EPSE 532 Positive Behaviour Support Plan for BD Systems Profile 2 Summary and Implications Strength and/or Challenge/Need

d Communication-Non Verbal Boredom No Friends Anxiety Sleep Deprived Easily Frustrated Physically Strong Parents divorced and feeling burnt out New Group Home Staff Recent move to Adult Group Home Likes routines and schedules Quick Learner and capable of complex tasks Good Receptive language Cooking Skills Kinesthetic Learner Recreation Centre in Neighbourhood BD interacts well with others who have cognitive challenges

Schulkowsky

Implication for PBS Plan

Imperative to implement a communication system that can be understood by all Provide a program with a variety of activities and opportunities to engage in meaningful tasks throughout the day Create opportunities to meet and engage with age appropriate peers and in age appropriate activities with said peers. Education, vocation, socialization opportunities needed Implement visual schedule to inform on daily/weekly/monthly schedule. Teach waiting skill. When sleep deprivation occurs, learning opportunities are impacted, and tolerance and mood are affected. Increase opportunities for physical activity during day. Create program with variety of activities and choice opportunities. Implement errorless learning where applicable. Teach break request skill Able to engage in a variety of activities, can be useful with selfregulation. Will be communicating with two households. May be difficulty with consistency due to parental burn-out. May require staff support when implementing PBS in parents homes. Staff require in-service on Autism and PBS. Collaborative approach with staff to create workable program. Significant age difference between BD and current group home residents. Loss of old staff members, co-clients, and routines. Use of visual schedules for daily, weekly, monthly routines. Portable schedule to be utilized. BD does not take long to learn new routines and systems. Can follow several step instructions. Understands spoken word, can engage in conversations with staff, peers and family members when communication device is implemented. Requires communication system! This interest in food can be utilized to have positive interactions with the staff and to increase self-esteem Teach new skills through movement activities Utilize community centre for opportunities to develop social skills, increase physical activities, and make connections to neighbourhood members. Opportunities to access services through local agencies which provide services for adults with developmental disabilities such as Mix n Mingle (weekly social event for people with disabilities)

EPSE 532 Summary of BD and Systems Strengths/Concerns

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BD is an energetic and bright 19 year old girl who currently resides in central Nanaimo in a staffed residential group home facility for adults. BD lives with two other developmentally delayed adults who are both in their fifties. BD has a mom, dad, and brother who visit her twice a week. BD enjoys these visits with her family and will often want to engage staff in conversation about her next visit. BD enjoys a variety of physical activities such as swimming, hiking, grocery shopping, and yard work. BD also enjoys cooking simple recipes and loves to eat a variety of foods. BD is least likely to engage in problem behaviours while eating. BD is non-verbal and communicates through signs and gestures. BD has excellent receptive communication but will become frustrated when she cannot communicate her wants/needs to others. BD will engage in problem behaviours when she is anxious and bored due to not having a set routine or schedule that incorporate activities she enjoys. BD also has a sleep disorder and will often engage in selfinjurious and destructive behaviour at night in her bedroom. Summary of Routines 1) Free time routine This refers to a period of time where BD is not engaged in eating or hygiene activities. The free time routine is unstructured activity that occurs after breakfast until lunch, after lunch until supper, and after supper until evening hygiene activities (bath, hair wash, brushing teeth, etc). The goal for this routine is to create a structured routine that will incorporate activities BD enjoys and will be consistent so BD can know what to expect in her day and upcoming week. This will help BD learn to wait when she requests an activity and cannot have it at that time. Behaviours of concern: a) Screaming Vocalizations that begin quietly and increase in pitch and volume. Screaming is usually the first problem behaviour to occur in a series of escalating behaviours. b) Stomping Heavy-footed stomping in one place. Stomping almost always occurs with screaming. c) Hitting BD uses a closed fist and hits hard in a downward motion on staff arms and legs. BD usually only hits once. d) Property Damage BD will break/rip apart structural items to group home building (E.g. smash windows, rip out light fixtures, rip moulding off walls, pull drywall off walls) This is the highest intensity behaviour of concern as BD will not stop until staff physically intervenes or the item is destroyed. 2) Sleeping in room routine This refers to the period of time after 9 pm when BD is left alone in her room with the lights out after completing evening hygiene routines. BD is diagnosed with a sleep disorder in which she has difficulty falling and staying asleep. The goal for this routine is for BD to engage in a quiet, leisure activity that she will enjoy until she feels sleepy. This will help to reduce problem behaviours that arise out of boredom. Behaviours of concern: a) Shredding/ripping - Ripping/shredding fabric items such as mattress, bedding, clothing, towels, and carpet. b) Nail picking - Picks at nail beds on both hands and feet until fingernails and toenails are gone and bleeding.

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Competing Behaviour Pathways Diagram

Sleeping in Room Go to sleep Well Rested Praise Preferred Breakfast

Desired Behaviour Unstructured Activity Boring Task Not tired enough for falling asleep Setting Event(s) Antecedent Trigger(s) Problem Behaviour Engage in a quiet leisure activity Alternative Replacement Behaviour Left alone in bedroom by staff with the lights out. Shredding/Ripping Mattress, clothing, bedding Picking Nails

Maintaining Consequence

Reducing Boredom (Automatic R+)

Maintaining Consequence

Strategies that Make Problem Behaviours Irrelevant, Ineffective, and Inefficient Setting Event Strategies Incorporate several physical activities throughout the day Provide noncontingent staff attention after evening hygiene routines 30 minutes prior to bedtime Provide access to mom/dad via speakerphone or a prerecording before going into bedroom Set up a medication review with DDMHT to look at promoting sleep Preventative Strategies Provide BD with a weekly visual schedule in her bedroom that staff will go over each night Allow BD to choose a reward that she will earn in the morning for sleeping and/or engaging in quiet leisure activities Give BD a choice of quiet reinforcing activities to choose from to do in her bedroom eg. Looking at pictures of mom/dad, puzzles, watching preferred video Reminders using visual symbols of desired behaviour Teaching Strategies Teach BD progressive relaxation using modelling and visual cues Teach BD to choose another calm/relaxing activity in bedroom if bored with current activity Consequence Strategies If BD stays in room throughout the night without engaging in problem behaviours, provide praise along with preferred breakfast If BD is engaging in quiet leisure activities when staff checks at regular intervals, provide praise with reminder of preferred breakfast in the morning If BD is engaging in problem behaviours, re-direct to progressive relaxation

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Competing Behaviour Pathways Diagram

Free Time Across the Day Participate in all daily scheduled activities Staff suggest an alternative activity that BD will enjoy

Positive interaction with staff and access to all preferred activities and reinforcers

Desired Behaviour

Maintaining Consequence Gets activity (Tangibles R+)

Tired/Unstructured setting/inadequate communication/Lack of choice/No predictability

Denial of a request of an activity

Screaming Stomping Hitting Property Damage

Setting Event(s)

Antecedent Trigger(s)

Problem Behaviour BD will ask when the requested activity will take place

Maintaining Consequence

Alternative Replacement Behaviour Strategies that Make Problem Behaviours Irrelevant, Ineffective, and Inefficient Setting Event Strategies Let BD sleep in until she wakes up naturally Have a structured, visual schedule for small chunks of time throughout the day with a variety of activities that BD can choose from Develop rapport with staff by staff giving noncontingent reinforcers throughout the day Preventative Strategies Pre-correct BD of what desired behaviour for waiting looks like when she asks for an activity she cant have right away If staff need to say no to a request, avoid saying the word no and present activities she can do instead. When BD chooses an activity, immediately do activity at first request Teaching Strategies Teach BD to ask when desired activity will take place using a sentence strip Teach BD to wait without problem behaviour Consequence Strategies Reward BD with praise at the end of each scheduled activity and a preferred food item for bedtime snack for participating in scheduled activities and accepting staff suggestions for alternate activities If BD asks when requested activity will take place reward immediately with praise and tell her exactly when on the visual schedule Staff calmly redirect BD with a discussion of when next visit with mom/dad will be when screaming/stomping occurs Staff implement Crisis Management Plan when BD hitting or engaging in property damage

EPSE 532 PBS Strategies for Sleeping in Room Setting Event Strategies: Sleeping in Room

Schulkowsky

1) Incorporate several physical activities throughout the day. BDs problem behaviours are less likely to occur when she is doing physical activity. Physical activity will also help to promote sleepiness at night. BD enjoys hiking, swimming, and has had a paper route in the past. Utilize the recreation centre nearby on days that the weather is poor. 2) Provide positive noncontingent staff attention after evening hygiene routines 30 minutes prior to bedtime. This will encourage the development of a rapport between BD and staff and also help BD feel more secure in her environment, reducing anxiety before bed. Staff can brush BDs hair, give her a deep pressure massage, and talk to her in a calm, soothing voice using positive language. 3) Provide access to mom/dad via speakerphone or a pre-recording before going into bedroom. BD is highly motivated by visits with mom/dad and knowing when she will see them next. Hearing mom/dads voice telling her that they love her and when they will see her next before entering her room each night will help her transition into her bedroom activities. 4) Set up a medication review with Developmental Disabilities Mental Health Team (DDMHT) to look at promoting sleep. BD has been diagnosed with a sleep disorder and a monthly medication review will help determine if the medication is effective or she needs to be switched to another dosage or type of medication.

Preventative/Antecedent Strategies: Sleeping in Room 1) Provide BD with a weekly visual schedule in her room that staff will go over each night. This will help to create structure in BDs bedtime routine, reduce anxiety about what will be happening during her daily activities, and to help transition BD to bedtime. A weekly schedule with Monday to Saturday with each day broken into one hour chunks during daytime hours can be painted on BDs wall. Picture symbols can be attached with Velcro depicting the activity. 2) Allow BD to choose a reward that she will earn in the morning for sleeping and/or engaging in quiet leisure activities. Using picture symbols, present BD with a choice of food items that she enjoys. (e.g. french toast, waffles with berries, etc.) Add that item to the schedule for the next day. 3) Give BD a choice of quiet, calming activities to choose from. (e.g. look at picture book with family pictures, do a puzzle, watch a preferred video, listen to music with headphones on, etc.) Present the activities as a picture symbol for her to choose, and then set the chosen activity out for BD. At this point, remind BD of desired behaviour. 4) Reminders of desired behaviour using visual symbols. Stay quietly in your room. Do this activity. Then go to sleep.

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Teaching Strategies: Sleeping in Room 1) Teach BD progressive relaxation. This will help to reduce anxiety and promote good sleep. Ask BD to tense and relax different parts of her body. Staff should model the following and have BD follow along. Give BD a body parts visual picture in sequence for the following progressive muscle relaxation routine by Dr Edmund Jacobsen: a) Take three deep breaths, exhaling slowly each time. b) Clench your fists. Hold for 10 seconds then release for 20 seconds. Use this timing for all the rest of the muscle groups. c) Tighten your biceps by drawing your forearms up toward your shoulders and "making a muscle" with both arms. Hold... and then relax. d) Tense the muscles in your forehead by raising your eyebrows as far as you can. Hold ... and then relax. e) Tense the muscles around your eyes by clenching your eyelids tightly shut. Hold... and then relax. f) Tighten your jaws by opening your mouth so widely that you stretch the muscles around the hinges of your jaw. Hold ... and then relax. g) Tighten the muscles in the back of your neck by pulling your head way back, as if you were going to touch your head to your back (be gentle with this muscle group to avoid injury). Focus only on tensing the muscles in your neck. Hold ... and then relax. h) Tighten your shoulders by raising them up as ff you were going to touch your ears. Hold ... and then relax. i) Tighten the muscles around your shoulder blades by pushing your shoulder blades back as if you were going to touch them together. Hold the tension in your shoulder blades ... and then relax. j) Tighten the muscles of your chest by taking in a deep breath. Hold for up to 10 seconds ... and then release slowly. k) Tighten your stomach muscles by sucking your stomach in. Hold ... and then release. l) Tighten your lower back by arching it up. Hold ... and then relax. m) Squeeze the muscles in your thighs all the way down to your knees. You will probably have to tighten your hips along with your thighs, since the thigh muscles attach at the pelvis. Hold ... and then relax. n) Tighten your calf muscles by-pulling your toes toward you. Hold ... and then relax. o) Tighten your feet by curling your toes downward. Hold ... and then relax. p) Take three deep breaths, exhaling slowly each time. 2) Teach BD to choose another calm/relaxing activity in bedroom if bored with current activity. Have a sentence strip on the wall with visual picture symbols that says, When I am finished insert activity here I will do insert next activity here. Have staff do routine checks on BD and when she looks like she is finishing up the current activity, point to her sentence strip as a reminder. The reminders can fade over time as BD switches to another activity on her own.

EPSE 532 Consequence Strategies: Sleeping in Room

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1) If BD stays in room throughout the night without engaging in problem behaviours, provide praise (eg. You did a great job going to bed) along with a preferred breakfast that was chosen the night before. 2) If BD is engaging in quiet, leisure activities when staff checks at regular intervals, provide praise, naming the desired behaviour, with a reminder of preferred breakfast in the morning. 3) If BD is engaging in problem behaviours, re-direct to progressive muscle relaxation strategy and then back to the leisure activity.

Crisis Management: Sleeping in Room: Not Applicable Monitoring and Evaluation: Sleeping in Room Level of problem behaviour: The group home staff will be provided with a daily data form that they will record the instances of problem behaviour, specifically nail picking and shredding items in bedroom. Level of implementation by staff: The group home staff will record anecdotal data on the use of the setting event strategies and the preventative strategies. The staff will record the level of effort that was required to implement the strategies. Social Validity: The group home staff, group home manager, and Behaviour Consultant will meet every two weeks to review the plan to discuss the implementation of the strategies and the outcomes. Revisions will be made as necessary. PBS Strategies for Free Time Across the Day Setting Event Strategies: Free Time 1) Let BD sleep in until she wakes up naturally. This will help to alleviate some tiredness throughout the day. 2) Have a structured, visual schedule broken into one hour chunks of time throughout the day with a variety of activities that BD can choose from. Go over this schedule as soon as BD gets up to help her have some predictability within her day and something to refer to at the first signs of anxiety. 3) Develop rapport with staff by staff giving noncontingent reinforcers throughout the day. This will help BD want to engage in scheduled activities with the staff and be more open to their suggestions. Staff should randomly provide praise and offer deep pressure massage or to brush and braid her hair.

Preventative/Antecedent Strategies: Free Time

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1) Pre-correct BD of what desired behaviour for waiting looks like when she asks for an activity she cant have right away. Say Remember to have a quiet mouth and quiet feet while you are waiting for Activity A. Do this right after a request for an activity that cannot happen at that time. Then direct her to use her sentence strip that says, When can I do Activity A? 2) If staff need to say no to a request, avoid saying the word no and present activities she can do instead. When BD chooses an activity, immediately do activity at first request. Present three activities at a time using picture symbols, and when she chooses one, add it to her schedule in her bedroom. Ensure that all activities presented can be done immediately. Teaching Strategies: Free Time 1) Teach BD to ask when desired activity will take place using a sentence strip. Have a laminated sentence strip that says, When can I do Activity A? Have a Velcro attachment in the spot for Activity A where the picture symbol for that activity can be placed. As soon as BD asks to do an activity that she must wait for or cannot do in the near future, staff will say You need to wait or We will do something else instead right now. Right after this, prompt BD to use her sentence strip. Once she uses her sentence strip, answer her question immediately using her visual schedule on the wall. 2) Teach BD to wait without problem behaviour. This is a social skill that can be practiced throughout the day with objects that BD enjoys (e.g. twirlies -pieces of fabric twisted up that BD twirls in the air). Staff can start to twirl the fabric and when BD asks to use the twirly, tell her to wait. Tell her to wait for 2 minutes. Set a Time Timer on countdown for two minutes so BD can visually see how long she needs to wait for. Tell BD to Remember to have a quiet mouth and quiet feet while you are waiting for your twirly. When BD has waited with a quiet mouth and quiet feet for the allotted time, reward her with praise and give her the twirly. Slowly increase her waiting time as she continues with the desired behaviour. Consequence Strategies: Free Time 1) Reward BD with praise at the end of each scheduled activity by telling her how proud you are of her for doing that activity with you. Give her a preferred food item (e.g. hot chocolate) for a bedtime snack for participating in scheduled activities and accepting staff suggestions for alternate activities.
2) If BD asks when requested activity will take place reward immediately with praise for

asking and tell her exactly when the activity will take place by showing her on the visual schedule. 3) Staff calmly redirects BD with a discussion of when next visit with mom/dad will be when screaming/stomping occurs. Bring her back to her visual schedule to remind her of the activity that is happening next. When the screaming/stomping has subsided, praise her for having quiet mouth and quiet feet.

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4) Staff implement Crisis Management Plan when BD hitting or engaging in property damage. Crisis Management Plan: Free Time Reason for plan: A crisis management plan is necessary to avoid escalation of BDs problem behaviour to a point where she will hit staff and engage in property damage. Problem Behaviour Cycle: When BD has made a request that has been denied by staff, she will begin to make screaming vocalizations and stomp on the ground. This can then escalate to hitting staff and then property damage (breaking drywall, ripping molding off the walls, smashing windows, etc) Who will implement the plan: Group Home Staff Procedures: 1) When BD makes a request that staff cannot comply with at that time avoid saying the word no and present activities she can do instead. When BD chooses an activity, immediately do activity at first request. 2) If BD begins to engage in minor problem behaviours such as screaming or stomping, verbally re-direct her to an activity that she enjoys such as going for a walk, giving her deep pressure massages, or brushing her hair. 3) If BD does not calm down and attempts to hit staff, staff must block her hits using methods learned in the physical intervention training (SIVA Inc. training). Have other staff immediately move other clients out of the area. 4) If BD continues to be aggressive toward property, re-direct her to sit down and count down until she has calmed down. 5) When BD is calmer, engage her in Progressive Relaxation techniques. Monitoring and Evaluation: Free Time Level of problem behaviour: The group home staff will be provided with a daily data form that they will record the instances of problem behaviour, specifically stomping, screaming, hitting, and property damage. Level of implementation by staff: The group home staff will record anecdotal data on the use of the setting event strategies and the preventative strategies. The staff will record the level of effort that was required to implement the strategies. Social Validity: The group home staff, group home manager, and Behaviour Consultant will meet every two weeks to review the plan to discuss the implementation of the strategies and the outcomes. Revisions will be made as necessary.