What are Positive Behaviour Support Plans?

Transcription

1 What are Psitive Behaviur Supprt Plans? Prduced by Deena M Martin, PhD fr the Alberta Cuncil f Disability Services March 2012

2 Written by Deena M Martin, PhD Alberta Cuncil f Disability Services Bay 19, Avenue NE, Calgary, Alberta T2A 5N1 Switchbard: Fax: Website: [email protected] Cpyright Alberta Cuncil f Disability Services 2015

3 Table f cntents Intrductin 1 Psitive Behaviur Supprts Apprach 1 Develping a Psitive Behaviur Supprts Plan 2 Ratinale 3 Gals 3 Objectives 3 Strategies 3 Implementatin 4 Evaluatin 4 Ethical Values and Psitive Behaviur Supprt Plans 4 Principle I: Respect fr the Dignity f Persns 4 Principle II: Respnsible Caring 4 Principle III: Integrity in Relatinships 4 Principle IV: Scial Respnsibility 5 Key Things t Remember 6 Cnclusin 6 Resurces 7

4 Intrductin The purpse f this resurce is t help define and describe the use f Psitive Behaviur Supprt Plans when wrking with individuals with develpmental disabilities. Smetimes individuals behave in a way that is a harmful t themselves r thers. The cncept behaviur f cncern means that an individual is displaying behaviur f such intensity, frequency r duratin that the physical safety f individuals r thers is likely t be placed in jepardy. Furthermre, the cnsequences f the behaviur are likely t have serius impact n activities f daily living and/r quality f life. This resurce has been designed t answer the basic questins a frnt line staff, family member, r individual may have abut Psitive Behaviur Supprt plans. Psitive Behaviur Supprts Apprach Over the past few years, the Applied Behaviural Apprach (uses learning thery t teach/replace behaviurs) was integrated with a persn centered apprach, resulting in the Psitive Behaviur Supprts (PBS) apprach. The defining feature f the PBS apprach is that behaviural interventins are expected t align clsely with the individual s dreams and persnal gals. As well, it recgnizes that the individual interacts with thers in different envirnments and that these cntexts must als be taken int cnsideratin when addressing behaviur. Psitive Behaviur Supprts: Plan as Part f a Prcess Sme individuals with disabilities have cmplex and challenging behaviurs. These behaviurs are likely preventing the individual frm having a quality f life that she r he desires. The behaviurs may als result in risk t the individual, thers, and/r the envirnment. If this is the case, several prcesses are put int place. Initially, a risk assessment will be cmpleted n the individual. The risk assessment prvides the big picture perspective in regard t situatins when an individual might becme a danger t self, staff, thers, r prperty. In situatins where the individual may engage in vilence, it is imprtant t develp a risk management plan. The risk management plan will help identify ways t enhance the safety and prtectin f all peple and perhaps prperty. As well, it wuld then becme necessary t explre the pssible need fr a functinal assessment t help identify the behaviurs assciated with the risk. Crisis Interventin Risk Assessment Functinal Assessment Psitive Behaviur Supprt Plan In a functinal assessment, the purpse f an individual s behaviurs is explred by cllecting data specific t the individual, their relatinships and their envirnments. Using this infrmatin, the specialist is able t develp apprpriate teaching and/r interventin strategies that are specific t the individual. A psitive behaviur supprt plan is then develped frm the results f the functinal assessment t assist with frmalizing, dcumenting, and mnitring the interventin strategies. 1

5 Develping a Psitive Behaviur Supprts Plan As discussed earlier, sme individuals have behaviurs f cncern, meaning that their behaviur may be cnsidered harmful in sme way. These behaviurs are typically cnsidered anticipated (likely t ccur) in that the persn may have a histry f the behaviur. Hwever, the behaviur may increase, decrease, r change ver time. As such, family/staff members may chse t seek prfessinal help t identify preventin and interventin strategies when behaviurs are interfering with an individual s safety and quality f life. Generally, a trained prfessinal (graduate level training in behaviur and/r psychlgy) is best suited t develp a Psitive Behaviur Supprts (PBS) plan. A certain level f training, educatin, and experience is imprtant as the prfessinal is required t interpret the infrmatin frm the Functinal Assessment and create a meaningful interventin plan. The prfessinal uses the infrmatin prvided, their training/educatin, and past experience when develping a PBS plan that is helpful fr the individual and care prviders/family. Smetimes, the situatin is mre simplistic and straightfrward. In these situatins, the agency may have a trained specialist wh will develp a PBS plan. Alberta Cuncil f Disability Services has defined Qualified Persn with respect t behaviural supprts as: A staff member, service prvider, r caregiver wh develps, implements, and/r reviews the use f planned psitive prcedures and/r restrictive prcedures must be qualified t d s. A qualified persn may be a psychlgist with relevant training and experience in behaviural management, r a persn with at least tw years f relevant training that includes behaviural supprts and a minimum f three years f practical experience in behaviural supprts (including planned psitive prcedures and restrictive prcedures). A qualified persn wuld als be respnsible fr supervising interventins that use planned psitive prcedures and restrictive prcedures. Nte: a persn with the abve training and experience wuld als be limited in the kind f restrictive prcedures they are allwed t apprve, implement, and supervise. Fr instance, a psychlgist culd be cnsulted fr anything invlving psychtrpic medicatins and fr the supervisin f individuals wh require mre cmplex behaviural prcedures (e.g., aversive cnditining); hwever, a psychiatrist r physician wuld be required t prescribe any medicatins. Remember, family and/r staff members as well as the qualified persn may have different ways f interacting with an individual. It is imprtant t chse a prfessinal that will listen t the perspective f the individual with the challenging behaviur alng with family members and key service prviders. 2

6 The fllwing are typical cmpnents f a Psitive Behaviur Supprt Plan: Ratinale It is imprtant t identify the philsphy and values guiding the plan. This is where the individual and/r family/staff members agree n why the plan is necessary and hw the plan will cntribute t the individual s quality f life. Ethical cnsideratins are discussed here and decisins/agreements are made very explicitly. Gals This sectin prvides the lng term directin f all teaching and/r interventin strategies. Fr example, it will address what behaviurs are being addressed. Please nte that typically it is expected that the gals will fcus n increasing apprpriate behaviurs. Generally, the fcus shuld nt be n reducing r eliminating a behaviur. The assumptin is that behaviurs f cncern are a cmmunicatin. Reducing a behaviur means clsing ff cmmunicatin. Teaching new skills, changing envirnments and/r scial expectatins are ways f increasing the cmmunicatin. This in turn is mre aligned with the philsphy f being persn centered and using PBS plans as a way t mve tward a better quality f life. Objectives Ideally, the gal will be able t be brken int several different shrt term tasks that are SMART (specific, measureable, achievable, realistic, time sensitive). The behaviural cnsultant will help with ensuring that the behaviurs are peratinally defined which means they are bservable and measurable. Strategies This part f the plan addresses the different strategies that can be taken int cnsideratin. Fllwing is a list f varius appraches and strategies that the prfessinal will cnsider when develping the PBS plan. Mdifying the Physical Envirnment The fcus here is n the actual physical setting such as the hme, r wrk place. Example: In many residences sharps (such as knives and scissrs) are lcked away. Mdifying the Scial Envirnment The emphasis here is n the expectatins f scial situatin. Example: It is apprpriate fr smene t yell during a hckey game but nt in a mvie theatre. Teaching Skills This is a psych-educatinal apprach and assumes that with new infrmatin/insight/skills, an individual wuld make better chices instead f using the behaviur f cncern. Example: Partly because f bld sugar levels, Jasn gets very irritable when he is hungry. His family/staff member decides t teach him hw t prepare a small snack by himself. 3

7 Implementatin This sectin identifies the resurces and prcesses assciated with implementing the plan. It may include things like staff training, prcedures fr dcumenting and recrding data, data cllectin and summary sheets, use f psitive reinfrces etc. Evaluatin This sectin utlines the prcess fr reviewing the Psitive Behaviur Supprt plan. It may include a brief summary f hw the PBS plan will be evaluated. Fr example, it shuld identify if and when the plan will be terminated. It shuld als identify wh will be invlved in the decisin t terminate a plan. There are several reasns t terminate a plan. Fr example ideally, the individual will mve twards an enhanced quality f life and n lnger have behaviurs f cncern. Anther reasn might be that the plan is nt wrking and it is time t try a different apprach/set f strategies. Ethical Values and Psitive Behaviur Supprt Plans Smetimes it is cnfusing and difficult t make decisins fr individuals wh have cmplex behaviurs. As care prviders, the gal is t help an individual have a better quality f life. It is smetimes easier t make decisins fr smene frm a place f caring and cmpassin instead f a place f respect fr the individual s right t make their wn decisins and determine their wn quality f life. There are very specific prfessinal values that help prfessinals make ethical decisins in these challenging situatins. Principle I: Respect fr the Dignity f Persns The fcus f this principle is t ensure the basic rights and chices f the individual are upheld and maintained. It includes cncepts like infrmed cnsent, cnfidentiality, and nn-discriminatin. This is the mst imprtant principle and it cmes first, befre the ther principles. Principle II: Respnsible Caring It is imprtant t ensure that all appraches taken twards an individual in service maximize the ptential benefits and minimize ptential harm. While it is necessary t make decisins based n caring fr the welfare f the individual, it is imperative t ensure the individual s chice is incrprated int any planning. Principle III: Integrity in Relatinships The fcus here is t ensure interactins and relatinships are in the best interests f the individual receiving services. The Human Services field is relatively small, and even smaller when wrking in rural cmmunities. In sme situatins, a staff may have multiple relatinships with an individual and family. It is imprtant t act prfessinally and discuss cmplicated relatinships. 4

8 Principle IV: Scial Respnsibility This principle fcuses n the fact that respnsibilities t an individual extend beynd the persn being served. There is a respnsibility t ther members f the family, hme, agency, and/r cmmunity that must be taken int cnsideratin. At times individuals with cmplex behaviurs may break the law. It is essential that family/staff members are aware and infrmed as t what curse f actin t take when this happens. Fllwing are sme samples f prfessinal and/r ethical cncerns that arise when wrking with adults with disabilities. 1. Jrdan, a 27 year ld male living n his wn dislikes huse wrk and prefers watching the televisin. His family/staff member decides t nly let him watch T.V. after his chres are finished. It makes sense that his family/staff member thinks it is best fr Jrdan t have a clean huse. Hwever, as a 21 year ld male, Jrdan has the right t make the decisin if he wants t clean the huse r watch T.V. in the evenings. His decisin makes sense given his age and stage f life, althugh it may nt be desired by family/staff members. 2. Shania, a 38 year ld female is living with her sister and wrking at a lcal cffee shp. The sister decides Shania is drinking t much cffee and replaces all the cffee in the huse with decaf. She desn t tell Shania. The sister wants what is best fr Shania, hwever, it is imprtant t talk with Shania and discuss the situatin. It is nt respectful t replace the cffee withut Shania s knwledge. Ideally Shania s cnsent and cperatin is required. In the end, it is Shania s decisin (unless there are medical issues which wuld require further discussin). 3. Mirek is a 43 year ld male with FASD. He will ften wander ut f the huse and dwn t the lcal crner stre withut infrming his family/staff member. The agency decides t attach an alarm t the dr s family/staff members knw when he leaves the huse. This is a very invasive apprach t Mirek s behaviur f leaving withut telling anyne. It is better t try ther teaching strategies befre using such a high intensity interventin. While this may be the easiest slutin t family/staff cncerns, it des nt ffer Mirek any pprtunity fr him t learn new behaviurs that will help him in his life. 4. Staszia is a 32 year ld female staff member wrking at a lcal agency. When she arrived at her lcal yga class, the mther f ne f the individuals that Staszia wrks with sits dwn beside her. The mther starts asking questins abut her sn his plans fr the week. Stasiza updates the mther n this week s activities. Staszia is in a very difficult situatin. Ideally she wants t maintain a gd relatinship with the mther, hwever, it is nt the right time and place fr this cnversatin. 5

9 Key Things t Remember PERSON CENTERED is the desired fundatinal philsphy when develping and implementing a Psitive Behaviur Supprt plan. COMMUNICATION is critical t successfully implementing a plan. The team must cmmunicate with each ther, the individual, family members, the persn verseeing the plan etc. ACCURACY is imprtant when cllecting data and mnitring changes (increases r decreases). Different tls measure different things it may be necessary t experiment with several appraches until data cllectin becmes efficient and effective. CLEAR and CONCISE is imprtant! A PBS plan must be easy t understand, straightfrward and easy t cmmunicate t thers. COLLABORATIVE TEAM apprach is imprtant. Everyne has infrmatin and insight t cntribute t the discussin and frmulatin f teaching and interventin strategies. Differences in pinins between staff, family and/r the qualified persn need t be addressed and reslved befre a plan is implemented. Cnclusin A Psitive Behaviur Supprt Plan ffers a frmalized plan that fcuses n specific gals and bjectives designed t increase an individual s quality f life. When used effectively, a PBS plan ensures that an individual with cmplex and challenging behaviurs is prvided a variety f supprts and resurces frm family/staff members in a way that is respectful and mindful f the larger picture. In clsing, it is imprtant t remember that a Psitive Behaviur Supprt plan is part f planning fr an individual with cmplex needs and challenging behaviurs. There are ther tls such as persn centered plans, risk assessments, crisis interventin plans, functinal assessments and service plans that are imprtant t ensuring the best quality f service. 6

10 Resurces Textbks Fischer, W. W., & Piazza, C.C. (2011). Handbk f applied behaviur analysis. NY: Guildfrd Publicatins. Kegel, L. K., Kegel, R. L., & Dunlap, G. (Eds.). (1996). Psitive behaviural supprt: Including peple with difficult behaviur in the cmmunity. Baltimre: Paul H. Brkes. Lucyshyn, J. M., Dunlap, G., & Albin, R. W. (2002). Families and psitive behaviur supprt. Baltimre: Paul H. Brkes. Maltt, R. W. (2008). Principles f Behaviur (6th ed). Upper Saddle River, NJ: Pearsn. Meyer, L. H., & Evans, I. M., (1989). Nnaversive interventin fr behaviur prblems: A manual fr hme and cmmunity. Trnt: Paul H Brkes Publishing C. O Neil, R. E., Hrner, R. F., Albin, R. W. Albin, R.W., Strey, K., & Sprague, J.F. (1996). Functinal assessment and prgram develpment fr prblem behaviur: A practical handbk. Flrence, KY. Wadswrth Publishing. Wheeler, J.J., & Richey, D.D. (2010). Behaviur management: Principles and practices f psitive behaviur supprts. San Francisc: Pearsn. Academic Jurnals Internatinal Jurnal f Behaviural Cnsultatin and Therapy Jurnal f Applied Behaviur Analysis Jurnal f the Experimental Analysis f Behaviur The Behaviural Analysis Tday Academic Articles Carr, E. G., Dunlap, G., Hrner, R. H., Kegel, R. L., Turnbull, A. P., Sailr, W., Andersn, J., Albin, R. W., Kegel, L. K., & Fx, L. (2002). Psitive behaviur supprt: Evlutin f an applied science. Jurnal f Psitive Behaviur Interventins, 4, Carr, E. G., Hrner, R. H., Turnbull, A. P., Marquis, J. G., McLaughlin, D. M., McAtee, M. L., Smith, C. E., Ryan, K. A., Ruef, M. B., Dlabh, A., & Braddck, D. (1999). Psitive behaviur supprt as an apprach fr dealing with prblem behaviur in peple with develpmental disabilities: A research syn- thesis. Washingtn, DC: AAMR. Strain, P. S., & Hemmeter, M. L. (1997). Keys t being successful when cnfrnted with challenging behaviur. Yung Exceptinal Children, 1(1),

11 Websites Assciatin f Psitive Behaviur Supprts Multidisciplinary rganizatin that is supprts Psitive Behaviur Supprts research and interventin strategies. Disability and Cmmunity Care Services (Australia) This site ffers resurces, infrmatin, plicies, prcedures, and tls related t PBS. References Wheeler, J.J., & Richey, D.D. (2010). Behaviur management: Principles and practices f psitive behaviur supprts. San Francisc: Pearsn. 8