behavior if not harmful or destructive • Redirect or distract the child • Remind child/ren of the rules, teach/review the rules before situation; point out appropriate behavior (target behavior) • Give choices: a very effective preventative strategy (McCormick, Jolivette & Ridgeley, 2003) Hoover, 2008

15. Prevent: Offering Choices • Helps promote self-determination, gives ‘control’—prevents or resolves a lot of power struggles! • Opportunities can you give a child to make a choice? 1) Order of tasks, materials (which color?) 2) Where to do it (living or kitchen?) 3) Person to go/do with 4) Partner (peer) 5) Which activity afterwards 6) When to take a break 7) When to end and do something else “Do this or go to time out” is NOT giving choices! • Choices must be honored –don’t offer if not available • Who should ultimately control the child’s activities, career, life when she is an adult? So teach now. Hoover, 2008

16. Skills children need to be able to make choices • Be aware of the options(understand) • Show them object, activity, or picture if they understand pictures • They need to have favorites (preferences) • Activities, events, people, objects • Be able to show you their choice • Reach for it, point to it, gesture, name it • Be able to make a choice when offered options • Be able to engage in the choice (play with it) • You can teach any of the above Hoover, 2008

17. Choices • Young children need choices within the activity or right before the next activity • For example: the child does not like his bath: “Joey, do you want Daddy or Mommy to give you a bath today?” (only if both are available) • Or: a child does not like to come in from outside, so a few minutes before it is time to go inside, ask “Carrie, do you want to watch your movie or help me with dinner when we go inside?” • The adult controls the choices, but give the child control over which to choose, and honors the choice. Hoover, 2008

18. B & C: Help the Child be Successful: Teach Prevention is a major part of success for the child Teach a Replacement Behavior is the next most important part of the Plan First identify what behavior will achieve the same goal (perform the same FUNCTION) Then decide how best to TEACH the child that behavior Is it a need to ask for a break? Understand the schedule or order of the day? Have control over some part of the task? (choices) Need more sensory input? Tell the child what she can do, show her what to do, and practice (role play) what she can do (when she is calm, and teachable) Include exactly what to say to the child in the plan Hoover, 2008

19. D. Crisis Management Plan • What will you do if you try all of these things (or until the plan has been developed and is in place) when the behavior occurs? • Needs to be respectful of the child: feelings, needs, age appropriate, not punishment but consequences to protect the child and others—this is a temporary stopgap • Example: interrupt the behavior: “You may not ________ because _________” and physically walk the child to the quiet area “You are _________ (label the emotion), let’s go to the quiet area until you are calm (define: “your voice is quiet” or “your feet are quiet”) then we will talk”. If child can be left, leave, if not stay and provide gentle physical support, not punishment, just help to be calm, while protecting yourself) then come back (or when calm) praise for regaining calm, and redirect or calmly review rules, encourage to try again, etc. Hoover, 2008

20. Prevent, Teach, Crisis Management • So with our case study child, what might we do to prevent the behavior? • What behavior might we teach him or her? • How? • What can we do if it occurs before learning takes place? (Crisis Management Plan) • With Handout 3, answer these questions in your group—NOTE that at every step you will ask the family if it will work for them—they will implement • AND Complete the Support Planning Chart • 15 minutes Hoover, 2008

21. Implementation and Program Evaluation • Now, with the plan developed, it is time to prepare to implement the plan • First, all those who will implement (family, child caregivers, teachers, therapists, etc.) need to be comfortable, and feel they can do it! • May need support to change the environment, change the way they talk to the child, etc. • Decide how it will fit into the routines of life • May want to practice: role play child, parent or teacher, and let them practice the plan • Role play crisis intervention implementation Hoover, 2008

22. Evaluating the Plan • After implementation begins, evaluate the plan • Handout 4: Evaluation: You want to know: • 1—How effective is the plan • Is the behavior happening less frequently? • Is the child learning and using the replacement behavior? Is the child more successful? • 2—Is the problem solved to the satisfaction of the family (and teacher if appropriate) • Is the behavior decreased enough? Does the intervention fit with daily life activities in the family (classroom), etc. • If not, go back to brainstorming; create another plan Hoover, 2008

23. Positive Behavior Support Works! • Remember, challenging behaviors have been developed over time, and it will take time and work to re-teach the child appropriate behavior • The adults must change their behavior first (ignore, redirect, change antecedents, teach, etc.) before the child’s behavior will change • Putting the effort into changing antecedents is worth the effort—it may be all that is needed! • Remember, it is for the child’s future! • Please complete my evaluation before you leave, thank you. Hoover, 2008