UNIVERSAL Positive Behavioral Supports Creating Healthy Responsive Environments 1 Day Workshop

1. UNIVERSALPositive Behavioral SupportsCreating Healthy Responsive Environments1 Day Workshop Massachusetts Department of Developmental Services June 2014 Patricia Cronin, Ph.D. Barbara Peebles Valarie Whiting, Ph.D.

2. Today—what you will learn Understand that behavior tells us something Understand what PBS is Learn about basic Universal Support strategies Understand that PBS is a person-centered, strengths-based approach to services and supports Become familiar with terms used by teams when implementing PBS

3. DDS’ Definition of PBS Positive Behavioral Supports is a systemic, person-centered approach to understanding the reasons for behavior and applying evidence based practices for prevention, proactive intervention, teaching and responding to behavior, with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan.

4. What PBS IS NOT…. http://youtu.be/YkFb-g7SAOk

5. Characteristics of PBS Understand communicative/function of behavior Understand that environment/context in which behavior occurs is important—change environment--early recognition and intervention Prevention rather than reaction to behavior Range of interventions and strategies: change environment, routine, expectations, task demands, teach Strengths-based, Person-Centered approach—holistic: person’s wants, needs, dreams, preferences Variety of interventions, including education, habilitative, psychological. Evidence based strategies and reviewed (data, observation, adjusted as needed)

6. So, to review, PBS….. • Focuses on preventing problems, rather than reacting to them (proactive) • Focuses on changing the environment, to change behavior and outcomes-easier to change environment than to change the person • Focuses on teaching skills aimed to replace the undesired behavior and/or learn prosocial and more effective behaviors • Person-centered • Targets self-regulation of behavior (not just behavior change) • Positive, capacity focused: strength-based Source: Rehabilitative Research and Training Center. Learnet.org What are Positive Behavior Supports?

7. What is Behavior? How can we tell if someone is behaving? Anything we say, do, think, feel is behavior. Behavior happens all of the time—mostly good, neutral, sometimes we consider some behaviors to be problem behaviors. Behavior happens for a reason—what’s the function of behavior? Behavior serves a purpose. Behavior is communication. Listen to a person and their actions in different ways—especially if people don’t use words to communicate

8. This process is accomplished by determining, with the person, what is important TO them and by LISTENING in new ways to their behavior. • Behavior is communicative and is telling us something. All behavior serves a purpose. http://youtu.be/IP0SQIIErMg

9. Exercise: How do we listen to behavior? How do we ‘listen’ to what people are telling us when they don’t use words, or even if they do? ► Talk about the different ways that people communicate information to each other, especially when they can’t use words to easily communicate?

10. Exercise Take a guess at what we think the person’s behavior means? Identify a person you work with and complete the following: When the person does _____, we think it means ______, so we _______. Discuss possible strategies that could be used with the person.

11. PBS is a Strengths-Based, Person-Centered Approach What contributes to a person’s well-being—across different settings in their lives? ►Control, perceived control ►Preferences ► Health ► Reliable preferred routines ► Growth ► Relationships

12. 3 Tiers of Support of PBS Only a few need it all Some need more Everyone gets it Begin to think about the 3 tiers of support: • Individualized • Targeted • Universal

13. PBS Universal Supports Provide environments that offer opportunities for healthy, happy lives PBS systems and practices benefit everyone Developed with individual’s preferences in mind (routines, consistency, choice, praise, activities, etc.)

14. PBS Universal Supports Are always in place for everyone, ALL of the time Enhance quality of life All activities, plans, routines, learning opportunities reflect individual’s preferences, needs, goals Socially appropriate behavior taught, expected, encouraged Sensible expectations developed in all settings Individuals given choices and have lots of opportunities to engage in preferred activities Staff are skilled, knowledgeable, caring-staff are teachers

15. Universal supports create physical and social environments that are positive and responsive. ENVIRONMENT plays a BIG role in the well-being of a person.

16. Check out DDSLearning.com website http://ddslearning.com/dds-pbs-initiative/ Check out this website to learn more about PBS and Universal Supports…..

17. Environmental Universal Supports Create environments that are predictable and consistent with routines and preferences of person Understand why people do what they do--Figure out what motivates people Best guess about what we know from and about people Listen to people in different ways Be flexible as we listen and implement strategies

18. Exercise Think of a home, class, day program, or other group setting and identify some strategies you would use to create an environment that is predictable, safe and consistent with the preferences of the individuals in that setting and their learning new skills.

19. Creating an Environment Supportive of and to the Person What do we mean by an environment? ▷ physical set up ▷ structure, routines-positive, well understood ▷ staff who interact with the people ▷ all the people in that setting ▷ broader environment ▷ similar past experiences in similar settings

20. Universal supports provide environments that are.. Pleasant to be in Responsive to needs, wants, preferences of people living in them Enhance the quality of life of the person and people so that people are successful Routines/schedules predictable, consistent Sometimes need to change the environment, get someone into a different environment Important to figure out what is important TO a person

21. Exercise What could staff have done differently? Name 3 things that a staff person could do in this situation.

22. Create opportunities for someone to exert individual control We like to feel that we are in control, of at least certain aspects of our lives—choice—person has preferred activities in their lives When someone takes control of a situation, person may feel out of control—often becomes a power struggle Is there a way to give the person more control? What does he/she want? Ask them. Provide a short list of choices/suggestions (pictures?). What’s your big picture? Big goal? Don’t sweat the small stuff.

23. Debbie’s Story Read story What could staff have done differently?

24. Create a win-win environment by trying another way What is the goal? Offer opportunity? Provide something important? Health/safety risk? Is there another way to reach the goal? Daily opportunities for choice making throughout daily lives in all settings—preferred activities Identify multiple opportunities— “Find the good and praise it.” Alex Haley Rule of 4: 4 positive statements to 1 negative statement Change environment to decrease likelihood of undesired behavior

25. Redirect Behavior….ways to do this Redirect behavior—often easier that confronting it ▷ Ignore undesired behaviors whenever possible if not a health/safety risk ▷ Use nonverbal gesture to direct… ▷ Always model acceptable way to deal with situation ▷ Staff remain calm, in control, clearly state behavioral expectation ▷ Offer activity, engage in a behavior that is incompatible with undesired behavior ▷ Always try to redirect person to appropriate behavior/activity

26. Create an atmosphere that allows a person time to think… Many people with intellectual disabilities need some time to process what is asked of them. Get someone to do something they want to do-like to do. Create an environment of YES.

27. CHOICE: Offer Real Choices Can you think of ways to specifically offer real choice that is based on desired preferences? Ways to enhance choice making: ► Schedule daily opportunities for people to make choice decisions throughout their daily routines in all settings ►Provide and plan as many choice-making opportunities as possible ► Doing so will help people learn, accommodates different learning styles, helps them finish tasks, increases positive behaviors

28. People don’t like to be ordered around. They’d rather make choices on their own Avoid power struggles and recognize if you are in one. Stop. Short break If you stop, back up, consider your next action—break cycle. Other person can consider what’s really happening Redirect behavior that is not pro-social

29. Three questions for staff about choice Why should I do it? When should I do it? How do I do it?

30. Why should I do it? • Way of empowering a person • Prevents power struggle • Makes a person feel engaged and a part of the decision making process • Increase prosocial behavior • People respond better to choices • Improved coping when having to do an undesired task • Decreases conflicts, refusals, defiance, and opposition • Builds rapport

31. When should I do it? • Offering a person choices should be a regular part of the day • When telling anyone to do something or giving a directive • When a person is reluctant to do something • When a person is stuck on making a decision • When a person engages in a power struggle or is argumentative • When a person is having a difficult time • When a person make excuses • When students are reluctant • When giving consequences • When giving rewards

32. How do I do it? • Speak in calm, neutral tone • Provide a person with two or more choices that you will fully accept, for example, “you can either do your work sitting at your desk or sitting at the table” • Present the entire group or house with choices when assigning work, for example, “you can either do the mall or the grocery store, you choose” • Give choices when rewarding, for example, “John, do you want computer time or a fancy pen?” • Develop task completion picture board • Provide list of preferred activities to select from • Opportunities to make choices throughout daily routines

33. Exercise—with a partner…. Discuss a person you know and how offering choices (additional choices) would affect their lives. When during the day could you increase choice making or add opportunities to make choices? Switch & share

34. PRAISE: Help person succeed Universal PBS supports create environments that let a person succeed—believe that it is possible, be positive If in a difficult situation, begin with a choice that leads to successful behavior (want juice or water with your meds?)

35. Create environment that lets someone know they had done a good job/something right--PRAISE Identify opportunities to praise and encourage specific behaviors—do so consistently—encourage prosocial behaviors Discover what motivates people and fill the person’s life up with enjoyable things to do We respond better to positive than negative consequences.

36. Three questions for staff about offering praise Why should I do it? When should I do it? How do I do it?

37. Why should I do it? • Some people need outward motivators • It helps keep people engaged • Provides encouragement • Boosts confidence, self-concept, and self-esteem • Increases buy-in • Builds rapport and trust • Is uplifting • Increases persons’ desire and drive to please and succeed • Increases persons’ resilience • Helps embed an internal desire to try, succeed, and persist • Helps people to push through difficulty, barriers, blocks, etc

38. When should I do it? • Positive praise, according to research, should always be done with every person at a ratio of at least 4 positive praises to 1 criticism • When a person is stuck, frustrated, getting bogged down, etc • When a person exhibits good behavior, expectations, help others, show generosity, share, etc • When a person puts forth good effort • When a person succeeds, overcomes, persists, pushes through, achieves, etc • When a person demonstrates positive behaviors

39. When a person uses productive coping skills, problem solving skills, etc • When a person is independent, self-start, etc • When a person looks down, needs encouragement, is having issues, personal difficulties, peer conflict, etc • When you want to increase a positive behavior • When you want to improve trust and rapport with someone • When a person steps outside their comfort zone, looks embarrassed, seems to feel stupid, takes a risk, etc

40. How should I do it? • Praise, according to research, should be given in a ratio of at least 4 praises to 1 criticism • When a person display positive or productive behaviors, actions, skills, characteristics, etc, or appear to need some encouragement, etc, verbally praise the person and/or give them a high-five, pat on the back, clap, exclamation, cheer, hop, etc • Praise can be done either quietly or if the person is motivated by peer approval, in a group • Praise can be verbal or physical (like pat on the back, fist pump, head nod, hop, jump, etc)

41. When delivering praise, use direct eye contact, positive demeanor, open body position, and get to the level of the person if possible Make praises specific, personalized, and individualized Repeat praises if the person seems unconvinced at the first stating of the praise Restate praises in different ways to get the point across.

42. Exercise Get a partner, discuss a person you know and how praising them would affect their lives. Switch.

43. Creative a positive, proactive YES environment • Don’t just say NO and STOP • Think of ways that a person can feel in control of their life.—Andrew’s story • PREPARE—It doesn’t always work • Learning new skills and having opportunity to practice these skills, creates positive environment for someone to succeed

44. Seven Actions: Things you can do right now.. 1. Be sure that people know what you are asking them and what is expected in a given situation 2. Offer opportunities for choice – especially for those things that are important to someone 3. Tell people when they are doing a good job or doing something right 4. Ask someone to do something else if what they are doing is socially unacceptable

45. 5. Interact with people in a positive, proactive way – assume the best in them 6. Look for opportunities to teach someone more appropriate things to do, wherever you are 7. Create a positive, responsive environment so someone is offered opportunities to be successful

46. Exercise In a small group, list 3 actions that you can take to create a happy, responsive environment for the people you work with. Discuss specifically what can happen on a big scale in your agency, house, etc., as well as what can happen to increase the quality of life for one person.

47. Summary Behavior IS communication Relationships ARE important We need to listen in new ways to people We need to be mindful of our own behavior and their consequences Give people meaningful choices Let people know when they are doing something the right way Create a positive, responsive environment which increases the likelihood that someone will be happy Think of ways to say Yes, instead of No/Stop Assume that people are able

48. Remember…. • PBS focuses on prevention, not reaction • PBS is all about teaching people skills and knowledge to improve their lives