Positive Behavior Support Instructor Narrative - des.az.gov · Positive Behavior Support Instructor Narrative . 2013 . 4 . Where are the restrooms? (summarize class answers to make

Positive Behavior Support Narrative

January 2013

Copyright © 2018 Arizona Department of

Economic Security. Content may be used for educational purposes

without written permission but with a citation to this source.

Positive Behavior Support Instructor Narrative 2013

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Classroom Set-Up List

� Participant Guide

o V:\Statewide Training Coordinators\Central Region\Positive Behavior Support 2012

For instructor to hand out

� One document maybe o V:\Statewide Training Coordinators\Central Region\Positive Behavior Support 2012

� 10 Ways to Support a Person by David Pitonyak

o V:\Statewide Training Coordinators\Central Region\Positive Behavior Support 2012 o Best practice is to highlight number of sections based on number of students (16

students, highlight 1-10 and then 1-6; keep them in order so you don’t miss someone)

� Messages in Bottles* o V:\Statewide Training Coordinators\Central Region\Positive Behavior Support 2012

*For the messages, print new messages each time so participants do not have torn sheets. Be sure that the messages uncurl in the bottles so they are challenging to get out – we do now want students to be able to turn over the bottle and have the message fall out.

Additional Equipment

� DVD: Supporting a Person with Challenging Behaviors

� DVD: I am Sam

� Laminated Behavior Cycle Posters (also used with Prevention and Support) (5 posters)

� Power Point (with laptop / projector) o V:\Statewide Training Coordinators\Central Region\Positive Behavior Support 2012


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Instructor: See Notes on last page regarding times for the class.

First Hour: 8:30 – 9:45

Introductions, David Pitonyak Good morning and welcome to Positive Behavior Supports.

Housekeeping (8:30 – 8:40, 5 minutes to start late if needed)

As we get started, can I see a show of hands – how many of you have been to a class here before?

Is there anyone who today is your first class? Excellent. Based on that, housekeeping is going to be really easy.


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Where are the restrooms? (summarize class answers to make sure everyone hears – down the hall, behind the elevators)

And where is the water cooler / refrigerator / break room? (down the hall, last door on the right)

How about the snack shop? (9th floor) For anyone who smokes, you can go downstairs and back towards the parking lot.

Where do you validate your parking ticket? (by the sign-in sheet)

During breaks, where can you make phone calls? (In the hallway)


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Right – and remember the lobby area right outside the door is part of a work area, so please take the calls in the hall. Remember, we need to show the same respect to each other that we show for the people we support. Please make sure that you have put your cell phones on silent, vibrate, whatever you need to do so they don’t make noise. Also be sure you have put your phones away – in a pocket, in your bag. Please do not have your phones on the table or in your laps.

Any questions about housekeeping or the building before we move on to introductions?


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Introductions

8:40 – 8:50, even better if done by 8:45 For introductions this morning, if you could please share with each other your name, Where you work and your role, such as the Southwest Office as a Support Coordinator or Windsor as a hab tech, The name of your supervisor And one behavior that you are really proud of. At this point, when I say “behavior,” just think about one thing you do that you are really proud of. Can I have a volunteer go first?


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Instructor note: do not introduce yourself to the end, because your introduction will also champion today’s topic. Do not provide correction or feedback on behaviors, but mentally file them away to reference and incorporate throughout the day. Now that we’ve heard each other’s names, a couple questions for you, just by show of hands if you are comfortable. (Keep the questions moving really fast)

How many of you are parents?

How many of you live with other people?

How many of you spend time at work with other people?

How many of you go shopping, including going to the grocery store? Chances are, your hand was up at least once. The topics we are going to be talking about today will


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work with the people we support, but it’s not just about the people we support. Positive behavior support works in our own lives, with ourselves, with people we interact with. Any time we are around other people, we can use the stuff we’re going to be talking about today.

Learning Outcomes (couple of minutes) On page 2 in your participant guide are six learning outcomes for the day. The main thing to focus on today are those behaviors we’re proud of. We’re going to be talking a lot today about the people we support and how we can be good advocates.


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We’re going to look at ways to increase positive behaviors and decrease behaviors that may be challenging. But it’s not just about the people we support – as I said a few moments ago, positive behavior support works with everyone in your life. We all have behaviors that we’re proud of. Whether we like to admit it or not, we all have behaviors we display that drive the people around us up the wall. With that in mind, we’re going to be defining behavior and looking at the reason we do the things we do. We’re also going to be looking at the behavior cycle and how we can use it for teaching. Finally, we’ll be looking at reinforcement. What it is and how to provide effective reinforcement.


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After we have done all of that, there will be a brief quiz, where you will have the opportunity to show what you have learned. The quiz will be open guide, so be sure to take notes and use your participant guide in the way that makes the most sense for you.

Behavior Support 8:50 – 9:00

On page three in your guides is some information that serves as our foundation for the day. If you have taken Article 9, the information will look familiar.


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The first sentence starts off talking about the fact that we do not control others, but support others in their own behavior change process.

What is the difference between support and control? Validate answers. In your guides there are four tenets of Positive Behavior Support. These are also addressed in Article 9. The first one is what we just talked about – we’re here for support, not to control people. The second one is that there is a reason behind difficult behavior. Behavior is always communicating something, and as a support provider, our role is to figure out what is being communicated. We are going to spend quite a bit of time today talking about behavior as communication.


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The third point is that we can’t just sit in a classroom and talk about this stuff. Talking doesn’t do us much good. We have to actually USE what we learn. And the last point links back to not being in the control game: we’re not here to punish. We are not going to use punishment. As a Division employee, punishment is not an option. We are here to support and teach.

Myths about Difficult Behaviors 9:00 – 9:30 We are going to watch about twenty minutes of a video looking at how we support people who display challenging behaviors.


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The video is from a presentation Dr. David Pitonyak did for the Division several years ago. He is a leader in the field of positive behavior support. For those of you who provide direct support, this video is also shown in another class, so it may be familiar. This time, watch it with the specific lens of behavior. For all of you, there is space on page 4 to take notes about the video, including two myths that are addressed in the video. Pay particular attention to the philosophy Dr. Pitonyak displays, and consider how this philosophy will influence your work.

Show DVD from beginning until after the section that he says “go home – be with your family. Go home.” (end of the section – I believe it may be section 5)


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Based on the video, who has problem behaviors? Yes, everyone!

True or false – people with developmental disabilities have problem behaviors as a result of their disability? False! (Be prepared for some discussion here – many times family members supporting a person with autism will have discussion here. Re-direct back to the autism itself isn’t the reason for the behavior – it may be meeting a sensory need, medical need, a form of communication)

What messages are you going to take away from the video? (pause for discussion – should be wrapping up conversation between 9:25 and 9:30)


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Quality Life

9:30 – 9:35 (earlier is better) Dr. Pitonyak spoke about loneliness and quality of life several times in the video. Let’s talk for just a moment about what makes life worth living, what leads to a good quality of life.

In your own life, what makes life good? What makes you happy?

Write answers on board. Topics may include: relationships belonging Control

Health Safety Food

Shelter Respect


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How does it benefit the people we support to have a good quality life? Pause. Validate answers. There’s the graph here that shows the happier a person is, with the best quality of life, the less likely the person is to “act out” or display challenging behaviors.

Relationships 9:35 – 9:40 On page six (11 in ADA guide) are the circles of support.

Who here has completed SC 101?


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Is there anyone here that has completed SC 101 that would feel comfortable talking about the circles of support? If volunteer is willing, have them summarize. Right, these are the circles of who is in your life. The circles look really different for every person. In SC 101 we talk about relationships, and who is paid to be in your life versus natural supports. We also talk about how long a person stays and turnover rates among paid providers. People get promoted, find new positions, or change houses where they work. Paid relationships do not last as long as natural supports.

How do you think the circles of support could influence behavior, both positive and negative? Pause for answers, validate participants.


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It’s time for our first break of the day. See you again at ______________ (ten minutes). Break should roughly be 9:40 – 9:50


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Defining and Describing Behavior

9:50 – 10:00 This is a class about positive behavior support. To discuss behavior, we need to make sure we’re all on the same page about how we define behavior.

When someone says “she’s having a behavior” what do they usually mean?

Usually something negative

Behavior isn’t necessarily negative. Behavior is simply an action; anything a person does that can be observed and measured. On page 7 in your guide is some space to fill in the blanks: Behavior is anything that a person does that can be observed and measured.


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We are always behaving. The only time we are not behaving is when we’re dead. I see lots of behaviors in this room – twisting in chairs, highlighting, filling in blanks, paying attention, drinking… Behavior isn’t emotions – behavior is what you do.

So if I kick the table, is that a behavior? Yes. Yes, it’s an action: “kicking.” You can see me do it and you could keep a tally sheet of how often I kick.

If I hug you, is that a behavior? Yes. Yup, it’s an action: hugging. You can see me do it and you can keep track of how many hugs I give.

How about if I am happy, is that a behavior? No. Be prepared for some discussion – chances are

people will say that yes, it’s a behavior. It’s not.


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Okay, wait – what are some actions or behaviors I could do that would let you know I’m happy?

Laugh, hug, sing, high five, smile, etc. Emotions are not behaviors. Emotions can be a reason we do something, so they can be a reason for a behavior, but they are not the behavior itself.

For example, if I punch you every time you walk in the room, what are some reasons I might be punching you?

Angry, we had a fight earlier, you punched me last time you came in the room, so excited to see you, etc. The lower part of page 7 (14 in ADA guide) talks about some considerations for describing behavior.

If someone tells you, “He’s really aggressive,” what does that tell you?

Not much!


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Would it be more useful to know “When someone talks during the game, he begins to yell and will throw the remote control”? We need to describe behavior so we know what a person is talking about. For example, there was a gentleman who hit himself on the head. If he hit with an open fist (demonstrate), that meant he was really excited and happy about what is going on. If he hit with a closed fist (demonstrate), that mean he was really angry and you better duck because he’s about to hit you.

Any questions at this point?


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Defining and Describing Behavior Cont. 10:00 – 10:05 Go ahead and turn to page 8. With the person sitting next to you, you have one minute to discuss three ways behavior is beneficial. On your mark, get set, go! Pause – give one minute. Give ten second warning. Make them think quickly.

From each group, can I please have two examples?

Answers can include: Necessary for survival. (Again, we’re dead if we’re not behaving.) Behavior is communication – “I do not like that.” “You have got to be kidding!” “Hear me roar!” “Wow, that feels good.” Behavior means we are engaged, reacting, responding. It’s a way to get our wants and needs met.


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Behavior

10:05 – 10:15 On page 9 (16 in ADA guide) it starts by summarizing several of the points we discussed: behavior is an action, which means it’s something someone does. You can see it or observe it. For example, if someone yells you can’t see it but you can observe it. You can keep a tally sheet or mark off each time it happens – you can count it. And really important – it has a beginning and end. It does not continue indefinitely. Behavior is communication, and we have a role in figuring out what a person is communicating.


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Now that we are all on the same page about defining behavior, it’s time to talk about what the Division defines as a negative behavior. There are three criteria, and we would need to say “yes” to at least one of these three criteria before we could say we need to work to change the behavior. The first is that it’s not safe for people involved.

If I am biting people, would that be safe for people involved? No! Next is that it violates the rights of others. This often can include following laws, such as not smoking in this classroom.


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The first two criteria: not safe for the people involved and rights violations, are usually pretty cut and dry. The third criteria can be more challenging: it limits the person’s ability to live a full, self-directed life as a member of society. This can be a gray area: whose definition of a full, self-directed life are we talking about? Personal values often play a large role here, and as advocates for the people we support, we need to sort out the individual’s values and the people in their life. The first example of this was a support coordinator who supported an adult man who lived in his own apartment. He was pretty independent, and had an attendant care provider come twice a day to help him with medications, housekeeping, and organizing his day. The gentleman and his provider were extremely close and had worked together for years. In fact,


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he called the attendant care provider “mom” and they considered each other family. The support coordinator was out for a review and everything was going well. A week later, the support coordinator got a panicked call from the attendant care provider, saying “We need to meet immediately! He’s an alcoholic and a sex addict.” In asking more questions, it turns out the gentleman had gone out the night before. He had picked up a woman at a bar and the two of them had come back to his place. When his provider arrived in the morning, she saw an open can of beer and a naked woman in his bed. Her values told her drinking and sex outside of marriage was a sin. Keep in mind he called her mom – and the woman in the bed was certainly not his wife! She’d never even met her before.


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As the gentleman pointed out, he was in his 30s.

Can he drink if he chooses to? Yes!

Even though he has a developmental disability? Yes! (If someone brings it up, if there was a negative medication interaction or a reason we need to limit alcohol, that would be a rights’ restriction and would require a Division-approved behavior plan, per Article 9.)

Based on the information you have, was his behavior of drinking and inviting a woman to spend the night limiting his ability to lead a full, self-directed life as a member of society? No!!! One more example for the third criteria: I received an incident report for “Joe.” Joe lived in a group home and the incident report simply said, “Joe refused to shave today.”

Is refusing to shave a safety concern? No!


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Is refusing to shave violating anyone’s rights? No!

How about limiting his ability to live a full, self-directed life as a member of society? Pause for discussion – this can go either way. Well, in Joe’s situation, he worked in food service and could not go to work if he didn’t have a clean-shaven face.

Knowing that, could it be limiting his life? Yes. Follow class lead – if they don’t go here, bring up the idea of needing to support Joe to see if this is the job he wants and educate him on the importance of shaving if it is the job he wants. If he doesn’t like his job, work with him to find a different job. Being detectives is important – in Joe’s case, it simply turned out he hadn’t been sick in over 8 years. All his roommates had recently been sick and gotten to stay home and watch movies. Joe wanted to stay home and watch movies.


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We ended up working with Joe to talk about arranging to take a day off every once in a while. The third area can be really difficult – you have to balance the family’s values with what is important to the person we support, and we need to make sure our personal values do not influence our decisions.

Target Behavior 10:15 – 10:20

If a behavior meets one of the three criteria we discussed, or the person identifies a behavior they would like to change, then we can call it a “target” behavior. Note the language: within the Division, we do not say a behavior is appropriate or inappropriate. We do not say negative behavior. Instead, we may use


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challenging behavior or interfering behavior. This is simply a way to refer to the “target” behavior – the behavior we want to decrease. Because all behavior is communication, if we are trying to decrease or stop a target behavior, then we’re going to need to replace the behavior with a positive, or alternative, behavior. We can’t just take away a person’s communication without replacing it with something else. To figure out how often a target behavior is happening, we need to take baseline data. On page 10 (page 21 in ADA guide) you have some fill in the blanks. We take data so that we can objectively record a change in behavior. Data gives us more information about behavior so that we can better understand.


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And baseline data is data that we take before we teach or change things with, for, or around a person.

What are some examples of target behaviors you have come across?

Hitting / kicking / biting / pulling hair/ scratching / screaming / running into traffic / eating cigarette butts/ jumping from moving vehicles, etc…

Message in a Bottle 10:25 – 10:40

I am about to bring around a plastic bottle with a message. Your goal is to get your message out of the bottle.


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A couple rules: you cannot rip or tear your message in the process. You also cannot damage your bottle. Once you have your message out, keep it to yourself for a few minutes – please do not share your message with anyone.

Any questions before I bring around the bottles? Pass out bottles. Do not get involved while participants get out their messages. It’s okay for them to work together if they initiate teamwork. Tip: erasers of pencils work really well to get messages out.


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Still keep your messages to yourself. How was it getting your messages out? Pause for discussion. For some people it may have been really easy, for others it may have been extremely complex, teamwork can be beneficial. Summarize the following paragraph as needed, based on conversation:

Sometimes figuring out the reason someone is doing something is extremely straightforward. Otherwise times it’s really complex and takes teamwork.

Take a moment to silent reflect on the message you received. If this was true for you and you did not communicate with words, consider how you might express this to people you haven’t met before. Consider how this might impact your life. Without sharing your message, please share with us some of the behaviors or ways this message might

impact your life. (pause for 2-3 volunteers) Isolate, cry, scream when someone asks you to do

something, hide when a provider comes, etc.


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Considering the behaviors being described, let’s share what is one everyone’s message. Please read aloud your message. Move around room, for each person to read. No discussion between each one; just the reading. All of these messages are functions, or reasons, for behavior. We all do things for a reason. Our role as support professionals is to figure out the reason someone is doing something. If the behavior is having a negative impact on that person’s life, then our role is to teach a new behavior that is more effective.

What were the three criteria to determine if a behavior needs to be changed? • Not safe for the people involved • Violates the rights of others • Limits the person’s ability to lead a full, self-

directed life as a member of society


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Excellent! Head to break. See you again in 10 minutes, at ______. (10:40 – 10:50) During break, put a piece of large flip chart paper on the end of each table for the activity after break.


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Calvin and Hobbes 10:50 – 11:00

Welcome back from break! Before break we were talking about the reasons people do the things they do, or the functions of behavior. On page 12 (25 in ADA guide) in your participant guides is a comic. With your table, you’ll have 5 minutes to brainstorm a minimum of 10 possible reasons Calvin eats his ice cream the way he does. Choose a writer for your table and that person will use the large paper at the end of your table to write down your ten – or more – reasons for Calvin’s behavior.


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Any questions before you get started?

Conduct activity – be sure to sit back and let the groups work. If a group gets stuck, as them a question to get them thinking. Roughly 3-5 minutes is usually enough. As you finish up, choose a spokesperson for your team and hang your page somewhere on the wall. Pause while teams hang up their pages. Okay, let’s go around the room – give us one idea at a time. If someone says something you have, cross it off and give us another idea. Quickly rotate through the groups, one idea at a time until every team has run out of ideas. Possible responses include:

• Entertainment • Likes feeling • Likes sound • Conversation

starter

• Attention • Avoid soggy cone • Toothache • Sensitive teeth • Too cold

• Licked too far down – can only reach this way

• Trend setter


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Analysis of Behavior 11:00 – 11:05

The top of page 13 (27 in ADA guide) gives us some of the areas we’ll be exploring throughout the rest of the day. We have already discussed defining behavior. We are soon going to be talking about setting conditions, antecedents, consequences, and all the parts of the behavior cycle. We briefly talked about the functions of behavior. This afternoon we will then be looking at the rewards, what has to be learned, and who has to learn it.


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Behavior Cycle 11:05 – 11:45

The next area we are going to look at is the behavior cycle. The cycle of behavior can be described in a lot of different ways, and people can spend years studying behavior. We are going to cover a basic model used by the Division, to make sure as support professionals we are all using the same approach. For those of you doing direct support, this may be familiar if you have taken a Prevention and Support class. The same model is taught in Prevention and Support – we simply go into a bit more detail today.


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As I said, this information can be a semester-long class or an entire field of study. We’re going to spend about a half an hour introducing it, and then spend the rest of the day applying the information. The behavior cycle is broken down into three main parts: Before. During. After. The cycle can apply to positive or challenging behaviors. On page 14 (29 in ADA guide) in your guides it gives an example of someone walking into a room, and I smile because I’m glad that person is there. The “during” is the behavior: giving the person a high five.


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And afterwards the person smiles at me and returns my high five. It’s a pretty simple process. Let me walk you through a day I had a while ago. Come with me into the “land of maladaptive behavior.” I know that having lunch is an important part of my day. If I miss lunch, I tend to get really cranky and have a hard time working. I just can’t concentrate. I was looking at my schedule for the next day, and realized that I had booked back to back meetings all over town. My lunch break was almost non-existent. Packing lunch was going to be critical to having a good day. My first meeting was at 8:30, so I knew I’d have to leave my house a little bit early to get there on time.


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So, I set my alarm and write a note reminding myself to make lunch in the morning and headed to bed. In the morning, I woke up to my phone ringing. It was the person from my first meeting, asking me where I was. I looked at the clock and realized it was 8:45. Dang it! I overslept. I double checked my alarm and realized I’d set it for 7pm instead of 7am. Anyone ever do that? So I flew out of bed, threw on clothes, and headed to my car. The note on my front door reminded me to go back in and make my lunch. I opened the fridge and it was like a scene from a bad sitcom. I swear, there was baking soda, lemon juice, and some leftover we’d been avoiding for weeks that was likely growing something at this point. It was definitely not edible.


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There was nothing for lunch in the fridge, freezer, or cabinets. Old Mother Hubbard’s cupboards had more food. I decided to stop by the grocery store quickly to grab some food. Sometimes, particularly when I’m in a hurry, I’m not very situationally-aware. Had I been paying attention, I would have noticed there was only one lane open in the store and the self-checkouts were closed. I would have seen all the people in line. But did I see that? No, of course not. That would have been too easy. So I grabbed my food and came back to checkout. And saw the line. And saw the single cashier. I hate waiting in line. I’m terrible at it. I also have strong opinions about stores knowing trends and being able to schedule staff accordingly.


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So now I’m frustrated and beginning pacing in mini-squares, doing a little box step. I start muttering, “all I want is my lunch – I only have two items. This is ridiculous.” As I get more frustrated, one thing you should know about me is I’m a bit of an instigator. I try to get the people around me involved, too. So my muttering becomes louder and I start asking the people in line around me, “Can you believe they only have one cashier? There isn’t a back-up? Really?!?” All the way at the front of the line I see the person counting out exact change. I keep sighing and asking the people in line around me if they see what is going on. And then, it happens. The worst of the worst. The cashier’s light starts flashing.


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We all know what that means, right? More waiting. It means the cashier needs help with something and I am going to have to wait longer. This is the moment I lose it. I throw my lunch on the ground, shouting “Seriously? Get enough staff!” and I storm out of the store. Once I’m outside, the moment has passed. Let’s talk a little bit about how all of this fits in with the behavior cycle.

The “before” stage has three main parts. The first is setting events.


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Setting events are the big picture things, things that are ongoing or not specific to the moment. If you haven’t slept well for a few nights, if you have the flu, if you’re fighting with your roommate. All of those are “big picture” setting events that reduce your coping skills.

In my example with the grocery store, what were some setting events?

Busy schedule, no food, oversleeping Hand in hand with setting events is the second part of the “before” stage: antecedents. Antecedents are the triggers, or situations that make something more likely to occur. These are the things that “set us off” when we’re talking about challenging behaviors.


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Think about things that upset you. For me, it includes…(include 3-4 of your own pet peeves. Examples include: people driving really slowly in the car pool lane, if my partner wakes me up by asking “are you awake?” or my dad’s ‘hospital’ voice – the tone he uses when someone is sick)

What is one of your triggers? Pause for 5-6 examples from students. If only 1-2 will share, that’s okay, too. The idea is that we all have stuff that upsets us and makes it hard for us to cope. Antecedents can be external – things that happen outside of ourselves. For the following, use student’s examples if applicable: _______ (student name) listed external antecedents, such as ________ (use student examples).

Can you think of any other external examples? Pause for answers. If listing internal examples, validate and point out it’s an internal antecedent.


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Internal antecedents are the things that happen within your body. Think about how you act when you don’t feel good. Do you always make the best decisions? Anyone know someone who is cranky when they’re sick or tired?

In my grocery store example, what were some antecedents you heard? Long line, single cashier, flashing light

The last part of the “before” stage are precursors. Precursors are simply the physical signs someone shows before the target behavior.


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If someone is about to “go off” – what are some signs that tell you something is about to happen?

Rocking, biting own hand, mumbling, “the voice” (or “Mom-voice”) “the look” (kids tend to know this look from their parents), sucking in their cheeks, laughing uncontrollably, crying, swearing, etc. Those are all examples of precursors. When I was in the grocery store, what were my precursors?

Mumbling, instigating others, box step

So the before stage consisted of what three parts? • Setting Events • Antecedents • Precursors

The before stage is an awesome time for teaching – this is where we can figure out things to change in a


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person’s situation and teach a person alternative behaviors.

But during the behavior is not a teaching moment. This is a moment to keep calm and assess the situation. For those of you who are support coordinators, this can be a conversation to have with teams. A lot of people will wait until a challenging behavior is in process and try to teach in the moment. This is the last place you want to try and teach. In your guides on page 18 (37 in ADA guide) are some tips for during a challenging behavior. For those of you who are direct care workers, you will be talking about these tips when you take Prevention and Support. These are tools you will use on a daily basis.


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For those of you who are support coordinators, this is information to consider when offering suggestions to a team or reviewing incident reports.

When we say “demonstrate respect,” what do you think that means during a challenging behavior? Listen, change your behaviors based on what the person is saying, recognize the person is a person who is having a tough time, if someone tells you to be quiet, be quiet, don’t use a condescending tone, etc.

How about when we say “validate a person,” what does that mean during a challenging behavior? Validate how the person is feeling, such as “I can see you are really upset,” or “I can understand how that can be frustrated.” Think about how you feel when you’re really upset and someone tells you, “That’s not something to be upset about.” Pause – people will frequently nod or add a statement or two.


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I’ve mentioned Prevention and Support. For aggressive and particularly challenging behaviors, we offer a class called Prevention and Support. The majority of the class focuses on preventative, proactive strategies to prevent behavioral emergencies. A small portion of the class addresses how to handle situations when the preventative strategies fail, including emergency physical intervention techniques approved by the Division. At this time, the class is only open to people providing direct support, such as hab techs. This class replaces a former class called C.I.T. If you are a support coordinator and you are working with someone who has intense behavior challenges, be sure you work with your supervisor and potentially your behavioral health liaison for your district. The behavioral health stand alone also talks more about supports that may be available from the RBHA. See next page for important instructor note.


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Work to end questions here – often people will want to “workshop” specific situations. Encourage people to see you during breaks if they have specific cases they need support with. They will NOT be allowed to take Prevention and Support at this time.

So after the behavior itself we have the after stage. “After” includes consequences, or the “payoff.” On page 19 (page 40 in ADA guide) you have some fill-in-the-blanks. Consequences are the direct result or outcome of the behavior. Consequences can occur in a person’s internal environment, in the external environment, and can be the response of others to the behavior.


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The consequence phase is a powerful teaching stage. We can look to see what is going on to reinforce the challenging behavior, and work to change it. We are going to be looking this afternoon at a lot of different reinforcers and ways to impact the consequence stage. But let’s think of some examples right now.

If I scream at my closest friend, what might be the consequence?

They scream back, we stop talking with each other, throat hurts, I feel better, etc.

In the grocery store, when I yelled and threw down my groceries, what would be some possible consequences? Kicked out of the store/not welcome back, embarrassment, others looking/staring at me, feeling good because I go some control over the situation

Think there is any possibility I would do it again? Pause.


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Absolutely I would do it again! The main reinforce for me was gaining control over the situation, and in that moment, I felt better. Sure, I was embarrassed and hoped I wouldn’t run into any of the people in the store again, but even that wouldn’t be enough to stop me from doing it. As I said, after the behavior is a great teaching opportunity.

It’s represented as a rocket ship because there are many, many things that happen to cause a rocket to launch. If any one thing changes, the launch may be delayed or canceled. During take-off, once the rocket launches, there’s really nothing that can be done.


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Landing happens quickly – it doesn’t take the weeks or hours preparing for launch. You’re going to come down at some point. There are a lot of steps you can take to make sure it’s a safe, positive landing and a lot you can learn from the landing for the future. So let’s look at page 20 (43 in ADA guide) now for a moment. At each stage we need to ask: What did we learn? What can be done differently in the future?

In the “before” stage, when I overslept, had no food in the house, or the store had a long line, what did we learn and what can we do differently in the future? Follow class lead on discussion. Make sure they’re on the right track, such as “set the alarm clock” “make lunch the night before” etc.


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If needed, ask If you were the person supporting me, what could you do to help? Careful if they offer to go shopping for you – we don’t want to take away independence. But in the store they might be able to support you by looking at magazines, playing games on your phone, etc.

Any questions so far? In that case, let’s head to lunch. See you again in one hour, at ____________. Typically between 11:30 and 11:45. Either way, give until 12:45 for lunch.


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I am Sam 12:45 – 1:30ish

Welcome back from lunch! This morning we defined behavior as something a person does. Behavior is not emotion – which led us to talking about the function or reason for behavior. We talked about the Division criteria for if a

behavior should be changed. What were the three criteria to define a challenging behavior? Not safe for the people involved Violates the rights of others Limits the person’s ability to lead a full, self-directed life as a member of society.


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We then talked about the behavior cycle, with before, during and after.

What are the teaching stages of the behavior cycle?

Before and after.

This afternoon we’re going to spend some more time looking at the behavior cycle in action, and then talking about what we can do once we know the stages. First of all, we’re going to watch a short clip from the movie I am Sam.

Show of hands, who has seen the movie?

Anyone remember it enough to give the class a brief summary of what the movie is about?

Summary provided on next page if needed.


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Sam Dawson (Sean Penn), has a developmental disability and is living in Los Angeles and is single-handedly raising his daughter Lucy (Dakota Fanning). Although Sam provides a loving and caring environment for the 7-year-old Lucy, questions arise about Sam’s ability to care for Lucy and a custody case is brought to court. Sam's friends recommend that he hire Rita (Michelle Pfeiffer), a lawyer. We’re going to watch Sam and Rita’s initial meeting. We’ll see the clip more than once, so this first time through it’s up to you if you want to take notes. You’re going to see a challenging behavior. Pay attention to what is going on in the environment to see if the behavior “comes out of no where” or if you can see things leading up to the behavior.

Show Scene 8 – Lovely Rita. Show entire scene – ends when you see Sam back in the coffee shop.


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So what target behavior did we see? Kicking the jellybeans. (other behaviors are

precursors – the behavior that put others in danger is kicking the candy bowl) Move to slide once you have class agreement.

What was the beginning of kicking the jellybeans? I’m not asking about the precursors – I am asking if you were keeping data about how many times Rita kicked, when would you consider the behavior as starting?

When she picks up her foot, aiming towards an object or when her foot makes contact with the object. Move to next slide once you have class agreement.


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In this clip, when would you consider the target behavior to have ended, or what would be the “off-set?” When she puts her foot back on the ground. She didn’t kick repeatedly – it was a single kick and it was over. Move to slide when you have class agreement.


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Right – Rita didn’t kick the table ten times in a row, it was a single kick. If you were supporting someone who has a history of kicking, you might define the end differently. It might be when the person’s foot stays on the ground for two minutes, or some other variation the team agrees upon. You want to describe the behavior so everyone measures it the same way, and knows precisely what is being discussed. Now that you have seen the clip and know who and what behavior we’re watching for, we’re going to watch the clip a second time. This time, pay particular attention to what is going on before and what happens after.


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Show Scene 8 – Lovely Rita. Show entire scene – ends when you see Sam back in the coffee shop. Now that you have seen the clip again, I want you to spend the next 8 minutes with your table. As a table, complete pages 23 and 24 (47 & 48 in ADA guide). Each team member should be taking notes and be prepared to talk about your table’s discussion.

Any questions before you get started?


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Conduct activity. Be sure not to get involved in team discussions unless they are way off course. Give about 8-10 minutes for discussion. Often teams only need 8. For de-briefing, recommend using a beach ball or paper airplane so each student has a chance to respond. Make sure people who have not talked much in class participate at this point. Okay, let’s start with page 23. Give me one example of a setting event or antecedent that started the whole thing off. Once you have provided ONE example, toss the ________ to someone else who is not sitting at your table. Toss ball / airplane. Get a whole range of examples, including car accident, scheduling error, son hung up, running late, not sure what to make of Sam, etc.


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Great! Now let’s move on to physical signs or precursors. What physical cues was Rita giving that she was getting upset? Again, give me one example and then toss the ________. Re-arranging sticky notes, tapping coffee cup, moving her hair, standing up to leave, sighing, etc.

Any questions on page 23 before we move on to page 24? Okay, let’s talk about what happened after Rita kicked the jellybeans. Note, in the video clip, this part was much shorter. Just like with the rocket launch, the consequence and calm down phase is usually pretty quick. Give me one example and then toss the ________. Sam stopped talking, assistant left, Rita instantly stopped sighing and became apologetic, seemed to calm down quickly, assistant looked scared, ultimately Sam was able to get her to give him a name for help, ate jellybeans


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Does anyone have any questions at this point? So we then need to ask ourselves what we learned and what could be done differently in the future.

If you were Rita’s assistant, what did you learn and what could you do differently next time?

Check temp’s work, ask Sam to re-schedule, rearrange room, keep therapist appointment (grin), etc…follow lead of class to get to the idea that there are a lot of possibilities for change.

Now that we know some ways to support a person with the behavior cycle, we’re going to talk about some tools to help teams figure out the stages of the cycle.


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Before we do that, it’s time for our first afternoon break. See you again in ten minutes at ___________.

Break is typically 1:30 – 1:40, sometimes a few minutes earlier During break, put a sheet of large easel paper on the end of each table


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Assessment 1:40 – 1:43ish

Now that we know the steps of the behavior cycle, it’s time to put them to work. Page 25 (50 in ADA guide) has some discussion points for you. For those of you that are doing direct support, you will be using this information daily. Sometimes, you get so involved in the moment it’s important to step back and evaluate what is going on in. For those of you in support coordination, this is where emergency staffing, phone consultations, or regular meetings come in to play.


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We need to do assessments to understand what the heck is going on: what is the reason someone is doing what they are doing. We need to understand what the person is communicating. We also need to know what patterns are happening: where is it occurring? When is it happening? How often and what does it look like? Once we know these parts, then we can figure out better ways to support the person. As we move forward in talking about assessment, we’re going to need to gather the parts of the behavior cycle.

What were the three parts? Before During After


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Sherlock Holmes 1:43 – 1:47ish Let’s look at two quotes on page 26.

Can I have a volunteer read the first quote for us, from a Scandal in Bohemia? Pause.

Can I have another volunteer read the second quote for the class, from A Study in Scarlet? Pause.


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I’ve been saying we need to assess the behavior cycle. What do these two Sherlock Holmes quotes have to do with assessment? Pause for discussion. Include the main point that we have to have data and do our research – we can’t jump to conclusions.

Supplemental Information 1:47 – 2:00 Assessment can be complicated. I am about to bring around a supplemental packet of information. Depending on who you are supporting will depend how often you use these resources. Some of you may bring out this packet once a year. For others, you may use it daily. These are NOT additional forms for support coordinators to complete. Instead, they are tools you may give to the person providing direct support or have the family complete.


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We will go through some of the more common forms, but I want you to start by working with your table to look at the pages. On page 27 (53 in ADA guide) in your participant guide is a situation regarding Cliff. No need to identify the behavior cycle at this point – the intent is for you to look through the supplemental packet and identify which forms you may think would be useful. Work together!


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Hand out supplemental packet of materials.

Watch time – give participants about 8 minutes to work, or until right before 2.

Review of supplemental materials 2:00 – 2:15 Keeping in mind what you just saw, let’s check out some of these pages. These can be extremely valuable tools when you are supporting a person with challenging behaviors. I have a couple forms I want to highlight, and then I want to hear what forms you identified for Cliff and any questions you have about the tools. We start on pages 2-3 with a reminder about Division approved behavior plans. Article 9 talks


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more about when you need a plan, but this document is just a reminder. Pages 6-13 has an aide to functional analysis. This is a very basic tool that can start a team thinking about the reason a behavior is occurring. Remember, as support professionals, we need to keep in mind all behavior is related to communication and isn’t just that someone has a disability. We need to figure out what is being communicated. In the video this morning, Dr. Pitonyak talked about the life people are living and how quality of life can impact behavior. On pages 17-29 there is an assessment tool for looking at a person’s quality of life. Again, you would not necessarily be the person completing this form – it might be something you give to a family or a team to work on individually and bring to a meeting or it may be something you just offer as a resource. My favorite tool is on page 29, a Behavior to English dictionary. This is particularly useful if you


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are supporting a person who has limited communication. It can be one page or it can be several – it’s a tool for providers and people supporting the individual to know when someone does something, such as when I suck in my cheeks (suck in your cheeks) during dinner, we think it means I don’t like the food you put on the table and we should ask if you want to make something else to eat. They can be simple, with just a few words, or it can be complex. One Behavior to English dictionary was made by a woman the Division supports who had limitations with expressive language. She worked with providers to take pictures of herself for the first column, and worked closely with her providers to document the remaining columns.


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Skipping ahead to page 54, you’ll find a reinforcement inventory. We’re going to be talking about reinforcement later this afternoon, and it can be challenging to find something that motivates a person. Feel free to reference pages 54-63 as needed for additional ideas.

Which forms do you have questions about or which forms did you think would be most useful for Cliff? Typically, people want to use all the forms. Remind them not to overwhelm Cliff’s parents – pick one or two you think would be most valuable. Probably the aide to functional analysis would be a starting point. If a team is completely stuck and a person’s behaviors are interfering with the quality of life, you might need more help. Working closely with the behavioral health system can be a starting point.


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The Division also has a service called Positive Behavior Support (or ASA in Focus), where we MIGHT be able to contract with an agency to come in and do a behavioral assessment, including writing a strategy to support the team. Work with your supervisor and behavioral health liaison for more information about this service.

Change Strategies 2:15 – 2:30

Remember, I said teaching is key. We can change situations to help a person be successful. Page 28 (58 in ADA guide) has 5 categories, which can be found on pages 29-33.


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As a table, I want you to work together to identify one new strategy that’s new to you per page. If you’re pros and none of the strategies or questions are new, then you can choose the one you like the best. Have a scribe write the page numbers and one strategy per page on the large paper on the end of your table. You have 10 minutes to work.

Any questions before you get started? Go!

Give groups roughly 10 minutes to work. Give 2 minute warning. As you finish up, go ahead and hang your page up along this wall. (Choose one wall so all the pages are together). Now that you’ve hung them up, I encourage you to review what other teams wrote.


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If you have to say one tip you found the most helpful for change strategies, what would it be? Pause for 2-3 answers. Okay, guess what time it is? Yup, time for a break. See you back at __________.

Break should be 2:30 – 2:40. If ahead of schedule, make it 2:45


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What has to be learned & By Whom? 2:40 – 2:45

So now that we’ve talked about some change strategies, the question comes back to who needs to learn something? Is it the person we’re supporting or is it the person providing support? Every situation is different, so the answer always varies. Does the person need new or better skills? Or maybe the provider needs new or better skills? Do we need new patterns? For example, if going grocery shopping when it’s crowded on the weekends


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isn’t working, maybe we need to switch when we go shopping. Or perhaps expectations need to change. For example, one instructor talks about her father who is SUPER friendly. He talks to everyone. And by everyone, I mean everyone. He talks to the mail carrier and the people walking their dog down the street. The instructor’s biggest pet peeve is that he talks to grocery store clerks the entire time he is checking out, and tends to tell personal information about his children. Does her father need to stop talking to people? Probably not. He’s done it his whole life and it doesn’t hurt anyone – it simply embarrasses his children. Instead, the expectation needs to change. His daughter has learned to go get the car while he’s


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checking out, or to go grab something else in the store while he’s waiting in line.

Alternative Behaviors 2:45 – 3:00

If we are truly providing support, that means our focus is on teaching. Behavior is communication and we’ve talked about the fact we cannot take away someone’s form of communication without giving them an alternative. Preferably, we give the person multiple alternatives. Target behaviors are the behaviors we want to decrease, or see less of. Alternative behaviors are the behaviors we want to increase.


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On page 35 it talks about the importance of an alternative behavior having greater effectiveness and efficiency. Let’s say you have a small child who is constantly interrupting your phone conversations. The child runs in and screams your name until you hang up the phone and give them attention. You might want to teach an alternative behavior, right? One alternative behavior I’d consider is having the child come in quietly and touch my arm to get my attention.


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When first teaching this, you have to make sure it’s going to be effective. Which means the minute the child touches your arm and is quiet, you get off the phone and give them attention. You do not make them wait. You might even give prompts to help teach, such as practicing when you’re not on the phone and when you are and the child enters the room quietly, smile and point at your arm as a reminder. But let’s say you’re trying this and the child screams and screams. You touch your arm but they keep screaming and then kick you.

Should you hang up the phone then and give them attention? No! Absolutely not.

Because if you do, what did you just teach this child? Just kick me – no need to touch my arm.


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Page 36 talks about functionally equivalent and functionally related alternative behaviors. Once you know the function of a behavior, it’s much easier to figure out what to teach. An example here was a gentleman who lived in a group home. He peeled everything. And by everything, I mean he peeled the varnish off tables, peeled all the wallpaper off the walls, peeled upholstery off furniture and in his group home van, the flooring in his home, and pretty much anything you can think of. He was a difficult guy to serve, because of all the property damage due to his peeling. The first step is to figure out the reason he’s peeling. The team ruled out medical conditions, and determined that it was a sensory need: he needed to “feel the peel.” So the team started to think about things he could do that would meet the sensory need and wouldn’t destroy his room or property.


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They thought of soup cans. You know how Campbell’s and some companies have the labels you can turn in to get rewards for schools? The agency the gentleman worked with started collecting cans from all their programs and storing them in the gentleman’s garage. When he felt the need to peel, he would go outside and peel labels. He took the labels to a local school and the school was able to get playground equipment and computers. He went from being someone difficult to serve to someone well respected in the community. Page 36 (70 in ADA guide) also talks about coping skills. This is something we all benefit from, right? You don’t need to share, but think about it – have you ever done something when you’re upset that maybe you shouldn’t have? Said something you shouldn’t have said? Behaved in a way you wouldn’t want your mother or your boss to see?


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Coping skills are critical for success with other people. Learning how to take breaks and strategies to calm down can help anyone. Sometimes we have situations we can’t avoid, and so we need to learn how to cope. Traffic, doctor’s appointments, rude people – we can’t avoid situations that upset us, so we need strategies of what to do when we encounter those situations. Page 37 goes on to address incompatible behaviors. If you’re peeling soup labels, you cannot simultaneously be peeling the carpet. If you’re bouncing a basketball with both hands, you cannot also be hitting the person next to you. A gentleman would take people’s beverages. He has run across streets to get someone’s big gulp. While teaching some alternative skills, when he goes in public, he always carries two drinks. That way, he doesn’t have an extra hand to take someone else’s.


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Finally, someone may need general skills development. Having words to say “I’m mad” may benefit someone. Someone may need support building relationships or knowing how to interact with other people. If skills are posing a problem, teaching the skills may be the solution.

Does anyone have any questions about these areas?

Teaching Techniques 3:00 – 3:02ish

Once you have figured out what you are going to teach, you need to figure out HOW you are going to teach it.


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Breaking something down into steps can be a great starting point. Your Article 9 packet also has a lot of information about teaching strategies. If you haven’t taken Article 9 yet, you’re going to get several pages of information about ways to teach. Typically, the provider will help identify the specific teaching strategy.

Reinforcement

3:02 – 3:08ish

During the “after” stage we can evaluate and look at reinforcers.


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Reinforcers are any event or item that makes the behavior stronger. It’s something that makes us want to do something again and again. Sometimes people will say, “Oh, I give her gum as a reinforce.” But if the person doesn’t like gum, it’s not a reinforce. If a person does not like recognition in public, an award isn’t going to do any good. If a person doesn’t like being touched, a hug is not a reinforcer. Reinforcers are something the person likes, wants, and will increase the likelihood of the behavior happening again. They are planned consequences. We can have positive reinforcers, when something is added to the situation. For example, if I want to watch TV and the TV is turned on when I ask, that’s a positive reinforce.


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We can also have negative reinforcers, when something is removed following the behavior and the situation improves. For example, if the TV was too loud and I ask to have it turned off, that can be a negative reinforcer. If I don’t like a particular person and that person leaves after the behavior, that’s a negative reinforcer. Just because the word “negative” is there doesn’t mean it’s something bad – it just means something is removed from the environment and the situation is better because of it.


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Article 9 Recap 3:08 – 3:20

Article 9 had 6 things that were “red light” techniques, meaning they are prohibited and providers can never ever, never ever use them. *Instructor note: remember, Article 9 applies to providers with the Division. It does not apply to family members who are not paid, schools, police, RBHA, etc. Let’s work as a class on page 40 to summarize the teaching techniques of Article 9.

The first prohibition represented on this slide is….? Locked seclusion time out.


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How about this one? Think “Ewwww!” Noxious stimuli / obnoxious stimuli

And this one? Overcorrection – having to do something over and over again or having to restore a condition above and beyond, such as spilling your drink and needing to clean the entire house


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What about this? Physical or mechanical restraints as a negative consequence to behavior

Behavior modifying medications have 3 situations they would be prohibited that are talked about in more detail in Article 9. The third situation is if someone is living in a licensed residential setting, such as a developmental home or a group home, and taking behavior modifying medications.


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What are the other two times behavior modifying medications are prohibited?

1. PRN or As needed basis 2. In interfering dosages, such as the person cannot

stay awake or is too revved up to function The sixth thing prohibited by Article 9 is psycho-surgery, insulin shock, experimental procedures, etc.

But in addition to the 6 prohibitions, we also have 4 things that require behavior plans. These are called “yellow lights” in Article 9, techniques that you must slow down and get team approval, as well as PRC approval and HRC review.


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The first three techniques don’t care where you live, they just care that a provider is involved with the technique. Anytime a team is considering using force, regardless of the person’s age, an approved behavior plan would need to be in place. Any rights’ restriction would need a plan. Protective devices due to someone’s behaviors would need to plan, such as helmets or arm splints. Finally, if someone is living in a licensed residential setting and taking behavior modifying medications, then the person would need a behavior plan. Article 9 goes into more information about all of these, and there is a brochure online you can share with families if needed. This is just a reminder when you are considering teaching techniques and reinforcement with a team that you must follow Article 9.


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Rules for Reinforcers 3:20 – 3:25

Page 41 (78 in ADA guide) talks about some rules for reinforcers. Don’t forget to use the supplemental packet for the reinforcement inventory. You’ll also want to watch the person, ask the person, and try out reinforcers to see what will work the best. Once you have clearly defined the alternative behavior, how you are going to teach it, and identified the reinforce, then it’s time to actually delivery the reinforce. Be sure people reinforce a new alternative behavior immediately and consistently. It doesn’t do any


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good to wait several days before telling someone good job or giving them a high five. We have said we’re not in the control game, but when it comes to reinforcers, it needs to be something we can control. You can’t control someone’s food or water. You need to use reinforcers that are something above and beyond what the person has access to. If they can get the reinforcer, such as a hug or money, by doing a different behavior, what is the incentive to learn the new alternative behavior? You also need to make sure the reinforcer and behavior are clearly linked, and the person understands “I do this, I get that.” Also, make sure someone’s life isn’t all about reinforcers. People should still get surprise trips out and definitely get positive interactions. Talking to someone should NOT be a reinforcer.


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Types of Reinforcers 3:25 – 3:35

We have five main categories of reinforcers. The last one, intrinsic, has an asterisk next to it because it’s the one reinforcer we cannot give to someone. Intrinsic is the “self” reward – you do it because it feels good, it feels like the right thing to do. The other four reinforcers we can plan and use for teaching.

Can anyone think of some examples and take a guess which category it would go under?


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Instructor tips on next page to help categorize: Social – anything you do for someone, such as smiles, high fives, good job, happy dances, etc. These are great reinforcers because you always have them with you. Material – stuff. Anything you can touch and put your hands on. Be sure it’s something above and beyond and appropriate to the behavior. Token economies – pay checks are token economies and serve as a good motivator to come to work. Keep in mind the person’s age and what is appropriate to the situation. Special activities and privileges – above and beyond, special trip to the park, staying up late. If in a group home / day program, remember Article 9 this is special activities – regularly scheduled activities cannot be a reinforcer without a behavior plan because it’s a rights’ restriction


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Go ahead and take our last break of the afternoon. It’s ______ now, and I’ll see you again at ___________. (Should be 3:35 – 3:45 or earlier)

During break, confirm that David Pitonyak article has sections highlighted – makes it easier to assign to students if the page they get already has their section highlighted. If less than 10 students, do not assign the 10th one, but you may have students do more than one to get to 9 areas.


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Ethical Use of Reinforcers 3:45 – 3:48ish

Page 43 (81 in ADA guide) has some considerations for the ethical use of reinforcers. We have to consider the person’s quality of life and dignity when considering reinforcers. Take a moment to read page 43 to yourself. Pause.

Does anyone have any questions?


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Types of consequences

3:48 – 4:00ish

In the after stage, we’ve talked about reinforcers for alternative behaviors. This morning we briefly hinted at consequences as well. Reinforcers are planned, strategic, positive consequences for positive behaviors. Consequences are whatever happens after a behavior. For challenging behaviors, we want to be strategic about what we use for a consequence. Remember, consequences are the pay off. There was a woman the Division supports who attends a day program. Every day about the same


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time she would take off at a full sprint down the busy street outside the day program. This was a challenge because the woman did not have street safety skills and needed supervision in the community. She was pretty fast, so the day program started sending one of their fastest staff members after the girl. He had been a state track champion, and could catch her pretty quickly. When he caught up with her, she would come back to the program without any challenges. The team started looking at the behavior cycle and the function of the behavior and discovered the consequence was the challenge.

Any ideas what would lead the woman to take off every day about the same time? Pause for discussion – don’t give “right” or “wrong” – let class brainstorm


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Those are all valid possibilities. In this woman’s case, ________ is right (if someone mentioned it). The woman had a crush on the staff member – she thought he was really hot. So the team started looking at how to change the consequences and what could be taught. The desired behavior was for her to stay at the program, and the function was she wanted to spend time with her favorite staff member. So, if she stayed at the program, she and the provider would work together to prepare snack for everyone else. If she took off running, another staff member would run after her. In fact, the team selected a staff member the woman liked but wasn’t particularly crazy about. It wasn’t who she necessarily would have chosen to spend time with. She did not get to make snack on those days she took off.


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It didn’t take long before the alternative behavior was learned, and the team was able to move on to teach her more skills. As you look over the list on page 44 of consequences, what questions do you have? Pause for discussion. Conversation should wrap up about 4pm.

After Immediate Consequences 4:00 – 4:05

We’ve talked about the three parts of the behavior cycle: before, during, and after.


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In the land of the Division, we have an additional step that includes documentation, evaluation, and follow-up. This is the After After stage. In this stage, if you are providing direct support, you have a critical role in making sure the person we support is reconnected with the environment, with others, with the routine. This may include reconnecting with you, as well. For everyone, we’re all involved in looking at the patterns and making sure these five steps: reconnection, reconciliation, restoration, learning, and further analysis, are all happening.

10 Ways to Support a Person 4:05 – 4:30


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I am about to bring you a handout that pulls together all the topics we have discussed today. The article is by David Pitonyak, called “10 Ways to Support a Person with Difficult Behaviors.” On your handout, you will see a section highlighted. That is going to be the section you will focus on. Using page 46, working individually to summarize your section and to create one action step or specific thing you can do at your job related to your section. If you finish your section early, take time to read the rest of the article. It’s definitely worth your time, and I know when you’re back at your job there is rarely time for reading. Take advantage of the time now. This is part of your final exam; take about 10 minutes to read your section and thoroughly answer the questions.


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Do you have any questions before we get started?

Handout David Pitonyak article, 10 Ways to Support a Person

#2 is long, best to give to someone who is a fast reader

For #3, try to give it to an SC Give students 10 minutes, with a 5 minute and 2 minute warning. Let’s hear what you came up with. When I call your number, you do not need to read your entire section – simply give us your summary and an idea you have for how you can do this at work.

Who had number 1, Get to know the person?


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How about number 2, remember that all behavior is meaningful?

And number 3, Help the person develop a support plan?

Number 4, develop a support plan for the person’s supporters?

And we’re halfway there – number 5 –don’t assume anything.

Number 6, a biggie, relationships make all the difference.

Number 7, help the person develop a positive identity.

Number 8, instead of ultimatums, give choices.


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We’re going to skip ahead for a minute and come back to number 9. First, let’s do number 10, establish a good working relationship with the person’s primary care physician.

If assigned, What did you have for that? If not assigned, No one was assigned this

particular question. Let’s take just a moment to brainstorm the reason this would be important.

If not assigned cont. How do you think it would help if you have a good relationship with the person’s PCP?

And now let’s go back to number 9, help the person have more fun. What did you have? Excellent! Based on that and looking at the information about helping a person have more fun, I want each of you in the room to think of one way you can do this at work. How can you help someone have more fun? I want to hear from each person in the room.


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Who will go first? Go around room, get one answer from each person.

Wrap-up 4:30 – 4:35 Great work! Keeping these principles in mind, let’s review.

What were the three criteria to determine if a challenging behavior should be changed? • Not safe for the people involved • Violates the rights of others • Limits the person’s ability to lead a full, self-

directed life as a member of society

What are the stages of the behavior cycle? • Before • During • After


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What stages in the behavior cycle are good for teaching? • Before and After

Who has challenging behaviors? • Everyone!

How does quality of life relate to behavior? • The better a person’s quality of life, the less likely

the person will display challenging behaviors Excellent!

At this point, does anyone have any questions? Remember the importance of building relationships and helping a person have more fun, looking at ways to improve the person’s quality of life. With that in mind, watch your e-mail for a course evaluation and have a great evening!


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Ta-da, end of class. Hooray! You survived!

Instructor note: This is a class that time can be

highly variable. The last couple of times it was taught were to smaller classes and we finished closer to 3 than 4:30.

Always make sure I am Sam is after lunch. If ending more than an hour early, students must

check in with their supervisors. When in doubt, talk more about David Pitonyak and

have people create action steps for all 10, so they have a great action plan.

Can also have them tear off page 46 and put their

name and e-mail on it. With their action steps on the page, they then can crumple them into a ball and throw them. Throw again. And throw a third time. With the final throw, have them make sure they didn’t get their own page and then assign them to follow-up with the person via e-mail in one month. Take time for them to


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put it on their calendars, phones – to touch base with the person.

Documents

Positive Behavior Support Instructor Narrative - des.az.gov · Positive Behavior Support Instructor Narrative . 2013 . 4 . Where are the restrooms? (summarize class answers to make