Pbs 101


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  • Pbs 101

    1. 1. PBS 101 What is it?
    2. 2. Definition (According to Polk County Health Services) <ul><li>Non aversive intervention technique designed to replace negative behaviors with desired behavior and make undesirable behavior obsolete. </li></ul><ul><li>“A philosophy and a set of tools.” </li></ul>
    3. 3. Positive Behavior Supports <ul><li>Used to assist youth in </li></ul><ul><ul><li>Identifying behaviors which are not working for them </li></ul></ul><ul><ul><li>Understand the triggers, antecedents, and consequences of the behavior </li></ul></ul><ul><ul><li>Identify and Learn to utilize other behaviors that are healthy. </li></ul></ul><ul><ul><li>Identify, Understand, Learn </li></ul></ul>
    4. 4. What does this mean? <ul><li>PBS is a way to view and guide behavior to improve a person’s quality of life. </li></ul><ul><li>Not punishment, consequences. </li></ul><ul><li>Understanding that all behaviors serve as a function for the person </li></ul>
    5. 5. What is a behavior? <ul><li>Any action or skill that a person uses to accomplish something. </li></ul><ul><li>Examples: </li></ul><ul><ul><li>Self inflicted injuries </li></ul></ul><ul><ul><li>Manipulation </li></ul></ul><ul><ul><li>Balancing a checkbook </li></ul></ul><ul><ul><li>Completing homework </li></ul></ul><ul><ul><li>Attending work </li></ul></ul>
    6. 6. Identifying a behavior. <ul><li>Use your ABC’s </li></ul><ul><li>A- Antecedent </li></ul><ul><ul><li>What happened first? </li></ul></ul><ul><li>B- Behavior </li></ul><ul><ul><li>What are we working on? </li></ul></ul><ul><li>C- Consequence </li></ul><ul><ul><li>What happens? </li></ul></ul>
    7. 7. What are your goals? <ul><li>Increase a behavior? </li></ul><ul><ul><li>Ex: Attending school </li></ul></ul><ul><li>Decrease a behavior? </li></ul><ul><ul><li>Ex: Cutting to reduce pain </li></ul></ul><ul><li>Replace a behavior? </li></ul><ul><ul><li>Ex: Calling a mentor instead of going to the psychiatric unit </li></ul></ul><ul><li>Improve a behavior? </li></ul><ul><ul><li>Ex: Balancing a checkbook </li></ul></ul><ul><li>Maintain a behavior? </li></ul><ul><ul><li>Ex: Attending doctor’s appointments </li></ul></ul><ul><li>Generalize a behavior? </li></ul><ul><ul><li>Ex: Saying no to unprotected sex in the moment. </li></ul></ul><ul><li>Extrapolate a behavior? </li></ul><ul><ul><li>Ex: Controlling anger with a CA as well as a girlfriend </li></ul></ul><ul><li>Eradicate a behavior? </li></ul><ul><ul><li>Ex: Suicide attempts </li></ul></ul>
    8. 8. Goal determines intervention. <ul><li>Identify appropriate tools and strategies. </li></ul><ul><li>Identify appropriate reinforcement. </li></ul><ul><li>Determine generalization opportunities. </li></ul>
    9. 9. Tools for PBS implementation <ul><li>Detailed functional assessment completed annually. </li></ul><ul><li>Behavior Analysis Form completed on identified behavior </li></ul><ul><li>WRAP (Wellness, Recovery, Action Plan) </li></ul><ul><li>Journaling and self-tracking </li></ul><ul><li>Crisis Planning </li></ul>
    10. 10. What are the principles of PBS? <ul><li>Staff Attitudes/ Competencies </li></ul><ul><li>Recovery focused plans and goals </li></ul><ul><li>Focus on a person’s strengths </li></ul><ul><li>Environmental Controls </li></ul><ul><li>Positive Reinforcement </li></ul><ul><li>Natural Consequences </li></ul><ul><li>Behavioral Techniques </li></ul>
    11. 11. Staff Attitudes <ul><li>Initiative to continuously engage youth in supports </li></ul><ul><li>Ability to identify and maintain a vision </li></ul><ul><li>Holding expectations for clients </li></ul><ul><li>Support and educate </li></ul><ul><li>Deliver positive critiques “critique sandwiches” </li></ul>What’s their vision? Working fulltime, driving, apartment Working part time, caring for self, Transitional shelter Homeless Shelter, unprotected sex, stealing for money
    12. 12. Staff Competencies <ul><li>Crucial Conversation communications </li></ul><ul><li>Understanding the function of the team </li></ul><ul><li>Proper PBS implementation techniques </li></ul><ul><li>Role comprehension </li></ul><ul><ul><li>Understanding the client/ staff relationship </li></ul></ul><ul><ul><li>Collaboration vs. caretaking or competition </li></ul></ul><ul><ul><li>Guidance vs. parenting </li></ul></ul><ul><ul><li>Active listening vs. advice </li></ul></ul>
    13. 13. Recovery Focus <ul><li>What does a great life look like? </li></ul><ul><li>How can each person have a meaningful role in society? </li></ul><ul><li>What are goals that lead to recovery? </li></ul><ul><li>What assistance can be provided to diminish behaviors with a negative impact? </li></ul>
    14. 14. How do you find strengths? <ul><li>What can this person do well? </li></ul><ul><li>What skills do they use to get what they need? </li></ul><ul><li>What personality traits are inherent? </li></ul><ul><li>What attributes to past successes? </li></ul><ul><li>What can you see? </li></ul><ul><li>What do they self identify as a strength? </li></ul><ul><li>What are they interested in? </li></ul>
    15. 15. Strength Based Approach <ul><li>Understand (behavior is always a message) </li></ul>Reframe Squeeze Taking a negative behavior and reframing it in a positive way. Best way to help someone change a behavior is to first understand the reasons behind the behavior.
    16. 16. Environmental Controls <ul><li>What can you do to create a positive environment? </li></ul><ul><li>How can you assist the youth in identifying positive environments? </li></ul><ul><li>Can the youth manipulate their current environment to be more positive? </li></ul>
    17. 17. Create a positive environment <ul><li>Consistently saying “please” and “Thank you” </li></ul><ul><li>Greeting each person each time enthusiastically (even though secretly you may be saying “Not you again”) </li></ul><ul><li>We are all ACTORS </li></ul><ul><li>Striving to RESPOND instead of react at ALL times (Don’t say or do anything you wouldn’t want said or done to yourself) </li></ul><ul><li>Understanding the importance of managing ourselves by using a STRONG observing ego. (Stay cool, Let is go Joe, Use the Force) </li></ul>
    18. 18. Providing Hope <ul><li>Positive Predicting </li></ul><ul><ul><li>Talking about the future in positive terms to make desired outcome more possible. When something is more possible it becomes more probable. </li></ul></ul><ul><ul><li>The Train “You’re Big and Powerful…but a bit off track.” </li></ul></ul><ul><ul><li>Poker “Life is like a poker game. Even if you’re dealt a bad hand, you can still win the game.” </li></ul></ul>
    19. 19. Natural Consequences <ul><li>Definition- actions that are not imposed upon a situation but occur as an effect of the behavior. </li></ul><ul><li>Using consequences not punishment </li></ul><ul><ul><li>A consequence is related to what the person does, a punishment isn’t. </li></ul></ul><ul><li>*When you bond with people they are less likely to behave in a way to disappoint you. </li></ul>
    20. 20. Behavioral Techniques How can I change behavior?
    21. 21. Chaining <ul><li>Skill teaching by linking simple individual tasks together to form a complex skill. </li></ul><ul><ul><li>Balancing checkbook </li></ul></ul><ul><ul><ul><li>1. Adding all activity on account to ledger </li></ul></ul></ul><ul><ul><ul><li>2. Adding or subtracting amounts </li></ul></ul></ul><ul><ul><ul><li>3. Comparing ledger to statement </li></ul></ul></ul><ul><ul><ul><li>4. Finding errors </li></ul></ul></ul><ul><ul><ul><li>Conquer one step at a time and link together </li></ul></ul></ul>
    22. 22. Fading <ul><li>Gradually decreasing support to promote independence of a certain skill. </li></ul><ul><ul><li>Ex: Reducing the amount of rides given by promoting public transportation. </li></ul></ul><ul><ul><ul><li>First- no rides to Psychiatric appointments. </li></ul></ul></ul><ul><ul><ul><li>Second- no rides to doctor appointments. </li></ul></ul></ul><ul><ul><ul><li>Third- no rides to daily living skill activities. </li></ul></ul></ul><ul><ul><ul><li>Fourth- no rides to recreational events. </li></ul></ul></ul>
    23. 23. Modeling <ul><li>Demonstration of a desired behavior. </li></ul><ul><ul><li>Ex: How to talk with members of the opposite sex appropriately. </li></ul></ul>
    24. 24. Role playing <ul><li>Experimenting a situation or view point by playing a role. </li></ul><ul><ul><li>Ex: Confronting a coworker about an issue– they play the co-worker and themselves. </li></ul></ul>
    25. 25. Shaping <ul><li>The process of reinforcing successively closer behaviors. </li></ul><ul><ul><li>What is the target behavior? Reinforce as a person gets closer to the target. </li></ul></ul>
    26. 26. Step Analysis <ul><li>Breaking down a complex task into more manageable steps. </li></ul><ul><li>How to get an apartment </li></ul><ul><li>Call apartments for availability. </li></ul><ul><li>Save money </li></ul><ul><li>Apply for apartment </li></ul><ul><li>Plan move </li></ul><ul><li>Turn on utilities </li></ul>
    27. 27. Stimulus Satiation <ul><li>The process of filling a need with purposeful events or activities. (Definition changed to match population) </li></ul><ul><ul><li>Application of recovery approach– fill their lives with good stuff to leave less room for the bad. </li></ul></ul>Tip: Think of a life like a pie chart--- replacing the bad with the good
    28. 28. How do I teach the client to apply these techniques? <ul><li>Transfer behaviors </li></ul><ul><ul><li>Taking a behavior and applying it to other situations </li></ul></ul><ul><li>Generalize behaviors </li></ul><ul><ul><li>Taking a behavior and making it occur more often </li></ul></ul><ul><ul><li>*These are also known as teachable moments* </li></ul></ul>
    29. 29. Generalize or Transfer Behaviors Desired Behavior Desired behavior different context Different behavior appropriate context Alternate behavior Same context
    30. 30. How to improve generalization Alternate behavior Same context Response maintenance Desired behavior different context Situation generalization Alternate behavior Different context Situation generalization Desired Behavior Same context Modified response
    31. 31. Positive Reinforcement <ul><li>Identify naturally reinforcing activities. </li></ul><ul><li>Introduce self reinforcement concepts </li></ul><ul><li>Are there contextually appropriate reinforcements? </li></ul><ul><li>Is the reinforcement enough to influence behavior? </li></ul>
    32. 32. Reinforcement Strategies How can I reinforce behavior?
    33. 33. Instructional Control <ul><li>Reinforcing the desired behavior, even in it’s absence. </li></ul><ul><ul><li>Ex: “It’s really great to see people get to doctor’s appointments on their own” </li></ul></ul><ul><ul><li>Ex: “Managing money well allowed them to take that vacation” </li></ul></ul><ul><ul><li>Ex: “Calling to check up on applications is a great way to get an interview” </li></ul></ul>
    34. 34. Conditioned Reinforcement <ul><li>Association of one behavior reinforcing another through a series of trials. </li></ul><ul><ul><li>Ex: Getting a paycheck reinforces arriving to work on time. </li></ul></ul><ul><ul><li>Ex: Getting an A on a test reinforces putting work before play. </li></ul></ul><ul><ul><li>Ex: A good work review reinforces the employee to go above and beyond. </li></ul></ul>
    35. 35. Contextual Reinforcement <ul><li>Reinforcement received through a natural or pseudo natural environment. </li></ul><ul><ul><li>Paycheck is received for attending work. </li></ul></ul><ul><ul><li>Girlfriend is happier now that they no longer smoke pot. </li></ul></ul><ul><ul><li>Family invites person over for holidays because they have improved their anger management. </li></ul></ul>
    36. 36. Differential Reinforcement <ul><li>Reinforcing all positive behaviors to a certain degree but providing strong reinforcement for the desired behavior. </li></ul>Asked for help to look for jobs Completed application independently Target behavior: Independently find work
    37. 37. Discrete Trial <ul><li>Reinforcing desired behavior without a person’s knowledge. </li></ul><ul><ul><li>Ex: Taking a person out for lunch every time they attend a psychiatrist appointment. </li></ul></ul><ul><ul><li>Ex: Extra time to “hang out” each time a person utilizes their WRAP plan. </li></ul></ul><ul><ul><li>Ex: Offering bus tokens when a person has been looking for work. </li></ul></ul>This is a way to say congratulations in a natural way that also shapes behavior.
    38. 38. Documentation <ul><li>Refer to goal </li></ul><ul><li>Refer to step </li></ul><ul><li>Use a counseling verb- This is your technique. </li></ul><ul><li>What did you work on– This is the “B” of ABC. Tip: Relate this back to their diagnosis. </li></ul><ul><li>What is their response </li></ul><ul><li>How will you follow up- Use strength based language. </li></ul>
    39. 39. Data Collection <ul><li>Currently use outcome measurements for the system. </li></ul><ul><ul><li>This shows that the model works. </li></ul></ul><ul><li>To show a change in behavior there must be data collection on the individual. </li></ul><ul><ul><li>This shows that PBS works. </li></ul></ul>
    40. 40. PBS 101 <ul><li>Any Questions? </li></ul>