PBS for Families of Children and Adolescents with Intellectual and Developmental Disabilities An introduction for family support professionals and transitional

PBS for Families of Children and Adolescents with Intellectual and

Developmental Disabilities

An introduction for family support professionals and transitional service specialists

Joseph Ricciardi, PsyD, ABPP, BCBA-DSeven Hills Clinical Associates

Seven Hills Foundation

What is PBS?

PBS: Positive behavior supports

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.

Research-based

Better quality of life

Less problem behavior

Learn new skills

Making a “better” environmental fit for the person

What is PBS?

Our Definition of PBS A systematic, person centered approach… …to understanding the reasons for behavior and

applying evidence based practices for prevention, proactive intervention, teaching and responding to behavior…

…with the goal of achieving meaningful social outcomes, increasing learning and enhancing the quality of life across the lifespan.

Massachusetts Department of Developmental Services (DDS, 2013)

What is PBS?

FORMER APPROACHES• Stopping people from demonstrating

challenging behavior (reactive)• Psychotropic medication• Punishment procedures (used after the

challenging behavior occurs)• Separation from the community and

institutionalization

CURRENT APPROACHES (PBS)• Prevent: Anticipating a person’s need

before a challenging behavior occurs• Changing environments to help people

experience a greater degree of success• Teach: Socially-successful skills to make

challenging behaviors ineffective and irrelevant (i.e., the skills are easier and more effective)

• Reinforce: Celebrate valuable achievements and important skills

• Integrate: Actively participate in the community (the person’s natural environment)

PBS is the Current Best Practice for Serving Individuals with IDD and Challenging Behaviors

What is PBS?

The rationale for PBS—three important points

1) PBS reflects a shift in thinking from reacting to challenging behavior to trying to understand and support the individual.

2) PBS assumes that people do what they do for a reason. Their challenging behavior serves a purpose and works for them.

3) The focus shifts reacting to the individual’s challenging behavior to teaching appropriate skills that the individual can use to achieve the same purpose.

The model: a 3-tiered system

Intensive supports—highly individualized strategies that require clinical assessment, design, and guidance

Targeted supports—strategies that are well-understood, target a specific problem with a specific strategy

Universal supports—the patterns, practices, approaches that work best for all kids with IDD and their families

What are “universal supports” in the home? Again, we are looking for those practices that help all

kids with IDD do well—

Health and emotional problems addressed• Physical health• Mental health• Family function• Family supports

Predictable routines• As many “scripted sequences” as possible• Covering the usual, routine, daily activities

Clear expectations and rules• Written, posted positive behaviors• Written, posted rules/consequences

Tier 1: Universal Supports








Supporting basic self-expression• Age appropriate choice offered• Visual accommodations• System for communicating needs and wants

(simple icons, PECS, more advanced AAC)

Quality parent-child interactions• Low use of coercion and punitive

interactions/High use of instruction and praise• “Differential reinforcement” (Prompt, Praise,

Pause skills)• Planned quality parent-child time








Supporting basic self-expression• Age appropriate choice offered• Visual accommodations

Quality parent-child interactions

Varied leisure/recreation opportunities• Nothing complicated, and nothing to provoke

struggles• But a little variety, planned, scheduled,

supported

Healthy habits• Healthy sleep habits• Healthy diet• Some physical activity each day







Supporting basic self-expression• Age appropriate choice offered• Visual accommodations

Quality parent-child interactions

Varied leisure/recreation opportunities• Nothing complicated, and nothing to provokeHealthy habits

A system for monitoring the intervention• Simple methods for assessing response to

intervention (behaviors of concern, skills)• Evaluating consistency of intervention

implementation

“Tier Two”—Targeted Interventions These are specific strategies, applied toward specific

problems Generally, these are easy solutions that come from

someone with experience The trick is to know “where do I begin?”

One strategy: contextual assessment Rather than asking about problem behavior itself,

discuss the occurrence of issues during various “recurring contexts” families encounter each day

“During which routine, daily, family events and activities do problem behaviors occur?”

Tier 2: Targeted Interventions

Typical events and routines that families face every day, and that may become challenges points for parenting a child with a developmental disability:

1. Getting out of bed

2. Sitting down for meals

3. Eating meals

4. Toileting

5. Bathing and self-care

6. Independent play time

7. Limits on certain activities (TV, computer, etc.)

8. Completing household chores and responsibilities

9. Driving in the car

10. Going shopping

11. Going out for a meal

12. Going to church

13. Getting off to bed


Report from the school behavior analyst:Aggression is “escape-motivated” and the intervention includes escape extinction during seated instruction and prompting through refusal of low preference events.


Behavior support: $50.00

THE BCBA


At home some issues have to be considered: • Is escape extinction possible? Can it be pulled off by a

parent?• Is the formulation relevant for every occurrence of

aggression? • Are there other approaches that might be tried?




Some findings of contexts of concern:Getting out of bed in the morning: Refuses to leave bed, struggles, and aggression likely. Goes to sleep around 7 PM, with meds. On weekends, sleeps until noon. Often awake around 3-4 AM, struggles to go back to sleep for a while. Interventions?

During prompted voiding: Refuses leave activity to use the bathroom. Or, follows prompts to bathroom, flops on floor, escalates, aggresses. Parents must yield. Interventions?Driving in car, especially long rides: Aggression, screaming. Parents must stop to calm him. Calmed with toys and music. Parents avoid taking him out and often feel “we are being held hostage by him”. Interventions?

Intensive Supports—Guided by Professionals Intensive supports require specialized assessment (the

Functional Behavior Assessment) The goal is to produce a home-based behavior support

plan

Tier 3: Intensive Supports

Must meet two special conditions for families:1) Must be do-able in the home, not “theoretical”

“Just tickle his belly, Ernie. Tickle his belly!”



plan



2) Must not be worse than the problem itself

“Hold still Carl. Don’t move an inch.”



plan



2) Must not be worse than the problem itself

Clinicians must meet two conditions as well:1) Interventions must be empirically-supported2) The plan should be “multi-component”—it

addresses the problem through multiple avenues: prevention, teaching alternatives, planned reinforcement, safety plan

Documents

PBS for Families of Children and Adolescents with Intellectual and Developmental Disabilities An introduction for family support professionals and transitional