Targeted Case Management
Introduction to Positive Behavior Supports
As human beings we all behave. Behavior may be displayed through different modalities, including physical and verbal. Whether verbal or physical, behavior may be a form of communication. All behaviors have a function as to why they are preformed. It is our responsibility as professionals to try to understand what the person is communicating, and what the function their behavior is, rather than to simply try to manage the behavior.
TELL ME AND I'LL FORGET. SHOW ME AND I MAY NOT REMEMBER.
INVOLVE ME, AND I WILL UNDERSTAND.
(Native American)
A. Introduction to Positive Behavior Support (PBS)
PBS is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and by making changes in the person's environment.
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PBS combines:
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Positive Behavior Support (PBS) strategies are considered effective when interventions result in increases in an individual’s success and personal satisfaction, and the enhancement of positive social interactions across home, work, academic, recreational and community settings. PBS is based upon behavioral and biomedical science. Research in applied behavior analysis has demonstrated the importance of analyzing the interaction between behavior and the environment. From this perspective, behavior is considered purposeful and is under the control of the environmental factors that can be changed. Positive behavior support assessment and intervention strategies are based upon research in applied behavior analysis and emphasize the importance of implementing intervention strategies that are effective in natural everyday settings.
Example: Ellen is a 14 year-old with severe disabilities who lives at home with two other siblings. Although Ellen likes to go out to eat, six months ago she began pinching other people on their arms and legs, sometimes causing bruises and redness. Ellen's mother and father were concerned because Ellen's problem behavior angered several restaurant owners who asked that she not return to their establishments. Ellen's behavior support team decided to intervene by avoiding all sit down restaurants and encouraging Ellen to go through the drive through to pick up dinner instead.
The behavioral intervention used by Ellen's team focused only on reducing the occurrence of problem behavior by avoiding public places. Although this intervention may be effective in reducing aggression, Ellen will never learn the skills she needs to socialize in her community successfully. Problem behaviors occur for a reason and often individuals engage in problem behavior to communicate what they want or need.
The goal of PBS is to improve quality of life, not only for the focus individual, but for all of the persons within the social network. PBS is now used in many different situations and contexts and with different types of problem behavior such as aggression, property destruction and self injury. Individuals with or without disabilities can benefit from the PBS process in all environments.
Positive behavior support assessment and intervention strategies are also based on biomedical science. In the past, behavioral and psychiatric interventions have often been managed separately with very little collaboration between behavior consultants and medical personnel. Information related to an individual’s psychiatric stage and the knowledge of other biological factors can assist professionals in understanding the interaction between the physiological and environmental factors that influence behavior.
Who is a Good Candidate for PBS Services?
KIPBS Introduction to Positive Behavior Supports
B. Critical features of PBS
"The best time to intervene with problem behaviors is when they are not occurring" (Carr et al., 1994, p. 15).
This quote refers to the importance of preventing problem behavior by acting before a problem has a chance to arise.
1. Prevention: It is always easier to be reactive than proactive; as professionals we are trained to be proactive in all areas of supports and services for the consumer. In the area of behavior supports prevention strategies can be much less stressful and requires lower levels of emotional energy when compared to the time spent coping with crises. You may encounter the family or support staff being resistance to invest the time and energy in prevention. However, the importance of understanding that placing an emphasis on prevention will set the stage for fewer crises in the future. For example, teaching social skills, designing predictable and positive environments can decrease the need for more reactive strategies.
2. Normalization and Inclusion:Normalization is the philosophical principle that focuses on the respect and dignity of all people, regardless of their level of ability, circumstances or nature of their challenging behavior. All support team members must be facilitators of the same respect and dignity we cherish for ourselves and our families. With the implementation of positive behavioral supports the individual will have opportunities for improved family relationships, new or improved social relationships, integrated employment, classroom inclusion, preferred community activities and much more. The individual must be supported so that he/she will have the opportunity and ability to exercise his/her right to live and participate in his/her natural community; as well as encouraged and supported in further integration and inclusion.
3. Person-Centered Values: Person-Centered Values is the starting point and foundation for all successful support for an individual. Through the process of the Person Center Support /Wraparound Planning the focus person and their complete support team will identify the focus person’s interest, strengths, preferences, communication methods, levels of ability, skills, limitations and supports needed to achieve the person’s preferred lifestyle. The Person-Centered approach emphasizes the individual’s strengths and focuses on meeting the individual’s needs across life domains and is based upon the hypothesis that if an individual’s needs are met, problem behavior will naturally decrease.
4. Life Span Perspective: Providing supports is a never-ending process as the focus individual changes or changes in his/her environment. New skills and supports maybe needed to adapt to the transition successfully. The support team must be proactive in supporting the individual through normal life transitions as well as unexpected situations requiring the focus individual to adapt.
5. Team-Based Approaches: As the member of the support team you have knowledge of the focus individual’s preferences and needed supports to assure his/her preferred lifestyle. Most behavior occurs within a social network or system and changing a social network requires a team-based approach. Making modification to environmental settings and teaching new skills naturally places the responsibility for behavioral change upon the support individuals within the social network. However, if additional support from an outside facilitator is needed, successful positive behavior supports plans are created in collaboration. The focus individual and each member of his/her support are very valuable and all must be treated with respect and their input be validated as well as each member must take an active part in each stage of the behavior support planning.
6. Multicomponent Interventions:Behavioral interventions that are successful one time, situation and setting may not be successful the next time. The focus individual must have the ability to transfer his/her skills across multiple settings. Components of the positive behavior support plan must teach the focus individual how to generalize his/her skills across multiple environments. Multicomponent interventions plans also involve changing organizational systems by enhancing staff development, reorganizing resources, and changing management strategies.
For more information regarding the Description and Background of Positive Behavior Support continue to KIPBS Module 1 Section 1 http://kipbsmodules.org/show.asp?to=m1s1.htm
Username: kipbs
Password: modules
C. Identifying the need for PBS
As a case manager during your visit with the focus individual you may have concerns regarding behaviors exhibited by the individual or how caregivers and or support team members interact with the individual. It will be your responsibility to conduct direct and indirect observations to gather information regarding your concerns. You may also receive a request from a caregiver or a team member for more behavior support or a formal plan. The focus individual should already have a Person Centered Support Plan; review the plan making sure there are no barriers in needed support or services needed to meet his/her preferred lifestyle. If the target individual is a student the Individual Education Program (IEP) should also be review. If the student is only having unwanted behaviors in the school environment the school must provide a behavior plan included in the IEP. As a case manager it is your responsibility to be the students educational advocate; making sure his/her needs are being met in the academic environment.
Included throughout this training are many great resources on what positive behavior supports are and how they will benefit the focus individual in all domain. After reviewing the different resources and tools you will be able to understand and explain positive behavior supports to the focus individual and all who is in his/her circle of support. With this information and understanding of the focus individual’s needed supports and capacity; the caregivers, team members and supporting agency can commitment to the successful implementation of the positive behavior plan.
Information to Gather and Share with PBS Facilitator
D. Glossary of Terms:
Overall Glossary of Terms
http://kipbs.org/new_kipbs/fsi/overallGlossary.html
Acronyms List
http://kipbs.org/new_kipbs/fsi/case_mgr/AcronymsList.docx
E. Resources and Tools:
PBS Extravaganza! Families Together Conference 2010 and Parent Handbook
http://pbskansas.org/files/Families_Together_Conference.pdf
http://www.pbskansas.org/files/PBS_Extravaganza_Workbook.pdf
Introduction to PBS
The Center on the Social and Emotional Foundations for Early Learning
Positive Behavior Support Family Questions and Answers
http://www.vanderbilt.edu/csefel/modules/module3b/handout6.pdf
ChallengingBehavior.org
Positive Behavior Support Family Questions and Answers
http://www.challengingbehavior.org/explore/pbs_docs/building_beh_support_team/PBS_familyQ&A.pdf
Center for Autism and Related Disabilities
PBS Fact Sheet
http://www.card.ufl.edu/handouts/fs6english.pdf
Special Connections
An Introduction to Positive Behavior Support (PBS) Planning
http://www.specialconnections.ku.edu/cgi-bin/cgiwrap/specconn/main.php?cat=behavior§ion=main&subsection=pbs/main
Educational and Community Supports, University of Oregon
Parents’ Guide to Functional Assessment and Support
http://darkwing.uoregon.edu/~ttobin/parent.pdf
PBS Websites
Kansas School-wide PBS
http://www.swpbs.org/schoolwide/index.html
Kansas Institute for Positive Behavior Supports
http://kipbs.org/new_kipbs/index.html
Association for Positive Behavior
http://www.apbs.org/index.html
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