Comprehensive Behaviour Support Plan for BL

Focus person summary B.L. is a 5 year-old boy attending Kindergarten. He has been diagnosed with Autism. He lives with his mother, father, younger brother, and grandparents in a middle-income neighborhood in Vancouver, BC. The grandparents from both sides of the family live in B.L.s extended family home. Both of B.L.s parents work full time and the grandparents take care of the brothers while they are at work from morning until the evening. B.L.s grandparents are native Chinese speakers and have difficult communicating in English. B.L. can find this frustrating. Both of B.L.s parents are accepting of him and offer him their love and support. B.L. has a stable and supportive family and considerable contact with peers his age through his extended family. His aunts and uncles live nearby and frequently drop their children off to be babysat by B.L.s grandparents. Alternatively, B.L and his brother may be looked after by his aunts and uncles, in their homes. All of the children have opportunities for social interaction and the extended family is tight-knit and very supportive. In addition to baby-sitting each others children, the extended family frequently visits each other during weekends and holidays. The family does not have any additional support outside the family circle. B.L. is a gentle and sweet boy who is quiet and calm compared to his younger brother. He enjoys playing alone when adults are busy and does not require a lot of attention. He is generally well behaved and an excellent role model for his brother. B.L. and his brother both enjoy playing with their cousins and get along well with them. In interacting with other children, B.L. sometimes has difficulty sharing toys. His parents have found it difficult to teach B.L. how to share and take turns when playing with his brother and cousins. While B.L. is generally well behaved, when his problem behaviours do occur, they can be difficult for his family to cope with. They find it difficult to assess his needs since he has trouble communicating in words, and instead tends to become very anxious, nervous and upset. He will cry for prolonged periods, up to thirty minutes at a time and is difficult to console. His family finds these emotional scenes very upsetting and wish they could help him. Sometimes B.L. becomes frustrated when he does not get what he wants. When problem behaviours occur outside the family home, the familys plans are generally ruined as B.L.s behaviour becomes impossible for them to manage. This behaviour support plan is necessary because BL has been showing problem behaviours at home and when the family visits relatives home. The plan is based on a comprehensive functional assessment that was developed in collaboration with BLs parents and BLs home team interventionists. The plan includes a summary of the functional assessment and the description of a multicomponent positive behaviour support plan.

Comprehensive Behaviour Support Plan for BL

Caution This plan is based on a comprehensive functional assessment that looks at each relevant feature of BLs problem behaviour determined by BLs parents. It is attempting to include multiple components of BLs behaviour and their maintaining consequences. Taken together, the plan addresses the two environments and conditions where BLs parents have determined that he is not being successful. We are aware that this plan might not be addressing all the issues that develop or maintain problem behaviour of BL. We plan this intervention to be implemented by parents, for they are the natural agents of BLs behaviour change. If you feel overwhelmed by the plan because you think it is difficult to address both settings at the same time, there are some considerations that can attenuate this concern. First, you do not need to implement all the strategies at the same time. You can select the condition that looks easier for you and where you feel your odds of being successful are good. Besides you will feel confident implementing the rest of the intervention. The second condition and set of strategies will be implemented once you feel that BL has shown improvements. The next consideration is related to the set of ecological/lifestyle changes that you can implement as soon as you start with the program. These strategies are included in the intervention and planned to preventing problem behaviour from occurring. We hope, that putting in place these changes in BLs context will reduce the likelihood of using reactive strategies that the plan includes for the cases were the situation goes out of control and you need to apply de-escalation procedures. Last but not least, this intervention was carefully planned in the results obtained through the functional and ecological assessment we conducted together and based on scientific proven practices. We are certain that if the plan is carefully consulted, it could be successfully applied and generalized to new specific situations that might arise. Functional Assessment Summary Behaviour of concern: Physical aggression (pulling siblings and cousins hair); disruptive behaviour (cry loudly, tearful eyes); Non-compliance (flops on floor, throws himself, refuses to get up). Function of problem behaviour: BLs problem behaviour serves one fu nction or purpose. BL engages in problem behaviour to avoid or escape aversive demands (request to go home), interactions (sibling or cousin approaching him even in parallel play or touching his toys). Personal factors: Even so BL level of expressive and receptive language is age appropriate, he struggles in effectively communicating his needs and wants to parents and selfregulating his emotions. Thus, parents experience great difficulty meeting BLs needs when his problem behaviour occurs. The mother attempts to get BL to use his words, but he often gets too nervous and anxious that cannot stop crying. He might easily cry for 30 minutes or longer before he is able to calm down. This can

Comprehensive Behaviour Support Plan for BL

be very heartbreaking for the parents to observe. Other than his diagnosis of Autism, BL is a healthy boy, with no physical impairments that affect his willingness and ability to learn and participate in task and activities. Environmental/Quality of Life Factors: Three environmental factors are determined to set the stage for problem behaviours in which BL wants to escape an aversive condition. 1. Play or free time with cousin/sibling that require sharing/cooperation: BL shows deficits in cooperative play skills. Indeed, he has some trouble with parallel playing, in particular with his sibling and/or cousin where he is expected to share and play nicely. Problem behaviour in this situation frequently results in removing sibling/cousin from the area where BL is playing. 2. Unsupportive environment: BL cannot handle situations where: a) there is a lack of predictability; b) there are unexpected changes or cancellations of schedule or activities. In these contexts, BL is more likely to engage in escape-motivated problem behaviour that often results in parents removing demands and allowing him to play alone or for longer period of time. 3. Presence of non-preferred cousin: BL does not do well in environments in which a non-preferred cousin is present. Within this context BL will exhibit problem behaviour that results in parents or adults removing cousin. Triggers: There are several observable events in BLs immediate environment that often trigger problem behaviour. 1. Triggers for escape motivated problem behaviour include: a) cousin or sibling touching BLs toys; b) cousin/sibling playing too close to BL; c) demands to go back home or terminate activity; d) demands to share his preferred toy with cousin/sibling; demands to share his IPad with sibling/cousin; b) interrupted by sibling/cousin when engaged in preferred activity.

Comprehensive Behaviour Support Plan for BL

-BL cooperates with transitions to other activities -BL plays parallel or cooperative play with cousin/ sibling -Poor social skills -Unpredictable event -Recent cancellation of event -Recent changes in routine. -Presence of nonpreferred sibling/cousin . Setting Event(s) -At relatives parent asks BL to clean up and get ready for home -Transitions from preferred to nonpreferred activity -Parent asks to do a non-preferred activity -Sibling/cousin interrupts activity Antecedent Trigger( -At home Cousin/sibling gets close or try to interact with toy or activity

-Praise -Give access to preferred activity in car (e.g. Ipad, oreo cookies)

Desired Behavior -BL cries aloud -Flops on the floor -Pulls hair and pushes sibling/cousin

Maintaining Consequences -Parent removes requests to clean up and go home -Parent allows more time -Parents remove sibling/cousin (Escape)
Maintaining Consequences

Problem Behavior

-BL asks parent: Can I have more time? -BL asks adult for help: I want to play alone, can you help me? Alternative Replacement Behavior

Comprehensive Behaviour Support Plan for BL

B. Positive Behavior Support Plan Strategies that Make Problem Behaviors Irrelevant, Ineffective, and Inefficient Setting Event Strategies Preventive Strategies Teaching Strategies Consequence Strategies

1) BL attends a social and playing skills group. 2) Prepare a visual schedule of activities at home/relatives/ community. 3) When an unexpected change occurs, as soon as possible: a) place picture with visual schedule that alerts BL of the change; b) add additional positive reinforcement during the change. 4) Make social story of family members and how to interact with them at home.

1) Give an advance warning for finishing activity 2) Review visual schedule before transitions from relatives house to home. Provide choice of reward for transition to home routine. 3) Use positive contingency statement. 4) Use pre-correction.

1) Teach him to ask adult for help when siblings/cousins are near: I want to play alone and teach him to ask adult for more time with activity: Can I have more time please? 2) Use video modeling to teach BL how to play cooperatively with siblings/cousins 3) Teach selfregulation strategies

1) Give praise contingent on independent, parallel, or cooperative, play with siblings/cousins 2) Give praise and offer preferred item contingent on successful transitions 3) When BL asks for more time, give access to 5 minutes more (Give tokens 5 minutes each); when BL asks to play alone, remove sibling/cousins 4) When minor behaviour occurs (cries), present visual schedule and prompt him to ask for more time and play alone 5) When major behaviour occurs (flop on floor and pull sibling/cousin hair and push them), do not remove demand to transition, and block physical aggression towards sibling/cousins. Use calm down strategies and redirect him to transition and playing nicely

Comprehensive Behaviour Support Plan for BL

Positive Behavior Support Plan Setting Event Strategies 1. Social and playing skills group. Find a social and playing skills group that is appropriate for BLs current skills for him to attend after school. This can help him develop appropriate social skills and play skills among his peers and practice these skills so he can interact appropriately at home with his sibling/cousins. BL can also attend these play groups with sibling/cousins if it is suitable for them. 2. Use visual schedule. Prepare a visual schedule of activities to use at home, at relatives house or in the community. The visual strategies can enhance predictability and choice. These include: a) picture sequence of BLs daily schedule at home after school; b) picture sequence of schedule for a specific visit to the relatives house, or c) picture sequence of schedule during times going to the community with family members. 3. Notify unexpected change in routine. When an unexpected change occurs, as soon as possible: a) give BL the information of change visually, b) place picture with visual schedule that alerts BL of the change; b) add additional positive reinforcement during the change. 4. Introduce social story. Create a social story to teach BL appropriate interaction with sibling/cousin at home and also interaction with peers. This can be reviewed with BL once a day just before bedtime (during bedtime story). Preventive Strategies 1. Give advance warning. Before a transition or a major change, provide BL information regarding the change beforehand with visual supports (e.g., picture schedule, social story). Immediately following the change, identify reinforcers in the new situation. When an activity is about to finish, or when it is about time to clean up an activity, give BL an advance warning by stating how much time is left until the activity is terminated. For example, when it is about time to wrap up and go home, warn BL 5 more minutes and then we clean up. 2. Review visual schedule. Review visual schedule before transitions from relatives house to home to prepare BL for a successful transition. Provide a choice of reinforcement for transition to home routine. Once the choice of reinforcement is established, place it into the visual schedule and review with BL. 3. Positive contingency statement. Use positive contingency statement that motivates BL to complete the transition to home and also during cooperative play with sibling/cousins. For example: Lets go to the car and pick your favorite snack while riding back home When you play nicely with sibling/cousins you can share a cake together during snack time! 4. Pre-correct during difficult transitions/ playtime with sibling or cousin. In a situation when potential problem behaviour could occur either during play with sibling/cousin or transition to home, a) model the behaviour or skills you want BL to do (previously accessed as the acceptable or desired behaviour you want BL to demonstrate), b) prompt him to do the desired behaviour or skills so that he succeeds, and c) praise him for his effort. Examples of behaviour to pre-correct include: a) sharing toys with sibling/cousins during free play; b) using language to request to play alone (e.g., I want to play alone) or ask for more time with an activity during transition (e.g., Can I have more time please?)

Comprehensive Behaviour Support Plan for BL

Teaching Strategies 1. Teach verbal language skills. Teach BL to use verbal language to achieve his wants and needs. When teaching the use of language, model the language, prompt BL to say it, and reinforce trying as well as successful use. The language you will want to teach BL is listed below: a. Asking for help from adult when he does not want sibling/cousin nearby: I want to play alone Please leave me alone or I want to play by myself b. Requesting an item or activity by saying I want [item] or I want to [activity] c. Requesting for more time by saying I want more time Can I have more time, please? Can I have 5 more minutes? 2. Use video modeling. When using video modeling to teach desired behaviors, make sure to illustrate specific situation in the video that is similar to the problematic routines being addressed. BI can be the role model and assist in the video modeling. a. Component of video modeling to teach transition: Play the role of BL following visual schedule. When it is time to clean up, role model can use verbal language to request for more time, and transition appropriately according to the acceptable target behaviour. b. Component of video modeling to teach independent/cooperative play with sibling/cousins. BI can model request to have sibling removed in play situation, or play cooperatively with sibling/cousin by sharing toys and turn taking. After successful making of the video, play video to BL before playtime and before a family outing to review and prompt him to behave appropriately 3. Teach self-regulation strategies. Teach BL calm down strategies such as counting down from 10 and deep breathing. Practice relaxation skills with him at least three times a day for 2 weeks before using the skills in proper situations. Calm down strategies can also be written down on a visual as prompt for BL to use. Consequence Strategies 1. BL plays independently, or participates in parallel or cooperative play with sibling/cousins, give praise contingent on desired behaviours 2. Give BL praise and offer preferred activity contingent on successful transition to home. 3. Give BL what he wants/needs contingent on the use of acceptable language. Give BL more time when he asks for more time; remove sibling/cousin from BL when he asks to play alone. Try your best not to give BL more time, or remove sibling/cousins when he uses problem behaviours to communicate his want or need. 4. When BL engages in minor problem behaviours such as crying to gain more time to an activity, or when he cries to indicate he wants sibling/cousin to be removed, do not allow him to have more time. Present visual schedule and prompt him to ask for more time or play alone.

Comprehensive Behaviour Support Plan for BL

5. When BLs behaviours escalates into engaging in major problem behaviours such as flopping on floor and pulling sibling/cousin hair or pushing them, do not remove demand to transition, and block physical aggression towards sibling/cousins. Do your best to minimize the amount of attention or help he gets while at the same time de-escalating the problem behaviour. Use calm down strategies and redirect him to transition and playing nicely.

Comprehensive Behaviour Support Plan for BL

Evaluation Procedures Implementation fidelity: Included in this plan is a two-page implementation checklist. This checklist provides the family with an opportunity to manage and evaluate the implementation of BLs comprehensive behaviour support plan. The checklist includes items that allow you to assess the implementation on a daily or weekly basis. Problem Behaviour: The two-page implementation checklist also includes an assessment of BLs occurrence of problem behaviour and the social validity of the plan; that is the importance and acceptability of the plan goals, procedures and outcomes. Quality of life: For the measurement of changes in the quality of BLs and family life, we will introduce the Quality of Life Survey. This instrument will be applied twice: the first one, before the intervention starts and the second one after six months of the intervention. We can see the effectiveness of the implementation plan on improving the quality of BL and the familys life as a whole.

Comprehensive Behaviour Support Plan for BL

Implementation checklist Play with sibling/cousins and transition to home BL March 2013 Date:_______________ Person completing checklist ________________

Not in place
1. 2. Enroll BL in a weekly a Social and Playing Skills Group Teach and rehearse Calm down strategy three times a day 3. Notify BL when an unexpected change might occur. 4. Read My family social story to BL at bedtime every night. 5. Watch video Playing nicely before engaging in play or free time. 6. Use positive contingencies to motivate smooth transition to home or cooperative play. 7. Use pre-correction during difficult transition or play time with sibling/cousin. 8. Honor BL requests for playing alone or more time 9. Provide praise and preferred item for independent or cooperative play with sibling/cousin 10. Use two 5 min cards for more time Problem Behaviour During Dinner 1. 2. 3. Crying aloud Flopping on the floor Pulling hair and pushing sibling/cousin 1 1 1 2 2 2 3 3 3 4 4 4 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 3

In place
4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 5 5 5 5

5 or more 5 or more 5 or more

Social Validity 1. 2. 3. 4. 5. The goals of the Independent and cooperative play and transitions to home are acceptable and important. The strategies are useful and effective The strategies are difficult to use BL is successfully transitioning to home BL is playing with cousin/sibling Disagree 1 2 3 1 1 1 1 2 2 2 2 3 3 3 3 Agree 4 5 4 4 4 4 5 5 5 5

Comprehensive Behaviour Support Plan for BL

Comprehensive Behaviour Support Plan for BL

Family Implementation Support Plan Independent and Cooperative play with sibling/cousin and successful transitions to home. Introduction and Rationale The purpose of this plan is to help you learn how to implement the positive behaviour support plan with your son BL. This plan describes the supports that we have agreed to use to make this happen. It includes support activities, roles and responsibilities, and a time line. Support Activities 1. Develop visual supports and materials like: i. Picture schedule for relatives house visit: depicting the activities to take place during the visit to relatives house. Make sure that you include all events in pictures. ii. Picture schedule for home: Prepare a visual of all activities at home. Have pictures of most of the events. Have blanks pictures to prepare unexpected changes. iii. Prepare a social story about family members. iv. Prepare a video with sibling and cousin (Sibling is playing alone when cousin approaches him and asks can we play together? sibling answers yes, they both play cooperatively v. Choice board: develop two boards with choices. Use pictures of BLs preferred activities or toys. vi. Prepare two 5 minutes cards. Depict in it a favorite toy. Prepare 5 sets of it. vii. Develop visuals for positive contingencies and have them at hand to be used during transitions and cooperative play time (i.e. Cousin approaches BL-BL plays nicely- Mom/dad praise and give access to preferred toy) viii. Prepare a visual support for calming down strategy. b. Prepare a grab and go bag with all the materials you need for going to relatives home (5 minute cards, schedule for transitions, preferred rewards, one choice board with pictures of rewards. c. Set up visual schedules at home in a visible place where BL can see it. d. Have a bag ready with materials for home intervention (video, social story. 2. Support and train BLs parents to implement the behaviour support plan: a. Schedule weekly in home support and training for independent and cooperative play with sibling/cousin and successful transitions to home. b. Prepare a schedule for the activities that are part of the intervention (watching video of playing nicely, reading social story about family members) c. Model to parents how to use: i. Positive contingency statement. ii. Pre-correction

Comprehensive Behaviour Support Plan for BL

iii. Visual schedules iv. Reading social story and watching videos. Use role-playing for teaching: praising, giving cards for 5 min showing visual supports. Conduct an in vivo training for calming down strategy. Include BIs in training session. Engage in problem solving discussions.

d. e. f. g.

3. Roles and responsibilities: a. Plan implementation: BL s parents (P) b. Training team: BC (In house Behaviour Consultant) c. Support (Home team BIs) 4. Timeline: a. 4 months (approx.)

Comprehensive Behaviour Support Plan for BL April 2013

Implementation Support Plan Outline Activity Goals Insure the successful implementation of the Independent and Cooperative play with sibling/cousin and successful transitions to home. Provide materials and execute actions needed to implement the Positive Behaviour Support Plan.

Tasks 1. Prepare visual schedules 2. Develop choice boards. 3. Develop social story and video. 4. Develop Positive contingency statements. 5. Prepare 5 min cards. 6. Prepare grab and go and home bag with materials. 7. Sign up BL in a Social and Playing skills group 1. Teach BL calming down strategy. 2. Run two days the plan while shadowing parents when implementing and guiding them through the process. 3. Attend a visit to relatives, shadow transition to home. 4. Provide feedback after implementation. 5. BL starts attending a social and play skills group.

Who P & BI P & BI P & BC BI & BC BI P P

When April 2013

Implementation of the Independent and Cooperative play with sibling/cousin and successful transitions to home

Set all materials in place, Rehearse with BLs parents.

BI P & BC

May 2013

P & BC BC P

Comprehensive Behaviour Support Plan for BL April 2013

Home meetings.

Parents will apply skillfully the Independent and Cooperative play with sibling/cousin and successful transitions to home

1. Schedule weekly home meetings. 2. Schedule one meeting to shadow parents while they implement the procedure. 3. Review data taken during implementation, check progress, and solve problems. 4. Self evaluate the implementation. 5. Increase BLs self control and cooperative play skills repertoire.

BC

BC

BI &BC

Initiated on April 2013 (Independent and Cooperative play with sibling/cousin and successful transitions to home) Proposed completion on Aug 2013.)

P & BI

Evaluation

1. BLs parents evaluate use of Independent and Cooperative play with sibling/cousin and successful transitions to home plan.

1. Design implementation checklist and selfevaluation forms. First, self evaluate each time you implement the intervention plan. Once you feel confident, self evaluate the plan each week. Put the checklist where you can easily find it or see it. In case you need to remember or check some step.

BC

P P

Initiated on April 2013 (Independent and Cooperative play with sibling/cousin and successful transitions to home) Proposed completion on Aug 2013.