Behavior Support Plans Research Articles

IMPROVING INTERVENTION INTEGRITY OF DIRECT‐SERVICE PRACTITIONERS THROUGH PERFORMANCE FEEDBACK AND PROBLEM SOLVING CONSULTATION

The purpose of this study was to improve intervention integrity of behavior support plan implementation by teachers at a specialized school. During the first phase of a multiple baseline design, performance feedback was given to the teachers during (correction) and immediately following (praise) classroom observations. In a second phase, the teachers received problem solving consultation that addressed behavior support plan misapplication and respective procedural modifications. Only one of the three teachers demonstrated improved intervention integrity with performance feedback, whereas problem solving consultation produced uniform improvement. We discuss these findings and implications for intervention integrity assessment and research. Copyright © 2014 John Wiley & Sons, Ltd.

Use of Coaching and Behavior Support Planning for Students With Disruptive Behavior Within a Universal Classroom Management Program

Even with the use of effective universal classroom management practices, some students will need additional behavioral supports. However, to translate implementation of new strategies into the classroom, professional development programs need to be adaptive to the complexities teachers face in providing instruction and managing classroom behaviors among diverse learners. Teachers also need support to successfully implement universal practices as well as to develop and enact plans for supporting students with disruptive behavior. This article describes a universal classroom management program that embeds coaching within the model. The coach supported teachers both in implementing universal strategies and in developing and implementing behavior support plans for students with disruptive behavior. The study evaluates the effectiveness of the behavior support plans and the types of coaching activities used to support these plans. Findings indicated that during meetings with teachers, coaches spent time action planning and providing performance feedback to teachers on their implementation of the behavior support plans. In addition, teachers reduced their rate of reprimands with the targeted at-risk students. Students receiving behavioral supports demonstrated decreased rates of disruptive behavior, increased prosocial behavior, and a trend toward improved on-task behavior. In comparison, a matched sample of students with disruptive behaviors did not demonstrate improved outcomes. Implications for practice are discussed.

A. M. Heru: Working with Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals

Working with Families in Medical Settings: A Multidisciplinary Guide for Psychiatrists and Other Health Professionals by Alison Heru is written for physicians who practice psychosomatic medicine, including psychiatrists, psychiatric residents, and psychosomatic medicine fellows. It also has applications for nurses, social workers, marriage and family therapists in providing services to families in medical settings. Finally, it also is intended to help hospital administrators and their patient committees in developing family oriented patient care. Part I of the book provides a review of current and past family theory and research. Although research on families of the medically ill is vast, it is scattered among many books and journals. Consequently, her review of the literature accomplishes the task of pulling that literature together for practitioners to use as a quick reference and resource. Of particular interest is her description of McCubbin’s resiliency model of family stress, adjustment and adaptation that describes how a family’s ability to handle the stress of illness is moderated by their strengths. A strength-based approach to assessment and intervention sets the tone for practitioners to look at families as their own resource for healthily coping with medical trauma and chronic illness. This strength-based approach is also in alignment with the sweeping changes in the field of mental health that focuses upon recovery and resiliency as a lifestyle that is goal and action oriented, rather than passive and expert driven. Applications of successful strength-based models result in empowerment and increased likelihood of family self-direction and positive adaptation to chronic and traumatic illness. Part II of the book describes the involvement of the family in the health-care system. Heru adequately describes what Family Centered Care (FCC) looks like, and effectively utilizes data from current health care systems utilizing FCC, such as with the Medical College of Georgia and Cincinnati Children’s Hospital. Increases in patient satisfaction, decreases in length of stay, and reduction in medical errors are powerful outcomes to support the FCC model. Heru’s follow-up of specific examples of the use in FCC in patient care setting further drives home the point that involving families in treatment and care is not just a good idea, but an absolute necessity for improving healthcare outcomes. Part II also provides interesting descriptions and support for behavior support plans for disruptive families. The behavior support plans seem to be more of a tool to actively and positively engage disruptive families to focus on the shared desires for patient recovery and wellness. For example, the behavior support plans identify staff and family concerns, and negotiate solutions and clearly inform the family of interventions when the disruptive family member does not meet expectations of the plan. Behavior support plans are not widely used in medical healthcare settings, especially for families, but Heru strongly demonstrates how these plans can give direction to staff, as well as provide expectations for families. Part III provides an analysis of family systems and interventions. This section describes coping styles of individuals, couples and families of illness, models of family assessment, and specific family interventions, and concludes with an analysis of multi-family group interventions. The description and examples of adaptive versus less adaptive coping skills will be particularly helpful for G. Harris (&) Benchmark Human Services, 530 C West Thomas Street, Milledgeville, GA 31061, USA e-mail: gharris@benchmark-hs.com

Effects of Fixed-Time Release Fading on Frequency and Duration of Aggression-Contingent Physical Restraint (Protective Holding) in a Child With Autism

We report the case of an 11-year-old boy with autism who displayed aggressive behavior and required aggression-contingent physical restraint (protective holding) to protect peers and teachers from injury. During a baseline phase, teachers implemented the boy’s behavior support plan and applied protective holding according to a behavior-contingent release (BCR) criterion in which they maintained physical contact with him until he was “calm” for a minimum of 30 consecutive seconds. In the intervention phase, baseline procedures remained in effect, but the teachers terminated protective holding with the boy according to a fixed-time release (FTR) criterion that was independent of his behavior during protective holding and faded (decreased) systematically over time. In contrast to BCR, FTR fading was associated with less exposure to and fewer applications of protective holding. Post-intervention and follow-up results revealed that protective holding was no longer required. We discuss the clinical implications of these findings.

The use of mechanical restraint with people who engage in severe self-injurious behaviour: impact on support staff

Purpose – There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support. Design/methodology/approach – Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data. Findings – All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made. Originality/value – This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them.

Carers’ commitment to behavioural support plans

Anthony McGrath provides a literature review of how to ensure treatment integrity by carers seeking to reduce clients’ challenging behaviour

Increasing the Rigor of Procedural Fidelity Assessment: An Empirical Comparison of Direct Observation and Permanent Product Review Methods

Although it is widely accepted that procedural fidelity data are important for making valid decisions about intervention effectiveness, there is little empirical guidance for researchers and practitioners regarding how to assess procedural fidelity. A first step in moving procedural fidelity assessment research forward is to develop a comprehensive understanding of the relation between currently recommended assessment methods, systematic direct observation (SDO) and permanent product review (PPR). To this end, we first discuss methodological issues related to procedural fidelity assessment via SDO and PPR, and how they are evidenced in the behavioral intervention outcome literature. Second, we present a single-case design study in which teachers’ implementation of behavior support plans was assessed via SDO and PPR. Third, we analyze the SDO and PPR data with regard to (a) relation between the methods; (b) methodological issues including definitions of procedural fidelity and intervention steps, representativeness of intervention steps, and collection of an adequate sample; and (c) association with student outcomes. Finally, we discuss implications for research and practice.

Applying adult behavior change theory to support mediator-based intervention implementation.

A majority of evidence-based interventions in schools are delivered through consultation models and are implemented by a mediator, such as a teacher. Research indicates that mediators do not always adequately implement adopted evidence-based interventions, limiting their effectiveness in transforming student outcomes. We propose that to transform student outcomes through evidence-based practice, conceptualization of mediators' intervention implementation must move beyond quantification of discrete intervention steps implemented. Intervention implementation requires behavior change and thus can be conceptualized as an adult behavior change process. The purpose of this article is to illustrate how adult behavior change theory may inform how intervention implementation is conceptualized, facilitated, and supported. An empirically supported theory of adult behavior change from health psychology, the Health Action Process Approach, and how it has informed development of PRIME (Planning Realistic Intervention Implementation and Maintenance by Educators), a system of supports to facilitate mediators' implementation of school-based interventions, are introduced. A case study demonstrating the application of PRIME with a public school teacher implementing a behavior support plan is presented. Implications for future research are discussed.

Implementation of a Culturally Appropriate Positive Behavior Support Plan With a Japanese Mother of a Child With Autism

The purpose of this study was to empirically investigate a family-centered approach to positive behavior support (PBS) that was designed to be culturally responsive to families of diverse linguistic and cultural backgrounds. A Japanese mother and a child with autism were the primary participants. Multiple research methods were used. A single-subject withdrawal design evaluated the functional relation between parent implementation of a culturally informed PBS plan and improvements in child behavior and participation in a dinner routine. Qualitative case study methods guided an understanding of the family’s culture, the mother’s perspectives on the PBS plan and outcomes, and the interventionist’s perspectives on the provision of behavior support to the family. Quantitative results documented a functional relation between implementation of the PBS plan and improvements in child behavior and participation in the dinner routine. Qualitative results provided a rich description of the parent’s and interventionist’s experience and perspective. Three themes emerged: (a) developing a rapport informed by family culture; (b) working with a cultural guide to facilitate understanding the family’s cultural values, beliefs, and parenting practices; and (c) accommodating the mother’s cross-cultural values and beliefs. Contributions to the literature and implications for behavior interventionists working with families of diverse cultural backgrounds are discussed.

A component analysis of positive behaviour support plans

Background Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness.Method Sixty-one staff working with individuals with intellectual disability and challenging behaviours completed longitudinal competency-based training in PBS. Each staff participant conducted a functional assessment and developed and implemented a PBS plan for one prioritised individual. A total of 1,272 interventions were available for analysis. Measures of challenging behaviour were taken at baseline, after 6 months, and at an average of 26 months follow-up.Results There was a significant reduction in the frequency, management difficulty, and episodic severity of challenging behaviour over the duration of the study. Escape was identified by staff as the most common function, accounting for 77% of challenging behaviours. The most commonly implemented components of intervention were setting event changes and quality-of-life-based interventions.Conclusion Only treatment acceptability was found to be related to decreases in behavioural frequency. No single intervention component was found to have a greater association with reductions in challenging behaviour.

Reliability and utility of the Behaviour Support Plan Quality Evaluation tool (BSP‐QEII) for auditing and quality development in services for adults with intellectual disability and challenging behaviour

Having an objective means of evaluating the quality of behaviour support plans (BSPs) could assist service providers and statutory authorities to monitor and improve the quality of support provided to people with intellectual disability (ID) who exhibit challenging behaviour. The Behaviour Support Plan Quality Evaluation Guide II (BSP-QEII) was developed to monitor and assess BSPs prepared by teachers to support children with disability in the school system. This study investigated the application of the BSP-QEII to the assessment of BSPs for adults with ID in community support services. The inter-rater reliability of the BSP-QEII was assessed. The utility of the BPS-QEII was then investigated with reference to a time series study of matched pairs of BSPs, developed for the same clients over a period of approximately 3 years. Differences in plan quality measured across a number of service and systemic variables were also investigated. The BSP-QEII was found to have good inter-rater reliability and good utility for audit purposes. It was able to discriminate changes in plan quality over time. Differences in plan quality were also evident across different service types, where specialist staff had or had not been involved, and in some instances where a statutory format for the plan had or had not been used. There were no differences between plans developed by government and community sector agencies, nor were there any regional differences across the jurisdiction. The BSP-QEII could usefully be adopted as an audit tool for measuring the quality of BSPs for adults with ID. In addition to being used for research and administrative auditing, the principles underpinning the BSP-QEII could also be useful to guide policy and educational activities for staff in community based services for adults with ID.

The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability

The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability. A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics. The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme. The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.

The use of multi‐element behaviour support planning with a man with severe learning disabilities and challenging behaviour

Accessible summary People with learning disabilities who have challenging behaviour often experience poor support which affects their quality of life. This paper looks at an example of work done with an individual and his staff team which helped reduce challenging behaviour and provided him with an improved service and better quality of life. The research indicates the importance of people with learning disabilities who have challenging behaviour receiving behaviour support to enable them to live full lives in the community. SummaryResearch has indicated that challenging behaviour leads to placement breakdown and poor quality of life for people with learning disabilities. This paper provides a case study example of successful intervention with an individual with learning disabilities and challenging behaviour, using a Multi‐element model of support, including functional assessment, behaviour support plans and use of a monitoring system (Periodic Service Review). Outcomes of this intervention are presented and their possible implications considered.

Use of Positive Behavior Support to Address the Challenging Behavior of Young Children Within a Community Early Childhood Program

This study examined the effects yielded from the implementation of assessment-based behavior support plans on the engagement and problem behavior of three young children with behavioral challenges in a community early childhood program. A concurrent multiple-baseline design across children with generalization probes was used with data collected during targeted and nontargeted routines, in phases with different staff members, and in new classroom settings. The results indicated that implementation of the individualized behavior support plan by teaching staff resulted in higher levels of engagement and a reduction in challenging behavior. Teachers generalized the use of intervention strategies to nontrained routines resulting in improvements in the children’s target behaviors within those routines. Follow-up probes for two of the children indicated that changes in behavior were maintained in new classroom settings. These findings support the efficacy of the implementation of behavior support plans that are assessment based by early educators within a community-based preschool program.

Toddler Teachers’ Use of Teaching Pyramid Practices

Effective strategies to promote social-emotional development and prevent occurrence of challenging behaviors in young children is critical. The Teaching Pyramid, a framework for supporting social-emotional development and preventing and addressing challenging behaviors, was developed for preschool children. This mixed methods study investigated toddler teachers’ use of Teaching Pyramid practices and the relationship between these practices and classroom quality. Results indicated that toddler teachers used practices associated with the universal level of the Pyramid (e.g., positive relationships with children and parents). At this level, however, it was also evident that some preventive practices were missing (e.g., posted visual schedules and rules). Missing across classrooms was evidence of practices associated with the secondary level (e.g., explicitly teaching behavior expectations) and tertiary level (e.g., participating in developing behavior support plans). Implementation of Pyramid practices appeared to be associated with classrooms rated as being high quality.

Assessing behaviour support plans for people with intellectual disability before and after the Victorian Disability Act 2006

Background This study sought to elucidate the extent to which behaviour support plans for people with intellectual disability are inclusive of best practice criteria, with a comparison made prior to and following proclamation of the Disability Act (2006) in Victoria, Australia.Method This study used a data collection instrument developed by the researchers incorporating best practice criteria as identified in the review of literature and Victorian legislative requirements. The instrument was used to assess a sample of behaviour support plans.Results Best practice criteria are inadequately included in behaviour support plans with little difference between pre- and post-Act plans.Conclusion The results of this study indicate that disability support staff are ill equipped to undertake the complex assessments, planning, and implementation associated with behaviour support strategies, despite the legislative framework that guides and directs this intervention.

Program-wide Behavior Support Plans for Programs Serving Students Who Are Deaf or Hard of Hearing in Illinois

Positive Behavior Interventions and Supports (PBIS) programs are being introduced in school districts throughout Illinois and the rest of the United States, resulting in decreased behavioral incidents and increased academic achievement. Programs for students who are deaf or hard of hearing benefit from implementation of this type of universal-level program, which includes teaching expected behaviors and reinforcing them when they are demonstrated. Staff training and data collection systems are essential components of the development and implementation of these programs.

Challenging behavior in elementary and middle school

Challenging behavior in elementary and middle school

Applied Behavior Analysis Assessment and Intervention for Health

The case of a 26-year-old man who had Prader-Willi syndrome and health threatening self-injury in the form of rectal picking is described. Functional behavioral assessment and analysis before intervention suggested that both nonrectal and rectal picking occurred because the behaviors sometimes produced social attention, escape from nonpreferred situations, and sensory pleasurable stimulation. Intervention was evaluated at the man's vocational training program. The behavior support plan included time-limited bathroom visits, functional communication training, and differential positive reinforcement. Intervention eliminated rectal picking, was associated with improved health status, and remained effective over a nearly 8-month period.

The effect of a residential-based behavioral treatment for an adolescent boy with a history of maltreatment and challenging behaviors.

This article involves two studies implemented within a behavior support plan designed for a 12-year-old boy who had a history of severe abuse and neglect and was removed from his parents by the police and placed into the care of the state. One study examined the effect of a multi-element intervention consisting of a concurrent token economy and contingency contract with response cost. Challenging behavior was reduced to zero levels as measured by monthly frequency of incidents. Within this behavior support plan another study targeting personal hygiene was implemented, increasing compliance with daily personal hygiene tasks to 100%.