Behavior Intervention Plans Research Articles

Modifying a behavior intervention plan according to classroom aides acceptability ratings: effects on treatment integrity and challenging behavior

This study evaluated the effects of an acceptability questionnaire on classroom aides' treatment integrity during implementation of behavioral intervention plans, using a multiple-probe-baseline across-participants design. Four classroom aides in a special education preschool classroom rarely used procedures recommended to manage the challenging behavior of a four-year-old boy with autism spectrum disorder (ASD) during baseline. After using the questionnaire results to create a functionally equivalent behavior intervention plan that was comprised of components the aides rated as more acceptable, three of the four aides greatly improved their use of the procedures and an ancillary reduction in the child’s challenging behavior was observed. Overall, results suggest that including staff acceptance measures during the intervention selection process may bolster subsequent intervention integrity.

DESCRIBE IT: A Strategy for Teacher Candidates Implementing Behavior Interventions

Teachers with years of experience in the classroom rely on that experience to help them develop behavior intervention plans for students with behavioral challenges. New teachers, however, may struggle with the complex steps needed to develop successful plans as they address other aspects of their professional work for the first time. DESCRIBE IT is a strategy that novice teachers can use to help generalize the process of behavior intervention planning they learned in university courses to their practice in the field. The purpose of this article is to demonstrate how DESCRIBE IT guided one special education teacher through the process for behavior intervention planning and implementation. Use of DESCRIBE IT may help new teachers plan and monitor behavior interventions as they start their careers.

CHALLENGING BEHAVIORS ON INPATIENT MEDICAL UNITS: INTEGRATED, NON-PHARMACOLOGICAL APPROACH FOR PATIENTS WITH DEMENTIA

Introduction Inpatient medical care is a critical hospital function, but is costly and associated with risks to both patients and staff. Patients often demonstrate behavioral problems that interfere with care, prolong length of hospitalization, increase utilization of resources, delay discharge, and even lead to staff injury. To address these challenges, the San Francisco VA Health Care System (SFVAHCS) developed the Behavioral Education and Support Team (BEST). This team is comprised of psychiatry, psychology, nursing, and occupational therapy staff. BEST provides support, education, and interventions to patients who are engaging in treatment interfering behaviors. Goals include reducing risk to patients and staff, improving treatment adherence, reducing utilization of resources, shortening length of stay, and facilitating discharge. BEST staff also collaborate with inpatient staff to develop and consistently implement behavioral treatment plans. Since implementation in October 2015 to March 2018, BEST has served 488 veteran patients. Data demonstrate that BEST is associated with a 40% reduction in staff injuries in acute medicine settings, a 42% reduction in emergency psychiatric codes, and a 25% reduction in formal inpatient setting complaints. In addition, it is estimated that BEST reduces inpatient costs due to improved time to discharge and reduced staffing turnover and work loss due to injury. This presentation will provide an overview of the BEST team function and outcomes. Given the critical nature and high costs of inpatient medical care, the SFVAHCS determined that investment in a dedicated team to address these problems would be justified by reducing utilization of resources, length of hospitalization, overall cost, and adverse patient and staff outcomes. Methods The BEST team was initially implemented as a behavioral consultation team for inpatient medical patients in October, 2015, and was comprised of 5 members: • A RN team coordinator • A part-time psychiatrist (.2 FTE) • A psychologist • An RN team member • An Occupational Therapist The data from the BEST consultations between October 2015 and March 2018 were reviewed, and analyzed. Analysis of data included identification of total number of consultations, average age of patients, marital status, discharge status, themes for admission, days in hospital, presence of psychiatric disorder, dementia, serious mental illness, staff injury frequency, frequency of emergent psychiatric code calls, frequency of formal inpatient complaints. Results Since initiation in October, 2015, the BEST program has served 488 patients. Complex geriatric patient accounted for 78.7%. As of July, 2017, the majority of veterans served had a psychiatric disorder or need, including depression (50%), dementia (26%), delirium (21%), serious mental illness (18%), and suicidal ideation (10%). Adherence to treatment was a target problem in 56% of those referred. Specific Outcomes: • 40% reduction in staff injuries among acute medicine staff • 42% reduction in emergency psychiatric code calls • 25% reduction in formal inpatient complaints. In addition, a conservative estimate suggests that improving compliance with treatment and reducing length of stay by 1 day per non-compliance referral, extrapolated to the current time point, would generate a savings of approximately $835,000. In addition, inpatient nursing staff report a subjective increase in morale and perception of competence for coping with behavioral disruptions. • Consult Summary (October 2015 to March 2018) • 488 Consults • Average Age 69 (youngest 29 to oldest 101 • 466 Males and 22 Females • Marital Status – 156 Never Married; 96 Married; 18 Separated; 181 Divorced; 33 Widowed; 4 Unknown • Discharge Status – 11 Against Medical Advice; 10 Died; 4 Homeless; 87 Skilled Nursing Facilities; 219 Home/Board & Care/Shelters; 31 Mental Health Rehabilitation; 83 Long-Term Care; 35 Unknown; 8 Acute Hospital • Themes for Admission – 55 Altered Mental Status; 43 Failure to Thrive; 28 Placement Issues; 15 Falls; 68 Pain; 39 Shortness of Breath • Days in the Hospital: • 13,827 Total days in the hospital • 7,218 Days in the hospital awaiting placement after being cleared by medical team • $28 Million – cost awaiting placement Conclusions Since implementation of the BEST team at the SFVA Medical Center, data reveal overall reduction in utilization of resources, length of hospitalizations, overall costs, and adverse patient and staff outcomes. Specifically: 1. A dedicated behavioral team can significantly improve the experience of inpatient nursing staff, reducing injuries, improving morale, reducing staff turnover and burnout. 2. A behavioral intervention team can significantly reduce psychiatric codes and patient complaints, while improving clinical outcomes and patient satisfaction. 3. Reductions in staff injuries and improvements in treatment adherence can recoup costs for team staffing. 4. Reducing risk factors for disruptive behaviors reduces overall costs to the system and overutilization of resources. This research was funded by Funded through the San Francisco VA

Handcuffs in Schools: Do School Resource Officers Fill a Role in Special Education?

When students with disabilities become agitated and physically aggressive, school resource officers (SROs) are often called to assist. This article addresses the question, “What is the role of the SRO when dealing with children who already have a behavior intervention plan (BIP) in place?” Faced with an increased presence of law enforcement officers in the nation’s school, administrators should be prepared to deal with these issues when they arise.

Ugdytinio, turinčio autizmo spektro sutrikimą, probleminio elgesio keitimas pritaikant funkcinio elgesio vertinimo metodiką

Autizmo spektro sutrikimą turintiems vaikams dažnai papildomai diagnozuojamas emocijų ir elgesio sutrikimas. Straipsnyje analizuojamos funkcinio elgesio vertinimo metodikos panaudojimo galimybės keičiant autizmo spektro sutrikimą turinčio ugdytinio probleminį elgesį. Empiriniu tyrimu siekiama atskleisti, kaip funkcinio elgesio vertinimo metodika gali būti panaudota pedagoginėms technologijoms, ugdymo turinį derinant su besimokančiojo individualia patirtimi ir mokymosi ypatumais.

Topography and Function of Challenging Behaviors in Individuals with Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) are at a greater risk for challenging behavior than individuals with other developmental disabilities. An essential step in the treatment of these behaviors is the identification of the function of the behavior. In the current study, data were collected from a large database, in which supervising clinicians from a community-based behavioral health agency recorded the topography and function(s) of behaviors treated as a part of an individual’s behavior intervention plan. In a sample of 3216 individuals (mean age = 10.67, SD = 4.61) with ASD, the frequency of the most common challenging behaviors and the identified function of the behavior were examined. Stereotypy was the most commonly reported topography, followed by noncompliance and aggression. Overall, escape was the most commonly reported function of behavior. To further evaluate how clinicians operationally define these behaviors, a part-of-speech text analysis was conducted and found a high degree of overlap in the operational definitions of challenging behavior (i.e., aggression, disruption and tantrum; noncompliance and tantrum; obsessive behavior and stereotypy; self-injurious behavior and aggression). These data are discussed in further detail.

Maintenance and Generalization in Functional Behavior Assessment/Behavior Intervention Plan Literature

School practitioners increasingly use functional behavior assessments to design behavior intervention plans when students engage in challenging behavior that is not improved by classroom management or standard interventions. Behavior intervention plans should aim to produce behavior change that maintains across time and generalizes to relevant contexts. In applied terms, maintenance occurs when a behavior continues to occur after the intervention is fully or partially withdrawn; generalization occurs when a learner engages in a trained behavior in an untrained context. This review examined the current status of maintenance and generalization in the school-based FBA/BIP literature and found that many school-based researchers continue to implement the intervention during the maintenance phase or in the generalization contexts. Implications for practice and directions for future research are discussed.

Using In-Vivo Modeling and Feedback to Teach Classroom Staff to Implement a Complex Behavior Intervention Plan

Behavior intervention plans (BIPs), implemented with high treatment integrity, are effective in decreasing challenging behaviors in individuals with autism spectrum disorder (ASD). High treatment integrity requires staff training such as Behavioral Skills Training (BST). Modeling and feedback alone, however, have been shown to be briefer and as effective as BST. Due to limited resources educational settings may prefer briefer training models to train staff to implement BIPs. This study used only two of the BST components, in-vivo modeling and feedback, to train three classroom staff members to implement a complex BIP. All three staff acquired the skills rapidly.

What’s Wrong with Being Funny? A Clinician’s Perspective on Humor and Behavioral Intervention

This non-data based paper is inspired by extensive clinical experience suggesting that behavior intervention plans tend to be overly rigid and, specifically, that the potential benefits of “humor” are frequently underappreciated.  Behavior plans usually include descriptions of supports and of behaviors to be reinforced, and careful operational definitions of behavioral excesses, to be put on extinction, punished, or from which students are to be redirected to a more appropriate behavior.  Subjective descriptions are difficult to define operationally, and this is likely one reason that humor is not typically addressed in behavior plans.  In the current paper, I describe some potential benefits of humor and argue that we should sometimes use more flexible criteria for describing “inappropriate” behavior.  I will provide behavioral analyses of some potential functions of “humor”, describe potential research methods, and describe cautions and recommendations regarding the use of humor in behavior intervention plans.

Extent IEPs for Students under Categories of Disability have Behavior Intervention Plans Based on FBAs

Extent IEPs for Students under Categories of Disability have Behavior Intervention Plans Based on FBAs

Factors influencing satisfaction among teacher candidates and cooperating teachers in conducting a functional behavior assessment

Functional behavior assessments (FBAs) and Behavior Intervention Plans (BIPs) support learners with behavior problems, but it is unclear which factors enhance FBA/BIP development. University students (n = 81) in a behavior course and their field-based cooperating teacher (CT; n = 35) responded to a survey. Only 12% of CTs were highly satisfied, and a low percentage of students were highly satisfied with FBA or BIP development (26% and 21%, respectively). Variables correlating with CT satisfaction (R2 = 0.966) and student satisfaction (R2 = 0.952 and 0.963, respectively) and implications for FBA/BIP development, field placements, and university–school partnerships are discussed.

The Effect of Teacher Training on the Knowledge of Positive Behavior Support and the Quality of Behavior Intervention Plans: A Preliminary Study in Taiwan

The purpose of this study was to investigate whether through a series of teacher training. The participants could acquire better knowledge on Positive Behavior Support (PBS), and develop high quality behavior intervention plans. Thirty-six teachers from three public schools participated in the study. The competency-based training consisted of 12 sessions based on several key concepts of PBS. The participants were divided into 7 groups, and each group was required to complete a section of behavior intervention plan after each training session, until all sections were completed. A group pretest-training-posttest pre-experimental design was used to compare the knowledge and the quality of behavior intervention plans before and after the training. Results showed the knowledge of PBS and the substantive quality of PBS plans can be improved with teacher training. The implications for future research and practices were discussed.

Functional assessment-based interventions: Focusing on the environment and considering function

ABSTRACTIt can be challenging for educators to select intervention tactics based on the function of the student's behavior. In this article, authors offer practical information on behavioral function and environmental-focused intervention ideas for educators developing behavior intervention plans. Ideas are organized according to the hypothesized function of the student's behavior of concern. Authors conclude with additional considerations for educators implementing behavior intervention plans to support students with the most intensive intervention needs.

Commentary on Zirkel: Judicial Rulings Specific to FBAs or BIPs Under the IDEA and Corollary State Laws—An Update

The authors discuss the journal article by Perry Zirkel on legal action in regard to functional behavioral assessment (FBA) and behavior intervention plans (BIPs). They contend that the Zirkel article opens larger questions that will be central to ongoing discussions at the national, state, district, school, and family levels. Such issues include the role of legal standards to guide quality education, specifically special education; the response of families, communities, and school personnel to problem behaviors; and a focus on the development of a full set of accommodations that result in academic, social, and physical growth rather than just FBA and BIPs.

An Update of Judicial Rulings Specific to FBAs or BIPs Under the IDEA and Corollary State Laws

Exemplifying the insufficient treatment of legal issues in refereed journals in special education and related fields, the limited legal coverage of functional behavioral assessments (FBAs) and behavior intervention plans (BIPs) tends to view the applicable case law through normative lenses. This skewed view characterizes the case law as requiring FBAs and BIPs rather broadly in terms of entitlement and rather rigorously in terms of appropriateness. In stark contrast, this systematic analysis of 91 recent judicial rulings concerning FBAs and BIPs reveals that, aligned with the trajectory of previous court decisions, the outcomes favor the defendant districts on almost a 7:1 ratio and that the pronounced prodistrict trend applies to entitlement as well as appropriateness. Special education professionals need careful differentiation of legal requirements from professional norms to make informed choices about FBAs and BIPs that balance the individual interests and the competing priorities within limited resources of school districts.

Improving Outcomes of Behavioral Intervention Plans

According to federal mandates, if a student’s behavior impedes their learning or the learning of others, the individualized education program team is required to address this with a functional behavioral assessment (FBA). The intent of the FBA is to determine the function, or reason, of the impeding behavior for the development of a behavioral intervention plan (BIP). The BIP process is a team-based approach that includes goals and interventions that result in positive behavior change. Procedural fidelity, or compliance with the plan, is of utmost importance to success of this process. Unfortunately, such integrity is often lacking, particularly when teachers carry the responsibility of implementing BIPs in the classroom. Therefore, capacity building within the school team is imperative to increase implementation fidelity of BIPs. This article provides practitioners with the tools to organize the monitoring and implementation of BIPs in classroom settings.

Mobile Apps for Behavioral Health: A Survey on User Engagement

Background: The number of mobile app interventions for behavioral health has grown exponentially over the last decade. A recent study by the IMS Institute for Healthcare Informatics found that health and wellness apps available to consumers more than doubled between 2013 and 2015, from 43,000 to over 90,000. Despite their availability, mobile app interventions are not yet offered or encouraged routinely in behavioral health treatment planning. One possible reason for minimal implementation is limited knowledge of patient preferences regarding use of these interventions. Objective: The current study seeks to increase knowledge in three key areas related to mobile app interventions designed specifically to address a key area of behavioral health: depression and/or anxiety. Depression and/or anxiety were selected as the focus for this project given that these mental health disorders affect over a quarter of the US population and are highly comorbid. Key research questions include (1) What are the demographics of patients who are most interested in using mobile app interventions for depression and/or anxiety? and (2) What are the reasons patients endorse for disinterest in mobile app interventions for depression and/or anxiety? Methods: Potential participants were identified at random from a list of veterans diagnosed with a mood and/or anxiety disorder (per the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) who attended a primary care appointment during 2014 at a Veterans Affairs Medical Center located in a major metropolitan area of the northeastern United States. A total of 400 potential participants are being mailed a brief (15 minute) survey. A modified Dillman method is being used in which a prenotification letter is mailed out to participants, followed by the survey with an opt-out form, followed by up to two additional mailings for those potential participants who do not respond. Results: Data collection is expected to be complete in late August of 2016. The poster proposed here will include findings from descriptive analyses on use of technology (smart phones, mobile apps in general, mobile apps for any behavioral health concern, and mobile apps for depression and/or anxiety) in different demographics. Additionally, descriptive data on reasons endorsed for low willingness to use mobile app interventions for depression and/or anxiety (when recommended by a health care provider as well as when accessed independently) will be presented. Finally, findings from analyses evaluating the relationship between demographic variables (race, gender, education, age, and symptom severity) and level of interest in mobile app interventions for depression and/or anxiety will be presented. Conclusions: The target audience for mobile app interventions for depression and/or anxiety and reasons patients may choose not to use these interventions will be identified. Limitations include using a veteran-only sample and focusing exclusively on interventions for depression and anxiety rather than other areas of behavioral health. Future research should seek to build upon findings by broadening the scope of investigation to civilians and other areas of behavior change. Findings from this study can inform healthcare providers and app developers on patient preferences regarding mobile app interventions. [iproc 2016;2(1):e42]

Functional Behavior Assessments and Behavior Intervention Plans: Legal Requirements and Professional Recommendations

Functional behavior assessments (FBAs) and behavior intervention plans (BIPs) are critical components in the education of students with, or at risk for, emotional disturbance (ED). The purpose of this article is to compare the legal requirements with the professional requirements for FBAs and BIPs. The comparison is first according to the procedural dimension (e.g., the when and how questions) and then on the substantive dimension (the what question). The results reveal a dramatic difference between the legal requirements under the Individuals With Disabilities Education Act and the professional recommendations for best practice. Our recommendation for both scholars and practitioners is not to fuse or confuse these two levels: one representing the mandatory minimum and the other representing the professional desideratum. Rather, due differentiation provides a proper framework for proposed additions to federal and state laws, strategic opportunities for advocacy in the litigation process, and ample latitude for effective choices for prophylactic practice.

Pilot Evaluation of the Medication Integration Protocol for Adolescents with ADHD in Behavioral Care: Treatment Fidelity and Medication Uptake.

Although Attention-Deficit/Hyperactivity Disorder (ADHD) is prevalent among adolescents in outpatient behavioral care, one of the few evidence-based treatment options, stimulant medication, is significantly underutilized. The Medication Integration Protocol (MIP) is a family-based intervention designed to help behavior therapists assume a lead role in educating clients about ADHD in adolescents, promoting family-centered decisions about medication initiation, and integrating medication management activities within behavioral treatment planning. This pilot study evaluated treatment fidelity and medication utilization for inner-city teens receiving MIP (n = 14) compared to a matched Historical Control (HC) group (n = 21) in a community clinic. Observational analyses revealed that in comparison to HC, MIP demonstrated basic protocol fidelity with regard to adherence to the MIP protocol, therapeutic alliance with the adolescent, and clinical focus on ADHD in session. MIP showed greater psychiatric evaluation completion and ADHD medication initiation than HC. Next steps in the ongoing development of MIP are outlined.

Measuring the complexity of treatment for challenging behavior using the treatment intensity rating form

Objectives: The goal of this study was to develop and evaluate a tool to measure the complexity and intensity of psychotropic medication interventions, behavioral interventions, and issues related to crisis management for challenging behavior using a standardized rating form.Method: The Treatment Intensity Rating Form (TIRF) is a 10-item scale with three categories: pharmacological interventions, behavior supports, and protective equipment. In a retrospective review, we examined the final treatment recommendations for 74 individuals with self-injurious behavior (SIB) based on psychiatric and behavioral notes and reports. We also compared whether TIRF scores differed across individuals for whom SIB was maintained by social reinforcement (e.g. to access attention or toys/activities, or escape from tasks) vs. those for whom SIB was maintained by automatic reinforcement (e.g. occurs independent of social variables, and is presumed to be maintained by sensory reinforcement).Results: The TIRF was demonstrated to have strong inter-rater reliability (98%) and appears to have good face validity. As hypothesized, individuals with SIB maintained by automatic reinforcement had significantly more medication trials (p=0.0005) and required more protective equipment than individuals with SIB maintained by social reinforcement (p=0.0002). Antidepressant medication was used more often with individuals with automatically reinforced SIB, although antipsychotics and anticonvulsants were also commonly used across both groups.Conclusion: Findings provide initial support for the TIRF’s reliability and face validity as a measure of the level of complexity of medical and behavioral treatment plans — although additional research is needed to fully evaluate its psychometric properties.