Positive Behavior and Visual Supports Project: Results of a UniversityDepartment of Public Health Collaboration

Lillie Huddleston, PhD, Breanna Kelly, LMSW, Allison OHara, EdS, Daniel Crimmins, PhD

Abstract

Methods

The Positive Behavior and Visual Support Project (PBVS), developed

through a collaboration between the Georgia Department of Public
Health and the Center for Leadership in Disability, was focused on
young children with autism or related developmental delays
between the ages of 2 and 3. Participants were referred through
the Part C, Early Intervention Program, Babies Cant Wait. The
university team developed and implemented a five-session, inhome, parent coaching intervention designed to increase positive
communication skills and decrease challenging behaviors. This
poster describes results based on parent and provider input.

Parent measures:
Challenging Behavior Autism-Self efficacy Scale (CB-SES;Hastings
& Brown, 2002). Self-efficacy was measured using the CB-SES, a
scale developed to assess the raters perceived confidence,
competence, control, and ability to positively impact their childs
challenging behaviors.
Depression Anxiety Stress Scale-21 (DASS-21; Lovibond &
Lovibond,1995). The DASS-21 was used to measure parent
perceptions their of mental health and well-being before and after
the PBVS intervention. The items of the DASS-21 yield three
subscales related to depression, anxiety, and stress.
Eyberg Child Behavior Inventory (ECBI;1999). The ECBI a 36-item
tool designed to assess the intensity of behavior for children ages
2-16, was administered before and after the intervention. Items
addressed externalizing behaviors such as getting angry, when
doesnt get own way; acting defiant when told to do something,
and having temper tantrums.
Satisfaction Survey (CLD, 2015). A parent satisfaction survey was
developed by the Center for Leadership in Disability to assess the
degree to which parents found the PBVS curriculum and
implementation to be acceptable, feasible, and useful. The survey
included eight Likert scale items and three open-ended questions..

PBVS Curriculum
Session 1: Getting to Know You
Parents were provided with an overview of the goals and
objectives of the Positive Behavior and Visual Supports Project.
Parents were introduced to a framework for promoting social
emotional development in young children.
Session activities included a discussion about developmental
milestones and behavioral principles.
Participants completed surveys to provide information about
themselves and their child.
The session concluded with a discussion of commitment to the
group and between session activities.
Session 2: Understanding Behavior as Communication
Each session began with a discussion of homework activities and
successes since the previous meeting.
Participants were provided with an overview of key concepts
related to Positive Behavior Supports.
Parents completed the Understand portion of the Brief
Behavior Questionnaire and Intervention Plan (BBQuIP) and
began the Prevent portion of the tool.
The session focused on the use of data to make decisions and
generate hypotheses.
Session 3: An Ounce of Prevention
After the review of homework and between session activities,
parents continued to explore the role of prevention.
The session included a focus on function-based
accommodations and use of visual supports to structure the
environment.
Session 4: Out with the Old: Teaching Replacement Skills
During Session 4, parents progressed from Understand and
Prevent to Replace on the BBQuIP.
Discussion and activities centered on function-based
interventions, problem solving, and use of visual systems for
communication and instruction.
Session 5: Taking the Show on the Road Generalization and
Maintenance
The final session group focused on implementing interventions
with other behaviors and in other settings.
Participants reflected on lessons learned and plan for
maintenance of new skills.
Parents were asked to complete post-surveys regarding their
beliefs, knowledge and experiences with the PBVS project.

Results - Qualitative
Question #1

What are the

skills you
learned from
this program

that are
useful to
you?

Improved
Communication
Skills
Increased ability
to understand,
prevent, and
replace
challenging
behaviors

Illustrative Quotes
We learned how to apply new skills with Dominic's
tantrums and now he hardly has them!

Continue searching for replacement behaviors when

he starts something inappropriate.
We practice every day and even started the training
tools with our childcare givers.

References

Utilizing the support kit and the best way to use it for
my daughter.

Establishing routines using the visual supports cards,

Improved routines daily schedule, and if/then scenarios to help avoid
meltdowns due to communication.
Using visual
supports
I learned to make a plan for behaviors I want to
address and I am thrilled with that.

Themes

Illustrative Quotes

How will
you apply
the skills
you learned
in this
program?

Teach new skills

during daily
activities.

We as a family do them every day [new strategies].

He sees it as a game, but it's a form of
communication to us.

Practice
strategies
regularly

I will continue to use the support pictures and apply

them in everyday events.

Involve other
caregivers
Use more
prevention
strategies
Respond to
behavior based
on function

Question #3

Themes

What are
some skills
you
currently
use that will
be
discontinued
as a result of
participating
in this
program?

The PBVS project has demonstrated success on multiple indicators

over the project year.
Parent feedback suggests that families observed significant gains
in communication and improvements in social engagement and
interaction.
Parents reported a decrease in the intensity and frequency of
challenging behaviors.
Most families found the visual support kits and strategies
valuable and applicable to their daily routines.
Providers also observed progress over the course of the
intervention related to communication, use of structured
routines, and decrease in the target behavior/increase in
replacement behavior.
Building upon the success of the PBVS pilot project, the Center
for Leadership in Disability and the Georgia Department of
Public Health have partnered to offer 10 Positive Behavior
Supports Parent Academies across the state between 2016 and
2017. The PBS Parent Academies utilize a modified version of
the PBVS curriculum adapted for group delivery.

We were able to significantly reduce head banging,

tantrums, drooling, and avoidance behaviors. We had
significant increases in speech skills and potty
training.

Question #2

Results - Quantitative
Parent measures:
Eyberg Child Behavior Inventory (ECBI;1999). Parents reported a
lower intensity of challenging behaviors following the PBVS
sessions (Figure 1).
Challenging Behavior Autism-Self efficacy Scale (CB-SES;Hastings
& Brown, 2002). Parents reported significantly higher levels of selfefficacy after completing the PBVS project (Figure 2).
Depression Anxiety Stress Scale-21 (DASS-21; Lovibond &
Lovibond,1995). The results of the DASS-21 suggested that parents
experienced significantly less anxiety and stress after the
intervention (Figure 3).
Satisfaction Survey (CLD, 2015). Positive perceptions of the PBVS
curriculum, personnel, and materials were revealed based on
parent response to the quantitative items with over 90% strongly
agree endorsed for six of eight items.

Themes

Conclusion and Next Steps

I use my skills to understand my son's behavior and

to be patient in helping him/teaching him in his daily
routine.

Illustrative Quotes

We give less attention to negative behaviors.

Ignoring
attentionWe dont have to spank or get frustrated and yell
seeking behavior anymore.
Using punitive
Stop giving her things without eliciting
punishment
communication

Giving in or
having fewer
expectations

Being reactive to Guessing what [my child] wants. He now can show
behavior instead me.
of understanding
and preventing

Eyberg, S., & Pincus, D. (1999). Eyberg Child Behavior Inventory &
Sutter-Eyberg Student Behavior Inventory-Revised: Professional
Manual. Odessa, FL: Psychological Assessment Resources.
Hastings, R. P., & Brown, T. (2002). Behavior problems of children
with autism, parental self-efficacy, and mental health. American
Journal on Mental Retardation, 107(3): 222-232.
Hastings, R. P., & Symes, M. D. (2002). Early intensive behavioral
intervention for children with autism: parental therapeutic selfefficacy. Research in Developmental Disabilities, 23(5), 332341.

I will have him try to vocalize or show me pictures to

make me understand, instead of giving him things
due to fussing or crying.

Figure 1. ECBI. Parents

Lower Reported Intensity

For more information contact:

Figure 2. CB-SES. Parents'
Increased Self-efficacy

Figure 3. DASS-21. Pre- and Post- Intervention scores

for the Stress, Anxiety, and Depression Subscales

Photo credit: Ryan Johnson, Center for Leadership in Disability

Lillie Huddleston, lhuddleston@gsu.edu, 404-413-1427