Positive Behaviour Support Plan B.D.

EPSE 532- Assessment and Positive Behavioural Support in School and Community Settings University of British Columbia

Katherine M Turner 17298100

December 02nd, 2011

Competing Behaviour Pathways Diagram

Bedroom Routine Well Rested Go to sleep Preferred Breakfast Praise Desired Behaviour Maintaining Consequence

Unstructured Activity Boring Task

Left Alone

Shredding/Ripping Mattress, clothing, bedding Picking Nails Property Damage

Relieves Boredom

Setting Event(s)

Antecendent Trigger(s)

Problem Behaviour

Maintaining Consequence

Engage in a quiet leisure activity

Alternative Replacement Behaviour

Positive Behaviour Support Plan Strategies that Make Problem Behaviours Irrelevant, Ineffective, and Inefficient Setting Event Strategies Preventative Strategies Provide a light carbohydrate & protein snack hour prior to bedtime Teaching Strategies Consequence Strategies

Allow BD to choose bedtime Provide non-contingent social reinforcement with staff prior to bedtime Provide age appropriate bedroom/sleep environment

Teach Progressive Relaxation through audio/video programs and relaxation story Teach how to select an appropriate quiet leisure activity

Give attention/praise contingent on sleeping through the night without incident Give preferred breakfast contingent on sleeping through the night without incident

Allow BD to choose preferred breakfast she will earn for sleeping through the night Provide age appropriate quiet leisure activities for bedroom routine-music, progressive relaxation CD, looking at a photo album Read relaxation story once in bed Fade presence of perferred staff from bedroom

Praise BD when she chooses & engages in an appropriate quiet leisure activity If BD engages in destructive behaviour implement the crisis management plan

PBS Plan for BD Summary of Focus Person and Systems Strengths/Concerns

BD is an engaging, energetic, and bright young woman 19 years of age. BD currently resides in Nanaimo, BC in a staffed resource with two other residents who are decades her senior. Mom, Dad and her brother all reside in Nanaimo and visit with BD bi-weekly. BD enjoys a variety of physical activities both indoor and outdoor. BD is easily frustrated and is often bored if not engaged in a purposeful activity and will engage in a deconstructive activity of her own choice when left to her own devices. BD enjoys and thrives from one to one attention from staff members and family. BD is non-verbal and communicates with others through single ASL signs, her own personalized signs, gestures and through behaviour. BS requires a formalized communication system, which will increase her opportunities for meaningful communication with others, as well as her ability to communicate her wants and needs. Preferably, BD will continue to live in a staffed resource where she will be provided the opportunity to continue to develop skills in the areas of communication, self-regulation, adaptive functioning, and socialization. It has been identified by BDs support team that her bedtime routine and sleep hygiene are a priority when focusing on BDs problem behaviour. BD frequently engages in destructive behaviours when she is supposed to be sleeping. Ideally, the staff would like BD to engage in non-destructive, quiet, relaxing activities in her bedroom prior to falling asleep. A second area of concern for support staff is BDs inability to tolerate the denial of a requested activity. BDs problem behaviour can escalate to the point of physical injury and/or property damage when she is denied a requested activity.

Functional Assessment Strategy Bedroom Routine and Goals The bedroom routine occurs at the end of the day when BD is to go to her own room and go to sleep. The goals for BD are to go to sleep and sleep through the night without engaging in any problem behaviours. Behaviours of Concern Shredding and/or Ripping - clothing, mattress, and bedding Picking Nails picking at nail beds of both fingers and toes until nail beds are bleeding Property Damage - removing moulding from around windows and doors, removal of light fixtures and wiring from walls, breaking windows and mirrors

Positive Behaviour Support Plan Setting Event Strategies 1. Allow BD to decide when she is tired and ready for bed with an upper limit of 11:30pm. 2. A preferred staff will spend 15 minutes prior to bedtime with BD delivering positive attention compliments, praise, and shared relaxing activities before BD goes to her bedroom. The preferred staff will spend 20 minutes with BD engaged in quiet leisure activities in BDs bedroom. The preferred staff member will read the relaxation story and review relaxation techniques with BD prior to leaving the bedroom. 3. Provide BD with an age appropriate bedroom, which would include a music source such as an MP3 or CD player. Allow BD to choose from a selection of relaxing music to listen to while falling asleep. Photo albums, high interest books and magazines for BD to look at prior to sleep should be available. Allow BD to select her bedding, colour and textural preferences can be accommodated to provide an optimal sleeping environment. Preventative Strategies 1. Allow BD to choose a light carbohydrate and protein snack, such as peanut butter or cheese spread on whole wheat toast, crackers and cheese, or an instant breakfast protein drink, hour prior to bedtime. Provide BD with a choice of possible, healthy options from which she can select her nightly snack. 2. Allow BD to choose a highly preferred food item for breakfast she will earn in the morning for sleeping through the night without engaging in any problem behaviours. Before going to sleep, ask BD what she would like for breakfast as a reward for sleeping through the night. Staff members need to know what BD wants for breakfast to ensure that BD can be rewarded immediately upon waking in the morning. Provide BD with a visual system which enables her to select her breakfast item the night before, to ensure morning staff are aware of the breakfast choice. As BD becomes more successful at sleeping throughout the night, the preferred breakfast items can be faded from every successful night to less frequent intervals. 3. The provision of age appropriate quiet leisure activities for BD to engage in prior to sleep onset is critical. A preferred staff member can read the relaxation story, A Boy and A Bear, written by Lori Lite with BD every evening. This story teaches breathing and relaxation skills to enhance the readers own level of relaxation. The preferred staff member will model the relaxation and breathing techniques illustrated in the story. After the relaxation story BD may select another book, photo album or magazine to read. 4. Provide BD with a selection of therapeutic audio files such as the Tranquil Moods-The New Age Sounds of Relaxation series, by Madacy Music Group Inc. to choose from for

her nightly listening enjoyment after she has completed the progressive relaxation program. The progressive relaxation MP3 file, created by Pam Mitchell should be played nightly as a routine part of the bedtime schedule. The preferred staff member can participate and model the exercise for BD as well as offering encouragement and positive feedback as BD attempts the exercise. Mastering the process of relaxation may take BD several attempts and she should be encouraged and supported for her efforts by staff members at every opportunity. BDs music selection is to be played immediately upon completion of the progressive relaxation exercise. 5. The preferred staff member will fade her presence from BDs bedroom and regularly check in on BD over the course of the night. The fading process will occur systematically over time. Fading from the room A preferred staff member will initially spend 20 minutes with BD in her bedroom reviewing the relaxation techniques with BD and sharing in choice of quiet leisure activity. The preferred staff member will follow a preset fading schedule as BD becomes increasingly skilled at relaxation and engaging in independent quiet leisure activities. The preferred staff member will sit beside BD and read the relaxation story and listen to the progressive relaxation audio program. The fading process of the preferred staff will occur over the course of several nights and will involve both the proximity of the staff to BD and the length of time the preferred staff member spends with BD in her bedroom. The fading process may resemble: Sitting beside BDs bedside for 20 minutes Sitting beside BDs bed for 19 minutes Sitting at the end of BDs bed for 18 minutes Sitting at the end of BDs bed for 17minutes Sitting at the end of BDs bed for 15 minutes Sitting at a further distance from BDs bed for 15 minutes Sitting at a further distance from BDs bed for 13 minutes Sitting at a further distance from BDs bed for 11 minutes Sitting at the door for 10 minutes Sitting at the door for 8 minutes Standing at the door for 6 minutes Standing at the door for 4 minutes Standing in the hallway Staying in the living room During the fading process, the staff member is not to engage or interact with BD. The preferred staff is to remain simply a physical presence. It is important that the preferred staff member not progress through the fading process to quickly. The pace of the fading should be determined by BDs comfort with the staffs new position in her room. It is important not to move backward in the fading process, either by increasing the time spent with BD or in physical proximity (moving closer) to BD particularly in the context of inappropriate behaviour from BD. The fading

process may take several weeks to complete. The preferred staff will check in on BD over the course of the night to ensure that BD is engaged in an appropriate leisure activity or sleeping. Use of safety signals in integral during the final stages of the fading process. Statements such as 'Stay in bed, I'll be back in a minute' helps build endurance for BD. When staff return to the room and find BD in bed behaving appropriately the must praise her for her behaviour. Teaching Strategies 1. BD will be taught deep breathing techniques and the process of progressive muscle relaxation. During her day relaxation techniques will be explained to BD and she will review the story relaxation techniques with a preferred staff member. A preferred staff member will model the relaxation techniques for BD. BD will listen to the progressive relaxation MP3 file, created by Pam Mitchell, or view the progressive muscle relaxation video created by Jennifer Yi as one of her activities during the day. A preferred staff member will demonstrate the process of progressively tensing and relaxing their muscles. BD will receive instruction on when to use the relaxation techniques and encouraged by staff members throughout the day to practice. When BD attempts to use the relaxation techniques of either deep breathing, counting to 10 or tensing and relaxing her muscles she will receive verbal praise and positive attention from all staff members for her attempts at relaxing. A visual guide could be posted by BD's bed to be reviewed as part of her bedtime routine. 2. BD will receive instruction on how to request and select an appropriate leisure activity prior to falling asleep in her bedroom. BD will be presented with a choice book that provides a selection of suitable quiet leisure activities which BD can engage in prior to going to sleep. By providing her with a predetermined selection of activities, such as listening to various music CDs or MP3 files, looking at a family photo album, reading a book or magazine, crocheting, spool knitting or macram, staff are supporting BD to make a request for an appropriate activity that can be granted immediately. Consequence Strategies 1. If BD has slept through the night without any problem behaviours reward her with positive attention and verbally praise her for her success at sleeping throughout the night without incident. It is important to acknowledge and praise her success as soon as she awakens so that she associates the good nights sleep with the praise. Ensure that the delivery of verbal praise is enthusiastic because we want to celebrate a successful sleep time for BD. Staff must communicate this message clearly. for example "Wow, you were relaxed and quiet last night! You slept well and there was no ripping or tearing! You slept great! You get your breakfast choice because you had a quiet night!" 2. If BD has slept through the night without incident immediately provide her with the preferred breakfast item she chose the night before. It is important that she receive the preferred breakfast item as soon as she wakens so she associates the good nights sleep with the reward of her choice breakfast. Staff need to pair verbal praise for the good

night with the preferred breakfast item. "You had a great night!" and serve the preferred item for BD. 3. When BD chooses and engages in an appropriate quiet leisure activity from her choice book reward her with verbal praise, "You are making good choices", "You are acting so mature", "Excellent choice, you are having a good night". 4. BD is a tall, healthy young woman, who is capable of great feats of strength. If BD does not fall asleep and begins to engage in problem behaviours, direct her to her choice book and the selection of appropriate activities available to her. If BD is restless, gets out of bed, paces in the room or beginning to 'pick' at her clothing or bedding review the relaxation techniques. Remind BD of her preferred breakfast choice which she will earn if she has a good nights sleep and does not engage in problem behaviour. 5. If BD is a danger to herself or other members of the household (staff and co-residents), or BD is destroying property it will be necessary to implement the Crisis Management Plan to support BD through a difficult period.

Monitoring and Evaluation 1. Data collection forms will be completed by staff members for instances of shredding, /ripping of mattress, clothing, and bedding, picking at nails and property damage. Data will be collected by staff on the number of minutes the staff spend with BD during the fading process. Initially data will be reviewed by management and staff on a twice weekly schedule for a month. Data will continued to be reviewed bimonthly and eventually during the monthly staff meetings. 2. Staff members will record data on the implementation of preventative strategies and setting event strategies on data recording forms. The ease of implementation and preference of activities will be recorded. 3. All data will be reviewed with the Behaviour Consultant during the weekly consultation. A review of the positive behaviour support plan will examine the relevance of goals, procedures and outcomes. Alterations to the plan will be made as required.

Crisis Management Plan BD BD is calm, smiling and engaging appropriately with the staff and co-residents. Praise BD and acknowledge her appropriate behaviour. Acknowledge waiting is difficult and praise her for her waiting behaviour.

BD begins to get upset, she starts to vocalize and begins to scream. Acknowledge how she is feeling, tell her you can see she is getting upset. Cue her to select an alternate activity from a choice list of available activities. Cue the Relaxation Techniques exercise. Praise BD for using appropriate behaviour.

BD becomes increasingly upset, continues to scream and begins stomping her feet. Cue her to make a selection from the choice list of alternate available activities. Verbally cue and model the relaxation' exercise.

BD begins to hit other people. Do not attempt to teach BD at this time. Place yourself between BD and others, call a staff member for assistance. Remove other individuals from the immediate area as soon as possible. Take an open and non-confrontational stance. Keep your hands visible at all times and take care not to clench your fists. Do not speak to BD at this time but model deep, slow breathing relaxation technique.

If BD continues to escalate and personal injury to herself or others is imminent, the physical restraint of BD will be necessary. Unless somebody is in physical danger, the best thing to do is to back off and give BD a chance to calm down. Only staff certified with on Violent Crisis intervention (CPI or Mandt) training is to perform physical restraint holds. Perform only a sanctioned 'least-restrictive' standing form of physical restrain, only the minimum amount of restraint necessary to ensure everyone's safety. The safety of BD, staff and other residents must be ensured during the initiation, employment and maintenance of a restraint. Continue with the 'least-restrictive' form of physical restraint until BD is definitely calm. Do not use a prone face down form of restraint. If you are utilizing a restraint hold, you are doing it because BD has demonstrated she is injuring herself or someone else. When BD is calm, do some relaxation and deep breathing exercises with her.

BD is not to be punished if the Crisis Management Plan has to be implemented. The plan is utilized to support BD in a time of need. There is to be no staff retribution for B's loss of control. Debrief staff, co-residents and/or community members as necessary after the event.