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ImplementingSustainablePBSinOrganizationsSupportingPeoplewithIntellectualandDevelopmentalDisabilities

Data-BasedToolsandResources

TeresaRodgersMissouriDepartmentofMentalHealthRachelFreemanUniversityofMinnesotaStewartM.ShearDevereuxFoundation

PresentationGoals

•  Describe3ExamplesofImplementationinIDDSettings

•  ProvideDifferentWaystoThinkAboutImplementation

•  ShareToolsThatPromoteData-BasedDecisionMaking

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MissouriIDDTieredSupports:EvaluatingSustainability

TeresaA.Rodgers,Ph.D.,BCBA-DChiefBehaviorAnalystMoDMH/DivisionofDD

APBSBaltimoreFebruary22,2019

Whatissustainabilityofapractice?

•  McIntoshetal(2016)-durableimplementationofapracticeataleveloffidelitythatcontinuestoproduceavaluedoutcome.

•  Whatis“apractice”?– Oneorsetofstrategies– Framework/structuretoapproachservices

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Agen

cyTeam Leadership

Communications

Trainer

Coach

Systems

TieredSupportsConsultant

TOOLS&Workshops

(developmentofsystems)

TierOne:UniversalSupports

MOTieredSupportsStructure

MoTieredSupportsProcess

Initiate• Overviewofprocessandbenefits

Inform• ASSETprocessandpurpose

• AgencyTieredSupportsImplementationTeam(ATeam)

Evaluate

• CompleteAssetwithA-Teamassistance

• ReviewResults

ActionPlan• Decideonareasoffocusandstepsforimprovementandmeasurementofprogress

Review• Coach–SetregularreviewtimesfordatawithA-Teameffectsofinterventions

Reinforce• WithA-Teamdesignreinforcementforstaff

• WithsteeringcommitteeAgencyteamsuccesses

• Regionalrecognitionofteams

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First,evaluatethecontextasitis

•  ASSET-AgencySystemandSupportsEvaluationTool•  BasedonSETfromSchoolWide•  Evaluatespresenceorabsenceofessentialelementsfor

Tier1practices–  Individualsneedahealthy,positive,enrichedenvironment–  Administration/familydecisionmaker(s)support,participation&leadership

–  Commonapproachtoteaching&providingencouragementforwhattodoandwhatnottodo

–  Proceduresforcoaching,feedback,re-teaching–  AndDatatoevaluateandre-evaluatefidelityofandeffectivenessofproceduresusedbybothfamilyandstaff

SampleofevaluationquestionsfromASSET

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PositiveandNegativeInteractionsobservations

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PartofoneoftheToolsforImplementationFidelity

Toolforevaluationofsustainabilityü  ContextualFit

–  PolicyandProcessesaligntosupport–  Braidedinitiatives–  Adapttocontextwithfidelitytocore/essentialelements–  AddresscontextIssues

ü  Considerchangesincapacity–  Fundingforimplementationofsystemandpractices–  Keypersonnel–planforturnover–  Writtenplananddocumentationofsystem,changesandprogress

ü  Considerchangesinconsequences–  Fidelitytomodel-collectandreviewdata–  FrequentlyShareOutcomesBroadly–  Perceptionofeffectiveness

ü  Collaboration,CrossTraining,andContinuousdatasharing–  Notdependonsingleperson,rolesidentifiedforimplementingand

maintaining–  Databaseddecisionmakingprocessestablished

–  Broadrepresentativeteamtoevaluateimplementationandsustainability

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HowdoesMoTieredSupportsstackup?Ø  ContextualFit

–  ASSET-assessmentofagencyimplementationsystems–  CoordinatorandSteeringCommitteeatStateLevel–  TrainingforSystemCoaches–  ProcessforSupportswithessentialelementsforfidelity

•  Adaptedtoeachagencycontext•  Implementationbycoachesandagencymeasured•  Datasharedwithcoaches,stateadministrationandagencies

–  Workingonpolicy(moneycontingencyforparticipation)–  Toplevelsupportforcoaches,workingwithagencieswhovolunteer,annualSummit

Ø  Capacity–  FundingforcoachesandCoordinators–  Notfundingforagencyparticipation–maybevaluebasedoutcomesonthehorizon–  Coordinatorimprovingdocumentationanddata,andsystemforfidelitycheckingat

statecoachesandagencylevels

Ø  Consequences–  Dataoneffectivenessandfidelityandcostinprocess–  Sharingoutcomesmonthlywithinstatesystem–  Summitannuallywhereagenciessharesuccesses

SampleASSETandSatisfactionSurveyResults-ContextualFit

79%

21%

1

HastheTieredSupportsConsultationhelpedyoucreatepositivechange

foryouragency?

YES NO

69%

50%

55%

50%

17%

38%

38%

88%

81%

75%

0% 20% 40% 60% 80% 100%

Physical/SocialEnvironment

Schedule&Predictable

Choice&Communication

BehavioralExpectationsDefined

PositiveInteractions&

Teaching&EncouragingNew

SystemsofReinforcement

Data-BasedDecisionMaking

AgencyLeadership

Regional/StateSupport

ASSETScore

ASSETFeature

AgencyAFindingsScore

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Someexamplesofstateleveldatacollected-Capacity

July-18 August-18 September-18October-18 November-18

3.56 3.51

3.07

3.35 3.29

NumberofBehavioralincidentsreportedper100IndividualsServedatTieredSupportAgencies

0%

5%

10%

15%

20%

25%

30%

IndividualCrisisConsultation

ToolsCoaching Travel OtherDuties(NOTBRT)

STATEWIDE%OFTIMEATSCSSPENTFY2019

0%

20%

40%

60%

80%

100%

July-18 August-18September-18October-18November-18

PercentofActionPlanItemsCompleted

0%20%40%60%80%

100%120%140%160%

July-18 August-18 September-18 October-18 November-18&ofO

bservatio

nsCom

plete

Percentof+/-ObservationsCompleted

DatasupportingeffectivenessoftheMoTieredSupportsModel-Consequences

84%

16%

TieredAgencyPercentageofPositive/NegativeInteractionsObserved

FY19asofOctoberreport

TotalPositives

0

20

40

60

80

100

120

140

NON-TIERED LOW-TIERED MODERATE-TIERED

HIGH-TIERED

NUMBE

ROFBE

HAVIORA

LEM

T'S(PER

100)

IMPLEMENTATIONLEVEL

Statewide number of behaviora l inc idents (per 100)

Based on t iered supports implementat ion level

FY17 & FY18 compar ison 20172018

$632

$44,860

NON-TIEREDAGENCIES

TIEREDSUPPORTSAGENCIES

StatewideTotalBehavioralIncidents(per100)

CostSavingsforAgenciesFY17-FY18

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PositiveBehaviorSupport&Person-CenteredPractices

UniversalTier

SecondaryTier

TertiaryTier

OrganizationalWorkforce

Person-CenteredPractices

PositiveBehaviorSupport

Freeman,R.(2018).Minnesotaorganization-wideperson-centeredpracticesandpositivebehaviorsupport.UniversityofMinnesota,InstituteonCommunityIntegration.Minneapolis,MN.

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UniversalThemesAssociatedWithPBSandPerson-CenteredPractices

•  BalancingWhatisImportantToandForaPerson

•  IncreasingAwarenessofPowerWithVersusPowerOver

•  BeingOpentoandShowOngoingInterestinCulturalDifferences(CulturalHumility)

•  UnderstandingHowTraumaImpactsOurResponses

Communication&Building

Relationships

Empathy&Culture

Mindfulness&Wellness

…..AndHelpsUsBuildontheInter-RelatedFeaturesThatCreatea

PositiveCommunityOrganization&Environment

PositiveSocialStrategies:

ToolsandStrategiesforImprovingSocialInteractioninPerson

CenteredPractices

SocialMatching

ProblemSolvingConflict

Resolution

UniversalTier1Strategies:Person-CenteredPractices&PositiveBehaviorSupport

ContextualFit

CommunityMapping

Predictable&PositiveSettings

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Region2Cohort2A(1County&4Organizations)

Region3Cohort2B(5Counties,PublicHealthDept.,2Organizations)IntegratedModel

Region1Cohort1&Cohort4SupportDevelopmentAssociatesPerson-centeredPracticesModel1County,5Organizations

MinnesotaStatewidePlanforBuildingRegionalCapacity

TrainingLayers•  TeamTraining•  RegionalTrainers•  Person-centeredThinkingTrainers/CoachTraining

•  PictureofaLifePlanners/Trainers

•  PBSFacilitators

Region4Cohort3&44Counties,1PublicHealth,7OrganizationsTeams=24

Organizations=27

0

5

10

15

20

25

30

14-15 15-16 16-17 17-18 18-19

Organ

izations

ImplementationbyFiscalYearsfromJuly1–June30

Sustaining

2ndYear

1stYear

Year Sustaining 2ndYear 1stYear2014-2015 0 0 42015-2016 0 4 122016-2017 4 12 62017-2018 16 4 02018-2019 20 0 8

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2015 2016 2017 2018 2019

Region 1 3 4 4 4

ActiveOrganizations 4 16 22 20* 27(24Teams)

TotalTrainedCoaches 44 167 212 282 318

TotalTrainedKeyContacts

6 24 36 29 45

PBSFacilitatorsbyRegion

0 6 15 73 77

PCTTrainersbyRegion

4 14 18 53 55

TotalPCTTrainers 46 66 86 78 78

TeamAttritionOccurredin2018N=2

EffortDataShowingExpansionOverTime

Data-BasedDecisionMaking:

SamplingToolsUsedinImplementation

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StagesofImplementationNationalImplementationResearchNetwork(NIRN).

LINK:http://implementation.fpg.unc.edu/sites/implementation.fpg.unc.edu/files/NIRN-Education-StagesOfImplementationAnalysisWhereAreWe.pdf

Organization-WidePerson-CenteredPracticesandPositiveBehaviorSupport

StagesofImplementationCompletedFebruary2019

60%

Exploration

74%

Installation

56%

InitialImplementation

50%

FullImplementation

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AddingUniversalPositiveBehaviorSupportStrategies

1. Teach,Promote,ModelPositiveSocialInteractions

2. DesignPositive,Proactive,PredictableEnvironments

3. EstablishData-basedDecisionMakingSystems

4. ConsistentResponsetoProblems

5. BuildCapacityforIndividualizedPBS

MatrixCompletedinAResidentialSettingwithTwoWomen

Cleaning Meal Prep Dishes start and Empty

Grocery Shopping

Respect

Get chores done on time, before dinner

Say, “thank you” Offer each other compliments on the good food

Honor each other’s process, but keep up the timeline

Tell the other person if you are not going grocery shopping. Watch for other people’s feet while driving the cart. Be ok with what the other person picks out.

Kindness

Say, “thank you” or, “that looks good.” Maybe get a kudos board

Assist each other in looking up new recipes on the tablet

Ask if help is needed

Learn how to make the grocery list. Do the grocery list together. Pick-up something your roommate might like.

Helpfulness

Offer to bring supplies if needed

Offer to teach each other cooking skills

Rinse your plate. Clear your dishes. Put away someone else’s dishes.

Help carry the groceries in from the car. Help make the list

Communication

Look at the calendar so you don’t have to remind each other. Let your great work speak for itself (No need to talk about what you did)

Look at calendar to know what is going on. Learn the likes and dislikes of each other. Ask the likes and dislikes of each other.

Tell each other if you need to switch days.

Tell your roommate if you are not going shopping. Look at the calendar to see whose day it is.

MatrixCompletedinAResidentialSettingwithTwoWomen

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Universal Social Skill Tool

Select a Social Skill Define the Social Skill so it is Observable

Routine Selected for Learning/Practicing Social Skill Prepare for the Training

• Decide how to share the training _________________________________________ • Who will participate in the training (List people involved) _____________________ • Materials are needed to complete the training: __________________________ • How much time is allocated for this training: ________________________________

Write down examples and nonexamples of the behavior below: Write Down “Non-examples” of Social Skill

Write Down Examples of Social Skill

Practice

1. Create the examples and non-examples of social skill 2. Assess what the is needed in order to learn/practice the social skill 3. Write down examples and nonexamples of the social skills 4. Create a scenario that helps people practice building alliance and ask each person to play a role in the

scenario or make one up together or use a real routine to practice new skills 5. Use other resources that help share what the social skill looks like (video, stories, etc.) 6. Choose two everyday routines and write down a plan to practice the social skill

7. Discuss examples and celebrate success

AssessingOrganizationalData

•  QualityofLifeEvaluation•  IncidentReports•  Injuries,SickDays•  InformationRelatedtoRetention,WorkersCompensation,StaffInjury

•  FidelityofImplementation•  OnboardingandInserviceTrainingData•  SurveysandOtherDocumentationRelatedto

– QualityofLife– Climate– Stress

•  DocumentedChangesinOrganizationalPolicies

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Person-Centered Organizational Development Tool

ThePerson-CenteredOrganizationalDevelopmentToolisusedbyTeamstoEngageintheAssessmentandActionPlanningProcessItisAvailableforFreeathttps://mnpsp.org/training-materials/

AssessingQualityofLifeQualityoftheSocialandPhysicalEnvironmentToolhttps://mnpsp.org/wp-content/uploads/2016/12/PBS-

QOL-socialphysical-next-version9-11-17.pdf

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IncidentReports&Data-basedDecisionMaking

33

People:25

Incidents:59

Waystoexamine:ByMonthDayoftheWeekLocationProgramTimeTimeofChallengeTriggerFunction

FidelityofImplementationTieredOnsiteEvaluationTool(TOET)KeyElements•  2-4HoursOnsiteVisittoOrganization•  OutsideEvaluationofProgress•  ReviewofDocumentation•  Interviews•  Observations

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FidelityofImplementationTieredOnsiteExternalEvaluation(TOET)Scores

0%10%20%30%40%50%60%70%80%90%100%

TeamActionPlanningandStakeholderInvolvement

UniversalPerson-CenteredStrategies

UniversalPositiveBehaviorSupport

CulturalAwarenessandCompetence

Strategies

MonitoringPlansandOrganization-wideDatafor

DecisionMaking

SupportforStaffLearningNewSkills

Visibility Total

Percen

tCom

plete

Subscale

ProviderOrganizationPerson-centeredpracticesandPositiveBehaviorSupport

SystemsEvaluationTool-OnsiteEvaluation

2/15/2016

1/29/2018

FirstStepsforDirectObservation

oftheMatrix

•  Team--staffmembers,supervisorinvolvedinobservations,&peoplesupportedmettoidentifypositivesocialvalues

•  Afterinitialobservations,thePBSteamcreated:–  Largeprintedversionsofthematrixinhallways,employmentclassrooms,andthecafeteria

–  Largerscaleemployeetrainingonthematrix– Additionaltrainingduringemploymentclasses.

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BeforeDayProgram Arrival InClass BreakTimes Lunchtime

Respect Communicatethoroughly

BeingPrepared&Communicate

BePrepared&Beontime

Cleanup,BeTimely,&CommunicateRespectfully

Cleanup&BeTimely

Inclusion Motivateonanindividuallevel

Communicateandworkasateam

Participateandhearoneanother InvolveEveryone

CommunicateyourneedsEncourageSocialbility

Support

CommunicatewithoneanotherPrepnecessaryitems(Meals,Meds,Phone,etc)

Communicateandhaveaplan

BeInvolved,LimitInterruptions

HelpeachotherbetimelyCommunicateyourbreakswithothers

BeTimely,HelpeachotherEncourageSociability

Empathy Beunderstanding

BeFlexible&OfferChoices

Makeitfun,Knowyouraudience

InvolveEveryone,CommunicateRespectfully

Helpeachother

DirectObservationStrategyPart1–StaffMembersObservedPCPractices•  Person-FirstLanguage•  NonjudgmentalLanguage•  WorkinginAlliance•  ReflectiveListeningSkills•  UniversalPerson-Centered

Strategies•  EmpathicBehaviourPBSPractices•  EncouragingSocialInteraction•  SupportingChoices•  ReinforcingOthers

Part2–PersonSupported•  ActiveInvolvementin

Conversations/Meetings/Activities•  EngaginginIdentifiedSocial

behaviors•  OperationalDefinitionsfor…

–  Respect–  Inclusion–  Support–  Empathy

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Part1:MatrixObservationProcess

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6

Percen

tageof5

minintervalsw

ithoccuren

ce

20minsessions

UniversalLevel:SelectedSocialSkills(Matrix)

Providingsupporttoothers Demonstratingempathyincommunication

InitialObservation PostMatrix-SpecificTraining

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Part2

MINNESOTA DIRECT OBSERVATION FORM

Freeman,R.,Watts,E.,Reichle,J.,Moore,T.,Maki,A.,O’Nell,S.,Baker,D.,Amado,A.,Piggott,M.,&Julian,H.

(2016).MinnesotadirectobservationandAssessmenttool.Minneapolis,MN:InstituteonCommunityIntegration.

UniversityofMinnesota.

Date and Time of Observation: _______________________ Number of People in the Setting: __________________________ Setting Observed: ____________________________________________________________________________________________

B. PromotingSocialEngagementandInteractions

ItemObserved Minutes0-5

Minutes5-10

Minutes10-15

Minutes15-20

EncouragingOtherstoInteract � � � �SupportingChoices � � � �ReinforcingOthers � � � �

SubtotalPerson-CenteredBehaviorsObserved______/12

______%

Part2Observeuptwostaffwhiletheyareworkingorobserveuptotwopeoplewhoarebeingsupported

usingthelistbelow.A. OpportunitiestoParticipateinPositiveSocialInteraction

ItemObserved Minutes0-5

Minutes5-10

Minutes10-15

Minutes15-20

ActiveInvolvementinConversations/Meetings/Activities

� � � �

EngaginginIdentifiedsocialBehaviors:PersonCenteredValue1 � � � �PersonCenteredValue2 � � � �PersonCenteredValue3 � � � �PersonCenteredValue4 � � � �

SubtotalPerson-CenteredBehaviorsObserved______/_______

______%

Part1ObserveStaffusingthelistbelow.

A. Person-CenteredBehaviors

ItemObserved Minutes0-5

Minutes5-10

Minutes10-15

Minutes15-20

Person-FirstLanguage � � � �NonjudgmentalDescriptiveLanguage � � � �WorkinginAlliancewiththePerson � � � �ReflectiveListeningSkills � � � �Person-CenteredBehaviors � � � �DemonstratesEmpathicBehavior � � � �

SubtotalPerson-CenteredBehaviorsObserved______/24

______%

ArePeopleActivelyUsingtheSocialInteractionalSkillsConsideredImportant?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1 2 3 4 5 6

Percen

tageof5

minintervalsw

ithoccuren

ce

20-min session

Universal Level: Positive Social Behaviors

Reflectivelistening Demonstratesempathicbehavior

InitialObservations Post-Matrix-Specific Training

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0%10%20%30%40%50%60%70%80%90%100%

Percen

tCom

plete

AgenciesAcrossAllRegions

TieredOnsiteEvaluationTool(TOET)PersonCenteredPracticesandPositiveBehavior

SupportYear1-Baseline

Year2

Year3

Oneagencylistedrepresentsfourcountiesthatarecollaborating

Teamsinyear3implementedorganization-wideperson-centeredpracticessupportedbySupportDevelopmentAssociates

AccesstotheTOET:https://mnpsp.org/wp-content/uploads/2016/12/Updated-SETedits-RF8-22-17-1.pdf

ToolsonMNPSP.ORG

MainResourceSitehttps://mnpsp.org/training-materials/#pbsPlanningOlderVersionofTOEThttps://mnpsp.org/wp-content/uploads/2016/12/Updated-SETedits-RF8-22-17-1.pdfDirectObservationToolsfromTOET•  Definitionshttps://mnpsp.org/wp-content/uploads/2016/12/Observation-Tool-Definitions-FINAL.pdf•  DirectObservationToolhttps://mnpsp.org/wp-content/uploads/2016/12/Observation-Tool-and-Worksheet.-7.31.17-js-3.pdf

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FidelityofImplementation-Self-Assessment

MNTeamChecklistPerson-CenteredSubscale•  https://mnpsp.org/wp-content/uploads/2017/06/

MNTICPCPsubscale2-18-17-Next-Version.pdfMNTeamChecklistPBSSubscale•  https://mnpsp.org/wp-content/uploads/2016/12/Blue-MN-

checklist-PBSNext-Version-Minor-Edit.pdfQualityoftheSocialandPhysicalEnvironment•  https://mnpsp.org/wp-content/uploads/2016/12/PBS-QOL-

socialphysical-next-version9-11-17.pdf

LookforTrainingMaterialsattheBottomoftheHomePage

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Training MaterialsQuick Links

Cohort 3 Training

Materials

�

Cohort 2 Training

Materials

�

Positive Social

Strategies

�

Universal Social

Skills Resources

�

Implementation

Examples

�

Organization-

Wide Evaluation

�

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�

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Support

Notebook

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Click Here for Cohort 3 Training Materials

Click Here for Cohort 2 Training Materials

Click Here for DHS Internal PCO Materials

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EncouragingandBuildingRelationships

Positive Social

Strategies

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Assessment

Types of

Listening from

EmpathyandCulturalResponsiveness

Improving

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Competence

Empathy in

Action Video

MindfulnessandWellbeing

Introduction

to

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Empowers Us

OrganizationalSystems

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Mapping Tool

Temperament

Tool – Toddler

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Home About Topic Areas Positive Support Practice

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ToolsandResourcesOrganizedbyTopic

Implementing Sustainable D-PBIS I/DD in Organizations Supporting People with Intellectual and Developmental

Disabilities

Stewart M Shear, Ph.D.

National Director of IDD Services

Devereux Foundation

APBS Conference

February 22, 2019

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Devereux-Positive Behavior Interventions and Supports (D-PBIS I/DD)

Scope n  The Devereux organization operates in 13 states n  There are 8 Centers across the United States serving I/DD n  Centers are located in (NY, NJ, PA (2), MA, Florida, Texas,

California) n  Devereux Adult Services implementing 24 of 72 D-PBIS programs Implementation Issues n  All centers are rolling out the D-PBIS I/DD framework with some

modifications n  Coordination across and within centers n  Continued focus on implementing with good fidelity n  Necessary to develop measures that ensure sustainability

3Tieredapproach:designedtoimproveprogramsandoutcomesfor

allindividuals

PRIMARYPREVENTION• BehavioralAssessment&Consultation• Clearexpectations• ProactiveFocus• SkillsTraining• DataBasedDecisionMaking• Self-Management• SafeandPositiveEnvironment• LessonPlans• CorrectiveInstruction• StaffandIndividualAcknowledgements

SECONDARYPREVENTION• Check-in/Checkout• Mentoring• Peersupport• GroupTherapy• SpecializedGroupSkillsTraining

TERTIARYPREVENTION• ComprehensiveFBA• PositiveBehaviorSupportPlans• IncreasedSupervision• IndividualandFamilyTherapy• Trauma-FocusedCBT• ModifiedPE

~80%?ofClients

~5%

~15%

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D-PBIS I/DD Sustainability

Once a D-PBIS framework is implemented, how do we sustain it?

What are we trying to sustain?

n  Program Integrity

n  Program Support

n  Acknowledgements & Satisfaction

Sustainability Threats – Staff turnover,

primarily supervisors and direct support professionals

Strategies for Sustainability

n  Contingency plan

n  Home visit spot check

n  Compliance data

The goal is to build a D-PBIS I/DD Culture

Contingency Planning

n  What is a contingency plan? £  A plan that identifies specific team members to assist in the consultation/

coaching process while vacancies exist. l  Frequency of consultation/coaching would be less during the vacancy

n  How is the plan implemented? £  Coordination of home visits £  Specific identified responsibilities £  Direct observation, data collection, performance feedback

n  How is the success of the plan measured? £  Analysis of the data £  Compliance monitoring

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Open Supervisor Position

•Program Coordinator notifies clinician of opening

•Program Coordinator schedules visits 1x per month

•Clinician schedules home visits 1x per month

•PBIS Project coordinator schedules home visit 1x month

Open Coordinator/Director Position

•Program Administrator notifies supervisor and clinician

•Clinician notifies Project Coordinator & Clinical Director

•Clinician completes home visit checklist 1x per month

Open Supervisor and Coordinator

•Program Administrator notifies Project Coordinator

•Appointed covering Coordinator schedules visit 1x month

•Clinician schedule home visit 2x month

•PBIS Project Coordinator schedules home visit 2x month

Open Clinical position •Clinical Director or Project Coordinator notifies Program Coordinator and Supervisor •Covering Clinician schedules visit 2x month •PBIS Project Coordinator schedule home visit 1x month New Staff •Supervisor notifies training department of new staff needing to be registered for on-line D-PBIS training •Supervisor has new staff observe active engagement and lesson plan teaching from experienced staff •Supervisor and/or clinician observes new staff and gives performance feedback until fidelity is complete Monthly Staff meetings •Need to occur every month •Are positively driven •Acknowledgements of individuals and staff •Data presented to the team •Bee card drawing

D-PBIS I/DD Contingency Plan For Devereux PAAS

D-PBIS Coaching Integrity

n  A training procedure leading to certification as a D-PBIS coach

n  Insures that all coaches can demonstrate the skills needed to teach the D-PBIS components effectively

n  Provides consistency in teaching new staff

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D-PBIS I/DD Certification Integrity Checklist

Category Date of Completion

Supervisor has met with clinician to review the implementation of D-PBIS I/DD  

 

Supervisor is able to list what needs to be posted on the white board  

 

Supervisor has developed and is implementing the Program Schedule and Activity Calendar  

Supervisor has implemented the system for Bee cards (bee box, bee card drawings for individuals (every 2 weeks, staff 1x month)

 

Supervisor observes staff and scores the consultation form correctly  

 

Supervisor is able to collect data with at least 80% reliability for each category  

 

Supervisor is able to provide performance feedback to staff with 100% accuracy  

 

Supervisor is able to correctly demonstrate each D-PBIS instructional component  •  Teaching with Lesson Plans  •  Effective redirection and Corrective Instruction  •  Level of Safety  •  System Self-management  •  Performance Learning  •  House Meetings  Supervisor is able to enter data into Profiler  

 

Supervisor is able to graph integrity and instructional data from Profiler  

 

Supervisor is able to analyze the data on the Profiler graph  

 

Supervisor receives Certificate of Completion for D-PBIS I/DD integrity training  

Date:

Home Visit Spot Check

n  A brief check on the home environment to determine if implementation is being maintained £  Home environment D-PBIS I/DD elements £  Implementation integrity - Positive staff/individual

interactions, active engagement

n  Completed by coordinators, supervisors or clinicians

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Category YES NO NAA.D-PBISInformationcenter

IsthereacurrentweeklyProgramScheduleposted?

Isthereacurrentactivitycalendar?

IstheTeachingMatrixposted?

ArethenineKeySignsposted?

B.D-PBISI/DDImplementation

Istheactivityschedulebeingfollowed?

Arematerialsavailablefortheindividuals?

Arestaffinteractingpositivelywiththeindividuals?

Aretheindividualsengagedinanactivity?

Ask-HouseMeetingsareheldweekly?

C.D-PBISI/DDIntegrityData

ActiveEngagementdataatorabove80%? LessonPlansteachingintegritydataabove80%? Satisfactionofindividuals,staffandconsultationatorabove80% D.D-PBISI/DDNon-verbal

Non-verbal–Pictureactivityscheduleposted? Non-Verbal–Individualcommunicationsystems? Non-verbal–Minimalverbalinstruction(gesturalormodeledprompts) Totals:

Home Visit Spot Check Sample

Compliance Data

n  Data that measures the number of times coaching has occurred over the past month (1 time per week expected)

n  Will be used to measure the success of contingency plan (2-3 times per month)

n  Data summarized from D-PBIS I/DD data input records

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Compliance Data

Integrity Data

n  Data that is collected by the coaches in the D-PBIS I/DD residences to ensure implementation integrity

n  Data compared prior to vacancy (as baseline data)

£  Staff/Individual Interaction data £  Active Engagement data £  (Teaching Integrity data)

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Integrity Data

Integrity Data

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Acknowledgements

n  Measures designed to ensure that both individuals and staff continue to be acknowledged (reinforced) for their participation in D-PBIS I/DD

n  Monitor to ensure acknowledgement system

continues to be used during staff vacancies

Acknowledgement Data

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Acknowledgement Data

Bee Cards

I SAW

__________________________ (name of individual)

_____________________________________________________________

_____________________________________________________________

(describe positive behavior)

Date_________________ Staff_____________

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Satisfaction Data

n  Satisfaction measure used to ensure that during vacancies, staff and individuals continue to be satisfied with the team support

n  Satisfaction measures completed by:

£  Individuals £  Staff

£  Consultation (coaching) process rated by staff

Individual Satisfaction Data

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Staff Satisfaction Data

Consultation Satisfaction Data

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Putting It All Together

Example - Supervisor Vacancy §  Contingency Plan – clinician & coordinator implement within first week of vacancy §  Coaching – clinician & coordinator schedule one home visit each, per month §  Home Spot Check - completed during each home visit §  Compliance Data – compliance data for home visits & spot checks monitored by clinician monthly §  Acknowledgements –coordinator ensures acknowledgements continue during house meetings §  Satisfaction – clinician monitors individual and staff satisfaction measures conducted every 30 days §  Program Integrity Data – clinician and coordinator review integrity data for the residence monthly

Monthly Data Analysis n  Were the above steps completed over the past month? n  Are the program integrity data (interactions, engagement) at 80% or above? n  Are the satisfaction measures at 80% or above? n  Are the outcome measures stable or favorable?

All Yes – Continue contingency plan No – Analyze where systems or supports are needed based on the identified category

1. 

Measuring Outcomes

Future Questions to Answer

£  Do vacancies affect program integrity?

£  Do vacancies affect program outcomes?

£  Are coaching and satisfaction rates stable over time?

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Building Culture

What We Are Learning n  We are finding that the roll out of the D-PBIS I/DD framework can

be implemented with good fidelity for adult individuals with I/DD

n  We are developing a Peer Mentoring system for training new supervisors and staff. Peer Mentors must be certified in coaching to qualify

n  Staff by-in does not come with good fidelity or good looking data but by the changes they see in the individuals

n  D-PBIS I/DD culture takes longer to develop after implementation

£  D-PBIS I/DD culture – i.e. “this is how we do it here”

D-PBIS I/DD and Sustainability

Questions?