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School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute, Saint John of God Hospitaller Ministries, Dublin, Ireland. NAMBSE 17 th October 2014 www.callaninstitute.org https:// www.facebook.com/pages/CallanInstitute/5781015522 01521 Hospitality Compassion Dignity Excellence Justice Respect Trust

School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

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Page 1: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model

Caroline Dench, Clinical Psychologist, Callan Institute,

Saint John of God Hospitaller Ministries, Dublin, Ireland.

NAMBSE17th October 2014

www.callaninstitute.orghttps://

www.facebook.com/pages/CallanInstitute/578101552201521

HospitalityCompassion Dignity Excellence Justice Respect Trust

Page 2: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Our time together…

Background Studies Positive Behaviour Support (PBS) School Wide Positive Behaviour

Support(SWPBS) SWPBS in Practice

Page 3: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Callan Institute• Callan Institute as part of Saint of John God Hospitaller

Ministries provides consultation and training services in Positive Behaviour Support and in Raising Understanding and Awareness (RUA) about Oneself, Friendships, Relationships and Sexuality.

• Services include Positive Behaviour Support plans using the Multi-Element Model; Relationship and Sexuality Education; Positive Futures Planning, Skills Teaching, Periodic Service Review.

• Individual consultation, staff training and regular support to staff on positive approaches for behaviours of concern and sexuality.

Page 4: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• A ‘challenging behaviour’ is any act by the child which disrupts their activities or the activities of others or their daily schedules, which causes injury or poses risk to themselves or others and which puts them or others in danger and which requires intervention from staff.

• Examples of ‘challenging behaviours’ in this context can include pushing, pulling, spitting, grabbing, pinching, biting, hitting, striking, punching, slapping, scratching, kicking, refusal to comply/to move, throwing objects, attempting to choke another, head-butting, running away, persistent loud vocalisations, self-injury as well as inappropriate touch, smearing and stripping.

• An ‘extremely challenging behaviour’ then can be said to exist

where, despite many planned interventions, a challenging behaviour is unrelenting, persistent, continuous or is of increased or particular intensity, severity or inappropriateness requiring an intensive, complex response from staff.

Page 5: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Behaviour of such intensity, frequency or duration that the physical safety of the person or others is likely to be placed in jeopardy, or behaviour which is likely to deny access to the use of ordinary community facilities. Emerson, (1998)

• “Children who present with severe challenging behaviour are amongst

the most vulnerable in our society. They demand constant care, supervision and support and have extensive needs (exhaustive and exhausting) and are particularly susceptible to potential abuse” Lyons (1994)

• “Behaviour, within the context of your school, which prevents participation in appropriate educational activities; often isolates children from their peers; affects the learning and functioning of other students; drastically reduces their opportunities for involvement in ordinary community activities; makes excessive demands on teachers, staff and resources; places the child or others in physical danger; and makes the possibilities for future placement difficult”.4 Harris John, Cook M, Upton G, (1996)

Page 6: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

The National Education Psychological Service (NEPS, 2010) define behavioural, emotional and/or social difficulties (BESD) as

‘difficulties which a young person is experiencing which act as a barrier to their personal, social, cognitive and emotional development. These difficulties may be communicated through internalising and/or externalising behaviours. Relationships with self, others and community may be affected and the difficulties may interfere with the pupil’s own personal and educational development or that of others. The contexts within which difficulties occur must always be considered, and may include the classroom, school, family, community and cultural settings.’

Page 7: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Influencing Factors

• Legal Validity: Legislation, Rights of the Child, EPSEN, Children’s First, Health and Safety at Work

• Social & Clinical Validity: Policy and Procedures: Department of Education and Skills, NEWB, Child Protection Procedures, PBS, NBSS, Adverse Incidents, Incident Reports & Risk Assessments; Other assessments; & IEP’s,

• Clinical Validity: PBS using the Multi-Element Model.

Page 8: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Some Studies

• Kiernan and Kiernan (1994) challenging behaviour in pupils in special schools in the UK; 22% of pupils showed challenging behaviours.

• They also found a weak but positive relationship between the proportion of pupils with poor communication skills in schools and the prevalence of challenging behaviour.

Page 9: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Some StudiesThe Irish National Teachers’ Organisation Education Committee compiled a report (INTO, 2002)

• 15% of schools had serious or major discipline problems, that over 70% of respondents surveyed considered that emotionally disturbed children were likely to present with behaviour problems, and over 30% believed pupils with general or specific learning disabilities were likely to misbehave.

• Also, 92% of schools surveyed had codes of discipline, but it was found that codes were particularly ineffective in dealing with pupils who are particularly seen as disruptive. The study recommended that schools develop a code of conduct with these pupils in mind.

• in accordance with the Education Welfare Act 2000. Further they recommended that the• home-school liaison scheme be implemented in all special schools and that parental• involvement in all aspects of the school be strongly encouraged.

• Kiernan and Kiernan (1994) reported that only 57.3% of schools surveyed reported that any specific in-service training had been given.

• A Nationwide Study of Challenging Behaviour in Special Schools in Ireland

Page 10: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Challenging behaviour in special schools in Ireland presents a significant problem. 31% of pupils in special schools presented with challenging behaviour in the current school year; (Kelly et al 2004)

Page 11: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

A little more…

Further, Principals rated on a four-point scale the degree of stress experienced from potential stressors in managing incidents of challenging behaviour

• Time pressure involved with dealing with the incident (n=58; 81%);• Trying to resolve the situation (n=58; 80%);• Additional workload that incidents cause (n=57; 79%);• Worrying over the welfare of staff in receipt of challenging behaviour (n=53; 73%);• Meetings with parents to discuss the incident (n=37; 50%);• Lack of physical and environmental facilities (n=35; 49%);• Threat of legal action from parents (n=28; 39%).

Page 12: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

And a little more…

Further, between 31% and 42% of all Principals described the following as effects on teachers:• Feeling of low personal accomplishment (46%);• Feeling disrespected (46%);• Negative attitude towards pupils with challenging behaviour (36%);• Loss of confidence (35%);• Receipt of constant verbal abuse (32%);• Physical injury (31%).

Page 13: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

And a little more…Out of a total of 74 Principals, over three quarters indicated the following as effects for students:• Loss of classroom learning hours (n=65; 88%);• General upset (n=63; 85%);• Disruption of play and leisure (n=58; 78%);• Anxiety (n=58; 78%);• Engaging in similar behaviour (n=56; 76%).• Safety concerns (n=53; 72%);• Being at risk of injury (n=51; 69%);• Feeling insecure (n=42; 57%);• Physical Injury (n=30; 41%).Principals of Schools for Pupils with Intellectual Disability (78%) and Emotional Disturbance (100%) viewed anxiety as an effect on other pupils.

Page 14: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

A survey of all special schools in Ireland conducted by Kelly et al. (2004) revealed thatthe most common behaviour problems that occurred over a 4-6 week period were:• (i) non compliance;• (ii) aggressive behaviour that physically harms

others; and• (iii) disruptive, nuisance or threatening

behaviour to others.

Page 15: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Positive Behaviour Support & the Multi-Element Behaviour Support Model

Positive Behaviour Support(PBS) is a multi-component framework, which is based on the principle that all behaviour(s) of concern have a function or message within it, once the function is identified a Positive Behaviour Support plan(proactive and reactive strategies) can be developed and implemented which is Socially Valid, Clinically Valid conforms to the principles of a HRBA and is focused on achieving socially valued outcomes for the person and others.

Page 16: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Fact Sheet of Positive Behaviour Support: • 1. It deliberately avoids the use of punishment and aversive interventions to change behaviour.

So no naughty step, chair; no taking away a favourite personal item; no ‘giving out’ to the person for example.

• 2. It focuses on looking at a person’s day, life and lifestyle, because if life is ‘bad or miserable’, it can be hard to change a person’s behaviour.

• 3. At each step, it includes conversations and time with the individual and the people that are important to the individual in order to clearly identify and agree a plan for support.

• 4. It is based on the theory that all challenging behaviour has a ‘message’ hidden in it. • 5. It uses a detailed assessment format to identify the ‘message’ of the challenging behaviour.

• 6. It uses behavioural techniques to change behaviour; in the environment, skills teaching, direct interventions and reactive strategies; for example, if you know what is causing the behaviour

problem and you can change the cause, the behaviour will reduce; if you can teach skills, the behaviour will reduce.

Page 17: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• All about Positive Behaviour Support:

• 7. It recognises that sometimes challenging behaviour is occurring because someone is feeling bored, confused, sad; has experienced loss, abuse, neglect; is unwell; (etc.) and that there are other evidence based approaches to support these underlying factors and that these may need to be used also.

• 8. It uses information from meetings, observations, conversations, file reviews to develop a plan

of support, called a Positive Behaviour Support Plan. • 9. The plan has lots of ideas and interventions many are implemented when the behaviour of

concern is not occurring, these are called proactive strategies, and also reactive strategies to guide everyone when the behaviour of concern does occur.

• 10. Positive Behaviour Support approach always checks (using data and evidence) to see if the plan is working, for example, is the individual more content, is the behaviour of concern occurring less, and is the individual together with their friends, family and teacher living a more fulfilled and

happier life. • These are the 10 Steps of a Positive Behaviour Support Approach.

Page 18: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Education (Welfare) Act 2000 all schools to have in place a Code of Behaviour. The Act also requires that a school’s Code of Behaviour must be drawn up in accordance with the guidelines of the National Educational Welfare Board (NEWB). The NEWB guidelines make it clear that each school must have policies to prevent or address bullying and harassment and that schools must make clear in their code of behaviour that bullying is unacceptable.

Page 19: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• NEWB Developing a Code of Behaviour Guidelines for Schools (2008) This guideline, does not name Positive Behaviour Support as an integrated framework of good practice.

• NEPS promotes a tiered approach, which includes classroom, school and school plus support, based on PBS.

• The National Behaviour Support Service (NBSS) was established by the Department of Education & Skills in 2006 in response to the recommendation in School Matters: The Report of the Task Force on Student Behaviour in Second Level Schools (2006) NBSS uses PBS practices and principles.

• Health Act 2007, Positive Behaviour Support is identified as required, and HIQA has PBS standards.

Page 20: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Special Education Support Service (SESS) was established under the remit of Teacher Education Section (TES) of the Department of Education and Skills (DES) in 2003. The SESS co-ordinates, develops and delivers a range of professional development initiatives and support structures for school personnel working with pupils with special educational needs.

• A review of support scheme applications reveals that 162 of the 874 applications (i.e. 18.5%) received by the SESS from schools between Sept 2009 and Dec 2009 sought support in the area of behavioural, emotional and/or social difficulties (BESD). Of these, 16% were marked urgent and indicated physical danger to pupils or staff. Examples of behaviours outlined in urgent applications included self-injurious behaviour, angry outbursts, aggression and violence.

Page 21: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Pupils with Behavioural Care Needs

The BCN1 form allows the school demonstrate what strategies and positive behaviour supports have been put in place to manage the behaviour prior to requesting access to SNA supports.

NEPS has published ‘Behavioural, Emotional and Social Difficulties - A Continuum of Support for Primary Schools - Guidelines for Teachers” to help schools develop systems, skills and structures for responding to the needs of pupils with behavioural, emotional and social, as well as learning, needs.

NCSE Guidelines for Principals and Boards of Management of Special Schools March 2014

Page 22: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Multi-Element Behaviour Support Model IABA

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Positive Behaviour Support & Multi-Element Behaviour Support Model

Page 23: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Traditional Versus

Positive Behaviour Support Approach

Traditional Approach

• Focus on Reaction Only• Behaviour Only• One Step Plan• Raise issues regarding

rights• Can rely on punishment or

consequence based learning

Positive Approach

• Multi Element Plans• Interventions in MEBS plan address

rights deficits identified in assessment• Supports Systems in PBS• Believes all behaviours occur within an

environmental context• Is proactive – intentionally structures

for success• Validates the function of the behaviour• Systematically teaches skills and

acknowledges appropriate behaviours • Builds capacity for all staff• Intentionally seeks to build positive,

flexible environments based on review of data

Page 24: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Multi-Element Behaviour Support Model IABA

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SPEED AND DEGREEOF EFFECTS

GENERALIZATION OF

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DURABILITY OF EFFECTS

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Positive Behaviour Support & Multi-Element Behaviour Support Model

Page 25: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Multi-tiered Support for Positive Behaviour Support

the NEPS continuum of support can be conceptualised as follows:

Tier 1: whole school or classroom approaches for all children, which include a consistently applied behaviour policy along with formal teaching and reinforcement of

desired behavioural expectations;Tier 2: small group or individual approaches for children whose behaviours are not sufficiently responsive to the whole school or classroom approach and who require

more structured interventions, more detailed monitoring and more frequent feedback;

Tier 3: intensive individualised approaches for children whose behaviours are not sufficiently responsive to either of the previous two support tiers and who require

additional specialised support.

The three tiers of the continuum of support should not be seen as separate phases. While many children receive adequate support at the whole school or classroom tier,

some children will require support at the first two tiers while a few children will require support at all three tiers of the continuum.

Page 26: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 27: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Responding to Inappropriate Behaviours: A Problem-Solving Approach

Scott et al., (2010) propose four steps common to all tiers of behaviour support that are equally applicable across the whole-school, among pupils who do not respond appropriately to whole school approaches and for pupils who require intensive support:

• (1) Prediction informed by an analysis of specifically identified challenging• behaviours, which includes the context in which they typically occur;• (2) High-probability interventions that include a focus on relationships,• differentiated instruction and behaviour management;• (3) Consistency to ensure and build staff consensus to implement

behaviour management practices in the same manner;• (4) Assessment to monitor key outcomes that may be used to inform data

based decision making.

Page 28: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

PBS in Practice

• Evidence-based interventions and • assessment (Kazak et al., 2010).

Page 29: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Our Commitment to PBSSchool Wide Approach

• We all understand and use PBS.• We offer an exciting and enjoyable curriculum.• We teach communication skills.• We teach social skills.• We catch students when they do well.• We use data to problem solve, understand behaviour or find ‘the

message’ and make decisions.• We have active supervision, reflective practice, training and

support of our children (and families) and ourselves.• We have access to experts as required.• We teach, support and encourage our school rules.• We offer an open, safe, fun, forever learning and welcoming

environment.

Page 30: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Behaviour Is Functional

We use behaviour to try and communicate an unmet need(s)• – Get/Gain• – Avoid/Protest

Page 31: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Functions or unmet needs of behaviour(s) of Concern

Let’s play

I need help

I don’t want to share your time with her

I’m unwell

I’m tired

I need a five minute break please

No!

Don’t say wait

I don’t want to work when they are here

Ask me nicely

I want to leave

Its very noisy in here

I’m confused

This is boring

I have a middle ear infection

I’m hungry

Page 32: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Behaviour is Human

Despite having called the meeting to order, a numberof people ignore the principal’s request to quiet down.Instead they continue to talk loudly with friends whilecomplaining about having to be at school.

What kind of meeting is this?• a) Student assembly• b) Staff meeting• c) Parent Teacher Association Meeting• d) All of the above

Page 33: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Behaviour is FunctionalBehaviour Get/Gain Avoid/ProtestBecause a student refuses to change for PE, he is told to “sit on the wall” during the class

As a result of misbehavingin the morning, studentsare sent to the hall during afternoon break-time.

Page 34: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Behaviour is FunctionalBehaviour Get/Gain Avoid/ProtestBecause a student refuses to change for PE, he is told to “sit on the wall” during the class

Free time Exercising

As a result of misbehavingin the morning, studentsare sent to the hall during afternoon break-time.

A largeroom to sit and work/play in, with active supervision.

Free-time in the play ground

Being bulliedduring free time

Page 35: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Put simply….. Behaviour is Meaning-full (Pitonyak, D. 2005)

Why is the person using this behaviour now? What’s the message?Can they say it in another way?

What would the person be doing instead, as in, if they were not engaging in the behaviour of concern?

What can I and others do to help?How does the person ‘feel good’ about themselves?

How are they contributing to their own life and other people’s lives?What is the person looking forward to?

Who are the person’s friends and who cares about them, who does the person care about also?

What does the person not enjoy/like?When they go to bed at night, what are they proud of?

Lots of choices….(no restrictions please)Stay healthy physically and emotionally….

What lights up the person’s eyes?What is the person’s favourite X?

Have fun….

Page 36: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Case Study

Page 37: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Robert’s Behaviour

• May grab at staff / pinch• May yell• May pull own hair• May dig nails into his scalp

Page 38: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Before we do Anything…..

• Why does the behaviour of concern warrant intervention and support?

• Whose concern is it?• Do we have consent to do so?• Are there any health concerns?

Page 39: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

VignetteComprehensive Behavioural Assessment

Background Assessment Functional Assessment Message/Function

Expressive Communication needs

Concept of time needs

Health needs; constipation

Likes textures/touch

Transitions/change

Offered a non-preferred activity

Enjoys Music and the outdoors

No thank you.

I find change hard.

Page 40: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

In the Proactive Strategies there are 3 types of interventions

• 1. Environmental Interventions; which can include the physical environment, as in what the environment looks like, the interpersonal environment, as in the relationships; and the programmatic environment as in what there is to do there;

• 2. Skills Teaching: There are four sets of skills included in a MEBS plan. A general skill, a skill just for fun and independence; a functionally equivalent skill, an appropriate communication skill to support the message of the referred behaviour, a functionally related skill, a skill to support other forms of communication and lastly a coping and tolerance skill.

• 3. Direct Interventions: These interventions are short-term and include reward contracts, trigger control(antecedent) strategies for example.

Page 41: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• All MEBS plans have at a minimum 1 environment intervention, 4 skills teaching (at least one from each category) and 1 direct intervention as part of the proactive strategies.

Function: ‘No thank you’

Environmental Skills Direct

Picture Schedule

Drinks

General Use Skype

Grow herbs

FE: ‘No thanks’

FR: This is what I would like please

C&T Hand creamMusic

Social Stories

Trigger control

Plan for transitions

Preferred tasks

Page 42: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Reactive Strategies• Reactive Strategies: These are implemented

with the consent of the individual(or family member) when they are upset with the whole purpose to reduce the episodic severity of the behaviour problem. The reactive strategies do not teach and are not concerned with reinforcement.

Page 43: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• Reactive Strategies as part of a Multi-Element Behaviour Support Plan are written based on the function of the behaviour. They can be functionally and non functionally based and are always non aversive and non rights restrictive.

Page 44: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

• All MEBS plans have at least one reactive strategy.

Function: No thank you

Reactive Strategies

Active listening

Confirm ‘no thanks’.

Offer Choice/Picture schedule/Transition protocol

Page 45: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Function: No thank you

Environmental Skills Direct Reactive Strategies

Picture Schedule

Chat time

Drinks

Hobby

General Use Skype Grow herbs

FE: ‘No thanks’

FR: This is what I would like please

C&T Hand creamMusic

Social Stories

Trigger control

Plan for transitions

My Hands

Preferred tasks

Active listening

Confirm ‘no thanks’.

Offer Choice/Picture

Schedule/ Transition protocol

Page 46: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Multi-Element Behaviour Support Plan for R To be completed each week This week beginning ____ + / - Comments 1.Picture timetable 2.Drinks 3.Chat-time M T W T F S S 4.Skype 5.No thanks 6.Choice 7.Hand cream 8.Transition plan

Periodic Service Review

Page 47: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

0

5

10

15

20

25

30

35

40

1 3 5 7 9 11 13 15 17 19 21 23

Weeks

Number of incidents of aggression

Baseline

PSR

Page 48: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Tier 1 Generic PBS Plans (Individualised) + PSR; Environmental Skills Focused Supports Reactive

Physical; My chair, my room, my space, lighting, noise, my things, my home, my work

Interpersonal;Chat-timeFriend timeFamily timeInformation sharing; picture schedules; social stories

Programmatic; My routine, (food, drinks, rest & activity) my work/tasks, my choices, fun, hobbies, activity sampling- work, fun, hobbies; exercise

General skills;(based on likes or motivational profile)

Communication skills; No, I want, Yes, Break, Finished, Help, Emotions- happy, sad, angry

Coping skills; relaxation activity; body awareness

Tolerance skills: sharing, waiting,

Other:

Trigger controlNoise, transitions, change, criticism, demands, pain checklist,

Reward contracts

Rules/Guidelines

Active Listening,

CapitulationRedirection to preferred x

Offer reassuranceFacilitate communication/ relaxation/ problem solving

Tag with another staff member

Change the activity/item/plan.

Emergency Management

Page 49: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Where to start: PBS School Wide

1. Know the child/children (observations, file review, interview, assessment)

2. Academic restructuring- fun and engaging

3. Communication skills training

4. Social & Coping skills training

5. Environmental modifications, physical, interpersonal, and

curriculum(programmatic)- PBS environmental checklist

6. Behaviour instruction; based on the function of the behaviour.

7. Incident Reports and Reflective Practice

8. A group committed to PBS; leading the way in consultation with others

9. A PBS Policy with practice guidelines

Page 50: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Multi-Element Behaviour Support Model IABA

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Positive Behaviour Support & Multi-Element Behaviour Support Model

Page 51: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 52: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Physical accommodations

• Setting• Light• Noise• Crowding• Space• Food and drink• Sensory differences• Pain

Page 53: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 54: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 55: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 56: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Interpersonal accommodations

• Respect• Communication• Social interaction• Expectations• Friends• Positive Relationships with adults

Page 57: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 58: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Programme accommodations

• Choice• Predictability• Rules• Motivation• Opportunity to learn• Variety• Task difficulty• Instructional methods• Working independently

Page 59: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 60: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 61: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Make Information Clear

Mon Tues Wed Thurs Fri

Kate Kate Kate Sue SueJim Jim Sue Jim ?Ann Carl Ann Carl Carl

Page 62: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 63: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Types of Skills

• General• Communication Skills: Functionally

Equivalent and the 5 critical communication skills (AAC)

• Coping skills• Tolerance skills

Page 64: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

“It’s Too Noisy!”

Page 65: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Escape – “What would you like to do instead?”

Page 66: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Coping & Tolerance skills

• Relaxation; breathing, my body, mood dots.• Mindfulness• Yoga• Footspa• Hand massage• Scents• Skills for waiting, transitions, self-management, self-monitoring and self-instruction

Page 67: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Step 1

Turtle Technique

Page 68: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Social Stories(Carol Gray)

I Can Use My Words

Page 69: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 70: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Purpose of a Direct Intervention

• See - Do• See – THINK - Do

Page 71: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Types of Direct Interventions

• Reward Contracts

• Antecedent (trigger) Control- key times in the school day which can cause behaviour of concern; transitions, play ground, snack time, bathroom, work for example.

Page 72: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Look with your eyes. Listen with your ears

Use nice hands and feet. Talk nicely.

Page 73: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.

Page 74: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Rules for me…

• Like…your dad/ or a famous person– Funny– Nice– Kind

– Example: The Cladagh Ring, Duck-Dog-Dragon,

Page 75: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Antecedent (Trigger) control

• Remove triggers• Reduce conditions in which behaviour is more likely• Increase conditions in which behaviour is less likely• Remove seductive or dangerous objects• Remove unnecessary demands• Eliminate provocative statements (“no”, “wait”)• Interrupt the behaviour in response to precursors

Page 76: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,
Page 77: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Reactive Strategy

• Designed around the message of the behaviour

• Role of reactive strategy – to reduce episodic severity, no teaching required.

• Non-aversive

Page 78: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

List of Consequences:(73=total no. of Principals who indicated whether the interventionsbelow are typical consequences)

N=number %

Put out of the classroom 36 49Isolation from peers within school 49 67

Sent to another classroom 32 44

Sent home early 14 19Suspension from school 21 29

Loss of privileges 53 73

Involvement of parents/guardians 57 78

Consultation with professionals (clinical/social) 57 78

Discussion among staff regarding future strategy 62 85

One to one time with special needs assistant 54 74

(Kelly et al 2004)

Page 79: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

ASSESSMENT BEHAVIOUR

OF CONCERN

UNDERLYING FACTORS

Page 80: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Once consent is in place…medical ruled out…

Let’s start with strengths and interests:Motivational Profile

– Inventory of favourite things (what lights up their eyes?)

– What opportunity do they have to access / engage in their favourite things?

– How varied is their repertoire of favourite things?

Page 81: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

BEHAVIOURAL ASSESSMENT

• The foundation of Positive Behaviour Support

• Result of improper assessment– Lengthy interventions with little success– Interventions with the wrong behaviour

Page 82: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Looking for clues

AntecedentsAntecedents Consequences

EnvironmentEnvironment

Experiences

CommunicationCommunication

Skills

HealthHealth

Page 83: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Components of assessment at Tier 2 and Tier 3

• Referral information and issues• Background Assessment• Functional assessment• Hypothesis and Formulation• Mediator analysis

Page 84: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Behaviour Recording

• Event recording• Interval recording• Time sampling (interval or momentary)

Page 85: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Human Rights Implications

• Assessment can highlight rights restrictions

• Interventions can address and reinstate rights restrictions

Page 86: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Tier 2: PBS

Page 87: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Mediator Analysis

• What resources are available?• What training have we received or is now

needed?• What is the wider support structure for this

classroom or this person?• What can we realistically achieve?• What other needs may be in the family, class,

school?

Page 88: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

PBS in Practice- Case work (Tier 2 & Tier 3)

• Rights Audit (Restrictive, Safeguarding and RIsk)• Person Centred Planning (Health check)

• Who is included- person( with consent evidenced), family, friends, paid professionals

• Functional Assessment- Function Identified• Other assessments – and Interventions which are evidenced based for ID

• A data driven approach• Functional assessment to inform functionally based interventions;

• Multi-component interventions(proactive/reactive)

• Implementation, monitoring and evaluation long-term.

• Professional with suitable qualifications (Tier 2 and Tier 3)

Page 89: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Is this Positive Behaviour Support?

• I think the function is…..• Let’s put a reward contract in place…• What skills does he need instead of…• The consequence for hitting is he can’t go

bowling….• He’s manipulating us….• Let’s do a functional assessment• He has to hand over his sweets…• He needs a consequence for…

Page 90: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Data Collection

• Incident reports• Reflective practice

There were 44 schools (66%) that recorded incidents of challenging behaviour using incident report forms or an incident book. (Kelly et al. 2004)

Page 91: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Data is good…but only as good as the systems in place to:

• Collect• Summarize• Analyse & Reflect & Assess• Make decisions• Make action plans• Implement interventions• Sustain implementation

Page 92: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Next Steps….• A clear understanding of PBS.• Form a representative PBS Team.• Review the Policy on Code of Behaviour and Challenging

Behaviour ( and Anti-Bullying Policy)• Adopt a referral database and referral forms using incident

forms/risk assessments to inform referrals, with administrative commitment.

• Develop a school-wide communication and social skills instruction schedule

• Develop a PBS checklist for each classroom.• Ensure that the curriculum is child centred and fun (and

shared) • Identify experts required; and source, e.g. Teacher with PBS

expertise, SLT, PT, OT, Psychology, PBS practitioners.

Page 93: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

Next Steps….• Create a school-wide and individual child reinforcement

system• Establish an environment which is responsive to data and

progress monitor Everything • Provide support, supervision and training to staff and families

in PBS. (88% (n=64) of schools indicated that they required staff training in dealing with challenging behaviour and a further 82% (n=60) indicated the need for challenging behaviour intervention programmes 49% (n=36) of Principals indicated the need for parental involvement.

• Is the Environment a PBS environment? (Physical, Interpersonal and Programmatic checklists).

• Include the children; student council, chat-time, ‘how are we doing- what do you like, and what do you not like’.

Page 94: School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model Caroline Dench, Clinical Psychologist, Callan Institute,

School Wide Positive Behaviour Support(SWPBS) and the Multi-Element Behaviour Support(MEBS) Model

Caroline Dench, Clinical Psychologist, Callan Institute,

Saint John of God Hospitaller Ministries, Dublin, Ireland.

NAMBSE17th October 2014

www.callaninstitute.orghttps://

www.facebook.com/pages/CallanInstitute/578101552201521

HospitalityCompassion Dignity Excellence Justice Respect Trust