What to Do When the Going Gets Tough: Tips for the

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What to Do When the Going Gets Tough: Tips for the Behavioral

Specialist

BAS Clinical Team

July 5, 2018


Supporting individuals who present with complex needs can be a challenge for even the most seasoned behavioral specialist. The challenge can be exacerbated when the team, especially those who provide the direct supports are frustrated and unsure of their abilities. This training will provide tools and suggestions for assisting team members who are struggling.

Virtual Targeted Training Description


Judy is a young woman with ASD and co-occurring significant mental health disorders. She has experienced significant trauma in her life and has spent the last 7 years in many different residential treatment facilities. She now resides in a community home with a roommate. The behavioral specialist has done a thorough behavioral assessment and has developed what he feels is a good plan. Despite the interventions in place, Judy continues to have frequent psychiatric hospitalizations, psychiatric ER visits, and threatens to harm herself and others. During meetings it is clear that staff are not following the plan and their comments made during meetings truly reflect a negative view of Judy and their frustration with her is obvious. The BS feels frustrated at the lack of cooperation and positive momentum.

Sound Familiar?


General Recommendations: A Recipe for Implementation Success


“To effectively assist individuals with severe disabilities to overcome challenging behavior, there must be a sound support plan and the plan must be implemented proficiently”

Reed and Parsons (2002)


• Staff involvement is key during assessment and plan development

• Staff buy-in increases when they are at the table

Initial Plan Development


• Establish the foundation for a good FBA

Pre meeting on what the process will look like

Establish and explain the expectations

Help the team focus what questions they want answered as a result of the process

Meet the team where they are at

• Trust the process and do it with integrity

How do you get buy in from the onset and maintain it?


Pre Meeting Handout - Expectations


1. Establish who is responsible for the day to day supervision

• Nature of the Behavioral Support Services does not typically place the Behavioral Specialist as the day to day supervisor

Even more complicated if the BS is not from the same agency as those implementing

• If not in a direct supervisory role, know who is and collaborate with that person

Are they trained in the plan?

Are they competent in the implementation?

Can they provide feedback in your absence

After the Plan is Developed


“Working with staff to implement a BSP for an individual is as much a part of the treatment as developing the plan itself.”

Reid and Parsons (2002)


2. Specify duties of staff in the plan

• Be detailed - what exactly must staff do

“keep Joe busy” – would you know what exactly you are supposed to do?

• Be sure that all components of the plan are specific

Tendency to be more clear on responses to the behaviors of concern, but less specific on antecedent or preventative strategies

• Plans are detailed when the BS, clinicians, supervisors can observe and readily tell that components of the plan are being implemented in the correct manner.


3. Train

• Make staff aware of the rationale and what the plan is intended to accomplish

• Ensure that staff acquire the skills to carry out the plan = Performance


• Verbally describe the skills to be taught

• Provide detailed written description

▪ Affirms what was verbally presented

▪ Provides a permanent product for reference

▪ List specifics (too much info is not good)

• Model the strategies

• Provide opportunities to for staff to practice

• Observe staff implementing in real time

Performance Based Training


4. Routinely observe staff implementing the plan

• Important to have an awareness of how well staff are performing their implementation responsibilities

• Necessary in order to provide corrective feedback or to determine if strategies are not working

• Need to think through how observations are being conducted

Staff need to feel comfortable, not punitive

Use a monitoring checklist



5. Support proficient implementation

• Don’t assume that if things are going well that additional support is not needed

• Staff need positive feedback that they are doing well in order to keep up the momentum

• Motivation made fade after a while if feedback is not provided


6. Provide corrective feedback when implementation is inadequate

• Despite your best efforts, things may go south.

• If plans are not being carried out as designed, it is important that corrective feedback is provided.

• Two primary reasons why plans are not being carried out correctly:

Lack of skills to appropriately carry out plans

Lack of motivation


Those providing direct support may be struggling with the following:

• Stress (physical and emotional)

• Questioning their abilities

• Taking it personally

• Infighting – not on the same page

• Caught in the middle

**Remember…. Problem behavior cannot be treated in a problem environment.

A view from the frontline


• Develop a clear understanding of staff perceptions

• Build knowledge and skills

• Develop/facilitate a shared vision for the individual

• Encourage/facilitate positive relationships between staff and the individual

What can you do?


• Relationships are important to us and impact how we behave

➢ Would you engage in activity that you don’t really care for just because you want to be with the person who invited you?

• Historically we have neglected the role relationships play in our line of work – why would impact of relationships be any different for individuals with disabilities?

• People with challenging behavior are often alienated and rejected by peers, friends, family, and community in general

• For some, the only relationships they have are paid relationships

Thinking about relationships…


• Tendency to focus primarily on natural supports

• We need to be careful not to minimize the importance of staff relationships, even if these are temporary

• Research studies are finding that the quality of relationship between individuals and their support staff was one of the most important factors in contributing to positive outcomes for the individual

Natural vs Paid Supports


McLaughlin and Carr (2006)

• Research studies have shown that the quality of staff-participant relationship is a important variable influencing the likelihood of problem behavior

• Rapport can function as a setting event➢ Good rapport decreased the “aversiveness” of task demands

(participated in more daily activities)

➢ Poor rapport increased the “aversiveness”

• “Why will he do that for you and not for me?”

Research Studies on Staff Relationships


• Robbedo & Donnellan (2008) study looked at properties of supportive relationships identified by individuals with autism

• Six properties were identified:

➢ 1. Trust

➢ 2. Intimate Connection

➢ 3. Shared vision of independence

➢ 4. Presumption of competence

➢ 5. Understanding

➢ 6. Communication

• Effective support was dependent on quality of relationship

Research Studies on Staff Relationships


• Unconditional regard or acceptance

• Understanding the participant’s perspective or walking in someone’s shoes

• Being in-tune: Ability to predict and interpret subtle cues or behavior

• Genuine caring

(Bambara presentation on Relationships and PBS)

Characteristics of Good Relationships


TOOLS AND ACTIVITIES


• Self-assessment

• Means to evaluate our interaction styles

• Based on the work of John McGee (Gentle Teaching)

What is your interactive posture?

Interactive Posture Survey


• Solidarity➢Values participant’s perspective

➢Provides growth-directed experiences

➢Participant success is important

➢Works together for positive outcomes

• Authoritarian➢Caregiver is in charge

➢Only one way to do something – caregiver’s way

Interaction Posture Survey: Four Postures


• Overprotective➢Values taking care of and protecting participant

➢Fosters dependency in safe, predictable routines

• Cold-mechanistic➢Values task/activity completion

➢Caregiver is robot-like

➢Knows little about the participant


• Definition:

“The biographical timeline process, sometimes called “biography,” “timeline,” or “life line,” is a facilitated process through which a team of people, having researched the events, passages, and interventions in a person’s life, lay out those facts in a linear fashion, to enable a group to correlate information in a meaningful manner. Events and personal experiences (often thought of as “insignificant” in other contexts) that were previously stored in compartmentalized reports and files, are grouped according to their occurrence along a linear lifetimeline.”

Beth Barol (2001)

Biographical Timelines


• Facilitated process

• Exploration of the individuals life and events that occurred

• Helps supporters to understand the life experiences of the individual and how those events could be contributing to who they are today

• Encourages empathy

Biographical Timeline


What is a One Page Profile?

• A One Page Profile captures all the important information about a person on a single sheet of paper under three simple headings: what people appreciate about me, what’s important to me and how best to support me.

One Page Profile


How are the helpful in supporting individuals?

• Improve relationships by understanding what is important to the individual and how to support them in a way that matters to them.

• Transportable record that moves with the individual or across services

• Being regularly updated helps to keep everyone informed of the individuals’ changing circumstances and desires

• When used, they contribute to fostering a person centered culture where the individual’s wants, needs, and desires are at the forefront.

One Page Profile



• “A crisis is a problem without the tools to address it”

• Crises should not happen frequent

• Recurrent crisis events indicates the existing BSP/CIP is not working

• Be responsive to the needs of staff

• Time to go back to the drawing board

A few word about crisis



• Bambara, L.M., Gomez.O, Koger. F., Lohrmann-O’Rourke, S. and Xin, Y.P (2001). More than techniques: Team members’ perspectives on implementing positive supports for adults with severe challenging behaviors. JASH, Vol. 26(4), 213–228.

• Barol, Beth (2001). Learning From a Person’s Biography: An Introduction to the Biographical Timeline Process. Positive Approaches, Vol. 3, No. 4.

• McLaughlin, D.M. and Carr, E.G. (2005). Quality of rapport as setting event for problem behaviors: Assessment and Intervention. Journal of Positive Behavior interventions, 7(2), 68-91.

• Reid, D.H. and Parsons, M.B. (2002). Working with staff to overcome challenging behavior among people who have severe disabilities: A guide for getting support plans carried out. Chapel Hill, NC: Habilitative Management Consultants

• Robledo, R. and Donnellan, A. (2008). Properties of supportive relationships from the perspective of academically successful individuals with autism. Intellectual and Developmental Disabilities, 46(4), 299-310.

References


• Have you visited the ASERT website (www.paautism.org)?

Did you create profiles for the participants you support?

Did you sign up to receive the ASERT monthly newsletter?

Do you follow ASERT on Facebook or twitter?

• Are you signed up on BAS list-servs (all providers and SC specific)?

Are you receiving Admin Notices and Communications via the list-serv?

• Do you communicate with the Regional and Clinical Reps to ask questions and share participant concerns?

• Do you visit the online training platform and save all pertinent documents and watch trainings? Do you participate in live training opportunities?

If you have questions on any of the above, please contact the Provider Support Mailbox ([email protected])

How to ensure you have all the information to do your job as a provider

http://www.paautism.org/

mailto:[email protected]


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What to Do When the Going Gets Tough: Tips for the