Positive Behaviour Support Plan for C.M.

EPSE 514- Seminar in Behavioural Assessment and Intervention University of British Columbia

Katherine M Turner 17298100

April 17th, 2012

Functional Assessment and Positive Behaviour Support Plan for Bedtime Routine C.M. March 2012 Introduction: C.M. is a 12-year-old boy, the youngest sibling of six and the only child living at home with his parents. C.M. has a diagnosis of Autism Spectrum Disorder (ASD), concurrent with Fetal Alcohol Spectrum Disorder (FASD) and Attention Deficit Hyperactivity Disorder. C.M. loves video games, searching music on You-Tube, and reading. C.M. has a great sense of humour and his family uses humour daily to manage in difficult situations. C.M.s mom has requested assistance with the bedtime routine that has become a source of stress. Family Vision of a Successful Bedtime Routine: At bedtime, C.M. will turn off his game system, television or computer when requested. C.M. will go to bed and turn out the lights without argument or untimely delay. Functional Assessment Summary A Functional Assessment (FA) is a tool that assists in understanding why an individual engages in problem behaviour. Problems can be dissected into four parts: 1) behaviours of concern, 2) contextual events that set the stage for problem behaviour, 3) immediate events that trigger problem behaviour, and 4) consequences that inadvertently reinforce problem behaviour (increasing the likelihood of problem behaviour occurring again). A functional assessment affords us the opportunity to examine these four parts of a problem in a systematic manner while gaining insight into strategies that promote positive and cooperative behaviour. The summarized functional assessment for C.M.s bedtime routine follows. Contextual Events that Set the Stage for Problem Behaviour There are four identified setting events that affect the probability that C.M. will engage in problem behaviour at bedtime. First, C.M. spends little time with his family members after school, choosing instead to retreat to his bedroom to entertain himself. Prior to bedtime C.M. is in his bedroom playing on one of the electronic devices (computer, X-Box 360TM , PlayStation 3TM, iPod touchTM, iPhoneTM, Nintendo DS TM, television, or stereo). Second, there is a lack of predictability in the bedtime routine and expectations. Sometimes C.M.s mom forgets the time and C.M. stays up later that she would like. Third, on these occasions C.M.s mom will rush C.M. to complete the bedtime routine quickly. Finally, C.M. lives in a busy environment, visually busy with many possessions kept in his personal space and auditory busy with frequent auditory stimulation from the stereo system, gaming console and/or television. Immediate Triggers for Problem Behaviour C.M.s problem behaviour is triggered by his moms direction to turn off the electronics and/or turn off the light and get into bed. Consequences that inadvertently reinforce problem behaviour C.M.s problem behaviour is maintained because he escapes the demand of going to bed. Moms attention increases as C.M.s non-compliance continues and bedtime is further delayed.

Strategies that work Up until this time, no intervention strategies have been attempted. Currently the bedtime routine is prolonged and frustrating for C.M.s mom. The current situation is having a negative impact on her health. A delayed bedtime results in inadequate amounts of sleep for C.M. which has a negative impact on his ability to function the next day.

Positive Behaviour Support Plan The plan below is based on the knowledge obtained from the Functional Assessment. Strategies that set the stage for success 1. Attention from Mom a. Allow C.M. to choose from a selection of activities that he and mom can do together during the evening free time. The Choice Book will have activities such as, artwork, Lego, walking Wyatt, baking, card games or board games. b. Mom will spend 15 minutes watching C.M. while he is playing a non-violent video game of his choice, prior to starting the bedtime routine. 2. Increase predictability a. Make a schedule for the laptop along with alarms to indicate 30 minute, 15 minute and 5-minute warnings to turn off the electronic devices. b. Provide C.M. with a schedule of steps in his nighttime routine for his bedroom wall/door. c. Provide Mom with a schedule of the nighttime routine to remind her of the steps and timeline in the nighttime routine. Assist mom with programming her smart phone alarm to remind her of timeline in the nighttime routine. d. Visual Contingency Map, to be used to demonstrate both the positive and negative consequences for behaviour. The request to turn off electronics and two pathways of possible behaviour are shown behaviour that is desired (turning off the electronics) and behaviour that is a problem (not turning off the electronics). For each choice, the consequences (praise, and preferred breakfast item vs. loss of time/privilege) are shown. A visual contingency map helps people understand the outcomes of both appropriate and inappropriate behaviour, leading them to make more positive choices and will hang on C.M.s wall next to his nighttime routine. 3. Busy Environment a. Reduce clutter in bedroom. Organize C.M.s stuff with labeled shelves, in labeled bins, labeled drawers and labels for the closet. b. Provide another place in the house for C.M.s gaming, television watching and computer use. c. Reduce the level of noise in the bedroom by removing stereo equipment, noise making toys and the laptop computer.

4. Being Rushed a. Use of verbal reminders and alarm system on PC to remind C.M. of time remaining before bed. Preventative Strategies 1. Provide positive attention to C.M. before bedtime routine begins. Mom and Dad to spend short periods of time with C.M. talking, watching T.V. playing cards or doing an art activity together during the evening prior to bedtime. 2. Use safety signals to increase C.M.s awareness of what time it is. Make C.M. aware of the passage of time with signals such as 30 minutes until bedtime, 15 more minutes until bed time. 3. Use of cues. Post the nighttime routine schedule in C.M.s bedroom and in the kitchen, pop-up reminders on the lap top will remind C.M. 4. Put bedroom lights on a timer system so the demand of turning off the lights has been eliminated. 5. Dad provides pre-correction to C.M. Dad explains to C.M. what his parents want his behaviour to be like for the bedtime-routine and how C.M. will respond when it is time for him to turn off the electronics and go to bed. Teaching Strategies 1. Teach C.M the appropriate way to ask for more time to play his with his electronics prior to bedtime. CM will be taught through Comic Strip Conversations TM and prompting by his mom to request more time by saying Can I have 5 more minutes to finish please? 2. Teach C.M. the appropriate time and way to ask his mother to join him while he is playing his games, through role-play and Comic Strip Conversations TM. C.M. will choose from a selection of E rated games and invite his mother to watch him play for 15 minutes by saying, Mom, can you come watch what I can do?. Mom will respond by coming to watch C.M. 3. Teach C.M. conversation skills, turn taking, changing topics, what to talk about with his parents, by video modeling, social skills programs and role playing activities with Katherine, Bob and Mrs. Singer. 4. Teach C.M. time management skills with weekly, daily and hourly schedules. Program his laptop so the clock function is viewable at all times and teach C.M. to look at the clock throughout the evening. Ask C.M. what time it is throughout the evening, to make sure he is checking the time. To increase independence provide C.M. with a clock/timer so he can monitor how much longer he has to focus on a particular activity. A timer can

be used while brushing his teeth or taking a bath/shower to increase his awareness of the passage of time. 5. Teach C.M. to use visual schedules. C.M. will be taught to refer to his visual schedule (posted nighttime schedule) for information regarding times, activities and what his parents expect to be done.

Consequence Strategies 1. Reinforce appropriate behaviour with praise from Mom. Reinforce appropriate behaviour with praise from Dad in the morning. 2. Reinforce appropriate behaviour by providing an entry on a daily compliance chart which translated into money at the end of the week. C.M. can buy extra time to game with money earned or save his money for a purchase during an outing to the store. 3. Reinforce appropriate behaviour with the reward of a preferred breakfast item (as outlined in the schedule) based on a successful bedtime routine. When C.M. follows the nighttime routine and goes to bed without difficulties, he gets to chose his favorite breakfast item. 4. Provide attention when C.M. asks. When C.M. asks Mom to join him and watch him game, Mom will join him for 15 minutes. 5. Minimize problem behaviour by: a) calmly prompting C.M. to ask for 5 more minutes b) calmly prompting C.M. to review his visual schedule c) Implement a Response Cost (Second Step) 1. Actively ignore and make no comment on behaviour, give C.M. a warning signal to inform him he is losing time tomorrow night if he does not follow the bedtime routine 2. Give C.M. a warning signal to inform him he is losing time from tomorrow night. Bedtime will be earlier the following night or 3. Give C.M. a warning signal to inform him he is losing out on earning money to buy more time or 4. Give C.M. a warning signal he will lose the privilege of his electronics 5. Provide C.M. with one warning then turn off the power to his room.

Competing Behaviour Pathway: Bedtime Routine C.M.

- Turn off the electronic devices when requested

- Buy time with minutes earned - Preferred Breakfast - Praise from Mom
Maintaining Consequence

Desired Behaviour

- Lack of Predictability - Rushed - Busy Environment - Little attention from Mom

- Demand/Request to turn off the electronic devices - Demand Request to turn off the lights

- Noncompliant

- Escape from demand/task (primary)

- Attention (secondary)
Antecedent Trigger(s) Problem Behaviour Maintaining Consequence

Setting Event(s)

Ask for a few extra minutes

Alternative Replacement Behaviour

A. Positive Behaviour Support Plan

Setting Event Strategies Little Attention from Mom Choice of activity with mom during evening that is not gaming related 15 minutes with Mom watching C.M. play video games Lack of Predictability Visual Schedule for PC with alarm Visual Schedule for bedroom wall Visual Schedule for kitchen (Moms use) Visual Contingency Map Busy Environment Remove excess clutter from room Provide alternate space for gaming Rushed Alarm system on PC indicate time remaining before bedtime Verbal reminders of time remaining before bedtime Preventative Strategies Demand/Request Positive Non-Contingent Reinforcement prior to bedtime routine beginning Safety Signals (15 more minutes, then electronics off) Put bedroom lights on a timer Use of redundant cues (visual supports: schedule, pop-up reminders) Dad provides Pre-Correction (what appropriate behaviour looks like for bedtime routine) Introduce new evening activities as an alternate to electronic entertainment through the use of choice Teaching Strategies Teach C.M. to turn off electronics when requested by parents Ask for more Time Teach C.M. the appropriate way to ask for more time Ask for Attention Teach C.M. the appropriate time and way to ask his Mother to join him while playing Teach C.M. conversation skills, topics of conversation to engage with Mom Teach C.M. time management skills Teach C.M. to use visual schedule Consequence Strategies When C.M. complies with request Praise C.M. on his effort Provide him with a preferred breakfast choice in the morning Provide C.M. with an entry on a daily Compliance Chart. At the end of the week, C.M. will receive money earned, contingent on receive entries on the Compliance Chart . Each entry has a .10 value which can be used to purchase a delayed bedtime When C.M. asks Mom to join him while gaming, provide attention for predetermined period of time If minor problem behaviour occurs Prompt C.M. to ask for a 5 more minutes. Review visual schedule If major behaviour occurs Actively ignore and make no comment on behaviours Give C.M. a warning signal to inform him he is losing time tomorrow night, losing out on earning money or losing out on the privilege of his electronics: turn off power to room if C.M. does not turn off electronics.

Visual Contingency Map

Turn of electronics

Favorite Breakfast

Told to Turn off Electronics

Keep playing

30 minutes less time with electronics tomorrow

Compliance Chart
Example of a Compliance Chart that can be used for recording and rewarding on-task behaviour for C.M.

. Date: Monday Monday ___________, 2012

to Sunday Total:

Tuesday ___________, 2012 Total: Wednesday ___________, 2012 Total: Thursday ___________, 2012 Total: Friday ___________, 2012 Total: Saturday ____________, 2012 Total: Sunday ______________, 2012 Total: YOU CAN EARN 25 CENTS A DAY AND A TOTAL OF $1.75 CENTS A WEEK $0.75 CENTS CAN BE EXCHANGED FOR 5 MINUTES OF EXTRA TIME BEFORE BED MONEY CAN BE SAVED TO MAKE A PURCHASE IN THE FUTURE

Positive Behaviour Support Implementation Checklist Bedtime Routine for C.M. April 2012 Date: ________________ Person Completing Checklist________________________________

Goal: C.M. turns off his electronic devices and lights at the appropriate time and go to bed. Not In Place 1. Show schedule to C.M. and have him read it to you. 2. Install a timer system to automatically turn off bedroom lights. 3. Check-in with C.M. throughout the evening prior to bedtime routine,. 4. Use safety signals to remind what time is bedtime. 5. Install pop-ups on C.M.'s lap top to remind him of bedtime. 6. Dad reminds C.M. of the behaviour he and mom want to see at bedtime. 7. Teach C.M. uses a clock/timer to increase independence in his bedtime routine. 8. Teach C.M to ask for more time in an acceptable manner. 9. Sit with C.M and watch his game for 15 minutes . 10. Minor problem behaviours prompt C.M. to ask for more time. 11. Major problem behaviours: (a) actively ignore and make no comment on behaviours; (b) provide C.M. with a warning signal; and inform him of potential lose of time, money and electronics turn off the power to C.M.s room 1 1 1 1 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 In Place 4 4 4 4 4 4 4 5 5 5 5 5 5 5

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

Problem Behaviour During Bedtime Routine 1. Non-Compliance 0 1 2 3 4 5 or more

Social Validity
Disagree 1. The goals of the bedtime routine are acceptable and important 2. The strategies are useful and effective 3. The strategies are difficult to use 4. C.M. is successfully participating in the routine 5. We believe the bedtime routine is successful 1 2 3 4 Agree 5

1 1 1 1

2 2 2 2

3 3 3 3

4 4 4 4

5 5 5 5

Implementation Support Plan Bedtime Routine April 2012 Introduction and Rationale The purpose of this implementation plan is to define the activities that will support implementation of C.M.s positive behaviour support plan. The PBS plan was developed through the collaboration of C.M.s parents and behavioural consultant. The plan is based on a functional assessment of C.M.s problem behaviour at home during his bedtime routine. The PBS plan is to define a context and support strategies that will help C.M. succeed in his bedtime routine. The plan provides C.M.s parents with proactive strategies that will afford C.M. the opportunity to engage in an independent bedtime routine. The implementation support activities are intended to facilitate the effective use of these strategies by C.M.s mother. Goals
Acquire Support Materials

Tasks
1) Prepare visual supports 2) Prepare Choice Book for appropriate evening activities 3) Organize room 4) Purchase Timer System for Lights 1) Review support plan and material 2) Review implementation checklist and directions for completing the checklist 1) Schedule weekly home meetings 2) Model Implementation of PBS plan (4 sessions) 3) Provide coaching to MM upon implementation of PBS plan (6-8 sessions) 4) Role play implementation strategies as required 5) Review implementation checklist, discuss progress, and problem solve as needed 1) Teach C.M. to follow a visual schedule 2) Teach C.M. to use choice book for activity selection 3) Teach C.M. to ask mom to participate 4) Teach C.M. to use clock/timer for time management 1) Review and evaluate progress weekly

Who
KTM KTM&MM MM&CM PM KTM&MM KTM&MM KTM&MM KTM KTM KMT KMT&MM KMT&MM KMT&MM KMT&MM KMT&MM KTM&MM

When
Apr 1, 2012 Apr 3, 2012 Apr 3, 2012 Apr 3, 2012 Apr 7, 2012 Apr 7, 2012 Apr 7, 2012 Apr 10, 2012 Apr 15, 2012 On-going On-going Apr 16, 2012 Apr 16, 2012 Apr 16, 2012 Apr 16, 2012 Ongoing

Prepare to implement plan

MM learns to use PBS plan for bedtime routine

C.M. participates in bedtime routine

MM skillfully uses the PBS plan for the bedtime routine

2) Develop/implement changes and/or provide additional support as needed 3) Administer goodness of fit and technical assistance evaluation 4) Fade assistance provided to MM

KTM KTM KTM

Ongoing Aug 1, 2012 Aug 1, 2012

C.M.s Nighttime Routine

Monday, Tuesday, Thursday, Friday, Saturday

7:30 7:30-8:30 8:30 8:40 8:45 9:00 Put Pajamas On Both Tops and Bottoms Finish Food No More Eating After 8:30 Brush Teeth and Wash Face 15 minutes until electronics turned off Fill Water Bottle All Electronics in the Bedroom Turned Off X-Box Off Computer Off TV Off Lights-Out C.M. can Listen to Music or Read

C.M.s Nighttime Routine

Sunday and Wednesday

7:30-7:45
Shower: Wash Hair with Shampoo Wash Body with Choice of Soap Get Pajamas On Both Tops and Bottoms

7:45-8:30 8:30

Finish Food No More Eating After 8:30 Brush Teeth, Floss Teeth and Wipe Face 15 minutes until electronics turned off Fill Water Bottle All Electronics in the Bedroom Turned Off X-Box Off Computer Off TV Off Lights-Out C.M. can Listen to Music or Read

8:40 8:45 9:00