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About Selena

selena Selena is a second grader at Feather Plume Elementary School. She has a seizure disorder, cerebral palsy, and a shunt. She had a stroke at birth, in addition to the anoxia that contributed to her Cerebral Palsy. She uses speech to communicate, but often depends on scripted language to communicate effectively. She does not like to be touched and is resistant to eating. In the cafeteria, Selena screams loudly if people try to encourage her to eat. She spits and hits people if offered food that is near her. She also takes a long time to eat. Her educational team is concerned because she has continued to lose weight over the past year. When presented with schoolwork, Selena tantrums and continues to tantrum until she is removed from the activity. In addition, she is perceived to be disruptive by her peers. As a result of these concerns, the team created a PBS plan to address Selena’s needs.

Selena’s Elementary School
The school is implementing a school-wide PBS model. Feather Plume’s schoolwide expectations are: Fairness, Pride, Education, and Service; Fairness for all, Pride in what we do, Education for everyone, and Service to each other. Since the inception of school-wide positive behavior support at Feather Plume Elementary, office discipline referrals have dropped from 60 per month to 22 per month and teachers report a greater sense of satisfaction with the school. Selena has just started attending the school’s after-hours program as a part of more tailored school-based interventions. She seems to enjoy the activity.

Understanding Selena’s Behavior
Selena’s educational team conducted a person-centered plan and a functional behavior assessment as part of the PBS process. During the person-centered plan, Selena’s mother stated she felt that Selena’s lack of desire to eat was rooted in her need to control her environment. She believes that choosing not to eat is the one way Selena can consistently exert control. Her mother also explained that early in her life Selena had had extensive one-on-one therapy that resulted in her becoming resistant to doing work. Her classroom teacher is worried that removing Selena from the classroom (and the activity) when she tantrums might be rewarding her for negative behavior.

The functional behavior assessment supported the discussion that occurred during the person centered plan. The staff and her family have been very concerned about Selena eating and lunchtime feels pressured. Selena sits with a staff member and is presented with individual bites of food. Selena is also isolated from her peers. During lunch time, Selena refused any presentation of food by saying, “No, no, no,” or “All done.” Selena consistently screamed and hit herself and her wheelchair to avoid any work activity. She also appeared to be sensitive to going near desks or tables and began to say “No, no, no” when placed near either her desk or the table in the lunchroom. Based on this information, the team agreed that there were two main behaviors of concern and developed competing pathways to address each of them.

Designing Strategies for Selena
The first behavior of concern identified by the team during the functional behavior assessment was Selena’s refusal to eat at school. A setting event for this behavior is that Selena does not have many opportunities to make choices during the day. By increasing Selena’s opportunities to choose activities, she gains a greater sense of control. This may reduce the need for her to refuse food over time.

An antecedent to the behavior is that eating is presented as a task, rather than as a pleasant activity. One of the activities suggested during the person centered plan is that Selena really enjoys telling stories and jokes. The team created a Joke club that included her. The Joke club meets at lunchtime every day. The expectation is that, initially, Selena would come and listen to jokes. She could choose whether to eat or not, and the cafeteria would become a more pleasant place to go. As she is comfortable in the cafeteria at the table with her peers, then food would be presented in the hope that she would eat while participating with her peers (Her sister reported success with this strategy at home.)

In order to address the Selena’s refusal to work, the team agreed that Selena needed reassurance that school was a good place to be. With respect to the antecedent or trigger of being placed near a desk or table, the team agreed that work production was the priority and that the location where Selena did her work was flexible. Selena could choose to work in the library where there are more creative seating options (tipi, bathtub, bean ban chairs). The team also believes that Selena is inadvertently rewarded by being removed from the classroom when she tantrums. In order to help her sustain in the classroom, the team suggested the use of a break card, so that Selena can escape work while continuing to stay in the class with her peers. In addition, Selena’s desk was moved close to the window so that she can look out if she is feeling anxious about being in the room.

Is the Plan Working?
After one week of the Joke Club, Selena asked a fellow student for a potato chip and ate it. One month after Selena was going to the cafeteria daily, drinking milk there daily during Joke Club and eating at least one time a week. After one semester, Selena was eating between 2 and 3 times a week in the cafeteria, but going happily every day.

After one month, Selena was choosing daily to work in the library. She resisted completing work about one half of the time. She used the break card the other half of the time. After one semester, Selena was completing about 66 percent of her work and does about half of that in the library. The team will continue to monitor the plan to ensure Selena continues to make progress completing her work.

Example of Selena’s Brainstorming Session Results for Both Behaviors of Concern

Selena's First Brainstorming Session

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Setting Event Antecedent Problem Behavior Consequence
Lack of choice making opportunities Eating presented as a task Selena screams, spits at, and hits people until the food is removed Selena escapes eating; she controls what she eats; the food is removed.
Setting Event Interventions Antecedent Interventions Replacement Behavior & Other Related Social and Communication Skills Consequence Interventions
Increase opportunities for Selena to choose activities and modes of work production in settings outside of eating environment The cafeteria is presented as a fun place to be.

Selena is not expected to eat.

Selena spends time with peers rather than with staff

A social activity is the basis of Selena’s presence in the cafeteria; eating is incidental.

Selena participates in an activity in the cafeteria with food present and chooses if and what to eat. Selena controls whether or not she eats.

Adapted from:

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

Selena's Second Brainstorming Session

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Setting Event Antecedent Problem Behavior Consequence
Extensive one-on-one therapy she saw as negative Being placed near a table or desk or being presented with work Selena says, No, no, no, then screams and hits herself and her wheelchair until work is removed Selena escapes work; she is maneuvered by others; she leaves the classroom
Setting Event Interventions Antecedent Interventions Replacement Behavior & Other Related Social and Communication Skills Consequence Interventions
Present school as a positive place; reassure Selena that school is not like therapy

Provide alternate ways to show work than showing compliance

Selena will direct her wheelchair. Staff will not place her near tables or desk without her direction.

Selena selects where she would like to work; the classroom or the library.

Selena will organize work tasks in the order she wishes to perform them.

Teach Selena to use a break card to ask to stop work.

Selena will move her wheelchair away from the table and engage in a favored activity in the classroom

She directs her own movements in the classroom

Selena organizes her work schedule and work location

She takes breaks as needed when she asks for a break

Avoid allowing escape when Selena self injures. Protect Selena from injury by blocking self injury and prompt request for break (next time prompt Selena to request a break before self injury whenever possible)

Adapted from 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.

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