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Module 5: Field-Based Activities KIPBS Facilitator Training September 9, 2011
Kansas Institute for Positive Behavior Support Life Span Institute – University of Kansas
Field-Based Activity Workbook - Module 5
TABLE OF CONTENTS
Person First Language Page 1
Developing Preferred Lifestyle Goals Pages 2-4
Indirect Assessment Page 5
KIPBS Tools CD Table of Contents Pages 6-8
Meet Annie Page 9
Motivation Assessment Scale (Durand) Pages 10-11
The Tool (Little) Pages 12-15
Direct Assessment Page 16
George Vignette & Data Collection Tools Pages 17-23
Annie’s Direct Assessment Information & Data Sheet Pages 24-25
Reliability Practice Page 26
Mentoring System Pages 27-32
Case Study Timeline Review Page 33
Case Study Checklist/Timeline Pages 34-38
Pre-involvement Form Page 39
Next Steps Page 40
Page 1
Developing Preferred Lifestyle Goals
The team translates the ideas from the dream or vision into goals in order to change the focus person’s quality of life towards their desired preferred lifestyle.
Page 2
Developing Preferred Future Lifestyle Goals
Based on the PCP you developed for yourself as part of the Module 4 Field-Based Activities, consider the Quality of Life Categories listed below. Choose one or more of the Preferred Lifestyle Areas and develop a goal for yourself.
QOL Category Preferred Lifestyle Areas/Indicators
Goal
Dignity & Personal Development
Worth and Equality Opportunities for Education and Habilitation Personal Competence
Personal Health/ Emotional Well-being
Contentment with Life Self-Concept Lack of Stress
Purpose
Future Dream/Vision
Home
Living arrangements/independent living
Natural Supports and Social Inclusion
Participation in inclusive and integrated environments Roles in the community
Finance and Material Well-being
Financial Status Ownership of possessions and meaningful employment
Interpersonal Relationships
With whom and how often an individual is able to live, work, and socialize with others Friendships and opportunities for intimacy and affection
Self-determination/ Personal Choice
Opportunity for choice, pursuing goals, interests and maintaining control of environment across 3 areas/settings
Rights Basic Human Legal
Adapted from Schalock, R., & Verdugo, M.A. (2002). Handbook on quality of life for human service practitioners. In D.L. Braddock (Ed.). Washington, DC: American Association on Mental Retardation.
Page 3
Identifying Needs for Goal Attainment
Using the Goal you developed, work with a partner to complete each of the needs & assessment sections. Preferred Lifestyle Goal “What will the YOU do?”
Activities Needed
Training Needed
Materials/Equipment Needed
Support/Services Needed
Ongoing Assessment of Goal
Current Status: Data or specific information to be collected:
Evaluating Preferred Future Lifestyle
Anecdotal & Empirical Data
Person-Center Planning Satisfaction Survey
Contextual Fit Survey (Discussed in Module 6)
Quality of Life Evaluation Survey (Discussed in Module 7)
Page 4
Indirect Assessment
Interviewing team members, caregivers and the focus person; reviewing records; and gathering other relevant lifestyle information are all methods of indirect assessment and are important components in the functional behavior assessment process. Discuss and share experiences with the group regarding the role that indirect assessment plays in the functional behavior assessment process. Use the following items to guide discussion:
1. Review the Indirect Assessment tools listed in the Table of Contents of the Tools CD 2. Discuss how PCP & Preferred Future Lifestyle information could be used as part of the
functional assessment process.
3. Discuss the benefits and downfalls of record reviews
4. Discuss use of meeting minutes to capture indirect assessment information 5. Share examples of caretaker interview forms
a. Information Gathering form (PCP) (Module 4) b. Functional Assessment Interview (green book, Appendix B, pgs. 1-9)
6. Meet Annie’s and review Indirect Assessment information
a. PCP Information b. Caregiver Interview c. Motivation Assessment Scale (Durand) d. The TOOL
Page 5
KIPBS Forms/Tools CD – Table of Contents Revised 3/31/2010
Preferred Lifestyle Tools Commonly Used:
Key Features of Person-Centered Planning Information Gathering Form for Person-Centered Plan PCP Agenda & Action Plan Worksheet Quality of Life Questionnaire (Schalock, R. L. & Keith, K. D., 1993) Quality of Student Life Questionnaire (Keith, K. D. & Schalock, R. L., 1995) PATH-Individual Consumer Template
Supplementary:
Checklist for the Interdisciplinary Summary of Individual Characteristics Preference Checklist Supported Living Monograph Positive Environment Checklist (Adapted from Albin, R. & O’Neil, R., 1994) Positive Environment Checklist (Albin, R. & O’Neil, R., 1994) Social Network Analysis Interview Form (Adopted from Steve Newton, University of
Oregon) Quality of Life Questionnaire (Schalock, R. L. & Keith, K. D., 1993) Quality of Student Life Questionnaire (Keith, K. D. & Schalock, R. L., 1995) Data Collection on Preferred Lifestyle Activities PBS Team Directory Things About Me THIS IS ME!!
Medical Information Tools Supplementary:
Albany Sleep Problems Scale (ASPS), Durand, 1996 Sleep Diary Seizure Log Medication Log Completion of the Medication Information Form & Medication Information Form
(Project ABLE) Common Medications and Potential Side Effects (Project ABLE) Potential Interaction Effects of Medication Combinations (Project ABLE) Identifying and Measuring Pain in Persons with Developmental Disabilities (Bodfish, J.
W., Harper, V. N., Deacon, J. R., Symons, F. J., 2001) Multiple Intelligence Inventory for Adults
Page 6
Checklist for Assessing Student’s Multiple Intelligences Global Risk Rating Scales Psychoactive Medications Side-Effects (Adapted from www.medline.com)
Functional Assessment (indirect) Tools Commonly Used:
Functional Behavioral Assessment Interview Form Functional Behavioral Assessment Interview Form- Young Child version The Functional Assessment Checklist for Teachers and Staff (FACTS) – 2000 Version The Functional Assessment Checklist for Teachers and Staff (FACTS) – 1999 Version Motivation Assessment Scale (Durand) Record Review Notes Behavior Data Sheet
Functional Assessment (direct) Tools Commonly Used:
Functional Behavior Assessment Observation Form Target Behavior Observation Form ABC (Antecedent, Behavior, Consequence) Chart Form ABC Analysis Scatter Plot Assessment Tool
Supplementary:
How to select a method of measurement Permanent Product Recording Form Event Recording (Frequency / Behavior Count) Form Momentary Sample Recording Form Partial Interval Recording Form Whole Interval Recording Form Latency Recording Form Duration Recording Form Graphing – Description, Procedures, & Example Graphing Form
Page 7
Brainstorming/ Collaboration Tools Commonly Used:
Effective Team Checklist Competing Behavior Diagram PBS Brainstorming Tool
Supplementary:
Weighted Voting First to Five Activity Likelihood Impact Analysis Practice Hypothesis Activity Sample PBS Prevention & Intervention Cheat Sheet Setting Events/Antecedents/Consequences 2007 Slow Triggers Worksheet
Evaluation Surveys Commonly Used:
The Person-Centered Planning Process Satisfaction Survey Self Assessment of Contextual Fit (Adapted from Horner, Salentine, & Albin, 2003) Quality of Life Evaluation
Other
Commonly Used: Timeline to Share with Teams RRTC Facilitators Guide
Page 8
Meet Annie Annie is a three-year-old diagnosed with autism spectrum disorder. She loves playing on the computer, music, ocean animals and swimming. She has many strengths, which were identified at her PCP meeting and include:
Adorable, Smart, Good memory, Happy, Strong-willed, Energetic Annie’s family has difficulty taking her into the community due to her exhibiting challenging behaviors, being “impatient”, running away or grabbing items that aren’t hers. She has difficulty waiting in line. Watch Interview video with Annie’s mother. What challenging behaviors might you look for? Based on the interview with Annie’s mother, routines and settings were identified.
The PBS facilitator continued collecting indirect assessment information:
Motivation Assessment Scale (Durand, 1986)
The TOOL (Little, 2009)
Routine Number
Annie’s Routine
Start End Setting Challenging behavior
1 Brushing teeth
“Time to brush teeth”
Put toothbrush away or termination by parent “all done”
Community preschool
Elopement, noncompliance
2 Transition to car
“Let’s go get the girls”
In car seat Home Noncompliance, delaying
3 Grocery shopping
Entering the grocery store
Out the front store door
Community Elopement, Touching items, Foot on side of cart, Eating items, Noncompliance
4 Leaving Toys “R” Us
“Time to go” instruction
Out the front store door
Community Elopement, noncompliance, crying
Page 9
Motivation Assessment Scale
1986 V. Mark Durand, Ph.D.
Name ___________________ Rater ____________________
Date _________________
Behavior Description ______________________________________________________
_____________________________________________________________________
Setting Description
________________________________________________________
0=Never, 1=Almost Never, 2=Seldom, 3=Half the Time, 4=Usually, 5=Almost Always, 6=Always
Questions Answers
1. Would the behavior occur continuously, over and over, if this person were left alone for long periods of time? (For example, several hours)
0 1 2 3 4 5 6
2. Does the behavior occur following a request to perform a difficult task?
0 1 2 3 4 5 6
3. Does the behavior seem to occur in response to you talking to other persons in the room?
0 1 2 3 4 5 6
4. Does the behavior ever occur to get a toy, food, or activity that this person has been told that he or she can't have?
0 1 2 3 4 5 6
5. Would the behavior occur repeatedly, in the same way, for very long periods of time, if no one were around? (For example, rocking back and forth for over an hour.)
0 1 2 3 4 5 6
6. Does the behavior occur when any request is made of this person?
0 1 2 3 4 5 6
7. Does the behavior occur whenever you stop attending to this person?
0 1 2 3 4 5 6
8. Does the behavior occur when you take away a favorite toy, food, or activity?
0 1 2 3 4 5 6
Page 10
9. Does it appear to you that this person enjoys performing the behavior? (It feels, tastes, looks, smells, and/or sounds pleasing.)
0 1 2 3 4 5 6
10. Does this person seem to do the behavior to upset or annoy you when you are trying to get him or her to do what you ask?
0 1 2 3 4 5 6
11. Does this person seem to do the behavior to upset or annoy you when you are not paying attention to him or her? (For example, if you are sitting in a separate room, interacting with another person.)
0 1 2 3 4 5 6
12. Does the behavior stop occurring shortly after you give this person the toy, food, or activity he or she has requested?
0 1 2 3 4 5 6
13. When the behavior is occurring, does this person seem calm and unaware of anything else going on around him or her?
0 1 2 3 4 5 6
14. Does the behavior stop occurring shortly after (one to five minutes) you stop working or making demands of this person?
0 1 2 3 4 5 6
15. Does this person seem to do the behavior to get you to spend some time with him or her?
0 1 2 3 4 5 6
16. Does the behavior seem to occur when this person has been told that he or she can't do something he or she had wanted to do?
0 1 2 3 4 5 6
Sensory Escape Attention Tangible 1._____ 2._____ 3._____ 4._____ 5._____ 6._____ 7._____ 8._____ 9._____ 10._____ 11._____ 12._____ 13._____ 14._____ 15._____ 16._____ Total Score = _____ _____ _____ _____ Mean Score = _____ _____ _____ _____
Relative Ranking
_____ _____ _____ _____
Page 11
The TOOL 2009, Amanda Little, Ph.D.
Name of interviewee: _________________________________ Date: _____________ Child’s name: _______________________________ After completing the tool, please complete the following statements. Please list the number of the preceding items that correspond to your 5 highest priorities.
1. __________________________ 2. __________________________
3. __________________________
4. __________________________
5. __________________________
Please list the top 3 problem behaviors to address.
1. ____________________ 2. ____________________ 3. ____________________
Page 12
--------------------------------------☺ 1. My ability to take my child out in the community (ex. grocery store, 1 2 3 4 5 6 N/A
park, doctor’s office, etc.). Comments:
2. The extent to which my child effectively follows the directions given. 1 2 3 4 5 6 N/A Comments:
3. My level of exhaustion at the end of the day. 1 2 3 4 5 6 N/A Comments:
4. How well I handle my child’s problem behavior across settings. 1 2 3 4 5 6 N/A Comments:
5. The ability to leave my child with other people (babysitter, family, etc.). 1 2 3 4 5 6 N/A Comments:
6. The strategies I currently use to stop the problem behavior when it 1 2 3 4 5 6 N/A is occurring. Comments:
7. The amount of time I have to do things for myself. 1 2 3 4 5 6 N/A Comments:
8. My understanding of why my child is engaging in problem behavior. 1 2 3 4 5 6 N/A Comments:
9. The preventative strategies I use to lower the likelihood of 1 2 3 4 5 6 N/A problem behavior.
Comments:
Page 13
--------------------------------------☺
10. Each person on the team’s interactions with my child (i.e. everyone 1 2 3 4 5 6 N/A is consistent). Comments:
11. My family’s participation in community activities. 1 2 3 4 5 6 N/A (Ex. church, school events, etc.) Comments:
12. My child’s ability to communicate his/her wants and needs. 1 2 3 4 5 6 N/A
Comments:
13. My child’s friendships or interactions with typical peers and/or siblings. 1 2 3 4 5 6 N/A Comments:
14. Our family’s ability to interact with friends at their or our house. 1 2 3 4 5 6 N/A
Comments:
15. My child’s progress with his or her current educational services. 1 2 3 4 5 6 N/A List current services:
16. Our ability to balance our family’s needs with my child’s needs. 1 2 3 4 5 6 N/A
Comments: 17. The ability of my child’s current school or child care to address 1 2 3 4 5 6 N/A his or her individual needs. Comments: 18. The intensity of supervision my child needs. 1 2 3 4 5 6 N/A Comments:
Page 14
--------------------------------------☺
19. My child’s ability to do things for him/herself (ex. self-help skills, 1 2 3 4 5 6 N/A such as hand washing, toileting, sleeping, eating, etc.). Comments: 20. The frequency, severity, and/or intensity of my child’s problem behavior. 1 2 3 4 5 6 N/A Comments: 21. My other children’s feelings about my child (i.e. siblings). 1 2 3 4 5 6 N/A Comments: 22. My child’s overall happiness and quality of life. 1 2 3 4 5 6 N/A Comments: 23. Others’ perceptions of my parenting and disciplinary skills. 1 2 3 4 5 6 N/A Comments: 24. The extent to which the child’s problem behavior affects the relationship 1 2 3 4 5 6 N/A between my significant other and me. Comments: 25. My ability to access support from professionals and/or network with 1 2 3 4 5 6 N/A other parents in similar situations. Comments: 26. My ability to cope with stress and other issues related to my child 1 2 3 4 5 6 N/A (i.e. emotional well being). Comments:
Page 15
Direct Assessment Remember, conducting an indirect assessment is not sufficient to help the student facilitator form a hypothesis about the function of behavior. Data collection by others is also not sufficient for the functional assessment report. Direct Assessment needs to be completed as well.
1. Discuss why student-conducted direct assessments (at least 3-5 onsite direct observations) are required and are critically important in confirming the functional assessment hypotheses.
2. Read George Vignette & practice using example formats a. ABC Chart b. Scatter Plot c. Flexible Data Sheet d. Functional Behavior Assessment Observation e. Functional Assessment Observation Form (green book, Appendix B, pg. 115 )
3. Discuss process for determining reliability a. Purpose of accurate and on-going data collection b. What makes it more likely for family members to collect data?
4. Watch Annie’s baseline video a. Evaluate the operational definitions for Tooth-brushing routine b. Review data collection sheet used during direct observation of Annie c. Conduct a 5 minute reliability observation using the baseline video d. Develop a draft for a data collection sheet to be used by Annie’s caregivers
5. Describe how Functional Assessment leads to Hypothesis Statements
Page 16
M5 Activity 2 Vignette (rev. 2-15-05) P. 1
Adapted with permission from: Zarcone, J., Freeman, R., Smith, C., Wickham, D., & Kidwell, P. (2002). (Module 5)
Functional behavioral assessment [Online]. Lawrence, KS: University of Kansas UCDD. Available:
http://www.kipbs.lsi.ku.ed
Vignette for Data Collection Activity
Using the story below, complete the
� ABC Chart Form,
� The Scatter Plot Form, and
� Flexible Data Sheet [codes - ABC]
� Functional Behavior Assessment Observation Form.
After completing the various observation forms, check your responses with the key provided and/or
with the instructor’s key. Your responses may not match up entirely with the key because the data
collection process is subject to some interpretation. Overall, you should see three patterns
regarding:
Time of day _____________________________________________________________________
Activity _________________________________________________________________________
The function of specific behaviors ____________________________________________________
________________________________________________________________________________
Story
George attends school from 9:00 AM to 3:30 PM. Lunch is from 12:30 to 1:00 PM. Mrs. England
is George’s teacher, and she works with him throughout the day. Mrs. England feels that George’s
problem behaviors have increased during the past few weeks, and has decided to gather some data
over a five-day period, beginning on Feb. 8th and ending on Feb. 12
th, to determine if there are any
patterns to these behaviors.
The behaviors that she is concerned about are: Humming loudly, telling inappropriate jokes,
putting head on table, refusing to participate, and throwing books. Information gathered from
interviews points to these behaviors being more likely to occur on days when George has not slept
well the night before and/or when he has a head ache.
During the five-day period of observation, this is what happened:
Day 1 - February 8
Around 9:35 AM, while Mrs. England was lecturing to the class about fractions and decimals,
George put his head on his desk, as if going to sleep. Mrs. England tried to engage him in the class
discussion by asking him to participate (9:38 AM). However, George ignored her requests, and
continued with his head on his desk. After asking him to participate a couple of times, Mrs.
England gave up and ignored him. Later George stated that he had not slept well the night before.
Later in the afternoon, at 2:40 p.m., while the class had free time to finish class work, start on
homework, or to work with their study partners, Mrs. England was at her desk working one-on-one
tutoring with students that were falling behind. George wasn’t scheduled to work with Mrs.
England for at least another 30 minutes. However, as time passed, it became apparent that Mrs.
England might not have time to work with George on that day. George started humming loudly.
He was ignored by peers and teacher.
Page 17
M5 Activity 2 Vignette (rev. 2-15-05) P. 2
Adapted with permission from: Zarcone, J., Freeman, R., Smith, C., Wickham, D., & Kidwell, P. (2002). (Module 5)
Functional behavioral assessment [Online]. Lawrence, KS: University of Kansas UCDD. Available:
http://www.kipbs.lsi.ku.ed
About 15 minutes later, his study partner suggested that they go over the assigned math sheets.
George said “No” and then threw his book at this partner. His study partner went back to his desk
and Mrs. England told George that if he did it again he would be sent to the office.
Day 2 - February 9
At around 9:40 AM, George again was humming loudly during math lecture. Mrs. England and
peers ignored him.
Ten minutes later, when Mrs. England called on George to answer a question, George proceeded to
tell an inappropriate joke about religion, which the class laughed at. When Mrs. England insisted
that George answer the question, he threw his book at her (9:55 AM). As a result, she told him she
was very disappointed with him and sent him to the office.
At around 11:00 AM, George was sent to see the school counselor. Even though the counselor tried
to get George to talk and interact with him by asking him several questions, George refused to
interact with the counselor, ignoring his questions and putting his head on the desk, leaving it there
the entire time he was in the counselor’s office. After about 15 minutes of trying, the counselor sent
George back to his class.
During class free time that afternoon, at 2:45 PM, George was alone working when he started
humming loudly. Mrs. England asked George several times to stop. About 5 minutes later, George
finally stopped humming, and no one said anything.
Day 3 - February 10
At about 12:45 PM, while eating lunch with his peers, George told several inappropriate jokes about
sex. At first, the peers laughed. However, after about five minutes, the peers were no longer
laughing at the jokes, and began to ignore George. Suddenly, George threw his lunch tray on the
floor, and walked away. His peers were surprised and just looked at him.
At 3:20 PM, as the class putting things away to get ready for dismissal, George told two
inappropriate jokes about sex. No one laughed at them, and the class went on as usual.
At about 3:30 PM, since George had not been helping to clean up, Mrs. England asked George to
wipe off the chalkboards. George said “No”. Mrs. England then told him that if he didn’t do it, he
would have to stay after school (3:35 PM). George then put his head on his desk and ignored Mrs.
England. After about 10 minutes, Mrs. England finally said, “Okay, you can go home now.”
Day 4 - February 11
At around 9:30 AM, George put his head on the desk during math lecture. Seeing this, Mrs.
England requested that George complete his class work. As soon as George heard the request (9:32
AM), George threw his book across the room, saying, “Leave me alone. I only slept 2 hours last
night.” Mrs. England responded “Go sit in the hallway until you calm down.”
That day, while sitting with his peers during lunch (12:45 PM), George told two inappropriate jokes
about sex. His peers laughed loudly.
Page 18
M5 Activity 2 Vignette (rev. 2-15-05) P. 3
Adapted with permission from: Zarcone, J., Freeman, R., Smith, C., Wickham, D., & Kidwell, P. (2002). (Module 5)
Functional behavioral assessment [Online]. Lawrence, KS: University of Kansas UCDD. Available:
http://www.kipbs.lsi.ku.ed
During free time (2:49 PM), while working alone, George began humming loudly. Mrs. England
told him to stop twice, but he ignored her and kept humming (2:50 PM). Finally, Mrs. England told
George that if he stopped she would let him go next for one-to-one tutoring time with her. George
stopped humming (2:51) PM, and Mrs. England stated, “You are next.”
Day 5 - February 12
During math lecture (9:40 AM), Mrs. England asked George a question. George ignored the
question, put his head on his desk, and spent the rest of the period with his head on his desk. After
this, Mrs. England ignored him.
While eating lunch with his peers (12:50 PM), George told two inappropriate jokes about sex. His
peers laughed and asked him to tell some more jokes (12:55 PM). George told two more jokes, and
his peers continued to laugh.
Page 19
ABC (Antecedent, Behavior, Consequence) Chart Form
Date/Time Activity Antecedent Behavior Consequence Date/Time when the behavior occurred
What activity was going on when the behavior occurred
What happened right before the behavior that may have triggered the behavior
What the behavior looked like What happened after the behavior, or as a result of the behavior
Page 20
Scatter Plot Assessment Tool
Date____/____/____ Name of Person Observed: ________________________________ Observer: ___________________
Behavior(s): ___________________________________________________________________________________
Directions: At the end of each time interval, fill in the square indicating the appropriate time and date on the chart using the code given below:
= nonbehavior
= 2-7 occurrences
= 7-10 occurrences
Time
Date
Adapted from: Touchette, P. E., MacDonald, R. F., & Langer, S. N. (1986). A scatterplot for identifying stimulus control of problem behavior. Journal of Applied Behavior Analysis, 18, 363-361.
Page 21
FLEXIBLE DATA SHEET Student: ____________________________________________ Date: ___________________
Problem Behaviors:
(1) Humming loudly (2) Telling inappropriate jokes (3) Putting head on table (4) Refusing to participate (5) Throwing books
Time Location For ex., in Math class, free time in class, walking to class, at lunch, at school counselor’s office, other [specify]
TRIGGER: What Happened Before? (Code by #)
1. Down time/no materials/no activities 2. Transition to-from activity 3. Couldn’t get what he wanted 4. Something didn’t go as he expected 5. Stopped from doing preferred activity 6. Asked to do something
(demand/request; difficult task) 7. Another person provoked him 8. Attention being given to others 9. Unclear/Other (specify)
BEHAVIOR
(Code by #)
RESPONSE: What Happened After? (Code by #)
1. Nothing (staff ignored) 2. Discussed problem behavior 3. Interrupted/blocked behavior 4. Verbal redirection to activity/place 5. Physical redirection to
activity/place 6. Removed from area 7. Others removed from area 8. Required to continue activity 9. Time out (note duration) 10. Other (specify)
POSSIBLE FUNCTION OF BEHAVIOR
(And Additional Notes): 1. Get/obtain attention (from
peers or adults) 2. Get/obtain item/object 3. Get/obtain _________ 4. Escape/avoid person(s) 5. Escape/avoid demand or
request 6. Escape/avoid activity/ task 7. Escape/avoid _______ 8. Self-stim (obtain or avoid)
Page 22
Event # Date Time Intervals:1 (Enter time intervals)
2 Target Behaviors3 List behaviors
45 (Enter event number
6 under time intervals)
7 Setting Event8 List setting events
910 (Enter event number
11 under time intervals)
12 Antecedent Demand/Request13 List other antecedents if Difficult Task14 needed Transition15 Interruption16 (Enter event number Told "No"17 under time intervals) Told "Wait"18 Alone (No Attention)1920
21 Actual Consequence22 List actual consequences
2324 (Enter event number
25 under time intervals)
2627
28 Perceived Function Obtain Attention29 List other functions if Obtain Item30 necessary Obtain:31 Escape Demand/Request32 (Enter event number Escape Activity33 under time intervals) Escape Person34 Escape:35 Self-Stimulation
Name: _____________________________ Observer: ___________________________ Dates Observed - From ____________ To _____________
Functional Behavior Assessment Observation Form
Directions: Preparing the form: Before you begin observing, enter: 1. The client's name under "Name"; 2. Your name under "Observer"; 3. Dates for which you will be using this form under "Dates Observed"; 4. Time intervals when you will be observing under "Time Intervals" (beginning on the left side); 5. Target behaviors being monitored next to "Target Behaviors"; 6. Additional antecedents and perceived functions, if necessary; and 7. If known, usual setting events and actual consequences. An EVENT is an occurrence of a target behavior, or cluster of target behaviors, in time. Event Numbers correspond to the order that target behaviors, or clusters, occur in time. When you observe, every time a target behavior or cluster occurs, enter: 1. The date on the column under "date," next to the appropriate event number; 2. The event number under the appropriate time interval column for a. The target behavior(s) that occurred within that event; b. The setting event, c. The antecedent, d. The actual consequence, and e. The perceived function. When you are done using this observation form: Look for patterns of behavior.
Page 23
ANNIE’S Direct Assessment Information Tooth brushing Routine
Baseline—brushing teeth routine (5 minutes) Start: Instruction to brush teeth (e.g., “Time to brush teeth”) End: routine ends after spitting and/or putting toothbrush away or mom saying “all done” Possible challenging behavior definitions: Elopement—leaving the sink area beyond 2 feet or attempt stopped by mom or not being in the bathroom unless it is a choice Noncompliance—not following an instruction within 2 seconds of it being given, taking toothbrush out of mouth for at least 2 seconds which may include saying “no” or turning her head Delaying—not engaging in the behavior as instructed or implied (e.g., steps of the brushing teeth routine) for at least 2 seconds. This includes engaging in or asking for other items or activities, engaging in conversation, etc.)
Page 24
Date: Child's name: Routine: Routine #: Child challenging behavior definition: Start time: End time: Coder's name: Reliability (yes or no) Interval 1 Interval 37 Interval 73 Interval 2 Interval 38 Interval 74 Interval 3 Interval 39 Interval 75 Interval 4 Interval 40 Interval 76 Interval 5 Interval 41 Interval 77 Interval 6 Interval 42 Interval 78 Interval 7 Interval 43 Interval 79 Interval 8 Interval 44 Interval 80 Interval 9 Interval 45 Interval 81 Interval 10 Interval 46 Interval 82 Interval 11 Interval 47 Interval 83 Interval 12 Interval 48 Interval 84 Interval 13 Interval 49 Interval 85 Interval 14 Interval 50 Interval 86 Interval 15 Interval 51 Interval 87 Interval 16 Interval 52 Interval 88 Interval 17 Interval 53 Interval 89 Interval 18 Interval 54 Interval 90 Interval 19 Interval 55 Interval 91 Interval 20 Interval 56 Interval 92 Interval 21 Interval 57 Interval 93 Interval 22 Interval 58 Interval 94 Interval 23 Interval 59 Interval 95 Interval 24 Interval 60 Interval 96 Interval 25 Interval 61 Interval 97 Interval 26 Interval 62 Interval 98 Interval 27 Interval 63 Interval 99 Interval 28 Interval 64 Interval 100 Interval 29 Interval 65 Interval 101 Interval 30 Interval 66 Interval 102 Interval 31 Interval 67 Interval 103 Interval 32 Interval 68 Interval 104 Interval 33 Interval 69 Interval 105 Interval 34 Interval 70 Interval 106 Interval 35 Interval 71 Interval 107 Interval 36 Interval 72 Interval 108
Page 25
Reliability Practice With a partner, determine reliability for the 5-minute observation: # of Agreements = (*100) = Agreements + Disagreements = Reliability % Consider the information provided about Annie. Develop a rough draft for a data collection format that could be family friendly. How efficient would it be to determine reliability?
Page 26
Review Mentor Process
1. Review the Mentor Checklists related to Functional Assessment process a. KIPBS Operational Definition & Recording Approval Checklist b. KIPBS Reliability of Data Collection Method Mentor Observation Checklist
2. Discuss the different areas and activities that will be observed
3. Discuss observation timeline
4. Discuss scheduling observations with an Instructor/Mentor and the Training Coordinator
Page 27
A Tale of Mentoring
A Tale of Mentoring
Featuring the KIPBS Amateur Theater Company Cast of Characters:
Narrator….…………..………………………..…… Pat Kimbrough Cohort 9 Student………..…………………………….Dennis Peters Mentor…………………………………………………Kelcey Schmitz Parent………..…………………………………………….Nan Perrin Child……….………………………………………… Kristin Rennells
Scene 1
Turn your attention to our make‐believe home where Dennis is portraying a Cohort 9 student
getting ready to do a data reliability mentor observation. He and his KIPBS Mentor, Kelcey, are
collecting data today on a child, Kristin, who has difficulties following the after school routine
by choosing not to follow mom’s instructions and blurting out “NO, YOU CAN’T MAKE ME”
when asked to do something. The mother, Nan, will also be collecting data.
Look at the operational definitions and the data collection sheet. Take time to review the
definitions and based on them we want you to collect the number of occurrences.
Scene 2
Again, turn your attention to our make‐believe home as the Cohort 9 student, Dennis, shows
the mom an intervention to follow the child’s after school schedule. The Cohort 9 student has
developed a series of steps for executing the intervention.
Look at the second handout to see if the steps are followed as he teaches the intervention.
Scene 3
Weeks have gone by and now the fidelity of the implemented interventions must be evaluated. We return to the scene of the home, where the mentor is observing the parent to see if s/he is implementing the interventions as they were taught.
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Operational Definition & Recording Approval Checklist
Student’s Name: _______________________________________ Date: ____________
Case Study Name:_______________________________ Observer’s Name: _____________
Operational Definition & Recording
Activity Performed?
Criteria met?
The student defined each target behavior using objective terms Y N N/A
Y N
The student defined each target behavior using specific, precise terms Y N N/A The student defined each target behavior using unambiguous terms Y N N/A The student defined each target behavior using observable terms
Y N N/A
The student defined each target behavior using measurable terms Y N N/A
For each target behavior, the student stated inclusions and/or exclusions, as necessary, to ensure clarity of the definition
Y N N/A
For each target behavior, the student included examples and non-examples of the behavior
Y N N/A
For each target behavior, the student included a time and/or location component of when the behavior is to be observed/ measured (ex. in class, during dinner time, at home, when shopping)
Y N N/A
For each target behavior, the student specified how the target behavior will be measured and recorded (ex. make tally marks on data sheet each time the behavior occurs, move beans from one packet to another and write down the total at the end of the observation period)
Y N N/A
For each target behavior, the student specified how to record non-occurrence of the behavior
Y N N/A
For each target behavior, the student specified who is to observe and record the target behavior
Y N N/A
Mentoring Coordinator instructions: 1. Please look for performance of the activities listed on the table below as you read through the student’s operational definitions for all
target behaviors. 2. At the end of the observation period, for each activity listed on the table, please circle: “Y” (Yes) if the student performed that activity,
“N” (No) if the student did not perform that activity but should have, or “N/A” if that activity did not apply to this meeting. 3. Check whether or not the student met criteria on this approval observation. In order for criteria to be met for a category, all of the items
for that category need to either be marked “Y” or “N/A.” 4. If all of the criteria are met, for all of the student’s operational definitions, the operational definitions are “Approved.” 5. Send the information about the approval, and feedback, by e-mailing the student and the student’s instructor. 6. The student may then enter this information on his/her KIPBS Student Mentor Observation Tracking form.
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KIPBS Reliability of Data Collection Method Mentor Observation Checklist - ONSITE
Student’s Name: ___________________________________ Date: __________________
Case Study Name: __________________________________ Location: _______________
Observer’s Name: __________________________________ Observation Length: _____
Reliability Activity
Performed? Criteria
met?
The student explains to the caregivers what reliability is (what he/she will be doing – i.e. testing of the data sheet by assessing reliability with the mentor specialist)) Y N N/A
Y N
The student is prepared: Has an Approved blank data sheet Y N N/A
The student gives an Approved blank data sheet to the Mentoring Specialist Y N N/A
The student observes the consumer unobtrusively in the natural environment and collects data on the consumer’s behavior using the approved data sheet
Y N N/A
The student does not interact with the Mentoring Specialist about data collection issues while gathering data
Y N N/A
The student does not provide assistance or feedback to the caregivers during the observation time (unless there is a crisis situation, and his/her assistance is needed)
Y N N/A
After the observation period, the student asks Mentoring Specialist for his/her completed data sheet
Y N N/A
The student calculates the percentage reliability for each behavior measured Y N N/A The student discusses recording differences with the Mentoring Specialist Y N N/A If reliability of a measure is very low, the student brainstorms with the Mentoring Specialist as to what may be the problem, and how to solve it
Y N N/A
Mentoring Specialist instructions: Using the Student’s Approved Data Sheet, collect data as the same time as the KIPBS Student. Have the KIPBS Student assess reliability with you. As you observe the KIPBS student conduct Reliability of the data collection system, look for performance of the activities listed on the
table below. At the end of the observation period, for each activity listed on the table, please circle: “Y” (Yes) if the student performed that activity,
“N” (No) if the student did not perform that activity but should have, or “N/A” if that activity did not apply. Check whether or not the student met criteria on this observation. In order for criteria to be met for a category, all of the items for that
category need to either be marked “Y” or “N/A.” After your observation, enter this information in the student’s KIPBS Student Mentor Observation Tracking form. Based on your observations provide constructive feedback to the student by praising the things that he/she did well, and by letting
him/her know what may be some things to work on, and how. Send the information on this sheet, by e-mailing an attachment of this form with the current information, along
with notes on feedback provided, to the Mentoring Coordinator and to the student’s instructor. Send a carbon copy of this e-mail to the student
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Intervention Training Meeting Mentor Observation Checklist - ONSITE
Student’s Name: _______________________ Date: _________________________
Case Study Name: __________________ Location: _______________
Observer’s Name: __________________________________ Observation Length: _____________
Modeling, Practice, Feedback Activity
Performed? Criteria
met?
The student explains each procedure to be implemented, step by step, using language that the implementers can understand Y N N/A
Y N
The student provides a rationale for each procedure to be implemented Y N N/A
The student demonstrates each procedure to be implemented by modeling the procedure, either “hands-on” or through role play
Y N N/A
The student has implementers practice each procedure to be implemented, either “hands-on” or through role play
Y N N/A
The student provides constructive feedback on procedure implementation practice to the implementers
Y N N/A
The student asks implementers if they feel comfortable with the procedures Y N N/A If implementers feel uncomfortable with any of the procedures to be implemented, the student problem solves the situation with them by either providing additional practice and feedback or by modifying the procedures
Y N N/A
The student asks implementers if they have any questions and answers their questions
Y N N/A
Mentoring Specialist instructions: Please look for performance of the activities listed on the table below as you observe the KIPBS student teach implementers the
interventions to be used (at least 2 interventions). At the end of the observation period, for each activity listed on the table, please circle: “Y” (Yes) if the student performed that activity,
“N” (No) if the student did not perform that activity but should have, or “N/A” if that activity did not apply to this meeting. Check whether or not the student met criteria on this observation. In order for criteria to be met for a category, all of the items for that
category need to either be marked “Y” or “N/A.” Enter this information in the student’s KIPBS Student Mentor Observation Tracking form. Based on your observations provide constructive feedback to the student by praising the things that he/she did well, and by letting
him/her know what may be some things to work on, and how. Send the information on this sheet, by e-mailing an attachment of this form with the current information, along
with notes on feedback provided, to the Mentoring Coordinator and to the student’s instructor. Send a carbon copy of this e-mail to the student.
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KIPBS Fidelity of Intervention Implementation Mentor Observation Checklist - ONSITE
Student’s Name: ___________________________________ Date: _________________________
Case Study Name: __________________________________ Location: ______________________
Observer’s Name: __________________________________ Observation Length: _____________
Fidelity Activity
Performed? Criteria
met?
The student explains to the implementer what fidelity is (what he/she will be doing) Y N N/A
Y N
The student is prepared: Has an Approved task analysis of each procedure to be implemented Y N N/A
The student observes the implementer unobtrusively in the natural environment and collects data on the implementer’s performance of procedures using the Approved task analysis
Y N N/A
The student does not provide assistance or feedback during the observation time (unless there is a crisis situation, and his/her assistance is needed)
Y N N/A
If the opportunity for implementation of a particular positive procedure did not take place during the observation time (such as teaching a particular skill), the student asks the implementer to set up the occasion for that procedure to take place, so that he/she can observe it
Y N N/A
After the observation, the student calculates the percentage of procedure fidelity for each procedure Y N N/A
The student gives constructive feedback to the implementer (praises appropriate implementation and effort, and discusses some things to work on)
Y N N/A
If fidelity of a procedure is very low, the student brainstorms with the implementer as to what may be the problem, and either conducts additional training of that procedure (model/practice) or plans on revising the procedure
Y N N/A
Mentoring Specialist instructions: 1. Please look for performance of the activities listed on the table below as you observe the KIPBS student conduct Fidelity of
Implementation on at least 2 interventions being implemented. 2. At the end of the observation period, for each activity listed on the table, please circle: “Y” (Yes) if the student performed that activity,
“N” (No) if the student did not perform that activity but should have, or “N/A” if that activity did not apply to this meeting. 3. Check whether or not the student met criteria on this observation. In order for criteria to be met for a category, all of the items for that
category need to either be marked “Y” or “N/A.” 4. Enter this information in the student’s KIPBS Student Mentor Observation Tracking form. 5. Based on your observations provide constructive feedback to the student by praising the things that he/she did well, and by letting
him/her know what may be some things to work on, and how. 6. Send the information on this sheet, by e-mailing an attachment of this form with the current information, along with
notes on feedback provided, to the Mentoring Coordinator and to the student’s instructor. Send a carbon copy of this e-mail to the student.
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Case Study Timeline Review
1. Review the Case Study Timeline 2. Set a date to meet with your instructor and finalize timeline 3. Complete Pre-Involvement form
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KIPBS Mandatory Case Study 1 Checklist (P. 11) Rev. 3-11-08 This checklist to be used as a guide of what needs to be done, in what sequence, in relation to the first case study. The actual time it takes to complete each activity will depend on the student’s ability to complete it, and on the data gathered. Each student is responsible for meeting with his/her instructor to develop a timeline for completion of Case Study 1. Once a potential case study has been identified, the student and the instructor should meet to set target dates for completion of each activity. After a timeline has been set, it is very important to follow the indicated timeline as close as possible. As each activity is completed, the date of completion should be entered, and the student should meet with his/her instructor so that the instructor signs off on the completed activity. This form is “mandatory” and should be submitted with the final case study report. If, for some reason, the student is unable to keep up with the timeline, the student should meet with his/her instructor to discuss the situation and to develop an alternative plan.
Student’s Name: Instructor’s Name:
Case Study Name:
Target Date
Date Completed
Instructor Sign off Activity
Complete Mandt training and submit documentation to Pat Kimbrough
Identify case study individual
Get case study approved by your instructor
Schedule an initial meeting with caretakers
o Introduce yourself, state why you are there, and describe the process o Obtain informed consent o Find out what their major concerns are with respect to the individual o Obtain previous plans if there were any
* If the individual spends a significant amount of the time in a different setting (e.g. school, work), schedule a meeting with the people in that setting and obtain the same information
Schedule and conduct meetings and observations
Conduct enough meetings and observations for you to assess and get to know the individual, his/her environment, and his/her team
Schedule and conduct PCP interviews with caretakers and team members
Conduct the necessary interviews to obtain information for the PCP meeting. Information gathered should include the individual’s history (medical and behavioral), strengths, preferred lifestyle, and possible challenges
Schedule the PCP meeting
Contact the Mentoring Coordinator to schedule the PCP Meeting Facilitation Mentor Onsite Observation
Contact the Mentor Specialist that will be doing your mentor observation, to discuss the
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Student’s Name: Instructor’s Name:
Case Study Name:
Target Date
Date Completed
Instructor Sign off Activity
details of Mentor Observation
Prepare for the PCP meeting
o The individual, all team members, and important people for the individual should participate in this meeting. From your interviews and observations, you should have a good sense of potential issues that might arise at the meeting, and you should be prepared for such. People should work as a team.
o The focus of this meeting should positive. This meeting should not be about the negative aspects of the individual or his/her challenges. Behavioral issues may be mentioned, but will be addressed in greater depth through the functional assessment and behavior plan. As such, a recommendation to address such behaviors may be made, with short-term goals to conduct the functional assessment and baseline measures.
o The aim of this meeting is for the team to get a good sense of the individual and his/her preferred lifestyle, and to develop goals to get the individual closer to that lifestyle. Goal development is very important: Long-term goals should be broken down, what needs to be done to reach each goal should be delineated, and how progress towards each goal will be measured should be stated.
o Some goals will involve environmental-type of changes, while other goals will involve behavioral-type of changes (to avoid the negative focus, you may approach the issue by discussing appropriate behaviors to increase or skills to teach).
o Since environmental-type of changes will likely impact the behavioral issues, it is a wise idea not to make these changes until functional assessment activities and baseline measures on the target behaviors are gathered. However, in the meantime, the team can work towards these goals by gathering information and resources so that once baseline measures are completed, preferred lifestyle interventions can be started.
Conduct the PCP meeting
o At the end of the meeting (or at the next meeting where all team members are present) conduct the PCP Satisfaction Survey
Schedule and conduct Functional Assessment Interviews with caretakers and team
members Obtain information about behavioral issues
Establish what the major behavioral issues may be Examine the Functional Assessment Interviews, as well as any other information you may have obtained from discussions, previous plans, records reviews, and observations, to establish what the major behavioral issues may be and what you should focus on and observe for in your assessment
Schedule and conduct observations (i.e., Functional Behavior Assessment Observation form, ABC Chart, Scatter Plot) Conduct enough observations to have a good sense of exactly what the problem behaviors are, when they are more/less likely to occur, and what their function might be. Develop a sound hypothesis. Note: YOU should conduct these observations. Caretakers may gather some data if the behavior occurs at a time you cannot observe, but you should conduct the bulk of these so that you have a good sense of what is going on
Videotape Case Study: Baseline – problematic & non-problematic routines
Develop a behavioral definition for each target behavior and determine how each will be
measured once you have a good sense of what these behaviors look like (from your observations).
Send your Operational Definitions to the Mentoring Specialist for approval
Develop a data collection sheet to measure all target behaviors (including replacement
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Student’s Name: Instructor’s Name:
Case Study Name:
Target Date
Date Completed
Instructor Sign off Activity
behaviors)
Send your Data Collection Sheet to the Mentoring Specialist for approval
Contact the Mentoring Coordinator to schedule your Reliability of Data Collection Method Mentor Observation
Contact the Mentor Specialist that will be doing your mentor observation, to discuss the details of Mentor Observation
Schedule a meeting with caretakers (or any one that might be involved in collecting data) and meet
Explain the data sheet that you developed and how to use it.
o Practice using the data sheet to ensure understanding o Have caretakers begin to collect baseline data using this data sheet
Schedule and conduct reliability observations Assess the reliability of the data and problem-solve any issues (reliability should be at least 80%). If necessary, modify data collection procedures.
o Have caretakers continue to collect baseline data
Monitor the behaviors by looking at the data regularly o Baseline data should be gathered for at least a few days, unless doing so would put the
individual or others in danger o Ideally, baseline data should be gathered until the data are stable and reliability is at least
80% o Data should be collected continuously throughout baseline and intervention
Set up a spreadsheet system to summarize the data
Graph the baseline data
Write the General Information and Assessment sections of your report (Part 1).
Write the Preferred Lifestyle Interventions section of your report, based on the information gathered from the PCP meeting
Develop the competing behavior diagram(s) based on functional assessment information gathered
Once baseline data are stable, schedule a meeting and meet with caretakers Discuss the findings of your functional assessment and Brainstorm function based interventions (i.e. PBS interventions)
o Go over baseline data gathered and explain what they mean o Explain functional assessment findings and discuss/brainstorm potential function based
intervention strategies using the Competing Behavior Diagram o Select a few function based interventions to implement, and discuss the details of
implementation o Have caretakers continue to collect baseline data, using the same data sheet that you
developed o Do not begin intervention implementation yet
Write the Interventions & Supports section of your report based on the interventions selected by the team
Schedule a meeting with caretakers to share the Interventions & Supports section of your report and to train them on the selected interventions
Contact the Mentoring Coordinator to schedule the Intervention Training Meeting Onsite
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Student’s Name: Instructor’s Name:
Case Study Name:
Target Date
Date Completed
Instructor Sign off Activity
Mentor Observation
Contact the Mentor Specialist that will be doing your mentor observation, to discuss the details of Mentor Observation
Meet with caretakers to share the Interventions & Supports section of your report and to train them on the selected interventions
o Practice and role play function based intervention procedures o Discuss details of preferred lifestyle interventions (from PCP meeting), o Make sure that caretakers understand the intervention procedures and problem solve
any issues that they may have o Conduct the Contextual Fit survey o Begin intervention implementation, and o Have caretakers continue to collect data, using the same data sheet o Remind caretakers to collect any necessary data with respect to preferred lifestyle
interventions, in order to determine the status of those goals, as discussed during the PCP meeting
Videotape Case Study: Caregiver intervention implementation
Write the Interventions and Supports section of your report (Part 2)
Develop task analyses for the interventions being implemented
Send your task analyses to the Mentoring Specialist for approval
Schedule a fidelity observation, once interventions have been in place for a short while (e.g., a
week), to determine if interventions are being implemented as intended, and if data are being gathered as agreed upon
Contact the Mentoring Coordinator to schedule the Fidelity of Intervention Implementation Mentor Onsite Observation
Contact the Mentor Specialist that will be doing your mentor observation, to discuss the details of Mentor Observation
Conduct the fidelity observation
o Calculate fidelity (fidelity should be at least 80%) o Problem-solve any issues; If necessary, modify intervention procedures o Calculate reliability (reliability should be at least 80%) o Problem-solve any issues; If necessary, modify intervention data collection procedures o Have caretakers continue to collect data
Monitor the behaviors by looking at the data regularly
Obtain data from caretakers on a regular basis, and closely monitor behaviors
Schedule a follow-up meeting with caretakers to share data and to discuss the status of target behaviors, interventions, and preferred lifestyle goals
Videotape Case Study: Intervention follow-up
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Student’s Name: Instructor’s Name:
Case Study Name:
Target Date
Date Completed
Instructor Sign off Activity
Conduct a follow-up meeting
Go over the data. Discuss the status of the behaviors and the goals
o If an intervention does not seem to be having the intended effect and enough time has been allowed for change, discuss modifying or changing the intervention strategy
o If PCP goals are not being met, problem-solve the issues o As PCP goals are met, update the plan accordingly o As behavioral goals are met, modify the procedures gradually to get closer and closer to the
“regular” environment (i.e. gradually fade prompts, gradually thin reinforcers) o Plan for sustainability and major changes o Conduct the Quality of Life survey o Have caretakers continue to collect data
Write the Follow-up section of your report (Part 3)
Ongoing
Form this point on, you should:
- Obtain data collected from caretakers on a regular basis, and closely monitor behaviors - Conduct fidelity and reliability observations sporadically - Have regular follow-up meetings to go over data and discuss the status of behaviors and
goals o If an intervention does not seem to be having the intended effect and enough time has been
allowed for change, discuss modifying or changing the intervention strategy o If PCP goals are not being met, problem-solve the issues o As PCP goals are met, update the plan accordingly o As behavioral goals are met, modify the procedures gradually to get closer and closer to the
“regular” environment (i.e. gradually fade prompts, gradually thin reinforcement) o Plan for sustainability and major changes o Conduct the Quality of Life survey at regular intervals
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Pre-involvement Plan Documentation Form
KIPBS Student: ______________________________________ Case Study Participant: ________________________________ Case Study Number: ______________________
Positive Behavior Support (PBS) Plan I am not submitting a copy of the PBS plan because: ___________ There was no PBS plan prior to my involvement. ____________ There was a PBS plan created prior to my involvement in my case study
but I cannot obtain access to the plan due to consent or other issues.
___________ The PBS plan is attached.
Person-centered Plan (PCP)
I am not submitting a copy of the PCP because: ___________ There was no PCP prior to my involvement. ____________ There was a PCP created prior to my involvement in my case study but I
cannot obtain access to the plan due to consent or other issues.
___________ The PCP plan is attached.
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WHAT DO I NEED TO DO NEXT:
1. Complete Module 5 Assessment & Reflection Activities 2. Complete Module 6 Assessment and Reflection Activities
3. Read the Molly Plan and Review 68 item PC-PBS Checklist
4. Update Case Study Timeline 5.
6.
7.
NEXT CLASS
Date: ______________ Location: ____________
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