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2 PROPRIETARY AND CONFIDENTIAL

THE SUCCESSFUL REPLICATION OF D-PBIS

ACROSS MULTIPLE CENTERS SERVING ADULTS WITH I/DDLeeann Haffner, MS – DPBIS Project Coordinator PA Adult ServicesMichelle Lipchock, DSW, LCSW Clinical Director, Devereux New JerseyMichelle Wonders, Psy.D – Clinical Director, Devereux Pocono


PRESENTATION OBJECTIVES Participants will be able to define the components of D-

PBIS and describe the framework for implementation.

Participants will learn how the D-PBIS framework has been successfully implemented across multiple centers and how it can be adapted to fit individual programmatic needs.

Participants will be able to describe measures necessary to sustain D-PBIS in programs servicing adults with I/DD.


DEVEREUX-POSITIVE BEHAVIOR INTERVENTIONS AND

SUPPORTS (D-PBIS I/DD)Scope The Devereux organization

operates in 13 states There are 8 Centers across

the United States serving I/DD Centers are located in (NY,

NJ, PA (2), MA, Florida, Texas, California)

Implementation Issues All centers are rolling out the D-

PBIS I/DD framework w/ modifications Coordination across/within

centers Focus on implementing with

fidelity Necessary to develop measures

that ensure sustainability


3 TIERED APPROACH

~80% ? of Clients

~5%

~15%

TERTIARY PREVENTIONComprehensive FBAPositive Behavior Support PlansIncreased SupervisionIndividual and Family TherapyTrauma-Focused CBTModified PE

SECONDARY PREVENTIONCheck-in/Check outMentoringPeer supportGroup TherapySpecialized Group Skills Training

PRIMARY PREVENTIONBehavioral Assessment & ConsultationClear expectationsProactive FocusSkills TrainingData Based Decision MakingSelf-ManagementSafe and Positive EnvironmentLesson PlansCorrective InstructionStaff and Individual Acknowledgements


Devereux Organizational FWPBIS Steering Committee

Meets quarterly

Center-based FWPBIS Leadership Team

Meets monthly

Self-ManagementGuided Self-Management

AcknowledgementsPerformance Based

Feedback

Level of Safety

Teaching for Positive Learning

Teaching Matrix and Lesson

Plans

Program Components




Feedback

Level of Safety



Plans

Program Components

SYSTEM-SELF MANAGEMENTSelf Monitoring –

Once lesson plans are written, models for self monitoring will be developedMust take into account various levels of intellectual disability and communication




Feedback

Level of Safety



Plans

Program Components

CORRECTIVE INSTRUCTIONStep 1: GET THE PERSON’S ATTENTIONStep 2 ACKNOWLEDGE THE PERSON’S EMOTIONStep 3 STATE THE SKILL THAT CAN BE PRACTICED IN THE MOMENTStep 4: PRACTICE THE SKILL Step 5: REVIEW AND PRAISE



AcknowledgementsCorrective Instruction

Level of Safety



Plans

Program Components

ACKNOWLEDGEMENTS

Center-wide celebrationsChecklist of unit likes/Reinforcement Inventories Employee Appreciation Committee interfaceRewards packet for students and staff




Level of Safety



Plans

Program Components

LESSON PLANSScripts were revised to remove incorrect model of the skill or behaviorLesson Plans will be develop for two levels of learners:

Mild to Moderate level of disabilitySevere to Profound level of disability9 Essential Signs


TEACHING MATRIX




Level of Safety



Plans

Program Components

LEVEL OF SAFETYUniversal List of Major and Minor Infractions was revised to include adult issues and concerns. Language was revised to positive and adults terminology and was expanded to include enhanced medical and wellness concernsTeach skills vs intervention


REPLICATION OF D-PBIS


OVERVIEW OF D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS

National Board of Directors

• 2012 mandate for all Devereux programs to implement PBIS• Goal to develop D-PBIS models (EBD, I-DD and Autism)• Balanced scorecard for all centers

D-PBIS Fidelity Advisory

Committee

• Creation of D-PBIS models• Assigned consultants to work with centers on specific

implementation of PBIS• Ensure fidelity of all implementing centers• Measuring progress the same manner—same data collection

across all centers

Center Leadership

Teams

• Team of center specific staff charged with D-PBIS Implementation including center leadership

• Meet once a month to review center implementation (fidelity, data analysis, and problem solving)


D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS

The primary goal is to ensure implementation of D-PBIS with integrity and to ensure positive gains of staff and the individuals we serve. In partnership with corporate liaisons, the leadership team is

composed of representatives from various disciplines in the center. Provides oversight of implementation of D-PBIS across center. Ensures our D-PBIS implementation maintains a high degree of

fidelity through on-going data based decision making.

Center Leadership Team



Monthly meetings are held to review and trend various data sets, create or alter permanent products for the programs and problem solve any issues or obstacles that may arise.

Charged with maintaining further implementation of D-PBIS programs across the center.

Consultation between Centers

Data collection is embedded in the Electronic Health Record

Center Leadership Team


D-PBIS DATA ANALYSIS ACROSS IMPLEMENTING CENTERS



Individual

Direct Care Staff

Management and Clinical Staff

Leadership Team

Fidelity Committee


HOW D-PBIS CAN BE ADAPTED TO FIT INDIVIDUAL PROGRAM NEEDS

Baseline data from observations of staff Active Engagement (materials and positive interactions) Preference assessments for individuals: motivators and

activities that are specific to each program Use of sign language (9 basic signs) Customized teaching matrix: expected behaviors for each

setting that D-PBIS is used: home, work and the community and the categories for expected behavior of the individual Lesson plans: instructional scripts to teach the individuals

appropriate prosocial behaviors: the instructional process uses an errorless learning approach to teach the skills to the individuals with a minimal amount of errors.


SUSTAINABILITY OF D-PBIS


SUSTAINABILITYWhy is it important?

Reduce challenging behavior Increase independence and use

of prosocial behavior Provide structure and

acknowledgments Increase/sustain satisfaction Improve quality of life How to Sustain

Develop a plan and build an infrastructure Monitor compliance Analyze data for fidelity Determine impact on outcomes

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TOOLS FOR SUSTAINABILITY Contingency Plan

Acknowledgements

D-PBIS Certification

Home Visit Spot Check

Satisfaction Surveys

Leadership Meeting and Compliance Data

Peer Mentoring


CONTINGENCY PLAN Crucial for sustainability as there will always be staff

turnover, vacancies, and leaves of absence.

Ensures D-PBIS implementation, oversight, and consultation occurs when there is an open position in any role.

– Home visit spot check– Direct observation, data consultation, and performance

feedback schedule – Acknowledgement procedure

Monitors compliance of implementation through data analysis


CONTINGENCY PLAN


ACKNOWLEDGEMENTS When desired behaviors are observed, staff provide

individuals with acknowledgement cards, paired with verbal behavior specific praise.

Weekly or bi-weekly drawings for individuals and monthly drawings for staff to receive a prize (gift card, dinner, outing, DVD, etc.).


D-PBIS CERTIFICATION Certified clinical staff are responsible for certifying supervisors


HOME VISIT SPOT CHECK Completed once per month by clinical staff and operational

staff Information and Implementation scores analyzed to identify

trends


SATISFACTION SURVEYS Completed by individuals, staff, and supervisors on a

quarterly basis


SATISFACTION SURVEYS


LEADERSHIP AND COMPLIANCE Monthly leadership meetings held at each center Data compliance graphed and reviewed monthly by

clinical team and operations


PEER MENTORINGAll D-PBIS certified supervisors are eligible to become a peer mentor for a supervisor rolling out their first D-PBIS program.

D-PBIS I/DD Peer Mentoring Teaching Procedure

1. Introduce the skill to be taught2. Give the rationale for using the skill3. State the steps of the skill4. Demonstrate the skill5. Have the trainee model the skill that was demonstrated6. Give the trainee feedback on their demonstration of the skill7. Have trainee demonstrate the skill with the individuals or staff8. Document on the checklist when the skill is performed correctly


PEER MENTORING

Questions?Contact Information:

Michelle Wonders, [email protected]

Leeann Haffner, [email protected]

Michelle Lipchock, DSW, [email protected]

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