Gil is an adult with Down syndrome. He lives with his mother and her sister, his Aunt Georgia. He has a twenty-five hour a week job at the local supermarket as a stocker and bagger. He also makes and sells beads at his aunt’s booth at the flea market. When Gil does not understand what is being asked of him, he will run and hide under objects or furniture. Earlier this year, there was a bomb threat at the supermarket. Gil hid under a car in the parking lot. Since that time, when asked to do things outside the typical routine of the day, Gil repeats this behavior. Gil’s Aunt Georgia has suggested a PBS plan to his mother. They requested PBS from Gil’s case manager.
Understanding Gil’s Behavior
Gil’s case manager brought together Gil’s mother and aunt, his supervisor and a co-worker, and friends of Gil’s from the flea market to conduct a person centered plan and a functional behavior assessment as part of the PBS process. The person centered plan revealed that Gil’s life has been consistently structured and oriented to routines. In the part of the plan that addressed Gil’s dreams and fears for the future, he made it clear that he was very afraid of losing his job. He became upset when the topic of the meeting shifted to his need to hide and asked everyone to leave. He and the team agreed to reconvene the next week. Gil also agreed that team members could observe at the job site and talk with each other and with him before the next meeting. When the team reconvened they completed the person-centered plan as well as began discussing the functional behavior assessment.
The functional behavior assessment indicated that Gil left the store and hid in the parking lot more often on days when his break was in the afternoon than when his break was at 10:30 in the morning. The team suggested a set time of 10:30 for Gil’s break. He also had less difficulty when Stan is the manager than when Collette was the manager. When discussing this observation from the functional behavior assessment, Collette explained that she writes down changes in the routine that affect Gil and discusses this with him after the meeting. The team agreed that this could assist Gil. The functional behavior assessment also indicated that Gil feels safe when he hides. The team agreed that if Gil could let the staff know he was leaving the meeting and why, he could wait in the staff lounge and get information on changes that affected him after the meeting.
Designing Strategies for Gil
In addition to the ideas discussed as a part of the functional behavior assessment, the team also discussed the past use and success of transition objects. Gil’s mother bought some small pocket items for the managers and employees to give to Gil to hold on to when changes in routine were discussed. This has assisted in Gil being able to listen to directions longer and here full descriptions of what is happening. In addition, the team brainstormed ways to teach Gil to ask for clarification. Gil suggested an “I have a question” card that he could show to the managers in meetings before he leaves. Gil can then take a break and the rest of the information is shared with him one-on-one. In situations when he feels very uncomfortable, Gil uses a cell phone to call his mother or aunt.
Is the Plan Working?
Since these strategies have been in use, Gil has hidden in the break room one time and gone into the parking lot only twice. Both times, Gil has been able to come back into the store without going underneath cars. The team is currently satisfied with the progress seen from the plan.
Example of Gil’s Brainstorming Session Results
|Setting Event||Antecedent||Problem Behavior||Consequences|
|Bomb threat and hiding under the car in the parking lot||Changes in the routine of the day presented at staff meeting||Gil runs and hides under a car in the parking lot||Gil avoids the confusion; he feels he is safe when hiding|
|Setting Event Interventions||Antecedent Interventions||Replacement Behavior & Other Related Social and Communication Skills||Consequence Interventions|
|Reassure Gil that the bomb threat was a very unusual event and that it is over||Notify Gil of
changes before the staff meeting
Create “I have a question” card
Teach Gil how his body indicates stress
Write down changes and present them to Gil outside
the staff meeting
| Gil shows the
“I have a question” card and leaves the
meeting to be in the staff lounge, and receives his
information later one-on-one
|Gil avoids the confusion; he participates with his peers and sees himself as capable.|
O’Neill, R. E., Horner, R. H., Albin, R. W., Sprague, J. R., Storey, K., & Newton, J. S. (1997). Functional assessment and program development for problem behavior.