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MASSACHUSETTS DEPARTMENT OF DEVELOPMENTAL SERVICES JUNE 2014 PATRICIA CRONIN, PH.D. BARBARA PEEBLES VALARIE WHITING, PH.D. 1 UNIVERSAL Positive Behavioral Supports Creating Healthy Responsive Environments 1 Day Workshop

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Todaywhat you will learn Understand that behavior tells us something Understand what PBS is Learn about basic Universal Support strategies Understand that PBS is a person-centered, strengths-based approach to services and supports Become familiar with terms used by teams when implementing PBS 2

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DDS Definition of PBS Positive Behavioral Supports is a systemic, person- centered approach to understanding the reasons for behavior and applying evidence based practices for prevention, proactive intervention, teaching and responding to behavior, with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan. 3

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4 What PBS IS NOT. http://youtu.be/YkFb-g7SAOk

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Characteristics of PBS Understand communicative/function of behavior Understand that environment/context in which behavior occurs is importantchange environment--early recognition and intervention Prevention rather than reaction to behavior Range of interventions and strategies: change environment, routine, expectations, task demands, teach Strengths-based, Person-Centered approachholistic: persons wants, needs, dreams, preferences Variety of interventions, including education, habilitative, psychological. Evidence based strategies and reviewed (data, observation, adjusted as needed) 5

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So, to review, PBS.. 6 Focuses on preventing problems, rather than reacting to them (proactive) Focuses on changing the environment, to change behavior and outcomes-easier to change environment than to change the person Focuses on teaching skills aimed to replace the undesired behavior and/or learn prosocial and more effective behaviors Person-centered Targets self-regulation of behavior (not just behavior change) Positive, capacity focused: strength-based Source: Rehabilitative Research and Training Center. Learnet.org What are Positive Behavior Supports?

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What is Behavior? How can we tell if someone is behaving? Anything we say, do, think, feel is behavior. Behavior happens all of the timemostly good, neutral, sometimes we consider some behaviors to be problem behaviors. Behavior happens for a reasonwhats the function of behavior? Behavior serves a purpose. Behavior is communication. Listen to a person and their actions in different waysespecially if people dont use words to communicate 7

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This process is accomplished by determining, with the person, what is important TO them and by LISTENING in new ways to their behavior. Behavior is communicative and is telling us something. All behavior serves a purpose. http://youtu.be/IP0SQIIErMg 8

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Exercise: How do we listen to behavior? How do we listen to what people are telling us when they dont use words, or even if they do? Talk about the different ways that people communicate information to each other, especially when they cant use words to easily communicate? 9

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Exercise Take a guess at what we think the persons behavior means? Identify a person you work with and complete the following: When the person does _____, we think it means ______, so we _______. Discuss possible strategies that could be used with the person. 10

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PBS is a Strengths-Based, Person-Centered Approach What contributes to a persons well-beingacross different settings in their lives? Control, perceived control Preferences Health Reliable preferred routines Growth Relationships 11

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3 Tiers of Support of PBS 12 Begin to think about the 3 tiers of support: Individualized Targeted Universal Everyone gets it Some need more Only a few need it all

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PBS Universal Supports 13 Provide environments that offer opportunities for healthy, happy lives PBS systems and practices benefit everyone Developed with individuals preferences in mind (routines, consistency, choice, praise, activities, etc.)

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PBS Universal Supports 14 Are always in place for everyone, ALL of the time Enhance quality of life All activities, plans, routines, learning opportunities reflect individuals preferences, needs, goals Socially appropriate behavior taught, expected, encouraged Sensible expectations developed in all settings Individuals given choices and have lots of opportunities to engage in preferred activities Staff are skilled, knowledgeable, caring-staff are teachers

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15 Universal supports create physical and social environments that are positive and responsive. ENVIRONMENT plays a BIG role in the well-being of a person.

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Check out DDSLearning.com website 16 http://ddslearning.com/dds-pbs-initiative/ Check out this website to learn more about PBS and Universal Supports..

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Environmental Universal Supports 17 Create environments that are predictable and consistent with routines and preferences of person Understand why people do what they do--Figure out what motivates people Best guess about what we know from and about people Listen to people in different ways Be flexible as we listen and implement strategies

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Exercise 18 Think of a home, class, day program, or other group setting and identify some strategies you would use to create an environment that is predictable, safe and consistent with the preferences of the individuals in that setting and their learning new skills.

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Creating an Environment Supportive of and to the Person 19 What do we mean by an environment? physical set up structure, routines-positive, well understood staff who interact with the people all the people in that setting broader environment similar past experiences in similar settings

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Universal supports provide environments that are.. 20 Pleasant to be in Responsive to needs, wants, preferences of people living in them Enhance the quality of life of the person and people so that people are successful Routines/schedules predictable, consistent Sometimes need to change the environment, get someone into a different environment Important to figure out what is important TO a person

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Exercise 21 What could staff have done differently? Name 3 things that a staff person could do in this situation.

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Create opportunities for someone to exert individual control 22 We like to feel that we are in control, of at least certain aspects of our liveschoiceperson has preferred activities in their lives When someone takes control of a situation, person may feel out of controloften becomes a power struggle Is there a way to give the person more control? What does he/she want? Ask them. Provide a short list of choices/suggestions (pictures?). Whats your big picture? Big goal? Dont sweat the small stuff.

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Debbies Story 23 Read story What could staff have done differently?

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Create a win-win environment by trying another way 24 What is the goal? Offer opportunity? Provide something important? Health/safety risk? Is there another way to reach the goal? Daily opportunities for choice making throughout daily lives in all settingspreferred activities Identify multiple opportunities Find the good and praise it. Alex Haley Rule of 4: 4 positive statements to 1 negative statement Change environment to decrease likelihood of undesired behavior

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Redirect Behavior.ways to do this 25 Redirect behavioroften easier that confronting it Ignore undesired behaviors whenever possible if not a health/safety risk Use nonverbal gesture to direct Always model acceptable way to deal with situation Staff remain calm, in control, clearly state behavioral expectation Offer activity, engage in a behavior that is incompatible with undesired behavior Always try to redirect person to appropriate behavior/activity

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Create an atmosphere that allows a person time to think 26 Many people with intellectual disabilities need some time to process what is asked of them. Get someone to do something they want to do-like to do. Create an environment of YES.

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CHOICE: Offer Real Choices 27 Can you think of ways to specifically offer real choice that is based on desired preferences? Ways to enhance choice making: Schedule daily opportunities for people to make choice decisions throughout their daily routines in all settings Provide and plan as many choice-making opportunities as possible Doing so will help people learn, accommodates different learning styles, helps them finish tasks, increases positive behaviors

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28 People dont like to be ordered around. Theyd rather make choices on their own Avoid power struggles and recognize if you are in one. Stop. Short break If you stop, back up, consider your next action break cycle. Other person can consider whats really happening Redirect behavior that is not pro-social

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Three questions for staff about choice 29 Why should I do it? When should I do it? How do I do it?

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Why should I do it? 30 Way of empowering a person Prevents power struggle Makes a person feel engaged and a part of the decision making process Increase prosocial behavior People respond better to choices Improved coping when having to do an undesired task Decreases conflicts, refusals, defiance, and opposition Builds rapport

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When should I do it? 31 Offering a person choices should be a regular part of the day When telling anyone to do something or giving a directive When a person is reluctant to do something When a person is stuck on making a decision When a person engages in a power struggle or is argumentative When a person is having a difficult time When a person make excuses When students are reluctant When giving consequences When giving rewards

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How do I do it? 32 Speak in calm, neutral tone Provide a person with two or more choices that you will fully accept, for example, you can either do your work sitting at your desk or sitting at the table Present the entire group or house with choices when assigning work, for example, you can either do the mall or the grocery store, you choose Give choices when rewarding, for example, John, do you want computer time or a fancy pen? Develop task completion picture board Provide list of preferred activities to select from Opportunities to make choices throughout daily routines

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Exercisewith a partner. 33 Discuss a person you know and how offering choices (additional choices) would affect their lives. When during the day could you increase choice making or add opportunities to make choices? Switch & share

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PRAISE: Help person succeed 34 Universal PBS supports create environments that let a person succeedbelieve that it is possible, be positive If in a difficult situation, begin with a choice that leads to successful behavior (want juice or water with your meds?)

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Create environment that lets someone know they had done a good job/something right--PRAISE 35 Identify opportunities to praise and encourage specific behaviorsdo so consistentlyencourage prosocial behaviors Discover what motivates people and fill the persons life up with enjoyable things to do We respond better to positive than negative consequences.

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Three questions for staff about offering praise 36 Why should I do it? When should I do it? How do I do it?

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Why should I do it? 37 Some people need outward motivators It helps keep people engaged Provides encouragement Boosts confidence, self-concept, and self-esteem Increases buy-in Builds rapport and trust Is uplifting Increases persons desire and drive to please and succeed Increases persons resilience Helps embed an internal desire to try, succeed, and persist Helps people to push through difficulty, barriers, blocks, etc

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When should I do it? 38 Positive praise, according to research, should always be done with every person at a ratio of at least 4 positive praises to 1 criticism When a person is stuck, frustrated, getting bogged down, etc When a person exhibits good behavior, expectations, help others, show generosity, share, etc When a person puts forth good effort When a person succeeds, overcomes, persists, pushes through, achieves, etc When a person demonstrates positive behaviors

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39 When a person uses productive coping skills, problem solving skills, etc When a person is independent, self-start, etc When a person looks down, needs encouragement, is having issues, personal difficulties, peer conflict, etc When you want to increase a positive behavior When you want to improve trust and rapport with someone When a person steps outside their comfort zone, looks embarrassed, seems to feel stupid, takes a risk, etc

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How should I do it? 40 Praise, according to research, should be given in a ratio of at least 4 praises to 1 criticism When a person display positive or productive behaviors, actions, skills, characteristics, etc, or appear to need some encouragement, etc, verbally praise the person and/or give them a high-five, pat on the back, clap, exclamation, cheer, hop, etc Praise can be done either quietly or if the person is motivated by peer approval, in a group Praise can be verbal or physical (like pat on the back, fist pump, head nod, hop, jump, etc)

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41 When delivering praise, use direct eye contact, positive demeanor, open body position, and get to the level of the person if possible Make praises specific, personalized, and individualized Repeat praises if the person seems unconvinced at the first stating of the praise Restate praises in different ways to get the point across.

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Exercise 42 Get a partner, discuss a person you know and how praising them would affect their lives. Switch.

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Creative a positive, proactive YES environment 43 Dont just say NO and STOP Think of ways that a person can feel in control of their life.Andrews story PREPAREIt doesnt always work Learning new skills and having opportunity to practice these skills, creates positive environment for someone to succeed

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Seven Actions: Things you can do right now.. 44 1. Be sure that people know what you are asking them and what is expected in a given situation 2. Offer opportunities for choice especially for those things that are important to someone 3. Tell people when they are doing a good job or doing something right 4. Ask someone to do something else if what they are doing is socially unacceptable

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45 5. Interact with people in a positive, proactive way assume the best in them 6. Look for opportunities to teach someone more appropriate things to do, wherever you are 7. Create a positive, responsive environment so someone is offered opportunities to be successful

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Exercise 46 In a small group, list 3 actions that you can take to create a happy, responsive environment for the people you work with. Discuss specifically what can happen on a big scale in your agency, house, etc., as well as what can happen to increase the quality of life for one person.

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Summary 47 Behavior IS communication Relationships ARE important We need to listen in new ways to people We need to be mindful of our own behavior and their consequences Give people meaningful choices Let people know when they are doing something the right way Create a positive, responsive environment which increases the likelihood that someone will be happy Think of ways to say Yes, instead of No/Stop Assume that people are able

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Remember. 48 PBS focuses on prevention, not reaction PBS is all about teaching people skills and knowledge to improve their lives