“Preventing a Crisis” Positive Behaviour Supports in the Workplace

1. “Preventing a Crisis”Positive Behaviour Supports in the Workplace Deirdre HayesBehaviour Support SpecialistKARE Deirdre Hayes

2. Objectives for today • Understand what is meant by ‘challenging behaviour’ and the factors that make behaviour challenging • Examine the various functions of challenging behaviours and identify and explore methods of identifying these functions • Introduce the concepts of Positive Behaviour Support and Applied Behaviour Analysis • Present the idea of multi-element support plans, and examine the four main aspects of them. • Briefly explore the various methods of increasing appropriate behaviours and decreasing inappropriate/challenging behaviours • Discuss the ethics surrounding the application of behaviour change procedures. Deirdre Hayes

3. What is challenging Behaviour? Definition: “Behaviour of such intensity, frequency or duration that the physical safety of person or others is placed in serious jeopardy; or behaviour which is likely to seriously limit or deny access to the use of ordinary community facilities” Emerson Deirdre Hayes

4. Deirdre Hayes

5. What makes behaviour challenging? • High intensity • High frequency • Wrong Context/Environment • Harmful (self/others) • Culturally inappropriate

6. Examples of Challenging Behaviours Property Destruction Self Injury Physical Aggression Excessive talking Poor Hygiene Not completing work tasks Excessive ‘comfort breaks’ etc Deirdre Hayes

7. What is the message? Functional Assessment: Method for investigating the possible function of the behaviour - What the person is trying to communicate Deirdre Hayes

8. Why challenging behaviour? Deirdre Hayes

9. Functions of Challenging Behaviour: Attention • Social Positive Reinforcement: Behaviour that is maintained by reactions from others. • Why? • Situations where attention is otherwise infrequent • Person doesn’t have a repertoire to gain attention in desirable ways • Others in the environment are typically otherwise occupied (work setting) Deirdre Hayes

10. Functions of Challenging Behaviour: Access to items • Tangible reinforcement: Behaviour that is maintained by access to reinforcing materials/stimuli. • Why? • Problem behaviour more consistently produces the desired item than appropriate behaviour (e.g. tantrum in public place more likely to provide item than asking politely). Deirdre Hayes

11. Functions of Challenging Behaviour: Sensory Stimulation • Automatic reinforcement: Behaviours directly produce their own reinforcement. • Only proposed to have this function if the person only engages in the behaviour when alone. • Examples: Head hitting, thumb sucking, skin picking etc. Deirdre Hayes

12. Functions of Challenging Behaviour: Escape • Social Negative Reinforcement: Behaviours are learned as a result of their effectiveness in terminating/postponing aversive events • Example: Person does work task incorrectly/does not complete task because some else will then complete the task for them. Deirdre Hayes

13. Functional Assessment Background Assessment Health – past and present Antecedents: What happens before the behaviour? Definition of behaviours – what the behaviours look like/frequency/intensity/duration Consequences: What happens after/as a result of the behaviours Context: Where/with whom do the behaviours occur?

14. Tools for Functional Assessment Functional Assessment Interview Form (O’Neill etal. 1997) Functional Assessment Observation Form (O’Neill etal. 1997) Deirdre Hayes

15. Functional Assessment Interview Form • Who should be interviewed? • People who know the person very well (family, key-workers etc) • The individuals themselves • What are the outcomes? • Description of the behaviours of concern • Identify factors that predict the non/occurrence of the inappropriate behaviour • Identify possible functions of the behaviours • Develop summary statements describing the relationships among situations, behaviours and their functions. Deirdre Hayes

16. Functional Assessment Observation Form • Where and when to observe? • Across settings, people, times of day • Who should observe? • Someone in direct contact with the person e.g. family, front line staff etc. • How long should data be collected? • Until a clear pattern has emerged showing some relationship between behaviours and environmental events indicating a potential function of behaviour. Deirdre Hayes

17. Positive Behaviour Support Definition: “PBS is a general term that refers to the application of positive behavioural interventions and systems to achieve socially important behaviour change” Deirdre Hayes

18. Basis of Positive Behaviour Support Respect and protect the rights and dignity of all involved Proactive strategies that emphasise environments, activities and choices that align with personal preference Reliance on principles of Applied Behavioural Analysis Use of strategies that are acceptable in community setting Deirdre Hayes

19. What is Applied Behaviour Analysis? Definition: “ABA is the science in which tactics derived from principles of behaviour are applied to improve socially significant behaviour” Cooper, Heron & Heward 2007 Tools of ABA: • Selecting, defining and measuring behaviours • Evaluating and analysing behaviour change • Examining what happens before a behaviour • Developing new behaviours • Decreasing inappropriate behaviours • Functional analysis Deirdre Hayes

20. What is socially significant behaviour? Social, language, academic, daily living, self-care, vocational, and/or recreation and leisure behaviours that improve the day to day life experience of the person and/or affect their significant others in such a way that they behave more positively with and toward the person Baer, Wolf & Risley, 1968 Deirdre Hayes

21. Multi-Element Behavioural Supports Non Aversive! Environmental changes Skills Teaching Direct Interventions Reactive Strategies Deirdre Hayes

22. Multi Element Behaviour Supports Proactive Strategies

23. Environmental Supports Purpose: To adapt the environment to better fit the person’s needs • Physical: Setting, light, noise, crowding, space, food and drink, sensory differences etc. • Interpersonal: Respect, communication, social interaction, friends, expectations etc. • Job: Choice, predictability, rules, motivation, opportunity to learn, variety, task difficulty, instructional methods. Deirdre Hayes

24. Skills Teaching Purpose: To teach the person ways in which they can manage their own behaviour. Types of skills: • General: Something fun, useful, age appropriate, in context, in the community e.g. using the internet. • Functionally Equivalent: A communication skill used in place of the challenging behaviour e.g. PECS, choice making, ‘I need a break’ • Functionally Related: Skills that support the equivalent skills e.g. conversation. • Coping and Tolerance: Helps the person cope/tolerate aspects of his/her life that cannot always be changed/controlled e.g. relaxation skills.

25. Direct Interventions Purpose: To get rapid control over the behaviour. Types of interventions: • Reward Contracts – Example: person receives an identified ‘reward’ (i.e. interaction from a colleague) upon completion of task. • Antecedent Control – Changing things you know could cause the behaviour to occur (e.g. if person has behaviours when hungry, ensure they have snacks available). • Stimulus control – Allowing behaviour but only under certain conditions (can crush cans - when sorting the recycling bin etc). • Satiation – Person has access to as much of the reward maintaining the challenging behaviour as they want before/after work – (e.g. chatting with friends). NB: Do not use this method with dangerous/addictive substances, or inappropriate situations (OCD, Prader Willi Syndrome etc).

26. Reactive Strategies Purpose: To get control of a situation safely and effectively, while keeping mindful of the person’s dignity and respect. • Crisis Prevention Training: Most agencies provide crisis training for staff (e.g. CPI training), and this should be implemented to de-escalate any crisis situation. • Behaviour reduction procedures: Procedures designed specifically to reduce the challenging behaviour e.g. time out, response cost (removal of reinforcers) etc. Note: The focus of positive behaviour supports is to be pro-active, thus reactive strategies are only implemented as a last resort. Deirdre Hayes

27. Increasing adaptive behaviours Reinforcement: A procedure that maintains or increases the future probability of a behaviour. There are two types of reinforcement: • Positive Reinforcement: The delivery of a reinforcer contingent on a behaviour/response. For example: Getting paid at the end of the week means you are more likely to go to work the following week. • Negative Reinforcement: The removal of an aversive stimulus contingent on a behaviour response. For example: I am more likely to put my seatbelt on to avoid the annoying sound my car makes when my seat-belt is open. Schedules of reinforcement: A description of when a reinforcer will be delivered Deirdre Hayes

28. Reducing problem behaviours Extinction: A procedure where the reinforcer maintaining the behaviour is withheld. For example – I make up stories to get attention from my colleagues, my colleagues start avoiding/ignoring me, which stops me from telling the stories. Punishment: A procedure that decreases the future probability of the behaviour occurring. There are two types of punishment: • Positive punishment: Application of an aversive event following a misbehaviour. For example: Having to sweep the floors (if you don’t like doing this!) because you were repeatedly late for work. • Negative punishment: Removal of an identified reinforcer following an inappropriate behaviour. For example: Being docked a percentage of your wages for being late to work. Satiation: Procedure in which a reinforcer is presented in unlimited amounts in order to reduce the value of the reinforcer and decrease the behaviour. Deirdre Hayes

29. Ethical Considerations Examples of questions you must ask before implementing a behaviour change programme: • Have the goals of treatment been adequately considered? • Has the choice of treatment methods been adequately considered? • Is the client’s participation voluntary? • When another person/agency is empowered to arrange for therapy, have the interests of the client been sufficiently considered? • Has the adequacy of treatment been evaluated? • Has the confidentiality of the treatment relationship been protected? • Is the therapist qualified to provide treatment? Deirdre Hayes

30. Ethical Considerations Least restrictive treatment model Definition: The least intrusive service or treatment that can effectively and safely address the clients needs and stated preferences. Deirdre Hayes

31. Some Research on Challenging Behaviour, Positive Supports & Supported Employment Stevens, P. & Martin, N. (1999) Supporting individuals with intellectual disability and challenging behaviour in integrated work settings: an overview and a model for service provision.Journal of Intellectual Disability Research, 43 (19-29). Ylvisaker, M., Jacobs, H.E. & Feeney, T. (2003) Positive Supports for People who experience behavioural and cognitive disability after brain injury. Journal of Head Trauma Rehabilitation, 18 (7-32). Bond, G.R., Drake, R.E., Mueser, K.T. & Becker, D.R. (1997) An update on supported employment for people with severe mental illness. American Psychiatric Association, 48 (335-346). Deirdre Hayes

32. Thanks! Deirdre Hayes KARE Support Services, The McMahon Centre, Kilcullen, Co. Kildare 086 3835659 deirdreh@kareld.com Deirdre Hayes