Positive Behavioral Change Practical Strategies for Changing Behavior Across the Lifespan

Positive Behavioral Change
Practical Strategies for Changing
Behavior Across the Lifespan
Presented by Barbara T. Doyle, MS
Clinical Consultant
www.barbaradoyle.com
2013
The ARC of Illinois
Living with Autism Conference
Let’s focus on:
 Quickly
targeting essential skills and issues
 More efficient teaming
 Recognizing and celebrating what is working
 Teaching appropriate and efficient
replacement behavior
 Providing peers with information and support
 Keeping track of what teams are doing
2
If you learn only one word of Japanese:
KAIZEN
Kaizen means continuous improvement
involving everyone.
Kaizen means preserve what is working
well while focusing on what needs to be
done next.
Adapted from Kaizen: The Key to Japan’s Competitive Success, by
Masaaki Imai
3
Step One: Kaizen






Kaizen: celebrates and preserves what is working
well.
Helps us recognize where to put more focused
attention and effort.
Provides an informal record of discussion and
progress
Quickly do a Kaizen at the beginning of each team
meeting.
Be sure it is signed and dated as everything written
about anyone must be
Take a look at a sample Kaizen
4
“We must BE the
change we wish to
see in the world.”
Mahatma Gandhi
5
Five Unifying Assumptions:
 We
are all fully human
 We all have thoughts and feelings beyond
what we can express
 Without communication we cannot be safe
or successful
 Everyone has a right to strive for a high
quality of life
 We should use only socially valid
interventions
6
The Assumption of Competence
Assume that there is always more “internal
life” in a human being than what they are
able to show us, even when they are
babies and little children, even when they
have lots of “Ds,” even when they cannot
speak or perform according to an age
expectation.
“I’ve always been in here.”
7
The difference between the right word
and the almost right word
is the difference between lightning and
the lightning bug.
Mark Twain
If thought corrupts language,
language can also corrupt thought.
George Orwell
8
Step Two: Teaming Skills
 Let’s
review the handout: Objective vs.
Subjective
 Let’s look at the handout Avoid Psychiatric
Terms”
 Rate yourself on your own objectivity and
your use of terms. How well do you separate
facts from opinions? Is there anything that
you want to change?
9
The Two-Minute Teaming Rule
 The
person who disagrees has two minutes
to say everything they want to about why
they disagree. NO ONE INTERRUPTS
 Everyone else takes notes about every point
being made
 After the two minutes, someone reads the
notes back to be sure the person was
understood
 Then, the meeting proceeds
10
Teaming Skills:
Assume CAN’T instead of
WON’T
Assumption of Won’t leads to
punishment, power struggles,
rejection, and embarrassment
(YIKES!)
11
of Can’t leads to creative
problem solving, and creative
interventions
 Assumption of Can’t keeps everyone
in a more calm emotional state
 Assumption of Can’t models
interpersonal support, belonging, and
acceptance
 Assumption
12
Discuss and take notes
with a partner
 What
are some positive, non-clinical words to
use to describe people and what they do?
 What are three ways that descriptions can
affect our interactions, service,
and outcomes?
 How can we better describe children and
adults focusing on their unique qualities as
individuals?
13
Step Three: Make a List
 List
current problems and issues the
person is experiencing
 Describe each objectively
 Retain subjective opinions as to cause:
this will be addressed in Step 6
14
Step 4: Prioritize the most serious
behaviors to address
Use these test questions to
determine priorities:

“If I allow this person to do this behavior, will the
police come? Will an ambulance come? Will I lose
my job? Will anyone be in danger? Will the person
be at risk?”
 If the answers are all no, it might not be a priority
behavior at this time. Stay calm, reduce input (like
stop talking and touching) and keep everyone safe.
 Make a note and ask for help BEFORE this
happens again.
15
Categorize and Prioritize
Sort” behavior into four categories:
 Dangerous or potentially dangerous
 Stigmatizing
 Unconventional
 Conventional
Take a look at the Behavioral Prioritization Grid
16
Step Five: Choose Target Behavior
and Take Data
 Select
one or two high priority behaviors to
address now
 Collect simple data: slash and tally, paperclips
in cups, hourly or activity-based sampling.
 Use the Data collection sheet for low incidence
behavior or to sample more frequent behavior
 Someone needs to collect and analyze data
with charts and graphs: saves time, reveals
hidden causes. Assign this responsibility.
17
ISBN#
0-8077-2911-6
18
Step Six: Develop Hypotheses
 “Best
guesses” as to underlying causes for
each behavior
 Be sure to note them as subjective.
 For each hypothesis, brainstorm a way to test
it. Some things cannot be tested.
 Make the plan to test. Assign responsibilities
and timelines.
 Take a look at the Sample Hypotheses and
Testing Plans handout
19
Remember
 Everyone
is always making sense.
 No one does anything “out of the blue.”
 No one does anything “for no reason.”
 Everyone does things responding to internal
stimulus or external stimulus
 Put yourself in the person’s shoes: What if
they did not have a disability label?
20
Step Six: Develop Hypotheses
 Think
about the “Why” behind the behavior.
 Don’t get “stuck” on “avoiding task,” or
“wanting attention.” People with ASD are
complex, just like everyone else.
 Look at sensory issues as causes.
 Don’t blame the person, the parents, or
yourself.
 Consider “fear” and “confusion”
21
Step Six: Develop Hypotheses
Some VERY common underlying causes are:
 Medication and medication side effects
 Being sick or in pain
 Having an undiagnosed condition
 Having an untreated condition
 Take people with disabilities to the doctor if
their behavior changes quickly or becomes
severe.
22
A word about medications
 There
are no medications designed to be
used to change the behavior of children
and adults with ASD
 All medications have side effects, some
are uncomfortable, some are fatal
 People with ASD are less able to tell us if
they are experiencing side effects
 Take a look at your handout about the
use of medications
23
Step Seven:
Select Replacement Behavior
Select one or more replacement behaviors
that:
 Have HIGH impact on people and events
 Send the same message without danger or
destruction
 Are easier (may not be the best, but better
than current behavior)
 Can be seen and reinforced
 Can have data collected about them
24
What are some important lifetime
behavioral goals?
 Being
a safe person (not hurting self or
others, not destroying property)
 Having
safe ways to express all
emotions (there are no wrong or bad
emotions)
 Using
privacy (caring completely for
own body, respecting others’ privacy)
25
ISBN #
1-885477-94-5
26
What are some important lifetime
behavioral goals?
But what about compliance???
 Compliance
as a goal might be over-rated!
What if the people with disabilities did what
everyone told them to?
 Systematically teach compliance to safety
and most important instructions
 Teach exceptions to compliance
27
Step Seven:
Select Replacement Behavior
 If
you can, begin to teach replacement
behavior, in private sessions/therapies
 Think about teaching, not just talking.
 Take a look at your handout: Using Visual
Strategies to Support and Teach
Successfully
 Take a look at the sample “Replacement
Behavior” chart
28
Step Eight:
Design Motivation Systems:
 Why
should people be “rewarded?”
 Neurological effects of working for rewards
include organization, focus, endurance,
tolerance, motivation, persistence…
 Why might verbal praise not be enough?
 Always add verbal praise but recognize it
may not MOTIVATE people with social
communication issues
29
Step Eight:
Design Motivation Systems:
 What
about “bribes?”
 Use only for objectively-defined, target
behaviors
 Keep it simple, Sweetheart
 Be sure people earn rewards quickly in the
beginning
 Later, teach self-monitoring
30
Step Eight:
Design Motivation Systems:
 Can
use different systems in different places
 Allow the person to choose and work for a
specific liked object, activity, person or
environment that you can easily provide.
 Consider reduction in the amount of “less
preferred” work as a reward
 Look at the Reinforcement Inventory
31
Step Nine: Real Inclusion
“Clue In”
 Can
have general discussions that are not
person-specific at any time
 Provide reasonable explanations for what
others observe
 Get appropriate permissions before talking
about a person specifically
32
We are changing our world!
Each time a (person) stands up for an ideal, or
acts to improve the lot of others, or strikes
out against injustice, s/he sends forth a tiny
ripple of hope, and crossing each other from
a million centers of energy and daring, those
ripples build a current that can sweep down
the mightiest walls of oppression and
resistance.
Robert F. Kennedy
P.S. This would be us!
33
Step Ten: What Will You Do Now?
It is only in the doing, the applying,
that knowledge and
understanding are internalized.
Stephen R. Covey, “The Eighth Habit:
From Effectiveness to Greatness”
34
Thank you for all you do!
To contact me:
Barbara T. Doyle, M.S.
708-966-4683
barbaratdoyle@gmail.com
www.barbaradoyle.com
www.asdatoz.com
35
Two award-winning books by Barbara T. Doyle MS
and Emily Doyle Iland MA
ISBN# 0-9768222-0-2
ISBN# 1-932565-07-8
36
Two New Products from Barbara T. Doyle, MS
Three Hour CD Set
for Staff, Teachers,
Therapists and
Families
DVD Teach Sign
Language to People
with Communication
Needs
37