positive behavior support intensive training · positive behavior support intensive training...

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Positive Behavior Support Intensive Training

Positive Behavior Support StrategiesDay 4

Objectives

• Intervention Strategies

• Strategies for Preventing Challenging Behavior

– Setting Event Interventions

– Antecedent Based Interventions

–Where to locate resources

• Consequent Based Interventions

‒ Strategies for Reducing Challenging Behavior

– Strategies for Increasing Appropriate Behavior

– Where to locate resources

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Positive Behavior Support

FBA/PBS Plan (Individualized

intervention, close monitoring of data)

Implementing Multi‐Tiered Systems of Support

Targeted intervention (small groups, certain areas/sites, less individualized,

increased monitoring of data from Tier 1)

Universal (everyone in organization, matrix(es), “big

data” (e.g., incident reports), QOL, workforce data

(attrition, turnover, etc)

Tertiary Tier (3)

Secondary Tier (2)

Universal Tier (1)

Reviewing/Wrapping up FBA

• 245D requirements for FBA (Mn Rule 9544.0040)

–When is an FBA required?

–Who is qualified to complete an FBA?

–What are required elements in an FBA?

https://www.revisor.mn.gov/rules/9544/

https://www.revisor.mn.gov/statutes/cite/245D

• Other settings/funders (e.g., schools, what are the requirements..)

Example Tier 1 Intervention

• Incident reports at a particular employment site suggest that 44% of problem behaviors occur in the break room area and outside the building

Intervention‐

• Increased staffing around break room and outside building paired with a system for reinforcing good behavior

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Tier 1: Teaching to and Monitoring Your Matrix

Example Tier 2 Intervention

• John, Pete, and Eduardo sometimes get into loud arguments that so far have not yet escalated into aggression.

– These arguments have focused on disagreements regarding T.V. shows (they share a T.V.)

Intervention

• Tutoring sessions have been held to introduce a T.V. schedule housed next to the television.

Example Tier 3 (Tertiary) Interventions

• Teach alternative skills that are equivalent to and potentially more efficient than problem behavior

• Teach skills that enhance self‐regulation

• accept signaled delay

• accept delayed reinforcement

• teach self‐monitoring skills

• (and many others)

Setting Event and Antecedent Interventions

Alternative Skill Instruction

Consequent Interventions

• Modify or eliminate setting events

• Implement tolerance for delay in delivery of reinforcer

• Implement within or across task schedules

• Change others interactional style

• Provide instructive feedback

• Introduce logical consequences

• Provide reinforcement for appropriate behavior

• Differential Reinforcement Strategies

• Non‐Contingent Reinforcement

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PROMOTING PRO‐SOCIAL BEHAVIOR AND PREVENTING INTERFERING BEHAVIOR

Setting Event Interventions

Behavior Pathway

Desired Behavior

Problem Behavior

AntecedentSetting Event

Alternate behavior

Natural Consequence

Maintaining Consequence and Function

Types of Setting Events

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Types of Setting Events

Example Setting Event Interventions

• Minimize or eliminate the setting event

• Design interventions that are implemented when setting events may be present

• Neutralize the setting event (ear phones in noisy environment)

• Add more prompts for desirable behavior (offer free assistance to lessen aversiveness)

• Increase the value of reinforcement for desirable behavior

• Offer alternative reinforcer (attention during difficult task if learner enjoys attention )

PREVENTING CHALLENGING BEHAVIOR

Antecedent Interventions

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Behavior Pathway

Desired Behavior

Problem Behavior


Alternate behavior

Natural Consequence


Antecedents

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


• PREVENTION

– Change the trigger (antecedent)!

–Make the behavior irrelevant

– Address the function AHEAD of time!

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Example Antecedent Interventions

Tier 1 Interventions

– Preferred Items as Distracters

– Choice

– Environmental arrangement

– Environmental enrichment

– Instruction Delivery Method

– Implementing pre‐activity interventions

– Using highly preferred activities/items to increase interest level



• Behavior Contracts

• Teaching Relaxation Skills

• Teaching Mindfulness

• Schedules

– Structuring time

– Structured Breaks

– Sequencing of high/low preference activities



• Functional Behavior Assessment (FBA)• Tolerance for Delay in Reinforcement• Contingency Maps• Competing schedules of Reinforcement

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Environmental Arrangement

• Environmental arrangement involves purposefully planning the placement and organization of classroom materials, furniture, and activities to promote appropriate behaviors and decrease the likelihood of problem behavior.

• Research has demonstrated environmental arrangement can lead to increases in the frequency of communicative acts and social interactions

Preferred Items as Distractor

• Preferred items as a distractor engages an individual in an activity or gives the individual an object to distract him/her from the activity or event that typically results in the challenging behavior. The individual is usually offered an item that he/she likes and one that does not interfere with the activity when he/she is given the request.

Preferred Item as Distractor

When to Use It

• most effective for behavior that are maintained by escape for a task or demand.

• when engaging in a preferred activity does not interfere with the student completing the preferred activity. For example, an individual may be able to listen to music while performing a simple task.

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Preferred Items as Distractor

Why Does it Work?

• Distracts learner from an aversive component of task.

• May establish persons associated with the task as reinforcers.

• May assist in recruiting social attention from others during more unpleasant activities.

Schedules

• Uses a group of symbols (objects, pictures, written words) to represent the order of events across a period of time.

• Used to organize sequences of time or steps in a task

• Real objects, photographs, picture symbols or written

– Words can be used to represent the activities

• Implemented during transitions between environments and/or activities for many individuals

Schedules

Why do they work?

• Enhances predictability

• Provides choices for learner

• Gives learner control

• Provides the learner with attention

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Sequencing High/Low Preference Activities

• Arranging an individual’s schedule so that high preference activities immediately follow low preference activities.

Schedules

Schedules can be

• Event Based

• Time Based

• Incorporate Choice

Schedules

• Schedules can occur WITHIN or ACROSS activities

Examples:

• Daily Schedule‐across

• Picture Recipes‐within

• Community Shopping‐within

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Tolerance for Delay in Reinforcement

Often individuals with disabilities have difficulty accepting delayed reinforcement or delays to accessing preferred items

Tolerance for Delay in Reinforcement teaches the person to (a) remain engaged in a task/activity, or (b) wait for a desired object/attention for increasingly longer periods of time.

Tolerance for Delay in Reinforcement

Example

During her work, Margaret starts to complain that she wants to leave. The job coach says, “ two minutes and we’ll take a break.” Contingent on no problem behavior and continued engagement during the next two minutes, she takes her break

Activity

• Create an antecedent strategy for a person you have supported in the past (or choose one from handout)

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CONSEQUENT BASED INTERVENTIONS

Strategies to Increase Adaptive or Contextually Appropriate Behavior

Reinforcement should be…

• Contingent

– On the behavior’s occurrence

• Immediate

–When initially reinforcing a new behavior

– Acquisition

• Competing

– There are many reinforcers in the world

– Sometimes peer attention (laughter) is more reinforcing than staff attention

Types of Reinforcement

• Primary

– Edible

– Sensory

• Secondary

– Tangible (item)

– Privilege (TV decider)

– Activity (special outing)

– Generalized (tokens)

– Social (smiles)

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Primary

• Stimuli with biological importance

– Food, liquid, sleep, shelter

– Sensory

• Deprivation

• Satiation

• What to do?

– Individual selects reinforcer

– Particular reinforcer to a particular task

– When satiation occurs, switch to new reinforcer

– Shorten the instructional session

– Decrease the size of pieces

– Do not reinforce every correct response

– Use multiple reinforcers, including natural ones

Secondary

• Do not have biological importance

• Their value has been learned or CONDITIONED

• Should eventually replace primary reinforcers

• Tangible

• Privilege

• Activity

• Generalized

• Social

Pairing (Conditioning)

• How do secondary reinforcers get their value?

• PAIRING – combining primary and secondary reinforcers

– “Good Job” – while giving an M&M

• Establish association, then gradually withdraw primary reinforcer

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Social Reinforcers

• Readily available

– Expressions (smile)

– Proximity (for appropriate and inappropriate behavior)

– Contact (fist‐bumps, hand on shoulder)

– Privileges (choose dinner menu)

–Words and phrases (“good job”)

Activity Reinforcers

• Use the Premack Principle

– Low frequency behaviors have low probability

– High frequency behaviors have high probability

• Pair low frequency behavior with a high frequency behavior as a reinforcer

• Example:

– Demetrius likes cooking. He hates doing laundry. You say, “Once you put your laundry in the machine, we can get started cooking dinner.”

Activity Reinforcers ‐ Limitations

• Cannot always do high‐preference activities right after behavior occurs

– Going to the gym

• An activity can be all or nothing

– You earned it or you didn’t

– Unless it is in increments of time

• Can be available to individuals regardless of behavior

• May cause interruptions in good behavior!

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Generalized Reinforcers

• Associated with a variety of other primary or secondary reinforcers

– Social – attention/praise

– Exchangeable – money/tokens

• Advantages

– Reinforce at any time without interruption

–Maintain performance over extended periods – less subject to satiation

– Provide same reinforcement to people with different preferences (individualization possibilities!)

Generalized Reinforcers – Token Economies

• Think through your system

–When will tokens be exchanged?

– How will you prevent “banking” of tokens?

– How will you prevent counterfeiting?

– How will you individualize?

• Mn Positive Support Rule 9544: cannot be punishment or cost response for a token system.

Contracts

• Systematic

• Put it in writing

• Include

– Behavior, Condition, Criterion, Reinforcer

• Rules:

– Immediate reward

– Successive approximations (shaping)

– Frequent, small rewards

– Reward accomplishment rather than obedience

– Reward AFTER behavior occurs

– Must be fair – reward matches behavior

– Clear terms

– Honest – you can carry it out

– Positive (I will do, if you do NOT I will do if you do not do)

– Consistent!

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CONSEQUENT BASED INTERVENTIONS

Strategies to reduce interfering behavior

Behavior Pathway

Desired Behavior

Problem Behavior


Alternate behavior

Natural Consequence



• Plan to eliminate/reduce challenging behavior

• Plan to reinforce both

– ALTERNATIVE behaviors

– DESIRED behaviors

• Do this from the beginning to establish those natural consequences!

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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.

Differential Reinforcement

Why it should be used:

• Positive approach

• Reinforcement‐based procedure

• May progressively change behavior

• Able to plan for fading reinforcement and/or natural contingencies

Summary of DR Procedures

Purpose Management Objective

DRLReduce behavior to acceptable level

Focus on reducing # of occurrences

Tom will be out of his work area no more than 2 times in 40 minutes

DROReduce behavior to zero occurrences

Focus on increasingtime of nonoccurrence

Tom will have no occurrence of leaving his work area in a 40‐minute period

DRIDRA

Reinforce a functionalalternative behavior

Focus on developing functional alternative behavior

Tom will press a button to indicate he wants to take a break instead of yelling and face slapping

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Differential Reinforcement of Lower Rates of Behavior (DRL)

• Schedule used to decrease the rate of behaviors

– These behaviors may be tolerable or desirable in low rates, are inappropriate when they occur too often or too rapidly

• Examples

– Sharing in group discussion? AWESOME!

• But not when you dominate…

– Making a mistake and leaving your work area without permission? IT HAPPENS…

• But it’s not okay when it happens all the time…

DRL – “How‐To”

• Baseline

• Compare the total # of responses in a session with a preset criterion

• Reinforcer is delivered if occurrences are below that criterion

• Can do with the following schedules:

– Full‐session

– Interval (may be able to increase length of interval)

– Changing criterion

DRL Guidelines

• Determine baseline but keep taking data

– The average # of responses can be the initial DRL limit

• Avoid reinforcing too frequently or not enough (but consider the need to fade…)

• Will you give the individual feedback?

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DRL ‐ examples

• Jill interrupts an average of 9 times per 30 minute session. If she interrupts no more than 2 times every 10 minutes, she gets a token at each interval

Differential Reinforcement of Alternative Behaviors(DRA)

• Replacement behavior!!

• Reinforce the alternative behavior so the inappropriate behavior decreases

DRA – “How‐To”

• Baseline

• If the individual attempts the challenging behavior

– Ignore (place on extinction) and appropriate behavior is reinforced

– Inappropriate behavior is interrupted and redirected

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DRA criteria

• Alternative behavior

– serves the same FUNCTION

– Is more appropriate

– Requires equal or less effort and complexity

– Results in same reinforcement

– Reinforced on the same schedule

DRA ‐ examples

• An individual with autism is reinforced for drawing pictures with colored markers rather than stereotypically flipping the markers or paper in front of himself.

• Reggie is reinforced for clipping his fingernails and biting his fingernails is ignored.

Differential Reinforcement of Incompatible Behavior (DRI)

• Similar to DRA procedure

• Reinforce a behavior that is topographically incompatible with the behavior targeted for reduction

– Screaming/normal voice

– On task/off task

– Running/walking

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DRI – “How‐To”

• Behavior that is incompatible is chosen

– You cannot do these two behaviors at the same time!

• Baseline

• Choose schedule of reinforcement

– Thin the schedule

• Reinforce appropriate behavior

DRI ‐ examples

• Reinforce individuals who are in their seat for meal time because you can’t be in and out of your seat at the same time.

• Give Idina a mirror to hold (she loves mirrors) so that she doesn’t grab or hit staff transferring her to her wheelchair.

Differential Reinforcement of Other Behaviors (DRO)

• A reinforcing stimulus is delivered contingent on the target behavior’s NOT being emitted for a specific period of time

• Reinforce ZERO occurrences (compared to DRL)

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DRO – “How‐To”

• Baseline

• Criteria for intervals (how long should they have to have zero occurrences?)

– Start small, then increase

• What happens if the behavior occurs?

– Reset the ‘timer’?

– Deliver a consequence or ignore it?

• Reinforcement

DRO ‐ examples

• Rhonda receives a token for each 5 minute interval she goes without engaging in verbal aggression.– After 5 successful intervals Rhonda earns 5 minutes of staff attention

• Jaylen receives a chore pass if he does not engage property destruction for one week.

Advantages and Disadvantages of DRO

• Advantages

– rapidly reduces behavior

• Disadvantages

– may be a less discriminable contingency for some learners

– other behaviors may worsen

– Performance under DRO results in deceleration of the challenging behavior during periods in which DRO is in effect

– BUT target behavior may accelerate at other times.

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Summary of DR Procedures

Purpose Management Objective

DRLReduce behavior to acceptable level

Focus on reducing # of occurrences

Tom will be out of his work area no more than 2 times in 40 minutes

DROReduce behavior to zero occurrences

Focus on increasing time of nonoccurrence

Tom will have no occurrence of leaving his work area in a 40‐minute period

DRIDRA

Reinforce a functionalalternative behavior

Focus on developing functional alternative behavior

Tom will press a button to indicate he wants to take a break instead of yelling and face slapping

Activity

Design a DRI/DRO/DRA for an example you have experienced (or choose one from handout)

Non‐Contingent Reinforcement

• There are limitations to DRO

– Identifying appropriate intervals

– implementing with fidelity

• An alternative is non‐contingent reinforcement (NCR)

• NCR is the use of positive reinforcement that is not related to the occurrence of a target behavior. It involves delivering reinforcement on a fixed‐time schedule independent of whether the individual exhibits the target behavior during the interval.

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Non‐Contingent Reinforcement

• Provides the individual the reinforcer (the one maintaining the inappropriate behavior) independently of the performance of the challenging behavior

• The individual receives the reinforcer at preselected intervals of time and challenging behavior is ignored

• Disassociates the reinforcer from the behavior (and decreases the challenging behavior)

Violet Case Example

• Read through the Violet Case Example

• Identify and operationally define the challenging behavior

• identify the potential setting events

• Identify the antecedent

• Identify the consequences following the challenging behavior

Violet Case Study Part 2

• Now lets place the behavior within the Behavior Pathway• Identify potential setting event interventions• antecedent interventions• Identify potential consequent intervention

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Behavior Pathway

Desired Behavior

AggressionAntecedent

Drowsiness is a side effect of

Violet’s medication

Alternate behavior

Natural Consequence


Behavior Pathway Plan



Teaching Alternative Behaviors


• Arrange Violet’s schedule so that she can get 8 hours sleep each night

• 30 minute nap after afternoon medication dose

Behavior Pathway

Desired Behavior

Aggression



Alternate behavior

Natural Consequence


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Antecedent Interventions Teaching Alternative Behaviors


• Arrange Violet’s schedule so that she can get 8 hours sleep each night

• 30 minute nap after afternoon medication dose

•Alerting Violet of upcoming difficult task•Preferred item as a distractor•Arrange schedule so highly preferred activity/easier activity follows difficult task•Offer choices of difficult tasks when possible

Behavior Pathway

Desired Behavior

Problem Behavior


Alternate behavior

Natural Consequence






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Behavior Pathway

Desired Behavior

Aggression

Supervisor asks Violet to perform a

difficult chore



Alternate behavior

Natural Consequence

Escape from Task Demand

Activity

Abdi Competing Behavior Pathway

• Read through the Abdi Case Example





• Fill in Competing Behavior Pathway

• Identify setting event interventions

• Identify antecedent interventions

• Identify consequent interventions

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Abdi Case Example

A 23‐year‐old man named Abdi recently moved from his parents’ home to a residential home with three roommates. Abdi reports that he enjoys living with “the guys”. Abdi has a diagnosis of Fetal alcohol spectrum disorder and bipolar disorder. Abdi takes medication for his bipolar, but does not report any side effects. Abdi enjoys playing sports such as football and basketball as well as watching sports. Abdi is highly verbal, but has difficulty regulating his emotions at times. Abdi has been making inappropriate sexual comments toward a female staff member when she enters the room. The female staff member has tried ignoring the comments but Abdi continues. “The guys” usually laugh at his comments. The female staff member reports that when she is working one‐on‐one with Abdi, he does not engage in this behavior.

Behavior Pathway

Desired Behavior

Problem Behavior


Alternate behavior

Natural Consequence






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Activity

Emma Competing Behavior Pathway• Read through the Abdi Case Example





• Fill in Competing Behavior Pathway

• Identify setting event interventions

• Identify antecedent interventions

• Identify consequent interventions

Emma Case Example

Emma is a 4 year old child in a preschool program who has been diagnosed with autism and is not currently verbally communicating (or using another form of augmentative or alternative communication). Emma will frequently lead her paraprofessional to areas or activities that she prefers (e.g., take the hand of the paraprofessional and guide her towards the door when she wants to go out to the playground). Emma will tantrum (bite and kick teachers, and hit her head on the floor) when these requests are denied (e.g., the paraprofessional tells Emma that “it is not time to go outside right now.”) When Emma tantrums, teachers and paraprofessionals often bring her to the calming corner (an area in the back of the classroom with beanbag chairs, weighted blankets, and sensory toys) until she calms down. Teachers have noted that these behaviors occur more frequently when there is a substitute teacher.

Behavior Pathway

Desired Behavior

Problem Behavior


Alternate behavior

Natural Consequence


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Teaching Alternative Behaviors


LIKE‐LEARN‐CHANGE

Three Post‐it Notes

• What did you LIKE about today ?

• What did you LEARN today?

• What would you CHANGE about today?

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Contact Information

Jessica Simacek, PhD

Email: [email protected]

Rachel Freeman, PhD

Email: [email protected]

The Collaborators Forum is an event for people interested in Positive Behavior Supports across settings and the lifespan in Minnesota. This year the MNPBS Network is planning to create host sites in other parts of the state and to increase the amount of interactivity for audience members who can’t travel but want to be a part of the Forum.

Keynote: Caryn Ward, PhD, HSP‐P Associate Director, National Implementation Research Network

Practical Use of Implementation Science to Meet Your Community’s GoalsWhat strategies and practices are needed to ensure effective use of positive behavior supports? How do we ensure these strategies and practices are relevant and feasible for our different contexts (e.g., rural, urban, clinic, community) and fields (e.g., early childhood, K‐12 education, adult education and services) in Minnesota? The keynote session will share how active implementation practices and strategies can be used to answer these questions through the use of case examples and their respective data stories.

3rd Annual Collaborators ForumApril 30, 2019

https://www.eventbrite.com/e/mn‐pbs‐network‐collaborators‐forum‐tickets‐56668780849

Upcoming Events

Save The Date: Intelligent Lives Film Screening and Panel Discussion

Film Screening: April 30, 2019 6:30pm‐9pmSouth High School 3131 S 19th AveMinneapolis, MN 55407

Panel Discussion with Dan Habib:May 1st, 2019 9am‐11amJohn B. Davis Educational Center1250 West BroadwayMinneapolis MN 55411

https://www.eventbrite.com/o/minnesota‐collaboration‐18504405425

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Preparation of this [presentation/report] was supported, in part, bycooperative agreement JPK%50470 from the Minnesota Department of

Human Services. The University of Minnesota undertaking projects undergovernment sponsorship are encouraged to express freely their findings and

Conclusions. Points of view or opinions do not, therefore necessarily representofficial MN DHS policy.

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