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Module 3b

Module Script
Individualized Intensive Interventions: Developing a Behavior Support Plan

Learner Objectives

Suggested Agenda

I. Introduction to the Topic (15 min.)

II. Group Discussion: Changing How You View a Problem (10 min.)

III. Importance of PBS (15 min.)
Discussion and Video Vignettes

IV. Process of PBS Overview (10 min.)

V. Activity: Think Outside the Box (5 min.)

VI. Components of a Behavior Support Plan (15 min.)

VII. Activity: Preventing and Addressing Challenging Behavior (15 min.)
Video Vignettes & Question/ Answer

VIII. Building the Plan: Prevention Strategies (20 min.)

IX. Building the Plan: Teaching New Replacement Skills (20 min.)
Video Vignettes

X. Skill Instruction throughout the Day (20 min.)

XI. Responding to Problem Behavior (15 min.)

XII. Effective Teaming (5 min.)

XIII. Group Discussion: What Works/ What Doesn't Work (10 min.)

XIV. Team Meeting Logistics (15 min.)

XV. Developing a Behavior Support Plan as a Team (30 min.)

XVI. Case Study Activity: Developing a Support Plan (50 min.)

XVII. Monitoring Outcomes (20 min.)

XVIII. When Problem Behavior Returns (10 min.)

XIX. Activity: PBS Quiz Contest (20 min.)

XX. Summary (5 min.)

Materials Needed

I. Introduction to the Topic (15 minutes)

A. Show the agenda for the day (Slide 2), and review training objectives (Slide 3).

B. Explain that this training is for the top of the pyramid, again reminding participants that the top of the pyramid is reserved for a very few number of children who still exhibit problem behavior even when teachers have addressed the other levels of the pyramid (Slide 4).

C. What we are referring to when we say "challenging behavior" is:

1. Any repeated pattern of behavior that interferes with learning or engagement in prosocial interactions with peers and adults.

2. Behaviors that are not responsive to the use of developmentally appropriate guidance procedures.

3. Prolonged tantrums, physical and verbal aggression, disruptive vocal and motor behavior (e. g., screaming, stereotypy), property destructions, self-injury, noncompliance, and withdrawal.

D. Show slide of "when a child . . . we teach" (Slide 5).

E. Facilitate discussion on traditional forms of discipline, where they come from, and if they are sufficient. Questions to pose could include:

1. Have you ever known a child who seemed not to respond to any consequences? What was used to change the child's behavior? Why was that approach not effective?

2. Sometimes in classrooms, we decide that a particular behavior (e. g., biting) will be addressed with a predetermined response (e. g., time out). Do these approaches always work for children? When have you seen them not be effective?

3. A traditional approach to discipline in families is often spanking. Where does spanking come from in our culture? How many of you were spanked as a child? Why was spanking used? Does anyone know of a child whose parents used spanking, and it didn't seem to work? Why did you think it may not have worked?

II. Group Discussion: Changing How You View a Problem (10 minutes)

A. Introduce Positive Behavior Support (PBS) as a new way of thinking about behavior. Explain to participants that you will be asking them to think about behavior in new ways.

B. Ask participants to identify times in their lives when they were forced to think about things in a new way (e. g., realizing they needed a budget, realizing their child needed extra support, realizing they needed to plan for aging parents, realizing they had to move to a new city).

C. Ask them to provide you with the emotions and struggles they had in accepting and making change. Write those emotions and struggles on chart paper.

D. After the list is developed, summarize by noting that change is difficult and that we don't expect everyone to make changes without emotional reaction or some discomfort. For example, we will be asking people to not blame the child for problem behavior but to look at contributing factors for problem behavior. This approach can be difficult to take especially when a child has disrupted a classroom or hurt other children.

III. Importance of PBS (15 minutes)

A. Show the 8 video vignettes to demonstrate the importance of PBS (video link clips 3b. 1 on Slide 6 or video clip: Importance of Positive Behavior Support).

1. The first set of videos will show how Brendan and his family have been through many struggles prior to PBS; and it will also demonstrate the power of successful PBS.

2. Then you will observe video of Tim before and after PBS. Tim is included in a typical community preschool that utilizes school-wide PBS. The assistant director at this community preschool will share the importance of PBS in the preschool.

IV. Process of PBS Overview (10 minutes)

A. Review the process of PBS (Slide 7 and 8). Explain that the process begins with building a team, conducting a functional assessment, and conducting observations.

B. Point out that the functional process results in a hypothesis statement about problem behavior (Slides 9 and 10).

V. Activity: Think Outside the Box (5 minutes)

A. Explain to participants that the next step is developing a behavior support plan.

B. Show the directions on the "think outside the box" activity slide (Slides 11).

C. Once the answer is revealed, point out that to develop a support plan, you must "think outside the box." (Slides 12-14).

1. Explain that the next step is developing a behavior support plan and that it is important to "extend" one's thinking beyond traditional approaches and really think about the individual child.

2. When thinking outside the box, there are many variables to consider with regard to the child: curriculum, peers, relationships (in home, community, and child care), classroom (including all learning areas), home, and instruction.

VI. Components of a Behavior Support Plan (15 minutes)

A. Describe the importance of a comprehensive plan (Slide 15).

B. Show pieces of the plan, and talk about the need to develop a plan with all components.

VII. Activity: Preventing and Addressing Challenging behavior (15 minutes)

A. Show three video vignettes of children having problem behavior (link Slides 16-18 or video clip3b. 2: Preventing and Addressing Problem Behavior).

B. Write the following questions on chart paper, and let the group know that they should think about these as they view the vignette:

1. What might have prevented the situation from occurring?

2. What skills does the child not have that makes the situation difficult?

3. What might be another way for the child to get his or her needs met without using problem behavior?

4. How did the teacher/ parent respond in a way that maintained the problem behavior?

C. Show the vignettes one at a time, and ask the group to respond to the questions after viewing each vignette.

VIII. Building the Plan: Prevention Strategies (20 minutes)

A. Ask participants to think about meeting the child where he or she is. Point out that prevention strategies should be selected such that the use of the strategy makes the behavior irrelevant- that is, the prevention strategy reduces the likelihood that the child will need or want to use the problem behavior.

Stress that strategies must fit within the child's natural routines in both the classroom and at home (Slides 19-20).

B. Show descriptor slides and picture samples of different prevention strategies.

1. Choice (Slides 21-25)

a. Choice can be offered using photographs, visual cues, or objects.

b. When used as a prevention strategy, choices must be offered explicitly and personally to the child.

c. Choices should represent options of desirable activities or materials.

2. Safety Signal (Slides 26-27)

a. Make eye contact and gain the child's attention.

b. Provide a warning to the child (e. g., "5 more minutes").

c. Give the child several countdowns (e. g., "2 more times, 1 more time").

d. State the ending activity and activity to follow (e. g., "5 more minutes and then clean up").

e. Use visuals, photos, or objects to represent the next activity.

3. Visual Schedule (Slides 28-30)

a. Use photos or line drawings. Point out that the visuals chosen must correlate with the child's developmental level.

b. Depict the major activities or steps of an activity.

c. Assist the child in removing the visual once the activity is complete.

4. Visual Activity Analysis (Slides 31-32)

a. Provide visuals of the steps used within an activity (e. g., art project).

b. Child can use the visuals to complete the activity independently.

c. Some children may need to remove each visual when steps are completed.

5. Visual Guidance (Slides 33-35)

a. Provide a visual for children that highlights boundaries.

b. Use feet for line-up (each child stands on a set of footprints), carpet squares for circle time, mats for block structures.

c. Use turn-taking cues to guide children with self- management of whose turn is next.

6. Activity Arrangement: Before you start, what do you need? (Slides 36)

a. Arrange activities so that children understand the steps.

b. Have all materials accessible to eliminate wait time.

c. Demonstrate an activity before prompting children to begin.

d. Break down an activity to accommodate differing developmental levels.

e. Use partial participation— support the child who can only do one part or one step.

7. Material Accommodations (Slides 37-38)

a. Arrange activities to provide accessible materials and decrease frustration.

b. Provide enough materials for the number of children in an activity.

c. Provide adapted materials (e. g., roller paints, special scissors).

8. Scaffolding Interactions (Slide 39)

a. Move into the play situation.

b. Interpret needs of children with challenges (e. g., "Billy, do you want to build?").

c. Assist the child with turn-taking or peer entry (" Joey, can Billy build on the Lego table with you?").

d. Continue with questions or instructions until children begin playing. Try to be minimally intrusive; do only what is necessary.

e. Move out of the situation as soon as possible.

9. Show two slides of possible prevention strategies for "escape" and "obtain" behavior. Review a few examples on each slide (Slides 40-41).

IX. Building the Plan: Teaching New Replacement Skills (20 min.)

A. Show the behavior support plan slide (Slide 42) to demonstrate that you have discussed prevention strategies and that now you are going to discuss replacement skills.

B. Ask "If we can't let children use problem behavior to express their needs, how can they express them in ways that are appropriate?" (Slide 43).

1. Point out that the new skill must replace the problem behavior- alternative behavior to problem behavior.

2. Point out that the new skill must be efficient and effective.

3. Suggest that participants consider what skills the child already has that might serve as a replacement behavior.

4. Explain that participants should make sure that when the child uses the replacement skill, there is consistent positive feedback.

5. Note that participants should teach the replacement skill throughout the day when the child is NOT having the problem behavior.

C. Show the competing behavior formula (Slide 44). Explain that although we want children to meet our expectations (e. g., sit in circle), we must meet them where they are. What we don't want to do is accept their problem behavior or reinforce the problem behavior; therefore, initially we may teach a child a way to signal, using appropriate behavior, that he or she wants to leave the activity. While we do that, we will also be using the prevention strategies to make the activity more meaningful, and we will be teaching the child skills to increase his or her engagement and attention.

D. Show picture samples (Slides 45 and 46).

1. Requesting Help (link to vignette on Slide 47 or show video clip 3b. 3: Teaching Request Help )

2. Review Components of Social Stories (Slide 48) and show video clip 3b. 4 (Slide 49) Teaching with Social Story (wait/ sit nice).

3. Social Skills Instruction (Slide 50) a. Determine the skill to be taught; be specific. b. Ensure that opportunities to teach and practice the skill are available.

c. Decide on the method of instruction (think back to Module 2).

d. Provide opportunities to practice the skill during ongoing activities and routines.

e. Reinforce the skill in natural contexts.

4. Self-management (Slide 51): Helping Children Monitor Their Own Behaviors

a. Identify a behavior that the child will self-manage. b. Visually display behaviors for the child (e. g., pictures, posters).

c. Provide instruction to the child on the targeted skill.

d. Give the child a mechanism to monitor the skill (e. g., a checklist or chart).

e. Provide positive attention to the child for engaging in the behavior and using the self-monitoring system.

E. Show sample pieces of a social stories, cue cards, and goal sheet used with the child to help him self-manage his behavior (slides 52-56).

1. Explain that each cue card represented a chapter in the social story.

2. Each chapter of the social story was taught independently of the other and the teacher only moved on to the next chapter once the child had some maintenance of the skills in the chapter being instructed.

F. View video vignette on social skills instruction (link on slide 57 or show video clip 3b. 5: Teaching Social Skills).

1. The video demonstrates teaching social skills through role-playing (i. e., teaching social skills and use of social story).

2. It also shows how self-management can be taught by using cues, a simple "child-friendly" goal sheet, and a certificate.

X. Skill Instruction throughout the Day (20 minutes)

A. Review rules for teaching replacement skills (Slide 58). Point out that when we conduct instruction, we need to have a plan, and it needs to be purposeful. Ask "How will you teach the skill?"

B. Skills must be taught throughout the day. Show the activity skill matrix and how that goal may be accomplished (Slide 59). A blank matrix is provided in Handout 3b. 2.

Show two slides of list of possible replacement skills for "escape" and "obtain" behavior. Review a few examples (Slides 60-61).

XI. Responding to Problem Behavior (15 minutes)

A. Show the behavior support plan review slide (Slide 62). Indicate that the next section is strategies for responding to the problem behavior.

B. Show the responding to problem behavior slide (Slide 63). Point out that we must respond in ways that don't maintain or reinforce the problem behavior. Note that a good basic strategy is to redirect the child to use an alternative skill or a new skill:

1. Select procedures that will make the problem behavior ineffective.

2. Make sure that rewards for appropriate behavior equal or exceed rewards for problem behavior.

C. Show two slides of list of possible new responses for "escape" and "obtain" behavior. Review a few examples (Slides 64-65).

D. Show the safety-net procedures slide (Slide 66). Explain that it may be necessary to include these procedures for some children. Explain when crisis intervention strategies may be used. Give rules for safety-net procedures. Point out that these procedures keep the child and other children safe from harm- they are not intervention strategies:

1. If a child is in danger of harming himself or others, you must first be concerned about safety.

2. You may hold a child or remove a child from the situation to keep children safe.

3. Safety-net procedures should be planned for children who have a history of dangerous outbursts.

4. Safety-net procedures only keep children safe; they do not change behavior.

5. Safety-net procedures are only appropriate when there is also a full behavior support plan or intention to develop a plan. They should be designed in collaboration with the team.

E. Ask participants for examples of safety-net procedures they have used. They may be:

1. Remove the child from the room.

2. Move the class away from the child.

3. Assign an adult to shadow the child until he or she is calm.

4. Have the child sit in a thinking chair.

5. Hug the child until he or she is calm.

XII. Effective Teaming (5 minutes)

A. Point out that the behavior support plan should be developed by the team of people who interact with the child the most, including the family (Slide 67).

B. Explain that if the team is involved in the development of the plan, they are more likely to follow through with implementation and have a good understanding of the components of the plan.

C. Emphasize that team members should be involved in all aspects of the plan.

XIII. Group Discussion: What Works/ What Doesn't Work (10 minutes)

A. Using chart paper, make two columns (effective and ineffective). Ask the group to respond to the following questions, and write down their responses:

1. We have all been a part of an effective team or group. Why did you identify that group as effective? What made the group effective?

2. Think about an ineffective group. What made the group ineffective?

B. Urge participants to think about these points when forming their teams.

XIV. Team Meeting Logistics (Slide 68) (15 minutes)

A. Meet in a comfortable location.

B. Meet at times convenient for the family.

C. De-jargon the process.

D. Use the room arrangement to facilitate equal exchange.

E. Be clear about starting and ending times.

F. State the goals and agenda for the meeting at the beginning.

G. Build a "family-centered" team (Slide 69).

1. Use facilitation techniques to promote active participation (e. g., round robin, group graphics).

2. Get input from the team about problematic routines and activities.

H. Refer participants to handouts (Handouts 3b. 3a and 3b. 3b) called "Strategies for Teaming with Families in the Process of PBS" and "Positive Behavior Support Family Questions and Answers."

I. Ask participants for additional ideas that have made team meetings successful.

XV. Developing a Behavior Support Plan as a Team (30 minutes)

A. Developing a Plan

1. Use chart paper to analyze problem behavior in routines, activities, or interactions.

2. Identify the basic equation (trigger, behavior, maintaining consequence) of the problem behavior, and write it on the chart paper (Slide 70-71). (Note: you may want to prepare chart paper so that the participants can see the entire process on chart paper, rather than on the slides or overheads.)

3. Show the slide with a sample (Slide 72).

4. Identify the function of the problem behavior, and write it on chart paper (Slide 73).

5. Show the slide with a sample (Slide 74).

6. Brainstorm prevention strategies: strategies to make routines or activities easier for the child; strategies to soften the triggers (Slide 75).

7. Show the slide with a sample (Slide 76).

8. Brainstorm ideas about what new skills should be taught to replace problem behavior; write them on the chart (Slide 77).

9. Show the slide with a sample (Slide 78).

10. Brainstorm ideas about how to respond to problem behavior when it occurs; write them on the chart (Slide 79).

11. Show the slide with a sample (Slide 80).

B. Support Plan Development (cont.)

1. Review plan ideas; eliminate pieces that don't fit or are difficult for a team to do (Slide 81).

2. Review the entire plan; emphasize that each column is necessary.

3. Repeat the process for other routines, settings, or behavior functions.

4. Show the slide with general tips on behavior support plan development (Slide 82).

a. Develop plan using plain language.

b. Develop mini-plans for difficult routines.

c. Make sure the plan will fit with routines/ activities/ values of family and teachers.

d. Develop an action plan of who will produce what components needed to implement the plan.

5. Show the slides with a sample of Cassie's action plan (Slides 83-85); see handout 3b. 4 Jackson's sample behavior support plan, as an example.

6. Suggest that participants include design components that are easy to use and easy to remember.

7. Point out that the plan must accommodate competing demands on teachers and the family.

C. Plan Implementation (Slide 86). Explain to participants that when they implement a plan, they should keep the following suggestions in mind:

1. Teach classroom staff and family members how to implement strategies and how to provide reinforcement.

2. Design supports that will help the adults interacting with the child to remember the plan.

3. Be cautious about "extinction bursts." Often when implementing an intervention in which you make a child's problem behavior ineffective, the child's use of the problem behavior will get worse as the child persists at trying to get the behavior to work.

4. Ask for time to implement the plan, and assure all team members of the commitment to creating a plan that will work and that is do-able for all team members.

XVI. Case Study Group Activity: Developing a Support Plan (50 minutes)

A. Case study groups. Provide handouts to groups with hypotheses Handouts 3b. 5D, 3b. 5P, 3b. 5Q, 3b. 5S, 3b. 5SH (groups should have all materials except the final handout for each child from their activities in Module 3a: Pablo Handout 5, Dana Handout 4, Quan Handout 4, Sarah Handout 4, Sashi Handout 4).

B. Review the steps to working as a collaborative team (Slide 87) and the roles of the team members: facilitator, recorder, time-keeper, reporter, encourager, jargon buster (Slide 88).

C. Ask team members to develop a behavior support plan and a plan for teaching the replacement skill. Present the plans (Slides 89).

Note: Module 3b Presenter's Answer Guide for the "Case Study Activity: Developing a Behavior Support Plan" contains charts with guidance on the strategies typically developed for each case study child's hypotheses. They are intended to be used by the presenter only.

XVII. Monitoring Outcomes (20 minutes)

Review Process (Slide 90)

A. Monitor outcomes: KIS (Keep It Simple) (Slide 91).

B. Schedule dates for check-ins.

C. In order to successfully monitor outcomes, the team first identifies outcomes that are valued by all on the team. "User-friendly" forms are then created to monitor outcomes. Forms could include ratings scales, duration of time, and check sheets.

D. Show slide with samples of data collection (Slides 92-97).

E. Refer to Handout 3b. 6 on "Evaluating the Support Plan."

F. Revisit Jackson's plan; assess new situations; show an example of a support plan checklist (Slides 98-101).

XVIII. When Problem Behavior Returns (10 minutes)

Discuss steps to take when problem behavior returns (Slides 102 and 103):

A. The team needs to review the plan and make sure that all members on the team are following through with the plan and that it is being implemented as originally planned.

B. The team needs to review evaluation data to determine if the pattern is an extinction burst, because often problem behavior increases before it gets better.

C. The team needs to examine events to see if there are new triggers that might be contributing to the occurrence of the problem behavior.

D. The team then needs to (1) restore the support plan and implement it with fidelity, or (2) continue with the plan through the extinction burst, or (3) add components to the plan to address the new triggers, or (4) conduct a new functional assessment and develop new support strategies.

XIX. Activity: PBS Quiz Contest (20 minutes)

A. Ask for a scorekeeper and a monitor (the monitor will determine the order in which announcers stood up after a question was read).

B. Divide the group into teams (5-8 members). C. Provide each group with paper and a marker. D. Ask the group to designate a recorder and an announcer.

E. Before starting the contest, review the rules slide (Slide 104).

F. Read a question. G. When a group has the answer, its announcer should stand up (without showing the answer or shouting out).

H. Call on the announcers in the order they stood up. I. Confirm the answer with the answer slide (Slides 105-134).

XX. Summary (5 minutes)

A. Show the summary slide and review key points of the workshop (Slide 135).

B. Refer participants to handout called "Positive Behavior Support Additional Resources" (Handout 3b. 7).

C. Refer participants to "Take Home Activity."

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This material was developed by the Center on the Social and Emotional Foundations for Early Learning with federal funds from the U.S. Department of Health and Human Services, Administration for Children and Families (Cooperative Agreement N. PHS 90YD0119). The contents of this publication do not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial projects, or organizations imply endorsement by the U.S. Government. You may reproduce this material for training and information purposes.

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