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PSY 3420 Applied Behavior Analysis/

Positive Behavior Support

Class #7:
PBS Characteristics & Basic Concepts

Lauren Moskowitz, Ph.D.


St. Johns University
MoskowiL@stjohns.edu
What Is
Positive Behavior Support (PBS)?
Behavioral technology + Educational methods + Ecological systems change

Understanding reasons for problem behavior;


intervention matched to hypotheses
Impact quality of life (not just reduce p.b.)
Educative: teach alternative skills
Proactive: change environment (systems change)
Person-centered values, stakeholder participation
Outcomes that are meaningful & relevant
PBS philosophy
Behavior is an interaction between the individual and
the context in which it occurs
When challenging behaviors persist, they are being
reinforced in some way
Effective interventions often require modification of
antecedent events in addition to instruction in
appropriate behavior
Planning is a multi-step process
People with challenging behaviors need better
teaching, not more discipline
Defining Features of PBS
1. Application of research-validated behavioral science
ABA is the conceptual foundation
Use of FBA
Prevention of problem behavior through redesigning
environment
Active instruction of desired behaviors
Organization of consequences that promote desired behavior,
minimize reinforcers for problem behaviors
2. Multicomponent interventions
Integration of multiple intervention elements to provide
ecologically valid, practical support
3. Commitment to substantive, durable lifestyle outcomes
4. Systems change
Implementation of support within organizational systems that
facilitate sustained effects Dunlap, Sailor, Horner, & Sugai (2008)
Key Features of PBS
Ecologically Oriented (systems change)
Assessment Based
Customized
Preventive & Educational
Lifestyle & Inclusion Focused
Comprehensive
Team-Based
Respectful (stakeholder participation)
Long-term focused
ABA & PBS
Applied Behavior Analysis (ABA)
The application of principles of operant conditioning
Positive Behavior Support (PBS)
Extension of ABA that applies in real-world settings
quality of life (QOL); not just problem behavior
Shared Emphases Differing Emphases
Empiricism Multiple theoretical perspectives &
methodologies
Conceptual foundation Independent and dependent variables
(e.g., systems, QOL)
Research Methods Ecological, social, and external validity
Assessment & intervention procedures
Focus on pragmatism & utility
Dunlap et al. (2008)
Comparison of Traditional Approach
with a PBS Approach

Traditional Intervention Positive Behavior Support


Crisis management (reactive) Preventive (proactive)
Topographical Functional
General intervention for all Intervention matched to
behavior challenges purpose of the behavior
Focus on behavior reduction Focus on teaching new skills
(suppression only) (educational)
Individual-oriented Systems-oriented
Molecular (specific behaviors) Molar (lifestyle change)
Quick fix Long-term intervention
Overall Intervention Strategy

Traditional Approach
Remediate problem behavior

Positive Behavior Support


Remediate deficient environments
Remediate deficient behavior repertoires
Three Themes of PBS
Happiness: Quality of Life (QOL) as the central
dependent variable in PBS
Helpfulness: Systems change as the central
independent variable in PBS
Hopefulness: Facilitating the development of
QOL and systems change by incorporating
knowledge from other sciences (move beyond
ABA)

Carr (2007)
Happiness
Happiness:
Centrality of QOL

What can go right in a persons life?

vs

What are the forms of psychopathology that


ruin a persons life?
Dimensions of Quality of Life
Material well-being
e.g., Housing, food, clothes, income, transportation, amenities

Health and safety


e.g., access to medical services, medication

Social well-being
e.g., social networks (friends), clubs, religious groups

Emotional well-being
e.g., close relationships (love, intimacy, attachment), positive mood,
emotional stability

Leisure and recreation


e.g., hobbies, sports, vacations, arts & entertainment

Autonomy
Autonomy
Being able to choose basic items: clothing, food,
personal belongings
Being able to make major life choices: living
arrangements, social relationships, recreation
and leisure, vocation, academic interests, religion
and spiritual preferences
Self-sufficiency: achieving a level of competence
that reduces the level of support required from
others (e.g., self-care, food preparation, safety in
the community, money management)
Impediments to QOL

Problem behavior
Skill deficits
Dysfunctional systems
The Problem With
Problem Behavior
Prevents full community integration
(home/school/employment)
Demoralizes family members (parents/siblings)
and teachers
Increases likelihood of institutionalization (loss of
choice/dignity)
Rejection by others (social isolation/no friends)
Damages self-esteem (shame/regret)
Summary: Destroys quality of life
Helpfulness
Support vs
Cause and Cure
Support: the use of educational procedures to enhance
personal competencies (e.g., skill development) &
systems-change procedures to create environments in
which those competencies can be used to promote a
good QOL
Medical disorders cant always be cured (e.g.,
diabetes, cancer, asthma, heart disease), but we can
give people a good QOL with treatment
Psychological disorders are the same; just because we
cant cure depression or autism, doesnt mean
treatment cant help people
Laboratory (Analog) Research as a
Prelude to Effective Support
Laboratory research is often an essential first
step
Ecological validity = can lab research be
translated into the real world?
Need to add more things to lab procedure to
make it work in the home, classroom, &
community
Support: Maintenance and
Sustainability
Maintenance: how durable are the effects of
treatment over time?
Maintenance is not a function of procedures;
maintenance is a function of systems
Sustainability: do the people in the home, school, &
community continue their treatment efforts over
time?
Gains are not maintained if efforts are not
sustained
What prevents us from being able to sustain
treatment?
Context 1 Bedtime:
Results
Multiple Baseline: TK's Bedtime Routine
Total Problem Behavior Per Night
Baseline Intervention
275
250
225
Total Problem Behavior

200
175
150
125
100
75
50
25
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28

Sessions

Intervention from 10/26/07 to 1/1/08


Context 1 Bedtime
Extended Data: Long-term follow-up
Multiple Baseline: TK's Bedtime Routine
Total Problem Behavior Per Night
BL Intervention
275
250
225
Total Problem Behavior

200
175
150
125
100
75
2/3 - 2/8
50
25
0
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 91

Sessions

Intervention from 10/26/07 to 4/16/08


Bedtime Intervention:
Barriers to Implementation
Hard to be consistent/predictable (e.g., guests, noise, events)
Slipping when things have been going well for a few nights
Providing intermittent reinforcement for attention-getting
behavior
Child keptcoming up with new ways of getting moms attention (covers,
lightswitch, door-slamming ). Keep pulling weeds!
Just like taking antibiotics,
bedtime intervention has to be used
consistently - the same every day - or else it just won't work!
Seems cruel to parents not to respond to child
Not responding is teaching the child to cope on his own ("self-soothe")
Context 2 Toileting:
Results
Daily Recording of Toileting vs. Accidents
In the Potty

10 Baseline Intervention Accidents

8
Number of Voids In & Off-Toilet

p d dd pp d
1

0
1 7 13 19 25 31 37 43 49 55 61 67 73 79 85 91 97 103 109 115 121 127 133 139 145 151 157 163 169 175 181 187

Sessions

11/15/07 to 6/2/08
Toileting Intervention:
Barriers to Implementation
Difficult to constantly monitor & prevent accidents

Difficulty finding a reinforcer that was motivating


enough

Difficulty using DVD or computer as only potty-specific


reinforcers

Occasionally still rewarding L for good behavior by


watching DVD on the toilet.
Confusing to L as to purpose/goal of sitting on toilet.
Linking Sustainability to
Systems Change: A Model
Analyze the system to see whats wrong
& change it
Skills deficits (e.g., social skills deficit,
academic skill deficit)
Change the system so that the system
will sustain the procedures that promote
a good QOL
Elements of a Model for Systems
Change to Promote Sustainability of
Effective Practices

Vision
Skills
Incentives
Resources
Action plan
Application of the Systems Change
Model
1) Vision (e.g., goodness-of-fit; person-centered
planning)
2) Skills (e.g., collaborative teaming and team
training)
3) Incentives (e.g., responsivity to social and
emotional needs)
4) Resources (e.g., life arrangement and life
coaching)
5) Action plan (e.g., group action planning)
1) Vision
Does everyone in the system have the same goal?
Unless people within a system share a common set of
goals or mission (e.g., everyone agrees that
community-based intervention must replace
intervention in segregated settings), they will be
working at cross-purposes with each other
Conflict often arises from people having different
visions
e.g., person-centered planning, goodness-of-fit
2) Skills
If there are too many people in the system who
lack the knowledge and expertise needed to
competently implement intervention
procedures, this will undermine sustainability
Many teachers are not equipped to deal with
problem behavior; they dont have the skills or
expertise to implement recommendations
E.g., Collaborative teaming & team training
3) Incentives
Motivation (an incentives issue) can derail efforts to
sustain an otherwise effective program if parents,
teachers, staff, administrators do not experience
relevant reinforcement for implementing the
program
E.g., for principal, motivation would be to not hear
from parents
E.g., from teacher, motivation would be class not
completely out of control so she can teach
E.g., for bus driver, motivation to have a safe trip
and not have to break up a fight
4) Resources
Resources become a factor impacting
sustainability when time, money, and the
material necessities required for proper
intervention implementation are lacking

e.g., life arrangement, life coaching


5) Action Plan
Are the roles & responsibilities of personnel
and caregivers carefully defined?
Are mechanisms in place for correcting newly
identified deficiencies?
If not, intervention may not be sustainable
E.g., Group Action Planning
must specify roles, responsibilities, team
problem-solving, monitoring, & repair strategies
Person-Centered Planning
A method for establishing a vision and setting
goals
Assesses the personal values of all participants
in the system (a vision issue) and identifies
strategies for overcoming the fiscal, legal,
material, and personal barriers to change (a
resource issue)
Come up with a plan where all the people
agree on the goals (versus experts coming in
and telling parents/teachers what to do)
Goodness-of-Fit
Do intervention plans take into account
the cultural and personal values of families (a
vision issue)?
responsivity to their social and emotional
needs (an incentives issue)?
how feasible it is to implement the intervention
with regard to the time, labor, money, and
support available (a resources issue)?
Collaborative Teaming
Put together a group of relevant people (e.g.,
parents, teachers, professionals, peers,
friends, bus drivers, cafeteria workers, etc.) to
solve the problem
Not one single person charge
All people in group need to be trained to have
skills (not just teacher or parent)
Life Coach
An advisor and advocate who arranges (or
helps arrange) your life so that you have a
higher quality of life
Working with a person to advocate for them
and build resources (e.g., employment,
friends, housing, recreation)
Hopefulness
Extending PBS: Multiple Populations
and Venues
Populations
Emotional and behavior Bullies
disorders Literacy issues
Mental health / mental Typical families
illness Fetal alcohol syndrome
Traumatic brain injury Alzheimers or dementia
Juvenile delinquency Sex offenders
Deaf / hard of hearing
Conduct disorder
Extending PBS: Multiple Populations
and Venues
Venues
Cross-cultural settings Interagency coordination
Underserved Rural settings
communities Normative work / living
Head start classes settings
High schools Medical / clinical settings

Note: Source of entries is from the first and second


conference agendas of the Association for
Positive Behavior Support, Orlando, FL (2003)
and Tampa, FL (2005)
Extending PBS: Linkage to Multiple
Sciences and Disciplines

Organizational management
Community / ecological psychology
Cultural psychology
Biomedical sciences
Positive psychology
Organizational Management: Systems
Change Themes
Models for effective service delivery
e.g., interagency collaboration, wraparound services
Models for effective training
e.g., trainer-of-trainer approach
Models for effective team building
e.g., integrate all staff in school into a unified team
Models for building motivation
to produce sustainability
Models for ensuring accountability
to ensure interventions applied with fidelity
Models for data management
basing decisions on evidence rather than opinion
Community / Ecological Psychology:
Illustrative Examples
A Focus on Prevention
Identification and analysis of environmental risk
factors
e.g., poverty, mental illness, marital conflict,
unemployment, racism, health issues
Proactively addressing the issue of scarce resources
e.g., not enough time, money, personnel
Preventive support plans that appeal to the broader
needs of settings and communities
Community / Ecological Psychology:
Illustrative Examples
Building Sources of Social Support
Support networks in the lifecycle (e.g., parenting,
childhood, adolescence, aging)
Self-help groups
Empowerment
Networking
Influencing policy formation
Effectively competing for resources
Building organizational coalitions
Cultural Psychology
Cultural relativism
Concepts of abnormality vary across cultures; therefore,
behavior needs to be assessed relative to its cultural
context
e.g., social phobia
Cultural values
Identifying acceptable goals is influenced by cultural
values
e.g., Autonomy & self-reliance vs. meeting
responsibilities/obligations to others
Cross-cultural competence
customs, rapport, cooperation
e.g., patriarchal, nuclear vs. extended family
Biomedical Science:
Some Possibilities
Knowledge of brain function influences how
to build competencies (e.g., TBI)
Biological factors as setting events for
problem behavior (e.g., pain, illness, fatigue,
hormonal states)
QOL and health psychology / behavioral
medicine
e.g., coping strategies for dealing with stress, pain
management, promotion of healthy behaviors &
wellness
Positive Psychology:
Our Greatest Scientific Ally?

Positive psychology is an umbrella term for the


study of positive emotions, positive character
traits, and enabling institutions (Seligman et
al., 2005)
Positive Psychology: Our Greatest
Scientific Ally?
A strengths-based approach
Address behavior challenges by increasing competence
Competence involves character building reflecting six
virtues: wisdom, courage, humanity, justice, temperance,
and transcendence
Improve QOL by focusing on social and emotional well-
being
Create institutions that enable positive affect
Widespread application across populations and venues
Components of PBS
1) Create a vision of ideal life for the individual
2) Conduct a functional assessment
3) Redesign the environment
e.g., Enhance predictability
e.g., Provide choices
e.g., Increase task relevancy
e.g., Embed rewards within an activity
e.g., Reduce difficulty or amount of time required for an activity
e.g., Intersperse easy tasks with difficult tasks
4) Teach new skills
e.g., Functional communication skills, coping/relaxation skills, daily living
skills, academic skills
5) Remove the rewards of challenging behavior
6) Avoid most dangerous behaviors
7) Ensure a cultural fit
8) Monitor for improvement
Dunlap et al. (2008)