OCALI on Demand

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Hi, and thank you for joining us today for Part four 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 be focusing on using strengths to help change challenging behaviors.

If you chose to work through the process with your own individual, since the last webinar, you completed the extensive FBA form with setting events, triggers, reinforcement, and your hypothesis.

And you updated section one of the Interventions form with new information and filled in section two summarizing your triggers, setting events, and hypothesis.

In this next part of the presentation, we will look at areas of strength to help complete the iceberg.  It will also set us up to talk about completing the positive behavior support plan.

Strengths need to be the foundation of building new skills.  To identify strengths, we can focus on the interests and positive attributes about an individual.  What is s/he like when working?  When calm?  While socializing?  When engaged?  When passionate about an activity?  Sometimes when we are dealing with challenging behaviors, it is more difficult to think about the strengths and positive interests a person exhibits.  Having conversation with school staff, family members, peers, and caregivers about interests and strengths can help develop a comprehensive list.

These are areas we can consider when thinking about strengths.  To support the positive behavior plan, we want to build from positive strengths, habits, skills, and interests.

Here is an example of strengths for this boy, Cesar.  In the communication area he is able to make choices; in academics he loves math; physically he’s a great runner; personality-wise he is liked by most of his peers; in self care he has some dressing skills; and in the sensory area he knows when he needs a break; as a motivator he loves music; and in social competence he works well with two of his peers.

Remember Molly?  Here is her strengths profile.  She is cute, has large motor skills, finds a way to get her point across, likes hands-on math activities, can be engaging, loves music and playground time, can work alone sometimes, knows when she is overwhelmed, is persistent, and can interact best one on one.  At this time, we are not sure about her coping skills.  You may not be able to think about something for each area and that’s okay.  Also, when you look at the blank strengths form in your downloadable file, you will notice we left some spaces without titles for adding your own categories and strengths.  Again, this can be part of the ongoing thought process that you can keep adding to about your individual.  Why do we take the time in this functional behavior assessment process to consider strengths and skills?  How is this going to help Molly?  If we discover what intrinsically motivates Molly, what makes her excited, what gets her interest bubbling, then we can use that information within the interventions and strategies we choose to support changing her challenging behavior.  This can work for your individual too.

On this slide, you can see that the next step on the Interventions form is to fill in section three with a summary of strengths and skills under these categories. This form shows a summary of Molly’s strengths in section three. For instance, she learns best if music is incorporated and she likes being able to make a choice.  This information will help us support her in a positive way with matching strategies.  More on that shortly.  Also, section four is where we start to think about what additional skills are needed to improve the behavior.  In looking back at the person’s challenges and underlying contributors, what skills need to be taught?  In Molly’s case, we listed some skills that might help her improve the target behavior:  she needs to learn coping skills to support her sensory, social, and environmental challenges; she also needs to learn some different communication skills for expressing her emotions and that allow her to ask for a break when she starts to feel anxious or upset; she needs to continue to develop academic skills so she can be more comfortable at circle time; and she needs to learn how to interact with peers successfully.

In this part, we will start thinking about how to tie in the appropriate interventions to support the target behavior and what we have discovered about the individual’s challenges and strengths so far.

Just to review, we started the interventions form by summarizing the underlying challenges and contributing factors in sections one and two.  Then, we summarized strengths and skills in section three, and started thinking about what skill could improve the behavior in section four.  We are now going to start making the connection of interventions to all of this information.

On this slide, section six now has some interventions listed for Molly.  We want to show you how they evolved from what we know about Molly’s strengths. This section is going to require you to think deeper because it is about what is happening under the surface of the iceberg.  This is where you are being asked to make the connections between what you have figured out so far about the person, and how it ties in to the interventions and strategies you are using, or are going to be using, every day. So, let’s look at Molly.  In the category Improving Learning and Development, the interventions tie back to strengths in learning and skill development, sensory/biological preferences, and motivations and interests. For example, we learned that Molly likes music and needs space, so that is built into the interventions.  The next category, Modification to Achieve Environmental Matches, shows that Molly can benefit from use of a visual schedule and timers, as well as sitting at the end of a table. In the next interventions category of Sensory/Biological Adaptations and Interventions, the ideas go back to strengths in the environmental matches and sensory/biological preferences area. This shows that structure and personal space came into play as the interventions were chosen. The thoughts under Social, Emotional, and Communication Support and Instruction come from Molly’s strengths in the successful social and communication and the motivations and interests areas:  she needs structure, space, and enjoys music.  And the last category, Ways to Add Motivation and Reinforcement, includes Music and choices on a schedule that come from the learning and skill development, successful social and communication, and motivations and interests strengths areas.  You can see there is not a one to one correspondence between the categories in sections three and six.  Interventions in the categories in section six should evolve from any and all categories in section three to support the challenges in section one.  We are going to delve further into intervention selection in the next webinar.

As we move into our discussion about interventions, we want to address the areas of data collection and reinforcement systems.

First of all, collecting and using data for behavior is a good thing.  Keeping data about a target behavior gives a baseline of how often and/or how much the behavior is occurring.  Continuing the collection of data during implementations gives ongoing monitoring of changes in the behavior and shows if the intervention is working.  Because we are all humans who have good and bad days, keeping concrete data takes guesswork, impressions, and emotions out of the process.  Also, data collection is required for the IEP and for legal purposes that sometimes arise.

These are some methods of data collection.  We are going to discuss each of them briefly.

One method is frequency recording.  For this method, you tally the number of times the target behavior occurs within a given period of time.  As you continue tracking during interventions, the number of times a behavior occurs will decrease if the intervention is effective.

The rate of behavior tells how often a behavior occurs during a given period of time.  With an intervention that is working, the rate would decrease.

When we measure duration of a targeted behavior, this shows how long the behavior is lasting.  As an intervention is implemented, we hope to see the duration decrease.

With interval recording, we mark if a behavior occurred during certain time periods of the day. This might show specific times of day when the behavior is present or absent, and then you can examine what is happening at those times.  Sometimes it is difficult to collect data ALL DAY, so this is a way to record “snapshots” of when it is occurring.

Using graphs to show data collection results makes the tally marks or numbers on daily charts into a visual picture of progress, or sometimes lack of progress.  This example shows measuring to see if a medicine change affected behavior.  Each day is broken into four quarters; the red line is the person’s ideal state of functioning that meant attentive and working and quiet, but able to be verbal.  
This graph demonstrates that this intervention did not show consistent progress.

This graphing example shows data about a student who grabs food from other student’s trays at lunchtime.  The first section is the baseline.  The space shows when the first intervention was implemented.  As shown by the data illustration on Thursday of the intervention week, you can sometimes experience a spike in the target behavior when an intervention is implemented and then the occurrence may decrease.  Being able to see the progress or lack of progress on graphs can support making decisions about interventions.  

You don’t have to collect data on everything.  Determine the when, where, and why about the data to help decide about what to track.  
It is very important that everyone involved understands how to collect the data.  It should be easy enough to collect so that anyone could do it.  
We want to collect data across environments to help us determine if skills are being generalized from environment to environment through the use of the interventions that are being implemented.  If data shows differently, then the team revisits environments, interventions, whether data is being collected consistently, changes in the student, and other factors that might be affecting progress.  If data is collected but not analyzed and used in decision-making, it is useless.  And data analysis truly is the only way to tell if an intervention being used is actually working.  

We are going to think through data and Molly’s targeted screaming behavior.  What would we measure? Probably the number and maybe the duration of interruptions.  How would we track the data?  On a data sheet.  Who’s going to make the sheet, track the data, and graph the data?  In Molly’s situation, the teacher or psychologist or behavior specialist would create the sheet; teacher and parapros could track data; teacher, psychologist or behavior specialist would graph the data.  When would the team meet to review the data and make decisions about interventions?  They decided to meet weekly the first month and then bi weekly and then monthly to monitor progress.

Reinforcement systems are the next topic that impacts interventions.  Reinforcement follows the behavior or skill we want to increase.

We talked about reinforcement during the FBA process.  Just as a reminder, reinforcement increases or maintains a behavior; it may be purposeful or unintentional; and it needs to be understood by the individual.  

Here are a few things to remember.  Reinforcement MUST be individualized.  Think about this: it would be like you being given a cup of coffee every time you take out the trash, but you hate coffee.  Not much motivation to take out the trash, is it?  We know if the reinforcement is working if the behavior changes in the way we expect.  For individuals who have complex needs, learning a new skill will require a lot of reinforcement at first and then you can lessen the frequency.  You want to know that everyone who is interacting with the person understands exactly what behavior or skill is being reinforced and that the reinforcement needs to happen immediately at the decided frequency.

These are types of reinforcement systems that might be utilized.  Let’s talk about each one briefly.

Natural reinforcers come from the behavior.  If the behavior is fun for the individual, it is more likely to continue occurring.

Social reinforcers show approval and praise.  For individuals with complex needs, this may not be strong enough by itself, but good when paired with another type.  So it’s good to pair a high five with a verbal “you did it” for a kid who loves tactile interactions.

Tangible reinforcers are physical objects used as rewards.  These would need to be valued by the individual and although powerful, may only give a short term result.  Think about pairing with social and how to fade them.  You might decrease the amount given, increase the amount of time or expected behavior, and/or try to move to a non-tangible.  For example, if the tangible is a little model car at first, try switching to earning time to play with the cars or playing a computer racing game.

A token system can be structured in a variety of ways. An individual may receive a token after every behavior or after a certain number of responses. Whatever schedule is used, the token must be awarded immediately after the desired behavior. Don’t take away tokens once they are earned.  Making the tokens themselves look like a desired item can also be helpful.  

Here are some special interest areas of individuals with complex needs that practitioners have shared with us.  As decisions are made about reinforcement systems, keep the special interest areas of the individual in mind.  We all are more likely to work for what we do like. Considering when to reinforce is part of setting up the system.  At first, it might be 1 to 1.  Variable ratio mixes up how many times the reinforcer is earned.  Fixed interval is at regular time periods.  Variable interval is mixed time periods.   

It’s important to have a variety of desired reinforcers.  If you use one thing too often or give too much, it loses its effectiveness.  Keep an eye out for what the individual is showing interest in or wanting to spend time doing so you can add it to his/her reinforcement inventory list.

Reinforcement also needs to be considered in light of what other people in the situation are doing.  Are adults, peers, or co-workers behaving in such a way that they are making the behavior more likely to occur?  Is anyone doing something that raises the anxiety or stress levels of the individual?  What actions or reactions might need to change?  Making a difference in challenging behaviors involves examining the person exhibiting the behavior, but we also need to examine the actions of those who are present when the behavior occurs.  Think about this:  if a positive behavior plan only expects changes of the individual with complex needs, and not the environment or the other people in it, then we are asking the person with the most challenges to make all of the adjustments.  Doesn’t it make more sense to expect others to make changes, adjustments, and to support the individual with the complex needs?

As we discussed in the previous webinars, if you have chosen to practice this process with the forms included in the downloadable file, you will complete the Strengths form. And then you can summarize the strengths in section three of the Interventions form and start listing what additional skills might be needed. You also can think about what data collection system is needed for the targeted behavior. And start making decisions about a reinforcement system before the next webinar.

Thank you for attending today.  See you soon for the final webinar.