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Competing Pathways Diagram

VIEWS: 11 PAGES: 25

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Family Ecology Assessment, Functional Assessment, and Positive Behaviour Support Plan, and

               Implementation Support Plan for a Dinner Preparation Routine

                                 Corine van Staalduinen

                                        EPSE 514

                                     Dr. J. Lucyshyn

                                      April 21, 2008
                                                                                            2


                               Family Ecology Interview

1. What would you characterize as the strengths of your family?

   They have access to some great resources (see question 3).
   Mom receives strength from her spirituality; she is also good at multi-tasking.
   Dad has a great ability to always stay calm and logical. He is also very good with
   technology (computers) and is very interested in science.

2. What might be some positive contributions that your child makes or has made to the
   family?

   G.V. is very popular. He is loving and funny. His parents met some wonderful people
   through him. He has made his parents stronger and they have a different perspective on
   what is truly important in life.

3. What formal or informal resources have you used to improve the situation (e.g. respite
   care; help with child-care and household chores from other family members; participation
   in a parent support group)?

   G.V. goes to a wonderful daycare three times per week, where his day care providers
   work on his endurance, language, and play skills. They live in an apartment building and
   have access to the conference room to use as a therapy room whenever they need it. They
   have been helped by the Infant Development Program and G.V. is on the waiting list for
   physiotherapy and occupational therapy at the Centre for Ability.

4. What are you sources of social support (e.g. someone with whom you discuss problems
   and find solutions; someone with whom you do leisure activities; someone who validates
   your worth as a person?)

   They discuss problems with each other and they validate each others’ worth. They also
   have some good friends who are their source of social support. They usually take turns
   going out. Mom does martial arts as a leisure activity. Mom is Japanese and her family
   lives in Japan and dad has limited or no contact with his family.

5. What are sources of stress in your family?

       a. What is the effect of your child’s problem behaviours on you as a parent?

           They both have felt hopeless. Mom was hospitalized for some time for depression.
           They have stopped traveling, because it is impossible to travel with G.V. due to
           his problem behaviour. They have also felt judged by other people, especially
           when taking G.V. into the community. They have lost many friends and only their
           true friends are still there for them.
                                                                                             3


       b. What is the effect of your child’s problem behaviours on the family as a whole?

           They don’t go out into the community as often as they would like. Nobody can get
           a good night’s sleep because of G.V.’s problem behaviour. G.V. also frequently
           pushes his little brother over to get his parents attention.

       c. What are other sources of stress in the family?

           Dad has a physical disability and he is able to do less then a third of what he used
           to be able to do. They also have financial problems, which causes a lot of stress.

6. What are you goals for you child? What are your goals for yourself as a parent? What are
   your goals for the family as a whole?

   Their goal for G.V. is for him to reach his full potential. It is mom’s dream to be able to
   have a conversation with G.V. one day about his day. It is dad’s goal to get brain surgery
   one day for his disability. Mom’s goals are to go back to work, to improve her martial
   arts skills, and to run a mini-marathon. She would also like to become a more positive
   person. They would like more opportunities to spend time in the community as a family.
                                                                                           4


                         Family Ecology Assessment Summary

1. Family Strengths

   Dad – Calm, logical personality. Great with technology and loves science.
   Mom – Spirituality and multi-tasking


2. Family Resources/ Social Supports

   Resources – Daycare, Infant Development Program, Centre for Ability. Two behaviour
   interventionists. Access to a room for G.V.’s therapy sessions.

   Social Supports – They have each other and a few good friends.


3. Stressors

   G.V.’s problem behaviour, other people’s negative judgements, dad’s physical disability,
   financial strain, sleeping problems, and G.V.’s aggressive behaviour towards his
   younger brother.


4. Child and Family Goals

   Goals for G.V. are to improve his behaviour and language skills so that he can reach his
   full potential. Dad would like to get surgery for his disability and mom would like to go
   back to work, improve her martial arts skills, run a mini-marathon and become a more
   positive person. The family would like to spend more time in the community together.


5. Problematic Valued Routines

   1) Sleeping routine
   2) Dinner preparation routine
   3) Community outings (e.g., shopping, going for walks, going to the park)


6. Prioritize Routines for Intervention

   We will target the dinner preparation routine for intervention now and focus on the
   sleeping and community routines later.
                                                                                             5


                         Family Vision of a Successful Routine

                               Dinner Preparation Routine

1. Time/Place:

   From 5:00PM to 5:45PM, G.V. is expected to play by himself or with his dad while
   his mom prepares dinner in the kitchen.

2. People:

   Usually mom, dad, G.V. and his younger brother are home at this time.


3. Resources:

   People:
   Behaviour interventionists will be able to teach independent play skills.
   Day care staff will also be able to target independent play skills.
   Dad will help G.V. to play with his toys during dinner preparation routine.

   Materials:
   Day care staff will use toys from day care to teach independent play skills.
   Behaviour interventionists will use toys from home to teach independent play skills –
   puzzles, shape sorter, books, Mr. Potato Head, blocks, and cars.
   Toys that G.V. has been taught to play with during behaviour intervention session will be
   used during the dinner preparation routine.

4. Tasks (Child and Family):

   Mom will cook dinner and G.V. and his younger brother will independently engage in
   parallel play in the living room without any problem behaviour. G.V.’s younger brother
   is only 14 months old and not developmentally ready to engage in cooperative play.
   When he is older, the parents would like the two brothers to also engage in some
   cooperative play.


5. Goals/Values:

   It is important to the parents that G.V. learns some independent play skills, so that he can
   entertain himself when necessary. It is also important that he and his brother are both
   safe and happy.
                                                                                                      6


                                     Family Ecology Summary

       G.V. is a popular, fun-loving child. He makes friends everywhere he goes and his parents

have met a lot of wonderful people through him. However, mom and dad experience a large

amount of stress due to G.V.’s problem behaviour. They experience a lack of sleep on a daily

basis and are not able to go out into the community or travel as much as they used to. Some other

sources of stress are their financial difficulties and dad’s physical disability. Nonetheless, they

have managed to cope with the support of each other and a few good friends. They receive

respite care three days per week by means of a wonderful day care. They feel more positive and

hopeful for G.V.’s future now that he has been diagnosed with autism and he is receiving early

intervention. Their goal for G.V. is for him to reach his full potential.

       It is important to keep the family’s financial difficulties and dad’s physical disability in

mind when designing a positive behaviour support plan. The family cannot be expected to

purchase any materials and dad would not be able to engage in gross-motor play with G.V. or sit

down on the floor to play with him. Therefore, only materials that the family already owns (i.e.

toys) or that can be purchased with autism funding will be used. In addition, when dad is helping

G.V. to play with his toys, dad will sit on a chair and G.V. will be seated at a table.

       Dad’s logical personality and interest in science make it easy for him to understand the

laws of behaviour. Therefore, he will be a great asset during the dinner preparation routine. He

will be able to teach G.V. independent play skills and let mom know when she needs to reinforce

G.V. Mom’s ability to multi-task will also be an asset during the routine. She will have to be able

to prepare dinner and regularly reinforce G.V. with a few minutes of play time with mom.
                                                                                                   7


       A long-term goal is to empower G.V.’s parents and increase their confidence by

providing them with the skills to handle G.V.’s behaviour in home routines as well as out in the

community.
                                                                                                                        8

                                 FUNCTIONAL ASSESSMENT INTERVIEW (FAI)

      Person of concern         G.V.                                     Age       4                        Sex          Male

      Date of interview         Feb 6 and Feb 13 2008                    Interviewer          Corine van Staalduinen

      Respondents               Mom and Dad


     A.         DESCRIBE THE BEHAVIORS.

           1.   For each of the behaviors of concern, define the topography (how it is performed), frequency (how
                often it occurs per day, week, or month), duration (how long it lasts when it occurs), and intensity (how
                damaging or destructive the behaviors are when they occur).

            Behavior         Topography                            Frequency           Duration            Intensity (out of 5)

      a.    Leaving the      Getting out of bed, opening the       3-4 times per       1 minute            3
            bedroom          door and walking into living room     night

      b.    Vomiting         Stomach contents coming out of        1 time per          Less than 1         5
                             mouth                                 month               minute

      c.    Crying           Tears coming down face                5-15 times          1-5 minutes         4
                                                                   per day

      d.    Screaming        Loud sound coming from mouth          5-15 times          Short bursts,       3
                                                                   per day             lasting 1-2
                                                                                       seconds
      e.    Destructive      Pulling items from                    1-2 times per       Lasts until         If there is company:
            behaviour        shelves/drawers/ tables.              day                 reprimanded or      5
                             Breaking/damaging items.                                  given time-out      If there is no
                             Pushing items over                                                            company: 2

      f.    Self-injury      Hitting head with open or closed      6 times per         Approximately 10    Dad: 2
                             hands. Banging head against floor     day                 seconds             Mom: 4
                             or wall.

      g.    Physical         Hitting, kicking, pushing,            Dozens of           Until brother       Usually 4, and 5 for
            aggression       scratching, eye-poking towards        times per day       screams (10         eye-poking and
                             his younger brother.                                      seconds)            kicking in stomach.

      h.    Running          In the community, running away        At least 1          Less than 1         3.5
            away             from the person who is                time per day        minute
                             accompanying him

1.   Which of the behaviours described above are likely to occur together in some way? Do they occur about the
     same time? In some kind of predictable sequence or 'chain"? In response to the same type of situation?

     Self-injury usually occurs together with crying and screaming, although not always in a predictable order.
     Physical aggression usually occurs together with crying and screaming, but again not always in a predictable
     order.
     Crying will always precede vomiting, but vomiting does necessarily always occur after crying.
                                                                                                                      9

B.DEFINE ECOLOGICAL EVENTS (SETTING EVENTS) THAT PREDICT OR SET UP THE PROBLEM
BEHAVIORS.

1.   What medications is the person taking (if any), and how do you believe these may affect his or her behavior?

     none

2.   What medical or 'physical conditions (if any) does the person experience that may affect his or her behavior
     (e.g., asthma, allergies, rashes, sinus infections, seizures, problems related to menstruation)?

     G.V. has autism. He has poor muscle tone that impairs his ability to walk and chew. It also impairs his ability
     to engage in fine motor tasks. Therefore, he is easily frustrated during fine motor tasks and may cry, scream, or
     engage in self-injury. He has some sensory problems and does not feel pain to the same extent as other
     children. Thus, he may not cry when he gets hurt. He is allergic to cats and dogs and he does not have any food
     allergies. When his allergies are acting up, he is more irritable.

3.   Describe the sleep patterns of the individual and the extent to which these patterns may affect his or her
     behaviour.

     G.V. seems to fight going to sleep. He goes to bed at 7 and his dad sleeps with him. G.V. wakes up 3-4 times
     every night and wakes up at 5-5:30 AM. Dad tries to keep him in his room as long as possible. G.V. is often
     tired. He takes a 1-2 hour nap during the day, except when he goes to day care. When G.V. is tired, he is more
     easily frustrated and is more likely to engage in any kind of problem behaviour.

4.   Describe the eating routines and diet of the person and the extent to which these may affect his or her behavior.

     Big breakfast around 7 A.M. G.V. often does not eat lunch. He eats healthy snacks and some treats throughout
     the morning and afternoon. He eats dinner around 4:30-5 PM. His parents try to keep him away from pastries
     because it aggravates his problem behaviour.

5.   Briefly list below the person's typical daily schedule of activities. (Check the boxes by those activities the
     person enjoys and those activities most associated with problems.)

     P = Problem behaviour
     NP = Usually no problem behaviour


      P     NP      Monday/ Tuesday/Thursday            P   NP        Wednesday/ Friday

                 6:30-7:30 Wake up                                  6:30-7:00 Wake up
                 7:30-8:00 Breakfast                                7:30-8:00 Breakfast
                 8:00-8:30 Dressed                                  8:00-8:30 Dressed
                 8:30-9:00 Drive to day care                        9:00-11:00 Intervention
                 9:00-3:30 At day care                              11:00-1:00 Nap
                 3:30-3:45 Drive home                               1:00-3:00 Intervention
                 3:45-4:30 Play time                                3:00-4:30 Play time
                 4:30-5:30 Dinner                                   4:30-5:30 Dinner
                 5:30-6:00 Bath                                     5:30-6:00 Bath
                 6:00-6:30 T.V./Play                                6:00-6:30 T.V./Play
                 6:30-7:00 Sleep                                    6:30-7:00 Sleep
                                                                                                                      10

P     NP     Saturday                                  P    NP      Sunday
            6:30-7:00 Wake up                                     6:30-7:00 Wake up
            7:30-8:00 Breakfast                                   7:30-8:00 Breakfast
            8:00-8:30 Dressed                                     8:00-8:30 Dressed
            9:00-12:00 Japanese class                             8:30-10:00 Play time
            12:00-12:30 Drive home                                10:15-11:30 Gym
            12:30-1:00 Lunch                                      11:30-12:00 Lunch
            1:00-3:00 Nap                                         12:00-3:00 Nap
            3:00-4:30 Play time                                   3:00-4:30 Play time
            4:30-5:00 Dinner                                      4:30-5:00 Dinner
            5:30-6:00 Bath                                        5:30-6:00 Bath
            6:00-6:30 T.V./ Play                                  6:00-6:30 T.V./ Play
            6:30-7:00 Sleep                                       6:30-7:00 Sleep

5b. To what extent are the activities on the daily schedule predictable for the person, with regard to what will be
    happening, when it will occur, with whom, and for how long?

     His weekly schedule is the same every week. He is told verbally what he will be doing that day and his receptive
     language is very good. However, he is not very aware of the days of the week. From G.V.’s point of view, his
     schedule may not be very predictable. He likely understands where he is going and what he’ll be doing next, but
     it is unlikely that he understands what he will be doing later on in the day, or the next day.

5c. To what extent does the person have the opportunity during the day to make choices about his or her activities
    and reinforcing events? (e.g., food, clothing, social companions, leisure activities)

     Parents try to incorporate choice throughout the day. He is given two choices for the clothes he wears, his
     snacks, which cup he wants to drink from etc.

6.   How many other persons are typically around the individual at home, school, or work (including staff,
     classmates, and housemates)? Does the person typically seem bothered in situations that are more crowded and
     noisy?

     Usually four other people: mom, dad, brother, and a “nanny” who helps with child care. At day care there are
     approximately 10 other children and two staff persons. Crowding does not seem to bother G.V. but loud sudden
     noises occasionally startle him.

7.   What is the pattern of staffing support that the person receives in home, school, work, and other settings (e.g.,
     1:1, 2:1)? Do you believe that the number of staff, the training of staff, or their social interactions with the
     person affect the problem behaviours?

     G.V. gets ABA therapy 8 hours per week and staffing is 1:1. At day care there are 3 day care providers for
     approximately 10 children, but usually he gets 1:1 attention there as well. The number of staff affects G.V.’s
     problem behaviour if he does not get enough attention.

C. DEFINE SPECIFIC IMMEDIATE ANTECEDENT EVENTS THAT PREDICT WHEN THE
BEHAVIORS ARE LIKELY AND NOT LIKELY TO OCCUR.

1.   Times of Day: When are the behaviours most and least likely to happen?

     Most likely: After day care
     Least likely: After a nap

2. Settings: Where are the behaviours most and least likely to happen?

     Most likely: At home, in the community, in the car with mom, brother, and dad.
                                                                                                                        11

     Least likely: In the car with dad, at day care, during intervention

3.   People: With whom are the behaviors most and least likely to happen?

     Most likely: With mom and brother
     Least likely: With dad

4.   Activity: What activities are most and least likely to produce the behaviours?

     Most likely: Any independent play, fine motor activities, going shopping, travelling by airplane.
     Least likely: During physical play (getting rocked, tickled) with mom or dad

5.   Are there particular or idiosyncratic situations or events not listed above that sometimes seem to 'set off' the
     behaviors, such as particular demands, noises, lights, clothing?

     Demands sometimes set off problem behaviour. Noise used to result in problem behaviour but this is not a
     problem anymore. Change often sets off problem behaviour, for example when mom changes her own clothes
     during the day.

6.   What one thing could you do that would most likely make the undesirable behaviours occur?

     Mom going into the kitchen and leaving G.V. with his younger brother in the living room.

7.   Briefly describe how the person's behavior would be affected if. .

          a. You asked him or her to perform a difficult task.

          Saying no, crying, throwing a temper tantrum, self-injury.

          b. You interrupted a desired activity, such as eating ice cream or watching TV.

          His behaviour is not too bad.

          c. You unexpectedly changed his or her typical routine or schedule of activities.

          He will do anything to make it go back to normal (any problem behaviour).

          d. She or he wanted something but wasn't able to get it (e.g., a food item up on a shelf).

          He will point or reach for it, and maybe ask for help. If he does not get help, or If he is not allowed to have
          it he will scream and cry. If the item is promised for later or if he gets something else instead the behaviour
          is not as bad.

          e. You didn't pay attention to the person or left her or him alone for a while (e.g., 15 minutes).

          Smack his brother, scream, cry, push things off shelves, and break things.
                                                                                                                          12

      D. Identify the consequences or outcomes of the problem behaviours that may be maintaining them (i.e. the
      function they serve for the person in particular situations).

      1.   Think of each of the behaviours listed in Section A, and try to identify the specific consequences or outcomes
           the person gets when the behaviours occur in different situations.

     Behaviour       Particular situations                    What exactly                               What exactly
                                                              does he or she get?                        does she or he avoid?
a    Leaving the     When parent leaves bedroom/ when         Parent comes back and stays with           Sleeping alone
     bedroom         parent is not there when G.V. wakes      G.V. until he falls asleep again
                     up
b    Vomiting        After crying for a long time upon        Parents put him in the shower, change      Sleeping alone
                     finding out that parent is not in        him and stay with him afterwards
                     bedroom anymore
c.   Crying          Demands                                                                             Demands often get
                                                                                                         removed
d.   Crying          Mom in kitchen                           Positive attention (hugs)
                     Mom playing with brother
e.   Screaming       Demands                                                                             Sometimes demands are
                                                                                                         removed after screaming
f.   Screaming       No attention                             Verbal reprimand or mom starts
                                                              playing with him
g.   Destructive     No attention, especially when not        Verbal reprimand (attention is primary     When there is company,
     behaviour       getting attention when there is          function)                                  they sometimes leave;
                     company                                                                             time-out also results in
                                                                                                         avoiding company
                                                                                                         (secondary function)
h.   Self-injury     No attention                             May result in positive attention (hugs),
                                                              physically hold his hands.
i.   Self-injury     Parent leaving                           Positive attention (primary function)      Parent may take longer to
                                                                                                         leave (secondary function).
j.   Self-injury     Demands                                  May result in positive attention (hugs),   Demands sometimes get
                                                              physically hold his hands.                 removed
k.   Physical        No attention and little brother is       Verbal reprimand, verbal redirect,
     aggression      nearby                                   physical redirect, parent plays with
                                                              G.V. (attention).
l.   Running         Walking to car in parking garage.        Getting chased (attention). Yelling
     away            Paying at store. In hallways in the      “come back”.
                     apartment building.                      Promise of treat.

      E. Consider the overall efficieny of the problem behaviours. Efficiency is the combined result of (a) how much
      physical effort is required, (b) how often the behaviour is performed before it is rewarded, and (c) how long
      the person must wait to get the reward.

                                                    Low                                                       High
                                                 Efficiency                                                 Efficiency
       Leaving bedroom                                1              2             3              4            5
       Vomiting                                       1              2             3              4            5
       Crying                                         1              2            3              4              5
       Screaming                                      1              2            3              4              5
       Destructive behaviour (with dad)               1              2            3              4              5
       Destructive behaviour (with mom)               1              2             3              4            5
       Self- injury                                   1              2            3              4              5
       Physical aggression (with dad)               1               2             3              4              5
       Physical aggression (with mom)                 1              2             3              4            5
                                                                                                                                                                                                                                                                                                                                                 13

    Running away (to get attention)                                                                                                    1                                            2                                3                                          4                                                       5
    Running away (to get food)                                                                                                        1                                            2                                3                                          4                                                        5

   F. What functional alternative behaviours does the person already know how to do?

   1.   What socially appropriate behaviours or skills can the person already perform that may generate the same
        outcomes or reinforcers produced by the problem behaviours?

        Uses some words (mommy, daddy, sit here, yes, no) and lots of gestures (pointing, nodding, shaking head).

   G. What are the primary ways the person communicates with other people?

   1.   What are the general expressive communication strategies used by or available to the person? These might
        include vocal speech, signs/gestures, communication boards/books, or electronic devices. How consistently are
        the strategies used?

        Mainly problem behaviour, some words and gestures

   2.   On the following chart, indicate the behaviors the person uses to achieve the communicative outcomes listed:

Communicative
                            Complex speech (sentences)




Functions
                                                         Multiple-word phrases




                                                                                                                                                                                                                                                                                                                                                 Aggression (pinching)
                                                                                                                                                                                                                                                                                         Moves away or leaves
                                                                                 One-word utterances




                                                                                                                                                                                                                                           Increased movement
                                                                                                                                                                                                                                                                    Moves close to you




                                                                                                                                                                                                                                                                                                                             Facial expression
                                                                                                                                       Complex signing
                                                                                                                   Other vocalizing




                                                                                                                                                                                                           Grabs/reaches

                                                                                                                                                                                                                           Gives objects
                                                                                                                                                                                             Shakes head
                                                                                                                                                         Single signs




                                                                                                                                                                                                                                                                                                                Fixed gaze




                                                                                                                                                                                                                                                                                                                                                                         Self-injury
                                                                                                       Echolalia




                                                                                                                                                                        Pointing
                                                                                                                                                                                   Leading




                                                                                                                                                                                                                                                                                                                                                                                       Other
Request attention                                                                                                                                                                                                                                                                                                                                            
Request help                                                                                                                                                                                                                                                  
Request preferred                                                                                                                                                                                                                                                                                         
food/objects/ activities
Request break                                                                                                                                                                                                                                                                                                                                                       
Show you something                                                                                                                                                                                                                                                                                          
or some place
Indicate physical pain                                                                                                                                                                                                                                                                                                      
(headache, illness)
Indicate confusion                                                                                                                                                                                                                                                                                                                                                   
or unhappiness
Protest or reject a                                                                                                                                                                                                                                                                                                                                                
situation or activity

   3.   With regard to the person's receptive communication, or ability to understand other persons . . .

        a. Does the person follow spoken requests or instructions? If so, approximately how many? (List if only a few.)

          Can follow simple instructions

        b. Does the person respond to signed or gestural requests or instructions? If so, approximately how many? (List
           if only a few.)

          Signs – more, break
                                                                                                                                 14

               Words – help, more, break, sit here, open, out, up, down, candy, smartie, playdo, hot, cold, mom, dad, yeah,
               no. He has more words but these are ones I hear consistently in his therapy session. He probably has
               approximately 30 words that he uses quite consistently.

          c.     Is the person able to imitate if you provide physical models for various tasks or activities? (List if only a
                 few.)

               Can follow any simple imitations. Trouble with chains.

          d.     How does the person typically indicate yes or no when asked if she or he wants something, wants to go
                 somewhere, and so on?

                He says no and shakes his head to indicate no. He says yeah/yes and nods to indicate yes.

H. WHAT ARE THINGS YOU SHOULD DO AND THINGS YOU SHOULD AVOID IN WORKING WITH
AND SUPPORTING THIS PERSON?

1.        What things can you do to improve the likelihood that a teaching session or other activity will go well with this
          person?

          1:1 staffing, predictability, get his attention first, keep teaching activity simple and short, make sure he has a
          nap before and that he did not just eat a big meal (he is calmer after a nap and more motivated by food
          reinforcers if he is not full).The activity will go better when he can choose what he is working for and when he
          can choose from a number of reinforcers. Choice in general works well (e.g., letting him choose where to sit,
          which activity to do first, etc.)

2.        What things should you avoid that might interfere with or disrupt a teaching session or activity with this
          person?

          Any interruptions are bad because he loses focus quickly. Complex language should be avoided as well. Not
          letting him take breaks is not a good idea, after he asks for a break you should give him a break within a
          reasonably short amount of time.

     I. WHAT ARE THE THINGS THE PERSON LIKES AND ARE REINFORCING FOR HIM OR HER?

          1.    Food items: candy, chocolate, hot chocolate and apple pie from McDonalds.

          2.    Toys and objects: toy vacuum cleaner, toys with sounds (although not loud sounds), play do. Toys do not
                hold his attention for long.

          3.    Activities at home: T.V. shows such as Elmo hold his attention for about 5 minutes.

          4.    Activities at school or in the community: Starbucks, getting apple pie from McDonalds, swinging in the
                park

          5.    Other: Adult attention, especially physical play such as rocking him, lifting him, and piggy back.

J. WHAT DO YOU KNOW ABOUT THE HISTORY OF THE UNDESIRABLE BEHAVIORS, THE
PROGRAMS THAT HAVE BEEN ATTEMPTED TO DECREASE OR ELIMINATE THEM, AND THE
EFFECTS OF THOSE PROGRAMS?

                   Behavior         How long has this been a              Programs                          Effects
                                           problem?
     1.         Leaving            Always (as soon as he           Fading by checking in      Effective until a trip to Japan,
                bedroom            could walk anyway)              with him every 10          where mom started sleeping in
                                                                   minutes and extinction     the same room as him again.
                                                                                                                   15

  2.    Vomiting              Always, although less of a   See above                See above
                              problem recently
  3.    Crying                Always                       Nothing in particular    N/A
                                                           (crying occurs in
                                                           many different
                                                           situations)
  4.    Screaming             Always                       Reprimand                Not effective
  5.    Destructive           2.5 years                    Time-out, reprimand,     Not very effective. Time-out may
        behaviour                                          watching him all the     be most effective
                                                           time
  6.    Self-injury           2.5 years                    Reprimand                Not effective

  7.    Physical              1 year                       Time-out                 Time-out is effective when dad is
        aggression                                         Reprimand                home. Reprimand and isolation
                                                           Isolating – for          are not effective.
                                                           prevention
  8.    Running away          1.5 years                    Holding hand to          Very effective
                                                           prevent running away.
                                                           Reprimand
                                                                                    Not effective


K. DEVELOP SUMMARY STATEMENTS FOR EACH MAJOR PREDICTOR AND/OR CONSEQUENCE


   Distant Setting Event          Immediate Antecedent           Problem Behaviour                   Maintaining
                                                                                                     Consequence

Not feeling tired               Parent leaving bedroom     Leaving bedroom, crying,          Attention
Dark room                       Parent gone upon           vomiting
                                waking up
Not seeing parents during       No attention               Crying, screaming, self-injury,   Attention (verbal
day.                                                       physical aggression towards       reprimand, positive
Feeling tired                                              little brother, destructive       physical attention)
Poor independent play                                      behaviour
skills
Unstructured time
Feeling tired                   Demand                     Crying, screaming, self-injury    Escape demand
                                Difficult tasks
No setting event identified     Being outside of           Running away                      Attention
                                apartment
Preference for sameness         Unexpected changes in      Crying, self-injury               Escape change
                                schedule
                                                                                                                                                                                                                                                                                                    16


                                                         Functional Assessment Observation Form

Name: G.V.
Date: 02/19/08                                                                                                                                                               Perceived Functions


                                Behaviour                                                     Predictors                                        Get / Obtain                     Escape/Avoid                                          Actual Consequences




                                                                                                                                                                                                                                                                               Mom out of kitchen
                                                                                                  Brother getting att.


                                                                                                                         Pref. item/ activity




                                                                                                                                                                                                                                                              Preferred item
                                                                                                                                                                                                                      Pos. Phys. Att
                                                                               No attention




                                                                                                                                                                                                                                                Verbal Rep.
                                                                 Self-injury
                                            Screaming




                                                                                                                                                  Attention




                                                                                                                                                                                  Demand
            Pushing




                                                                                                                                                              Activity




                                                                                                                                                                                                  Activity
                                  Kicking
                      Hitting




                                                        Crying




                                                                                                                                                                                                             Person




                                                                                                                                                                                                                                       Ignore
                                                                                                                         denied




                                                                                                                                                                                           Task
                                                                                                                                                                         Item
Time
4:00-5:00   1,        5,6,        2,7,      3,4         8,9,     8             1,8,9             5,6,7                   2,3,                    1,2,                    3                                            1,7              8,9      2,4,          3                5,6,7,1
PM          10        7,8,        10                    11,                    10,                                       4                       4,5,                                                                 11,                       5,6,                           0,11,12
                      10                                12                     11,                                                               6,7,                                                                 12                        10
                                                                               12                                                                10,
                                                                                                                                                 11,
                                                                                                                                                 12




            2          5           3          2          4       1                    6                          3         3                        9                    1                                             4                2          5              1                                 6
Total
                                                                                                                    17


            Competing Pathways Diagram and Positive Behaviour Support Plan for G.V.
                                 Dinner Preparation Routine

                                                               Play independently/            Praise/ Preferred
 Tired/ Not seeing                                                Play with dad                activity (mom)
 parents all day/ un-                                         _________________                ____________
 structured activity/                                          Desired Behaviour                Maintaining
 Poor independent                                             Crying, screaming,               Consequence
 play and language           Mom cooking in the               aggression (towards
 skills                      kitchen: No attention            little brother), self-          Attention (from
   ___________               ________________                 injury, destructive                 mom)
    Setting Event            Antecedent/Predictor             behaviour                      _______________
                                                              _________________                Maintaining
                                                               Problem Behaviour               Consequence


                                                             Say “mommy” or “come
                                                             here”
                                                              ___________________
                                                                   Alternative/
                                                             Replacement Behaviour


Setting Event                 Antecedent/Preventive Teaching                           Consequence Strategies
Strategies                    Strategies            Strategies

When possible, let G.V.       Pre-correct G.V. to use his    Teach appropriate         Provide praise and physical
have a 1-hour nap after       words to ask for attention     ways to ask for           displays of affection contingent
day care and let him go to    (e.g. “say mommy when you      attention (e.g.           on appropriate playing. Provide
bed about an hour later at    want me to come play”)         mommy, daddy,             preferred activity with mom (e.g.
night.                                                       come, help).              rocking) contingent on completion
                              Use safety signals (e.g. put                             of an independent activity.
Give G.V. 15 minutes of       in one more puzzle piece       Teach G.V.
one on one attention after    and then mom will come)        independent play          Provide praise and brief attention
day care (either at home      when you return to the         skills                    contingent on appropriate asking
or at day care)               kitchen to cook and when       -books                    for attention. Provide help
                              G.V. asks you to come play     -puzzles                  contingent on asking for help.
Use a visual schedule to      but you are unable to leave    -shape sorter
increase choice and           the kitchen at that time.      -blocks                   Prompt G.V. to use his words 1-2
predictability playtime                                      -cars                     times when he cries, screams or
during dinner routine                                        -potato head              engages in self-injury. When he
                                                                                       uses his words, honour his request
Dad will help G.V. play                                      Use safety signals to     or use a safety signal.
with his toys.                                               build endurance over
                                                             time                      When G.V. engages in major
Let G.V.’s little brother                                                              problem behaviour (aggression,
play in the kitchen. When                                                              destructive behaviour): (a) Tell
problem behaviour                                                                      him that’s not ok, you get a time-
decreases, K.V. will be                                                                out; (b) without eye contact, take
able to start playing near                                                             him to his room and close the
G.V.                                                                                   door; (c) after 1 minute, tell him
                                                                                       time-out is over; and (d) redirect
                                                                                       him to a toy and do not say
                                                                                       anything else.
                                                                                                  18



                            Positive Behaviour Support Plan for G.V.
                                   Dinner Preparation Routine
                                          March 2008

Introduction: This PBS Plan was designed to provide support for G.V. and to teach him skills to
allow him to play independently while his mother is cooking dinner in the kitchen. It is based on
a functional assessment interview and observation as well as on a collaborative process of
hypothesis development and plan design with G.V.’s parents.

Summary Statement of the Problem: When G.V. is in the living room and his mother starts
cooking dinner in the kitchen, G.V. cries, screams, and engages in self-injury, aggressive and
destructive behaviour to get attention from his mother. This behaviour is more likely to occur
when G.V. is tired, when he has not seen his parents all day as well as because it is an
unstructured routine and G.V. has poor independently play and language skills.

Goal: G.V. will play independently or with his dad while his mother is preparing dinner in the
kitchen and he will receive praise or a preferred activity for appropriate playing.

                Positive Behaviour Support Plan for Dinner Preparation Routine

Note: The PBS plan contains many strategies that address each aspect of the problematic
routine. However, due to the preventative nature of the plan, some strategies may not need to be
implemented. In addition, as the plan is implemented it will become clear which strategies are
essential and which strategies are not necessary for success.

Setting Event Strategies (Setting the Stage for Success)

   1. Give one-hour nap. When both parents are present, allow G.V. to have a one hour nap
      after day care (on Mondays, Tuesdays, and Thursdays) so that he is not as tired. Since he
      will have a nap in the late afternoon, he can go to bed one hour later so that he will be
      able to fall asleep more easily.

   2. Provide non-contingent attention after day care. Spend 15 minutes of one-on-one time
      with G.V. after day care. This will make it less likely that G.V. will engage in problem
      behaviour to get attention later.

   3. Use a choice board to select toys to play with. To increase choice, place four pictures of
      toys on a choice board and let him choose which toy he wants to play with first. Ask
      G.V., “Which toy do you want to play with: the ____, ____, ____, or____?” He can
      either point to a toy or verbally tell you which toy he wants to play with.

   4. Use a visual sequence to increase predictability. Use a visual sequence that predicts the
      independent play activities and reinforcers.
                                                                                                     19


               a. Place the picture of the chosen toy on the visual sequence board and a picture
                  of mom to the right of the picture of the toy.
               b. Use first-then statements to explain the schedule. For example, point to the
                  pictures and say “first make the puzzle, then play with mommy.” For some
                  toys, it is clear when it is finished (e.g., puzzles), but for others it is not (e.g.,
                  cars). When it is not obvious when a toy is finished, tell G.V. that he has to
                  play with it for five minutes before he gets to play with mom (e.g., first play
                  with cars for five minutes, then play with mommy) and use a visual timer that
                  shows when five minutes is up. Place the timer in a place where G.V. can see
                  it but where he is unable to reach it.
               c. When G.V. is finished playing with the toy, remove the picture of the toy
                  from the schedule and say “puzzle is all done, it’s time to play with mommy!”
                  After playing with mom for 1-2 minutes, remove the picture of mom and start
                  over at step 3.
               d. Gradually increase criteria to play with mom. First G.V. can play with mom
                  after completing one toy, then after completing two toys, then after
                  completing three toys, etc. Only increase criteria when you feel that G.V. will
                  be able to complete a greater number of toys with a minimal amount of
                  problem behaviour before playing with mom.

   5. Dad will provide assistance with toy play. When mom goes into the kitchen to prepare
      dinner, dad can sit down in front of G.V. and provide assistance as needed. Due to fine
      motor difficulties, G.V. may occasionally need hand-over-hand help with the completion
      of puzzles, Mr. Potato Head, or the shape sorter.

   6. Let K.V. play in the kitchen. While you prepare dinner, let K.V. play in the kitchen so
      that G.V. cannot engage in aggression towards him. When G.V. has learned some
      independent play skills and problem behaviour has decreased, you can initially let K.V.
      play in the living room at some distance away from G.V. and gradually move him closer.

Preventative Strategies

   1. Pre-correct the use of language. Practice using language to ask for attention one or two
      times: (a) prior to going into the kitchen (e.g., you need to say “mommy” if you want me
      to come play with you); and (b) when it looks like he might start to engage in problem
      behaviour (e.g., when he is getting off-task). See teaching strategies on how to practice
      the use of language.

   2. Use safety signals to prevent problem behaviour. A safety signal is a verbal warning that
      reinforcement will occur soon, thereby preventing problem behaviour. When you have to
      return to the kitchen to cook, you can tell G.V. to complete his puzzle and then you will
      come play with him. Also, when G.V. shows signs that he needs attention, you can tell
      him, “one more puzzle piece and then I will come play.”
                                                                                              20


Teaching Strategies

   1. Teach appropriate ways to ask for attention. Teach G.V. to use verbal language to
      achieve his wants and needs. When teaching G.V. to use language, model the sentence,
      prompt G.V. to say it, and praise attempts at language as well as progress and successful
      use. The phrases you will want to teach G.V. are listed below.

          a. Asking for mom to look: Saying, “Look mommy.”
          b. Asking mom to come: Saying, “Mommy, come here”
          c. Asking for help: Saying, “Help”

   3. Use safety signals to build endurance. A safety signal is a verbal warning that
      reinforcement will occur shortly. When G.V. uses his words appropriately to ask for
      attention, but you are not able to give him attention immediately, say “put in one more
      puzzle piece and then mom will come.” Over time, you will build endurance by
      increasing the amount of time that he will have to wait before you give him attention. For
      example, you will start saying “two more puzzle pieces and then mom will come” and
      then “three more puzzle pieces and then mom will come”, etc., until you believe that
      G.V. is able to wait for a reasonable amount of time.

   4. Teach independent play skills. We will start by teaching him to play with toys that have a
      clear beginning and ending, such as puzzles, books, and a shape sorter. G.V. is already
      being taught these skills during his behaviour intervention sessions and will be able to
      complete them with minor assistance. Mom and dad can also teach him play skills
      incidentally throughout the day, by:

          a. Modeling how to use novel toys
          b. Providing physical assistance with any step he is unable to complete
             independently
          c. Providing reinforcement upon completion of the play activity

Consequence Strategies to Strengthen Appropriate Behaviour and Reduce Problem Behaviour

   1. Regularly (every 1-2 minutes) give G.V. lots of praise and affection contingent on
      appropriate play behaviour.

   2. Provide praise and brief attention contingent on appropriate asking for attention.

   3. When G.V. cries, screams, or engages in self-injury, provide him with a reminder to use
      his words and then prompt him to make the request one or two more times. Then honour
      his request or use a safety signal. For example, when G.V. starts to cry, tell him “if you
      want mommy to come, you need to say mommy, come here….say it again…Thank you
      for asking.” Next, mom can either go see him or she can use a safety signal, e.g., “one
      more puzzle piece and then I’ll come see you”.
                                                                                                21


   4. Give G.V. a time-out in his bedroom for one minute contingent on major problem
      behaviour, such as destructive and aggressive behaviour. For example, when G.V. hits his
      little brother:

           a. Very briefly but clearly reprimand G.V. Say “that’s not ok, you get a time-out.”
           b. Without eye contact or additional verbal reprimands bring G.V. to his room and
              close the door.
           c. Open the door after one minute and say “time-out is over.” Re-direct G.V. to his
              toy. Do not say anything else about his previous problem behaviour.
           d. Return to the kitchen (or if dad implemented the time-out procedure, sit back
              down in front of G.V and continue helping him to play with his toys). Continue to
              provide praise regularly contingent on appropriate playing.

Evaluation Procedures

G.V.’s parents will use the implementation checklist at least two to three times per week for the
first few weeks of implementation to determine (a) the level of implementation of each strategy
(e.g. 1 = not in place, 3 = partially in place and 5 = in place), (b) frequency of problem
behaviour, and (c) the acceptability of the PBS plan.
                                                                                                           22

                                        Implementation Checklist
                                        Dinner Preparation Routine

Date:_______________________ Person Completing Checklist:__________________________

Instructions: The purpose of this implementation checklist is to help you implement G.V.’s positive
behaviour support plan. Before using the checklist, it is important to read the plan so that you will
understand how to implement the strategies below. On the right is a place to evaluate your level of
implementation. A “1” indicates that the strategy is not in place yet.. A “5” indicates that the strategy is
in place. The checklist can be used to: (a) remind you of what to do to support G.V.; (b) help you plan
what you will do to support G.V.; and/or (c) self-evaluate you level of plan implementation. The checklist
also provides a place to assess levels of problem behaviour and to evaluate the importance and
acceptability of the plan (i.e., its social validity).

                                                                               Not in     Partially   In place
                                                                               place      in place

1. Let G.V. take a nap after day care                                                 1   2   3   4 5 N/A
2. Spend 15 minutes of one on one time with G.V. after day care                       1   2   3   4 5
3. Use a choice board to select toys to play with                                     1   2   3   4 5
4. Use visual sequence to predict play activities and reinforcers
5. Dad will provide physical assistance with toy play                                 1   2   3   4 5
6. Let K.V. play in the kitchen while mom is making dinner                            1   2   3   4 5
6. Pre-correct G.V. to say “look, mommy”, “come here” and “help”
prior to going into kitchen                                                           1   2   3   4 5
7. Use safety signals to prevent problem behaviour when G.V. is getting
off-task (e.g., one more puzzle piece and then I will come play) and when you
return to the kitchen to cook (e.g.,. finish the puzzle and then I will come play).   1   2   3   4    5
8. Teach G.V. to say “look, mommy” or “come here” to get attention and
to ask for help when he needs it.                                                     1   2   3   4    5
9. Use safety signal to build endurance in waiting for attention                      1   2   3   4    5
10. Teach G.V. independent play skills by: (a) modeling; (b) providing physical
assistance; and (c) providing praise                                                  1   2   3   4    5
11. Every 1-2 minutes provide praise and affection contingent on
appropriate playing                                                                   1   2   3   4    5
12. Provide praise and brief attention contingent on appropriate asking for
attention                                                                             1   2   3   4    5
13. When G.V. engages in minor problem behaviour (e.g., crying, screaming):
a) prompt him to ask for attention 2-3 times; b) honour his request; or c) use
a safety signal                                                                       1   2   3   4    5 N/A
14. When G.V. engages in major problem behaviour (e.g., aggression,
destructive behaviour): a) tell him “that’s not ok, you get a time-out; b) without
eye contact, take G.V. to his room and close the door; c) after one minute open
the door and say “time-out is over” and redirect him to his toy; and d) return to
the kitchen or to providing assistance with toy play                                  1   2   3   4    5 N/A
                                                                                                      23

Problem Behaviours During Routine

    1.   Crying                                                  0   1   2    3   4   5 or more
    2.   Screaming                                               0   1   2    3   4   5 or more
    3.   Self-Injury                                             0   1   2    3   4   5 or more
    4.   Aggression                                              0   1   2    3   4   5 or more
    5.   Destructive Behaviour                                   0   1   2    3   4   5 or more

Social Validity
                                                                                  Disagree        Agree
    1.   The goals of the dinner preparation routine are acceptable and important 1 2        3   4 5
    2.   The strategies are useful and effective                                  1 2        3   4 5
    3.   The strategies are difficult to use                                      1 2        3   4 5
    4.   GV. successfully participated in the routine                             1 2        3   4 5
    5.   We believe the dinner preparation routine was successful                 1 2        3   4 5
                                                                                                24


                              Implementation Support Plan for G.V.
                                   Dinner Preparation Routine
                                          March 2008

Introduction and Rationale

G.V.’s PBS plan contains multiple components and strategies. Because several potentially
effective strategies to prevent problem behaviour and promote desirable behaviour were
identified during a collaborative meeting with G.V.’s parents and the behaviour interventionist, it
is necessary to provide training and support to G.V.’s parents to help them implement the
multicomponent PBS plan. The implementation support plan defines the training and support
activities that will be provided in the home as well as the roles and responsibilities of each
person involved in the implementation of the PBS plan.

Training and Support Activities

   1. A behaviour support plan with a written explanation of each strategies will be provided
   2. An implementation checklist will be provided that can be completed a few times per
      week to determine implementation fidelity, frequency of problem behaviour, and social
      validity of the PBS plan
   3. Provide modeling and coaching for G.V.’s parents in the use of the plan strategies
   4. Provide in-home support and training two to three times per week for the first two to
      three weeks.
   5. Provide support and training once every two to three weeks once parents initially succeed
      with implementing the strategies independently.
   6. During the first month of implementation, the behaviour interventionist will contact the
      family once per week to engage in problem solving discussion. After the first month,
      progress and problems can be discussed at monthly meetings. The parents can also
      contact me or the behaviour consultant by phone or email to engage in additional problem
      solving discussions.
   7. Discuss progress and problems at monthly team meetings with the behaviour consultant
      and behaviour interventionists
   8. Teach G.V.’s parents to conduct functional assessments of additional problematic
      routines (e.g., going to bed, community outings) and to develop technically sound and
      contextually-appropriate positive behaviour support plans.

Roles and Responsibilities

   1. Training and support: The behaviour interventionist (me) will be responsible for in-home
      training and the behaviour consultant will also be available for training when the parents
      feel they need additional support. The behaviour consultant and behaviour interventionist
      will schedule monthly meetings with the parents to discuss G.V.’s progress in his
      intervention sessions as well as problems and success during the dinner preparation
      routine. The behaviour consultant and the behaviour interventionist are responsible for
      teaching the parents how to conduct functional assessments and how to develop PBS
      plans during team meetings and when targeting subsequent routines.
                                                                                             25


   5. Plan Implementation: G.V.’s parents will be responsible for implementing the behaviour
      support plan. G.V.’s behaviour interventionists will be responsible for teaching language
      and independent play skills during his behaviour intervention sessions.
   6. Materials Development: The behaviour consultant will be responsible for supplying the
      family with a visual sequence of the independent play activities and a choice board with
      pictures of toys/independent play activities.

Timeline

Training will begin in March 2008
Parents will start implementing the plan independently by the end of April 2008

								
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