Greg Morro (Director of Psychological Services ) and Gina Morro (Groden Center) presented at the 5th International Conference on Positive Behavior Support in Chicago on March 27, 2008. The presentation described methods for supervisors to utilize positive behavior support principles in their interactions with staff working with adults with developmental disabilities, primarily by focusing on increasing desirable qualities rather than pointing out deficits. The session was entitled:

Be the Change You Want to See...

This presentation described methods used to encourage supervisors to utilize positive behavior support principles in their interactions with direct support professionals working with adults with developmental disabilities in residential and community settings. The main objective is to offer alternative methods to aid the staff training and feedback processes. Developed behavioral and other treatment plans for consumers are often only as good as those directly responsible for daily implementation. If direct support staff are not satisfied with their roles and motivated to perform at a high level, delivery of quality services becomes difficult. There is also a general consensus that it is increasingly challenging to attract experienced and educated professionals to these positions. This approach trains individuals in supervisory roles to focus on increasing desirable qualities in staff, more so than dwelling on deficits. An underlying theory is that using positive behavioral principles in a varied application will also benefit supervisors' competences in effectively developing and monitoring programs with the consumers they serve. 


Minimal empirical literature will be used in the introduction-- the majority of the session will describe the procedures which were developed and implemented. An initial seminar was developed to introduce this behavioral approach with staff to a small agency's administrators, supervisors, nurses and other professionals. It highlighted many of the techniques successfully used with the population served, and then translated those methods to supervisory situations. Those attending were able to describe challenges they regularly faced, and the group developed potential "staff training interventions". For example, if a direct support staff regularly shows a poor interaction style, their supervisor may work to create an opportunity for a positive exchange and then reinforce the employee's actions. In the way of follow-up to the primary training, every two weeks at a Director's meeting, aspects of the first seminar were presented in detail and discussed. A number of methods were used to reinforce these points outside of formal in-services (i.e., visual representations, website, flyers, staff recognition program) on an ongoing basis. Effects on staff evaluations and job satisfaction surveys were analyzed.

Positive behavior support (PBS) involves the changing situations and events that people with problem behaviors experience in order to reduce the likelihood that problem behaviors will occur and increase social, personal, and professional quality in their lives. It is an approach that blends values about the rights of people with disabilities with a practical science about how learning and behavior change occur.  PBS is a set of research-based strategies used to increase quality of life and decrease problem behavior by teaching new skills and making changes in a person's environment. Positive behavior support combines valued outcomes, behavioral and biomedical science, validated procedures; and systems change to enhance quality of life and reduce problem behaviors such as self-injury, aggression, property destruction, pica, defiance, and disruption. The overriding goal of PBS is to enhance quality of life for individuals and others within social settings in home, school, and community settings. 

PBS is now used in many different situations and settings and with different types of social challenges. Children with and without disabilities participate in the PBS process in schools, at home, and in community settings. In school settings, PBS strategies are used to build a positive climate and include all students, not just children who may engage in more serious problem behavior. Adults with disabilities are actively involved in PBS team processes regardless of their age and where they live and work. The Association for Positive Behavior Support (APBS) has been created to build a community of individuals who are interested in the PBS process and who represent many different voices and perspectives. Family members, school professionals, psychologists, adult service providers, higher education professors, researchers, and community members are all involved in APBS. Regardless of the different settings and individuals involved in PBS processes, the key elements remain the same for individual planning. The PBS process involves a team of individuals working together collaboratively to gather information and create strategies for preventing problem behavior.

Functional Assessment. The cornerstone of PBS is the design and use of functional (behavioral) assessment to understand what maintains an individual's problem behavior. Individuals engage in a behavior because it is functional; it helps them acquire some form of reinforcement (e.g., they get something desirable or pleasant, or they avoid something undesirable or unpleasant). A person may engage in problem behavior because circumstances in both the internal and/or external environment (i.e., antecedents, setting events) trigger or ‘set the stage’ for behavior to occur. Functional assessment is a process for identifying the events that trigger and maintain problem behavior. This process involves information gathering through record reviews, interviews, and observations and the development of summary statements that describe the patterns identified. Primary outcomes of the functional assessment process include:

    * A clear description of the problem behaviors
    * Events, times, and situations that predict when behaviors will and will not occur (i.e., setting events)
    * Consequences that maintain the problem behaviors (the function)
    * Summary statements or hypotheses
    * Direct observation data to support the hypotheses

Comprehensive Intervention. The team that forms around a child or adult in order to create a PBS plan should represent all of the situations and settings that are part of the person’s life. Information that is gathered from a functional behavioral assessment helps this team develop and implement behavioral intervention plans that are positive, proactive, educative, and functional. PBS plans include a number of interventions that can be implemented across situations and settings. These interventions include: 1) proactive strategies for changing the environment so triggering events are removed, 2) teaching new skills that replace problem behaviors, 3) eliminating or minimizing natural rewards for problem behavior, and 4) maximizing clear rewards for appropriate behavior. A hallmark of PBS planning is emphasis on improving overall lifestyle quality (relationships, activities, health) as an integrated part of behavior support.

Lifestyle Enhancement. PBS focuses not only on reducing behavior problems, but on enhancing a person’s overall quality of life. Outcomes include lifestyle improvements such as participation in community life, gaining and maintaining satisfying relationships, expressing personal preferences and making choices, and developing personal competencies. Such improvements in quality of life are facilitated by establishing a positive long-range vision with the individual and his/her family (e.g., through person-centered planning) and establishing natural supports through effective teamwork.

What is positive behavior support?

 
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