#1110 6900 GRAYBAR ROAD, RICHMOND, B.C.

V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

1 Positive Behaviour Support Plan For B. April/May 2013 Introduction B. is a happy and bright 8-year-old boy who enjoys being around his peers and talking about his current interests (i.e., bus schedules, gondolas, time you left the house, etc.). B. has a younger sister and lives part time with his mom and part time with his dad. There is concern about the consistency of strategies across environments. Also, B. is engaging in problem behaviours at home and school that serve an escape function. For this reason, a comprehensive functional assessment was developed in order to give B. more effective and efficient ways to get his needs met. This plan includes a summary of the functional assessment and a description of a multi-component positive behaviour support plan. Goals 1. 2. 3. 4. 5. For B. to have reduced anxiety and to lead an enjoyable life. For B. to be included in regular classroom routines 60% of the time. For Bs family and school staff to learn more effective strategies to promote new skills and reduce problem behaviour. Priority routine #1: general school routines without escape-motivated problem behaviour. Priority routine #2: TBD Functional Assessment Summary Behaviours of concern: screaming, pushing, scratching, hitting, punching, kicking, spitting. Functions of problem behaviour: B.s problem behaviours serve one function. B. engages in problem behaviours to escape aversive demands, tasks, and situations. Person/ecological/lifestyle factors. Several person-specific, ecological, and lifestyle factors set the stage for problem behaviours during aversive situations in which B. wants to escape. 1. Developmental disability. Bs disability is pervasive and, in all likelihood, sets the stage for his problem behaviours. Due to his disability, he has delays in communication, social understanding and functioning, fine motor skills, self-management skills. Each of these delays or skill deficits makes certain aspects of daily living difficult for B., especially learning and doing new things.

#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

2 2. Physiological impairments. B.s deficits in fine motor skills affect his willingness and ability to engage in some tasks and activities. Most notably, B. has difficulty with paper and pencil tasks, typing on a keyboard, using his cutlery, and clipping his nails. Unsupportive environments. B. does not do well in environments that: (a) lack structure and predictability, or (b) offer little to no choice. In these contexts, B. is more likely to engage in escape-motivated problem behaviour to avoid or delay the activity.

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Triggers. There are several observable events in B.s immediate environment that often trigger problem behaviour. These are listed below: 1. Triggers for escape-motivated problem behaviour include: (a) demands or requests related to difficult tasks, (b) being physically guided or moved, and (c) being reprimanded. Positive Behaviour Support Plan Ecological/lifestyle Strategies 1. Use visual strategies. Use visual strategies to enhance predictability and choice. These include: (a) textual sequences of B.s daily schedule at home (daily, weekly, monthly) and school (daily and weekly). The schedule at home should clearly show, far in advance, when he is at moms house and when he is at dads house; (b) textual sequences of the steps within specific tasks, activities, or routines at home or at school; (c) choice symbols in which B. is given the opportunity to choose a preferred task, activity, item, or way in which to do an activity (e.g., number of questions, duration of time, etc.); (d) picture sequences of common positive contingencies (e.g., finish worksheet, then get favourite item; sit at circle time, then get favourite item); and (e) visual reminders (e.g., a no chewing school supplies sign at his desk). Teach to use 5-Point Scale. Sometimes it may be difficult for us to observe B.s escalating anxiety before it is too late. Also, it may be difficult for B. to identify and articulate his own escalating anxiety/frustration before it is too late. Use this tool throughout the day at regular intervals (e.g., as soon as he arrives in new environment and then every 20 minutes) to help B. manage his anxiety/frustration by providing appropriate activities to remain well regulated.

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#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

3 Rather than wait until B.s anxiety/frustration is too high and clearly observable (and it is difficult to calm him down), B. will learn to engage in a variety of calming activities so that he stays regulated. The 5-Point Scale should be created with a support of an adult and individualized so that it is most useful for B. B. needs to get plenty of practice using the scale through modeling and video review. 3. Teach clear rules, expectations, and contingencies. To help B. make sense of his world, spend some time working with him to develop appropriate rules, expectations, and contingencies for moms house, dads house, and school. It will be helpful if B. plays an active role in this (i.e., helps develop rules), rather than have an adult tell him the rules. These can then be incorporated into visual contingency maps (described in preventative strategies). Include reinforcers in tasks/activities. During problematic tasks, activities, or routines at home or at school, include preferred materials, types of activities, and/or types of interaction into the task, activity, or routine. This may include: (a) preferred items while at circle time; (b) favourite items to play with while waiting in line; and/or (c) free access to favourite activities throughout the day. Build supportive relationships. B. and several key staff members have developed a less than ideal relationship. It would be advantageous for relevant staff members to (a) go out of their way to praise and reinforce appropriate behaviours, (b) spend some time each week engaged in a highly motivating activity with B., and (c) change the negative association of the office from a negative one to a positive one by sending B. to the office when he has accomplished something and/or to deliver items.

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Preventative Strategies 1. Change task characteristics in order to promote desired behaviour. Whenever possible, task materials should be modified so as to promote interest in the activity. An example of this that naturally occurs is during library time when B. is permitted to choose materials that most interest him. This same principle should be applied to other activities, especially those that are problematic. For example, during math activities, questions could be created that incorporate statistics from his favourite hockey players or bus schedules. Use contingency maps. Prior to and during a problematic task or routine (but before problem behaviour occurs), review the if-then relationship of behaviour options available to B. on a visual contingency map. More specifically, this

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#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

4 visual will depict: (a) the trigger for problem behaviour; (b) the problem behaviour(s); (c) the previously available reinforcer that will no longer be available (plus any punishers); as well as (d) appropriate, alternative behaviours; and (e) the reinforcer that will be available contingent on appropriate alternative behaviour. 3. Provide simple visual reminders. Provide visual reminders of appropriate or inappropriate behaviours in locations where problem behaviour is likely to occur. For example, a no-eating-pencil symbol could be placed at his desk or a remember-to-use-the-bathroom symbol could be placed near the computer. Give B. choices throughout the day and especially during problematic routines. Opportunities for choice should be available for all individuals. Providing B. with choices will give him the opportunity to arrange his environment so that it is suitable to him in ways that we may not have been able to identify. Examples of opportunities for choice include: (a) the order of steps in a visual sequence, (b) reinforcers contingent on appropriate behaviour, (c) the tasks/activities in which he can negotiate, and (d) variables within a task/activity (e.g., duration of time on task, number of questions, etc.). It will help to present these choices in a visual format. Use prompting strategies that promote cooperation and predict reinforcement. These include: (a) positive contingency statements rather than emphasizing the negative consequences (e.g., Walk to the truck to choose your prize, Sit in your chair and cut your nails then you can choose your dessert) and again, (b) offering visual choices of reinforcers. Pre-correct problematic tasks or situations. There are three steps to completing a successful pre-correction. First, before engaging B. in the task or situation, consider potential problems or common errors. Next, consider what acceptable or desired behaviours or skills you want B. to demonstrate. Last, directly teach B. to do the accepted or desired behaviour or skill. Do so within a one to three minute mini-teaching session. During this brief instruction: (a) model the behaviours you want B. to do, (b) prompt him to do the behaviour or skills, (c) assist B. as needed so that he succeeds, and (d) praise him for his effort. Examples of behaviours or skills you will want to pre-correct include: (a) using language to request more time before a transition, (b) using language to request a break, and (c) using language to negotiate.

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Teaching Strategies

#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

5 1. Design instruction to match B.s learning style. During instruction, structure tasks to match B.s learning style and preferences. Features of instruction that match B.s learning style are listed below. a. Tasks should be kept short in duration (i.e., short enough so that he is not losing interest and wanting to escape!) b. More complex lessons should be broken up into a logical sequence, outlined by a visual sequence. c. Lessons should be taught with as much hands-on role playing as possible. d. Lessons should be taught with the aid of visuals (e.g., social story, videos). e. Provide opportunities for success. Praise and encourage attempts and progression and not just complete success. f. Present tasks as positive and fun and involve peers if it doesnt interfere with the learning process. 2. Teach verbal language skills. Teach B. to use verbal language to achieve his wants and needs. When teaching the use of language, model the language, prompt B. to say it, and reinforce trying as well as progress and successful use. If we do not reinforce his use of language, B. will resort back to his problem behaviours in order to get what he wants! You can also teach these language skills by reviewing short video clips of examples on his iPad and rolemodeling the behaviours. The core language you will want to teach B. is listed below: a. Requesting a delay: Saying, Can I have 2 more minutes? or Can I have some more time? b. Asking for help: Saying, I need help. c. Negotiating a component of an activity: Saying, Can I do this for only 10 minutes? or Can I do every other question? 3. Teach relaxation/coping techniques. Directly teach B. the strategies associated with his 5-point scale to help him manage stressful situations. This may include: (a) muscle relaxation techniques, (b) breathing techniques to name only two, and/or (c) any other strategies suggested by Julia Ward (OT). Teach B. to tolerate delays in reinforcement. Although we will be teaching B. to appropriately request reinforcing items/activities, breaks, help, and alteration of activities; immediate access to his request will not always be possible, therefore B. must be taught how to tolerate delays in receiving reinforcement. In brief, this procedure will involve incremental delays in reinforcement and will be discussed in more detail when implemented into specific routines (e.g., delaying access to a break when B. appropriately asks).

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#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

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6 Teach ideal and alternative behaviour through role-playing. Although already mentioned within other components of teaching strategies, role-playing warrants its own entry because of its importance. Because B. has a long history of engaging in some of his problem behaviour in certain routines, simply telling or reading about how to behave appropriately will probably not be enough; B. will have to be physically taught how to behave appropriately. When role-playing, praise attempts and progression and have fun!

Effective Consequences 1. If B. successfully displays ideal behaviour, provide lots of praise and provide reinforcer (which will be pre-chosen most of the time). Ideal behaviour includes: (a) completing a specified amount of work without escape-motivated behaviour and (b) enduring a specified amount of time without escapemotivated during an activity (e.g., clipping his nails). In addition, provide B. with descriptive praise for trying and progress (e.g., Wow, you did the whole worksheet! Great job!). For some routines (and especially initially), we will need to reinforce progression towards ideal behaviour. In order to do this, we will give B. tokens contingent on a specified amount of time, or a specified amount of work, without problem behaviours. These tokens will then be traded in for a reinforcer once a set amount has been earned. Examples of situations in which tokens may be earned include: (a) B. not engaging in escape-motivated problem behaviour for small periods of time during circle time, and (b) B. completing a small amount of work without engaging in escape-motivated behaviour. It should be noted that before this strategy is implemented, criteria for fading this strategy will need to be made (e.g., increase time intervals by 30 seconds for each day that reinforcer is earned). Give B. what he wants or needs contingent on the use of acceptable language. Specifically, (a) give him more time before a transition when he asks, (b) give him help when he requests it, (c) give him a break when he requests it, and (d) honour his request when he engages in negotiations. It is extremely important that you try your best to not give B. more time, help, a break, or engage in negotiations when he uses problem behaviour to communicate his want or need. As already mentioned, B. will also learn to tolerate delays in reinforcement so that you will not always have to immediately honour his requests. We will also gradually fade out his opportunities to request breaks and negotiate.

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7 When B. engages in precursor behaviours or minor problem behaviours that typically precede significant problem behaviours, try to redirect or de-escalate the behaviour. There are two strategies: a. Actively ignore the precursor behaviour or minor problem behaviour, redirect B. to the task or situation, and when he is re-engaged, return to using positive, proactive support strategies. i. Example: B. begins to get red in the face and you know this is a sign of rising anxiety and a precursor to yelling. You could say, Lets do one more question and then look at your 5-point scale to see what we should do. b. Prompt language that matches his want or need, prompt him to make the verbal request one or two more times, then honour his request or use a safety signal. i. Example: B. leaps up from table while doing a worksheet. This behaviour often precedes yelling and hitting. You could say, It looks like you need a break. Say, Can I have a breaksay it againThank you for asking. Go get a drink of water.

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When B. escalates into moderate to high intensity problem behaviour to avoid or escape, do your best to not let B. immediately escape or avoid the situation. It is your task to make his problem behaviour inefficient at getting his wants or needs met. a. Very briefly but clearly reprimand B. Say, Thats not okay. b. If possible, put B. through the step or steps that he engaged in problem behaviour to avoid or escape. If possible, put him through the step or steps one or two more times. c. While doing this, state a safety signal (e.g., Were going to do this two more times and then you can have a break.) d. After putting him through the task or the step one or two more times, give him his break. e. When he returns to the task or activity, use proactive strategies aimed at preventing escape-motivated problem behaviour f. B. will not receive any chosen rewards. You can refer to the visuals outlining the routine and state, Maybe next time.

#1110 6900 GRAYBAR ROAD, RICHMOND, B.C. V6W 0A5 PHONE 604 232-4122 FAX 604 232-9515

8 Evaluation 1. Included in this plan will be one-page implementation checklists; one for each problematic routine. The purpose of these checklists are to provide you with a quick and easy way to evaluate: (a) your level of implementation of the provided behaviour support plan strategies, (b) improvement in B.s problem behaviours, and (c) the extent to which the plan is viewed as acceptable and valued. Use the checklists on a daily basis until the team agrees that sufficient fidelity and behaviour improvements have been attained. At this point, we can fade the use of the checklists to once per week and begin to strategically select the next routines to target. When new routines are initiated, provide daily summary reports (via phone or email) to the behaviour specialist of any relevant information (e.g., major problem behaviours, success stories, difficulties). Once sufficient fidelity and behaviour improvements have been attained, this can be faded to once a week as well. Bi-weekly team meetings (phone or in person) in order to review plan effects and address any issues will be scheduled. Child quality of life meetings to be held one a month.

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