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Positive Behavioral Supports (PBS) for young adults: meeting behavioral challenges in community-based settings. (Transitioning).

In greater numbers than ever before, young adults with developmental disabilities and challenging behaviors are graduating from high school alongside their peers. Most would agree that the similarities are remarkable--a new generation of self-confident and accomplished youths with the same hopes and dreams for leading successful independent lives.

Oftentimes, however, this passage into adulthood is overshadowed by uncertainties and worries. Parents of children with behavioral challenges ask: What resources and supports are available in the community? Have all the years of special education adequately prepared my child for successful life experiences in community-based settings? Who will take the role of advocate now to insure that my child's special needs are met?

With the advent and implementation of Positive Behavioral Supports (PBS) in community-based settings in our area, the majority of young adults with whom we work have proven to be capable of experiencing fulfilling lives after high school and becoming active, functional members of society. In addition to maintaining semi-independent- or independent-living situations, these young adults are productively engaged in supported employment, and participate in age-appropriate classes with their peers at day treatment centers. They participate in Special Olympics and numerous other community groups.

While many have heard the term Positive Behavioral Supports and are aware that these principles are used increasingly with children who experience challenging behaviors, the concept is relatively new in adult populations within community-based settings. Over the last seven years, our Behavior Consultation Department has experienced a high degree of success using PBS strategies to assist young adults in northern Idaho.

The University of Idaho's Center on Disabilities and Human Development (CDHD) in Moscow, ID, provides Behavior Consultation as just one option created for individuals in the state who qualify for Medicaid-funded waiver services. The waiver is designed for adults with developmental disabilities who are working toward independent living within the community. Four Behavior Consultants at the CDHD implement the PBS program that serves two counties.

What are Positive Behavioral Supports?

Positive Behavioral Supports are common-sense approaches to developing person-centered behavioral interventions. They are team-oriented and offer a simplified format for preventing challenging behavior by teaching self-management skills and replacement skills. As a result, they serve as prevention against problem behaviors that might escalate into crisis situations. Ultimately, Positive Behavioral Supports are implemented through the dynamics of team collaboration, individualized therapy and consistent follow-through in community-based settings.

Self-management skills permit young adults to communicate their needs in an appropriate and socially acceptable manner. For example, modeling the behavior of a peer or caregiver teaches an individual how to order dinner at a restaurant; the goal is for the individual to self-man age this behavior and eventually generalize its use in other restaurants in the future.

How Does PBS Work?

The Center on Disabilities and Human Development Behavior Consultation Department has devised a protocol for use of PBS with people who are transitioning into independent or semi-independent community living situations. Upon an individual's referral to the program, the Behavior Consultant (BC) obtains releases of information, and reviews the individual's personal files and historical data. Then the BC arranges a meeting with the individual's parents or guardians to gather more information and to determine strengths, needs and interests.

Over a period of several weeks before graduation, the individual is observed in school to determine strengths and needs for the future. The BC then interviews parents and teachers to collect more information about individual's learning styles and previous learning experiences, in order to incorporate existing skills into the new behavior plan.

Young adults respond best to their own specific learning styles, which instructors and peers in school and other community-based settings may have already identified. If a style is not yet established, a variety of techniques can be used to determine which works best, including visual, verbal and/or tactile modes of instruction. We recommend encouraging self-instructional methods whenever possible. Often, self-instruction and self-monitoring receive a warmer reception and foster increased self-esteem and independence. An example of a positive self instructional method is to have young adults create their own checklists for completing tasks. They can then self-monitor their progress over time with repeated use of the checklist.

After completing the initial interviews, the BC and parents or guardians form a team and devise a behavior plan that is best suited for the individual's transition from high school to the working world. Jana Schultz, a parent whose son received Behavior Consultation for two years, described the initial transition from high school to the adult world as very difficult. Jana and her son, Toby, wanted the transition process to be a team effort from the beginning. At first, she said, there were few support systems in place and the family felt it was difficult to access services without outside assistance. "There is no way as a parent that you can easily learn what services are out there and access them alone," states Schultz. She believes that families need professionals to help them access resources within the community. Fortunately, with the assistance of his high school special education teacher and his service coordinator, Toby was eventually connected with developmental disability services and the PBS program at the University of Idaho.

Sariah Mackowiak, a program coordinator for a local residential habilitation agency, works with four people who receive Behavior Consultation. She thinks that the biggest advantage of PBS is its ability to teach young adults with behavioral challenges how to self-manage negative behaviors. "It allows young adults to gain independence and promotes more positive social relationships with their peers. These factors help eliminate crisis situations and increase self-confidence, thus naturally reducing behavioral issues," says Mackowiak. PBS helps parents understand how to address behavioral issues they might have struggled with for years. "Behavior Consultation gives new perspectives on how to handle behavioral concerns in the home or out in the community," states Mackowiak.

PBS and Self-Management

PBS supports people with DD in self-managing their behaviors and strives to reduce societal barriers to attaining independence and happiness. While many settings for young adults with challenging behaviors are inclusive or community-based, certain obstacles and stereotypes still undermine the rights and dignity of these individuals. The long-standing "medical model" generally sees the person as the "problem." This approach focuses on "fixing" the individual with a program of consequences and punishment. The medical model in this context is both outdated and potentially harmful.

To fulfill the special needs and desires of individuals with disabilities who experience challenging behavior, it is often necessary to change the environment in which the individual lives and works. "In my experience working with high school students," explains Jerry Hartstein, special education teacher at Moscow (ID) high school, "consistent follow-through of PBS guidelines has had a major positive effect on a student's ability to hold a job and be successful in community-based workplaces."

Hartstein says team collaboration with PBS personnel insures that consistency is maintained in school, home and work environments. When teachers, staff, job coaches and therapists are clear on behavior goals and objectives, students are able to understand and meet expectations. "Ultimately, students reap the rewards. They are happier and can participate more fully in all aspects of their lives in the community," he explained. When discussing students who have benefited from PBS, Hartstein identified Shahna Sprecher, who graduated eight years ago and has been receiving Behavior Consultation for the last six years. "She is doing better than ever out of school," he said.

Shahna, who has Down syndrome, experienced a smooth transition from high school to community-based living. "It was both challenging and exciting for her," said her mother, Leah. "The supports she received with behavioral issues in high school helped her prepare psychologically to go out into the world of work." Today Shahna receives two hours of Behavior Consultation a week, lives at home with her mother, maintains a part-time job, and attends a day treatment center with her peers. According to her mother, Positive Behavior Supports have been a tremendous help.

Shahna has benefited most by responding more positively to new situations as they arise. She makes eye contact now, and asks for what she needs instead of suddenly running away and compromising her safety. According to Shahna's mother, she is learning responsibility and consistency. "She has learned what to do in order to stick with things. Over the years, personality changes and new social skills have helped her to relate better to others," explains Leah Sprecher.

Behavioral Intervention Plans

Behavioral intervention plans, which are created by the Behavior Consultant with input from the team and family, contain concise, measurable goals and objectives. These plans provide guidelines for practical and attainable implementation. The PBS intervention plan calls for individualized behavioral therapy sessions and application of PBS strategies by both the Behavior Consultant and community service providers.

In the therapeutic setting, instructional methods are highly individualized and cover a broad spectrum of topics. Individual behavior consultation sessions of one-on-one time between the young adult and the Behavior Consultant ideally range from two to six hours per week. Subjects include training in social pragmatics, self-management, problem-solving and communicating emotions appropriately. Other self-management techniques are also taught, to help reduce stress and anxiety or to develop and nurture creative expression.

Multifaceted behavior plans are created, emphasizing the return of control and responsibility to the young adult. Simple strategies are employed to set the person up for success and to encourage positive, self-directed choices that become new habits. Ultimately, replacement behaviors shape new worlds for young adults with challenging behaviors by infusing them with unprecedented feelings of self-reliance and self-worth.

One young man, who experiences learning disabilities and is currently on probation, says he is much happier since he began receiving Behavior Consultation two years ago. "Positive Behavioral Supports have helped me keep out of trouble. During therapy, I have someone to talk to about my problems and figure out ways to resolve them without getting angry. It keeps me focused on my responsibilities," he said. "The monthly team meetings are really helpful and keep everyone on track."

PBS Self-Development Techniques

After years of working with adults with developmental disabilities, we noted an area of training that seemed to be most neglected and least understood, a muitifaceted component called self-development. In our practice, we have found that fostering self-development through direct therapeutic techniques has proven to be a valuable key to successful and long-lasting outcomes. We have also noted that incidents of challenging behaviors and the need for crisis intervention decrease dramatically by combining team collaboration and ongoing weekly behavioral therapy.

Self-development serves as an umbrella under which these PBS skill areas of self-management are found: problem solving, expression of feelings and emotions, social pragmatics and self-management of daily living skills. Below we present samples of four of the techniques we have used successfully. Other techniques we have found to be successful for young .adults and their families include positive self-talk, stress reduction techniques and creative exploration through the arts.

PROBLEM-SOLVING

A key element in problem-solving is getting the young adult's input in whatever fashion necessary and encouraging his/her proposals for solutions. Problem-solving can occur successfully with adults in a verbal, written or pictorial format that provides a narrative and/or visual documentation of a behavioral episode. If a written review is used, the parent or BC can follow it with a problem-solving discussion if warranted. The discussion should outline techniques for self-management, and offer helpful suggestions for coping with a similar problem in the future. Problem-solving in this manner encourages a repertoire of new skills to resolve internal and external stressors and conflicts appropriately.

PROBLEM-SOLVING: THINGS TO REMEMBER

* Respond quickly if crisis behaviors occur.

* Interview individuals who were pre sent at the occurrence of the challenging behavior.

* Use a communication format that works best for your child and the team (verbal, written, visual).

* Use the creative process to solve problems.

* Involve your son or daughter as much as possible in the problem-solving process.

FEELINGS AND EMOTIONS

Most of us agree that stress, psychological conflict and/or an inability to express negative feelings have an unhealthy impact on us. Inhibiting emotions or failing to discuss a stressful event is a common occurrence. A Positive Behavioral Supports program can address the cause-and-effect relationship between the occurrence of challenging behaviors and expression of emotions. Thus, preventive measures and solutions can be developed for the person in transition from high school to the adult world.

Fostering self-awareness through talking, writing or creating an artistic rendering of concerns and problems can help individuals feel better about themselves and reduce anxiety. In addition, we have seen encouraging results when teaching problem-solving, coping skills and self-management techniques simultaneously with the "feelings" work.

FEELINGS AND EMOTIONS: THINGS TO REMEMBER

* When left unexpressed, negative feelings and emotions can contribute to illness, accidents and challenging behaviors. Teach your child about the wide range of feelings and emotions.

* Help the individual understand the differences among feelings. Teach ways to express an emotion appropriately.

* Encourage people to express their emotions by talking, writing, using sign language or drawing pictures of what they are feeling.

* Help your young adult to discover the intent of the potential conflict and find positive alternatives for expressing stress and anxiety.

* Provide a safe opportunity for self-disclosure of feelings and emotions. Take time out to discuss these important issues as often as possible.

Social Pragmatics

Social pragmatics are social skills or interactions between speaker and listener that use words or expressions in a social context. Social pragmatics use experiential training to instill new concepts and are often highly successful in supporting the generalization of material.

SOCIAL PRAGMATICS: THINGS TO REMEMBER

* Use consistent, respectful and very specific feedback.

* Use role modeling in community based settings in which social pragmatics are to be developed.

* Encourage self-management skills and inclusion in society. Skill areas are individualized and may include maintaining eye contact, sitting up straight, developing a well-modulated tone of voice, learning how to read the facial expressions and body language of others accurately and thinking before speaking.

* Feedback is essential and is best given verbally along with a behavioral checklist. This checklist works best when created with the young adult. It should be reviewed before and immediately after the social context in which it is to be used.

* Both positive and constructive feedback should be provided.

Self-Management of Daily Living

In order to develop healthy lifestyles in community-based settings, people must be given opportunities to make personal decisions about the direction in which their lives are headed. Individuals experience an increased sense of autonomy and tend to be more productive and happy when provided predictable and consistent opportunities in which to make choices and self-monitor activities.

STEPS TO SELF-MANAGE ACTIVITIES OF DALLY LIVING SUCCESSFULLY:

1. Make sure the activity is clearly presented and can be initiated at a set time and with a specific behavioral expectation.

2. Use something tangible, such as a behavioral check sheet, for self-monitoring. Your child must be able to see clearly when he or she has accomplished the task at hand.

3. Agree to expectations and a schedule for completion before beginning self-management tasks.

4. Provide an opportunity for self-evaluation and feedback.

5. Use a self-monitoring form to write down areas in which improvement has taken place. Review accomplishments regularly and provide consistent positive verbal reinforcement.

6. Set goals for future activities.

STEPS FOR OBTAINING SERVICES DURING TRANSITION FROM HIGH SCHOOL:

1. Contact your local Developmental Disabilities Program or other state agency (e.g., Department of Health and Welfare or Department of Health and Human Services) to find qualified staff within the community.

2. Obtain additional contact information through the school district's main office, special education teachers or other special resource instructors. School personnel should be able to help with your child's transition and to assist with identifying resources that provide Positive Behavioral Supports or similar programs in your area.

3. Set up interviews to be conducted by you and your child to meet area service providers who would be the best "fit."

4. Upon initial referral, provide historical data about your child's disability to service providers.

5. Outline strengths, interests and needs of your child for service providers before meeting with them.

6. Find a trusted advocate such as a case manager, service coordinator or behavior consultant.

7. Once services are in place, set up regular monthly team meetings to insure consistency and follow-through in community-based settings.

8. Develop a Positive Behavioral Supports intervention plan.

9. Set up weekly sessions for your child with a behavior specialist if needed.

RESOURCES

Positive Behavioral Supports for Adults: A hands-on training manual for Behavior Consultants and other professionals working with persons with challenging behaviors.

The manual is a practical guide to working with adults with potentially challenging behaviors in an array of settings. Included are detailed instructions for formulating behavior plans, functional assessment of behavior protocols, and 47 reproducible forms for hands-on therapeutic activities. The manual is also helpful for parents as a resource guide. CDHD is offering the manual for half price ($20, including S&H) to Exceptional Parent readers. Please order before August 31, 2002.

To obtain a copy of the manual or to learn more about Positive Behavioral Supports for adults, contact:
Kimberly Brown Campbell or
Celia Flinn
University of Idaho
Center on Disabilities and
Human Development
129 W. Third St.
Moscow, ID 83843
(208) 885-3554
E-mail: behavcon@uidaho.edu


This article is dedicated in memory of Jean E. Overholt-Emery, MEd, for her many years of service and devotion to the fields of special education and service coordination for individuals with developmental disabilities.

Julie Fodor, PhD, serves as the Executive Director of the Center on Disabilities and Human Development (CDHD) at the University of Idaho. She is also the Director of the Positive Behavioral Supports project that serves individuals of all ages with challenging behaviors.

Kimberly Brown Campbell, MA, holds a master's degree in art therapy. She currently works as a Behavior Consultant at the CDHD, is an art therapist and administrator at a children's mental health clinic, and maintains a private practice.

Celia Flinn, MEd, has provided clinical services for adults with developmental disabilities for 20 years. She currently serves as the Coordinator of the Behavior Consultation Department at the CDHD.
COPYRIGHT 2002 EP Global Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2002 Gale, Cengage Learning. All rights reserved.

 
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Author:Fodor, Julie; Campbell, Kimberly Brown; Flinn, Celia
Publication:The Exceptional Parent
Date:May 1, 2002
Words:3028
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