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Hello, and thank you for joining us today for Part one of the “Understanding and Addressing Challenging Behaviors of Individuals with Complex Needs” webinar series.  My name is Wendy Szakacs and I am the Regional Coach for Autism and Low Incidence at OCALI in the northeast and eastern parts of Ohio.

And I am Chris Filler, the coordinator of the Lifespan Transition Center at OCALI, the Ohio Center for Autism and Low Incidence. We serve families, educators and professionals working with individuals with autism, low incidence disabilities, and complex needs.

This series will teach you a systematic process for addressing and changing challenging behaviors.  We will be building your knowledge step by step through each of the webinars in this 5 part series.  Today we will start by looking at defining behaviors.

  Behavior. We have all had experiences with individuals that exhibit challenging behaviors.  This is what it can look like.  It is upsetting to the person as well as those around them. So we want to help people avoid the point of frustration, upset, and meltdown.  You probably already know there are no “canned” solutions for challenging behaviors.  Individualized interventions are the most successful and respectful ways to support people to change their behavior. During this webinar series, you will learn a process that can be used to look comprehensively at what is underlying and driving behaviors to occur and to continue, especially for people with the most significant challenges.

On this slide are several definitions of behavior.  Behavior is action that you can see and measure.  There are expected actions or behaviors for certain environments and ages.  Different factors influence behavior, such as a person’s neurology or previous life experiences.  So let’s think about how these behaviors can develop.

Behavior is like an iceberg. An iceberg sits both above and below the waterline. Only a small piece of the berg is actually easily in view. As one gets close … and sometimes you must get very close…. You start to see that there is a huge piece of ice under the surface that holds the tip out of the water and in plain sight. Be careful…one must take caution to respect that chunk that lies below the surface. Otherwise you could find yourself in a dangerous situation.

Behavior again is much like the iceberg. We can easily identify the intense behaviors that disrupt and might even be dangerous, but we often miss the emotions and situations that lie below the surface that drive the behaviors at the tip of the iceberg. Those situations and emotions under the water…below the surface…are the ones that we need to attend to. Those issues are the ones that need respect and intervention.

This iceberg concept will show up several times as we work through the materials.  When this webinar, we hope this visual will help you understand the importance of attending to all aspects of a behavioral situation.

So what do we do when someone exhibits a challenging behavior?  People do a variety of things. Sometimes we try everything we know at the same time.  We throw every intervention we have at the behavior hoping something works. But sometimes, it makes very little difference.

Or, we might try consistently using that one thing at a time.  Trying to go to that one tried and trued strategy… again and again, and still there is no change.

And finally, sometimes, we cannot even decide if the behavior is a challenging behavior!

So, let’s talk about what is included in the spectrum of “challenging behavior”.  There are different levels of behaviors that can be concerning.   It can start with just annoying habits, which might be chewing skin around the fingernails or laughing loudly when no one else is laughing.  Next might be things that just drive me crazy, such as someone tapping on a desk or clearing their throat continuously.  These two levels may cause some to intervene, but the consequences of these situations are not as great as those for the next several areas. Behaviors at the next level are described as those that limit opportunities, like pacing, jumping, invading other people   space, or looking in others personal belongings. These behaviors can limit when and where a person may be welcomed.  As we move up the continuum, there are behaviors that prevent learning, which can include getting stuck on a topic, refusing to do homework or even sleeping in class.  And finally, we might see dangerous and destructive behaviors, such as hitting, kicking, or running away. These are the most serious and truly impact the person’s ability to participate in a full and meaningful life. Next, let’s talk about how we can decide when a behavior needs intervention.

There are some questions a team can consider when trying to decide if a behavior is a problem.  As you read these, you see that behaviors that interfere with a person’s ability to engage in important social and learning activities is a priority. Ultimately, these behaviors have the greatest impact on the individual’s quality of life, which warrants the team’s close attention. That team might include the education personnel who work with a student that includes the parent, or the family group who assist an individual in the home, or a vocational team who support an individual at the job.  The team, which may also include the individual, needs to examine the behavior in question and decide together if the behavior needs to be addressed. 

So, why does there need to be a consensus? If there is not agreement, the team will not be working together to provide the appropriate supports for the individual.  Most of us have experienced the frustration of working in a silo and the lack of progress that results. Input and participation from all team members is essential.  You can establish a team responsible to work on a behavior plan.  In a school setting, that might include the members listed on this slide.

In the school setting, this team would need to consider the positive interventions and supports that need to be put in place to help improve the identified behavior.  Wendy will now talk about positive behavior interventions and supports, also known as PBIS.

Thanks Chris.  PBIS is a school wide system that talks about three levels of supports.  The Primary level is supports that will be provided for all students and staff across all settings.  And torhese supports address the needs of about 80% of the whole.  For the 20% of student needs not met by Primary Prevention, we move to Secondary Prevention supports.  These might include reinforcement systems or small group instruction.  For those 5% of students whose needs are not met by the Primary or Secondary supports, there are specialized, individualized systems set up to address their unique needs.  This webinar series is addressing the top of the triangle kiddos.

These are the elements of PBIS. In general, PBIS emphasizes four integrated elements: data for decision making; measurable outcomes supported and evaluated by the data; practices with evidence that show these outcomes are achievable, and systems that efficiently and effectively support implementation of these practices.  These are supported by the six principles on the next slide.

The six principles talk about evidence based practices or EBP, use of data to make behavioral decisions, making changes in the environment to try to prevent a behavior from occurring, the teaching of social competence skills, making sure the EBPs are implemented with consistency across people and environments, and that continuous monitoring occurs.  You will hear each of these principles address as we work through this webinar series.

So how do we look at our population of students with complex needs?  At the primary level we have supports in place for all of our students with developmental disabilities, which will also help other students.  The secondary level brings us to more involved supports that will help another 10-15% of students with disabilities.  And then we get to the individualized supports for the 5-10% of students with disabilities for those with the most complex needs.  So, we are looking at a subgroup for which PBIS is definitely applicable.

The Council for Exceptional Children’s magazine Teaching Exceptional Children had a terrific article in the September edition of 2011.  It listed various supports for each of the 3 levels.  Here is the Primary level list, including high expectations, organized classroom, and frequent feedback.  These same supports can be seen as applicable in home, community, and vocational settings.

These are some supports that might be used for the 20% not addressed by the systems for all.  Some groups might need a behavior contract or a more specific token economy.  In the home, community, or vocational settings maybe remedial interventions, such as teaching a new job or having a list of chores for the night, might be helpful.

And here are some ideas for the top 5-10% at the tertiary level not addressed by the primary and secondary supports.  This is the group of individuals who need specific examination of what is happening around the challenging behavior using functional behavior assessment (FBA), or who need individualized social competence instruction.  Again, you will be hearing about these interventions throughout the webinar series.  Chris will now explain about FBA.

Thanks Wendy.  This webinar series is going to help you learn a process that uses functional behavior assessment.  We will teach you steps to work through that will lead to developing an individualized positive behavior plan.

Based on your background and experience, some of this may be familiar. However, in order to assure that we are all on the same page, we will review vocabulary throughout the webinar.

For ongoing challenging behaviors, a Functional Behavior Assessment or FBA, should be conducted to obtain a thorough understanding of the behavior and the circumstances that surround it.  The acronym A-B-C is used to represent: Antecedent Events (or those things that occur before the behavior)  - Behavior of Concern, and Consequences to the Behavior (or those things that occur after the behavior).  In the school settings, a BIP, or Behavior Intervention Plan, would be developed based on this information.  For our purposes across environments, we will be showing you how to develop a positive behavior plan. We are going to look at each of the “A-B-C” areas to help complete the iceberg. This provides the basis for completing a support plan that is individualized and targeted.

This slide represents a form that was included in the packet you downloaded.  You will be using this form throughout the webinar series.  At this point, it may be a bit overwhelming or confusing, which is why the series takes the viewer step by step through each section. In section one, you will summarize the individual’s challenges that are associated with a specific behavior.  Section two allows you to summarize the issues that you discovered that are driving or influencing the behavior of concern.  Section three will summarize the individual’s strengths that can be used in the support plan.  In section four, you will brainstorm new skills to develop to support the individual to change his behavior.  And then finally in section five, you will refine that list to prioritize the new skills that will be taught to change the targeted behavior.  Section six will list the identified and associated interventions to support change and teach the new skills and replace the challenging behavior.

So let’s start with some vocabulary.  Antecedents are things that happen before a behavior and have an influence on the behavior.  The behavior is that measurable, observable action that is understandable to all observers.  Consequences occur after and in response to the behavior, increasing or decreasing the chances that it will occur again.  Remember, in this context, “consequence” is not necessarily something that we “do” to a person as a punishment for the behavior. It can include many things that will unintentionally occur after the behavior.  We will delve into that further as we move through the series.

First, we will explore the “B” in the A-B-C model. Behavior. We are going to talk about defining the behavior. Why? Because if we don’t get this piece right, the rest of the plan will be built on inaccurate information.  The behavior description needs to be recognizable by anyone who reads it.  Making it observable, able to be measured, and sometimes, adding a description of the setting can make it even more accurate.    So let’s look at some examples.

Here are words we sometimes use to try to describe challenging behaviors. Tantrum. Aggression. Frustration.  Are they observable?  Not really.  Can you measure them?  No as they are written.

They really aren’t specific enough to count.  Do we know where these happen?  No.  These examples could mean different things to different people.  How about the phrase, “Ryan runs and screams”?  What is considered “screaming”? Does that mean anything over a conversational tone? When it is loud enough to interrupt? Or When my head starts to split? Is that it something that is important in all settings? What is running? Is it only running if I can’t catch him? While I exaggerate somewhat, the point is we cannot all agree on what “screaming and running” is from this description.   

How about these behaviors?  Are they observable?  Yes.  For the most part, can you measure these? We have more specific information. We know where this happens?  And this description of Ryan’s behavior would be observable and measurable by most anyone watching.

Now lets meet Molly. This is our case study for this webinar series.  Molly is a young child that is attending her first year of "organized" education. She has been described as a being very cute and engaging, until things don't go her way! She likes many aspects of the kindergarten class but certain activities seem to be a problem. Circle time is just not her favorite time and that seems to be the time when she becomes the most unhappy. Activities at the table, hands on activities, music and the playground are all happy times for Molly. She likes a schedule and generally wants the schedule to be on her time. Although Molly is verbal, she seems to have trouble finding words to tell the teachers "what's wrong" (and) when she is upset. Instead she screams and kicks and hits.

What do we know about Molly’s behavior?  She struggles with circle time and transitioning according to the classroom schedule.  Molly enjoys hands on activities, music, and playground.

Now let’s look at Molly’s challenging behaviors in the context of the iceberg:  “Molly screams loudly enough to interrupt the teacher’s instruction to class.”  Is this clear?  Yes it is.  Would most people be able to identify the same behavior?  I think so. Can we measure it?  Yes.  For example, we could count occurrences, or even time how long it lasts.  For other case studies samples, check the folder you downloaded.  There is an example of Molly in the home setting and an example of Joe, an older student.

To help you practice this process, we have included a file of forms you can fill out with information about your student or family member.  This is the first assignment.  Before the next webinar, choose and define a challenging behavior to target for your individual.  Describe it in a way that is observable and measurable.  

Thanks for attending the first webinar.  We’ll see you for part two very soon.