Texana Center Behavior Treatment and Training Center BTTC

1
Texana CenterBehavior Treatment and Training
Center (BTTC)

• Providing expertise in changing behavior.

2
Is PBS Evidence Based Treatment for Autism?

• TxABA 2007
• Christie Enzinna, M.A., LPA, BCBA
• Behavior Treatment and Training Center (BTTC)
• BTTC Outreach Program
• BTTC Autism Treatment Day Treatment Program
• BTTC PBS Training Program

3
Texas Council for Developmental Disabilities
Request for Proposal

• Funding For Three Positive Behavioral Supports
  (PBS) Training Projects
• Funds up to 100,000 per project per year for up
  to five years

4
Results of the project

• An increase in the number of Texans who are
  trained to provide comprehensive positive
  behavioral supports on a consultative basis
  through public school districts and community
  organizations that provide supports and services
  to children and adults.

5
Project to include

• Classroom training
• AND
• Fieldwork experiences for participants

6
Training shall include but not be limited to

• Functional analysis
• Positive reinforcement
• Classroom management
• Social and communication skills
• Violence prevention
• Wrap-around services
• Person-centered and family-centered supports

7
Training shall include but not be limited to
(contd)

• Skills for developing collaboration between
  schools, families, and community members in the
  application of positive behavioral supports
• Cultural differences relevant to the community
• Ethics
• Legal considerations

8
Training shall include but not be limited to

• Functional analysis
• Positive reinforcement
• Classroom management
• Social and communication skills
• Violence prevention
• Wrap-around services
• Person-centered and family-centered supports

9
PBS Conference

• Provide training for the participants to teach
  positive behavioral supports techniques to others
  through a conference.
• Conference participants shall include parents of
  children with behavioral concerns, day care
  providers, and other community organizations who
  work with individuals with disabilities.

10
Consultants and Presenters Should be Experts in
the Field

• Proficiency does not come from reading a book or
  attending a workshop
• Knowledge base
• Supervised practice of skills
• Feedback from an exemplar
• Competency evaluation

11
Positive Behavioral Supports

• An applied science that uses educational methods
  to expand an individuals behavior repertoire,
  and systems change methods to redesign an
  individuals living environment to achieve first,
  an enhanced quality of life and, secondarily, to
  minimize problem behavior
• Carr, 2002

12
PBS Emerged from

• Applied Behavior Analysis
• Provided one element of a conceptual framework
  relevant to behavior change
• Provided a number of assessment and intervention
  strategies
• Normalization/Inclusion Movement
• Person-Centered Values
• Person-centered planning
• Self-determination
• Wraparound approach

13

• PBS has not only incorporated the elements of
  applied behavior analysis.. but has also evolved
  beyond the parent discipline to assume its own
  identity. This identity is strongly influenced
  by the realities of conducting research and
  intervention in natural community settings that
  necessitate changes in assessment methods,
  intervention strategies, and the definition of
  what constitutes a successful outcome (Carr, 1997)

14

• In the past two decades, positive behavior
  support (PBS) has emerged from applied behavior
  analysis (ABA) as a newly fashioned approach to
  problems of behavioral adaptation. Glen Dunlap

15
PBS

• Blends best practices in
• behavioral technology,
• educational methods,
• and ecological systems change
• with person-centered values
• in order to achieve outcomes that are meaningful
  to the individual and to his or her family.

16
Texas Education AgencyTEA

• Texas Behavior Support Initiative Training
  Program
• Defines PBS
• Systemic and individualized strategies based on
  an extensive body of research-based practices
• Prevention based approach for all students
• Focus on teaching academic, social and behavioral
  expectations
• Emphasis on culturally appropriate practices

17
Positive Behavioral Supports (PBS)

• PBS is a service-delivery framework
• It is not
• New (termed in the 1980s)
• Only for children
• Only for individuals with developmental
  disabilities
• An alternative for applied behavior analysis (ABA)

18
Defining PBS

• Person-centered planning
• Functional assessment
• Positive intervention strategies
• Multifaceted interventions
• A focus on the environment
• Meaningful outcomes
• Focus on ecological validity
• Systems-level intervention

19
Designing Positive Behavior Support Plans

• Assessment based
• Comprehensive, usually involving multiple
  interventions
• Proactive, involving teaching alternative skills
  and adapting the environment
• Lifestyle enhancement in inclusive settings

20
Designing Positive Behavior Support Plans (contd)

• Reflects person-centered values that honor the
  dignity and preferences of the individual
• Everyday settings using typically available
  resources
• Holds a broad view of intervention success that
  includes (a) increases in the use of alternative
  skills, (b) decreases in the incidence of problem
  behavior, and (c) improvements in quality of life

21
Goals of Positive Behavior Support

• To support people to
• Enjoy life
• Be as independent as possible
• Live a normal life
• Overcome problem behavior
• Reid

22
ABA

• The science in which procedures derived from the
  principles of behavior are systematically applied
  to improve socially significant behavior to a
  meaningful degree and to demonstrate
  experimentally that the procedures employed were
  responsible for the improvement in behavior.
• Cooper

23
ABA

• scientific research
• determines behavioral principles
• applied to treatment

24
Defining Characteristics of ABA

• Applied
• Behavioral
• Analytic
• Technological
• Conceptually systematic
• Effective
• Generality

25
Defining Characteristics

• PBS
• Person-centered planning
• Functional assessment
• Positive intervention strategies
• Multifaceted interventions
• A focus on the environment
• Meaningful outcomes
• Focus on ecological validity
• Systems-level intervention

• ABA
• Applied
• Behavioral
• Analytic
• Technological
• Conceptually systematic
• Effective
• Generality

26
Two Categories of PBS Intervention

• Interventions designed to make positive behavior
  more probable by
• Remediating deficient environmental conditions
  (stimulus-based intervention)
• Remediating deficient behavior repertoires
  (reinforcement-based intervention)

27
Stimulus-based interventions

• Interspersal training
• Expansion of choice
• Curricular modification
• Manipulation of setting events

28
Reinforcement-Based Intervention

• Functional communication training
• Differential Reinforcement of alternative
  behavior (DRA)

29
Non-PBS (Environmentally Based) Intervention

• Differential reinforcement of other behavior
• Extinction
• timeout

30
Journal of Positive Behavior Interventions
2004-2007

• Language development 2
• Social interactions 6
• Compliance to directives 1
• Academic performance 2
• Independent play skills 2
• Eliminating prompt dependency 1
• Accepting food 1
• Decreasing aggression and self-injury 4

31
Intervention Strategies

• Video modeling
• Self-management
• Task analysis
• DRO
• Social stories
• Contingency mapping
• Extinction and reinforcement

32
Parent or Staff Training

• Skills taught to the parents
• Prompting
• Reinforcement
• Responding to a childs communicative efforts
• Turn-taking
• Shaping
• Non-contingent reinforcement
• Escape extinction
• Differential reinforcement
• Scheduling and conducting discrete trial
  opportunities

• Procedures for teaching the parents
• Written information
• Modeling
• Feedback

33
Pivotal Response TrainingRobert and Lynn Koegel

• The adult provides a clear, uninterrupted
  instruction to the child while maintaining the
  childs attention
• The instructions that the adult provides vary
  frequently and maintenance tasks are interspersed
  with acquisition tasks
• The child has significant input in the selection
  of toys and activities however, adult and child
  must share control over the items and activities

34
Pivotal Response TrainingRobert and Lynn Koegel

• Rewards are functional and are administered
  immediately and contingently following the
  childs behavior
• Reinforcers are directly and naturally related to
  the childs response
• Reinforcers are administered to the child
  following clear attempts, as well as correct
  responses

35

• PBS is as much a way of thinking about people
  and their support as it is an intervention
  approach
• Glen Dunlap, Linda Bambara,
• and Ilene Schwartz in the preface of
• Positive Behavior Support Critical Articles on
  Improving Practice for Individuals with Severe
  Disabilities

36
RRTC-PBS Seven Essential Elements in PBS Training

• A collective vision and goals for intervention
• Collaboration and team building among families
  and professionals
• Functional assessments and gathering of
  information and data
• Hypothesis-driven, multi-component support plans

37
RRTC-PBS Seven Essential Elements in PBS Training

• Intervention strategies that include prevention,
  teaching, appropriate consequences, and lifestyle
  enhancements
• Monitoring and evaluation of intervention
  outcomes
• Addressing broader system issues

38
PBS on-line training

• The Kansas Institute for Positive Behavior
  Support
• http//www.kipbs.org/home.aspx
• Floridas PBS Project
• http//flpbs.fmhi.usf.edu/

39
Judith Favell, 2005

• No idea, model, method, or movement should be
  allowed to ordain what is right or wrong for an
  individual. Data can inform, advocacy can
  exhort, but at the end of the day, decisions
  regarding the issues unique to an individual
  belong as close as possible to that individual
• Page 29 in Controversial Therapies for
  Developmental Disabilities

40
Evidence-Based Treatment
41
Why is it important?

• Which will you attend?
• the 33rd Annual Convention of the Association
  for Behavior Analysis in May
• Or
• the 4th International Conference on Positive
  Behavior Support in March

42
Keynote Address by Dr. Edward Carr

• Quality of life is the foremost dependent
  variable in PBS.
• One goal of PBS is to assist in the provision of
  supports needed for individuals to live complete
  and fulfilling lives.
• Extending PBS across populations and across venues

43
Areas of Concern

• Limits the use of science
• In practical application cannot address all
  behaviors
• Utilization of emergency procedures
• Emphasis on supports and accepting people as they
  are
• Certifying people without credentials
• Making policy changes to eliminate ABA

44

• Positive Behavior support (PBS) is a great and
  worthy idea predicated on the notion that
  creating a life of quality and purpose, embedded
  in and made possible by a supportive environment,
  should be the focus of our efforts as
  professionals. Our chief concern is not with
  problem behavior, and certainly not with problem
  people, but rather with problem contexts.
• Carr, 2007

45
Response of Texas BCBAs To PBS

• Look at the TCDD Grants
• Look at TEA PBS Training
• On-going education of the public

46
Applied Behavior Analysis

• A scientific approach for discovering
  environmental variables that reliably influence
  socially significant behavior and for developing
  a technology of behavior change that takes
  practical advantage of those discoveries.

47
PBS

• A philosophical frame-work within the broader
  discipline of applied behavior analysis
• All of its defining features are true of ABA also
• The new term PBS may help present our humane
  technology and allow for better communication of
  procedures

48
What Weve Gained From PBS

• Getting ABA procedures into the schools
• Emphasis on Functional Analysis
• Emphasis on Antecedent Manipulations
• Emphasis on Reinforcement

49
Is PBS Evidence Based Treatment for Autism?

• That depends.
• Yes, if you consider it a philosophy
• frame-work within the broader discipline of
• applied behavior analysis.
• No, if you consider it some new discipline
• separate from applied behavior analysis.

50
Popularity of PBS

• PBS is a form of ABA which the public schools
  have been more receptive to because of its
  limitation in using only positive techniques
  without any of the punishment techniques
  available, and sometimes considered necessary,
  through the complete science of ABA.
• The schools also like PBS because it does not
  require extensive training or qualifications to
  be qualified to use it. Schools can send someone
  to a one day workshop and then have on staff a
  PBS trainer and save themselves the cost of a
  BCBA or BCABA.

51
Intervention TechniquesDetermine the Behavior
Change

• While the emphasis on quality of life is
  important, it is essential that the intervention
  techniques be implemented correctly in order to
  get changes in behavior. Those intervention
  techniques are from the applied behavior analysis
  research, and should be implemented and
  supervised by qualified professionals.

52

• Thank you
• christie.enzinna_at_texanacenter.com