Positive behavior support

Overview
Positive behavior support strives to use a system to understand what maintains an individual’s challenging behavior. Students’ inappropriate behaviors are difficult to change because they are functional; they serve a purpose for the child. These behaviors are supported by reinforcement in the environment. Functional assessment clearly describes a behavior; identifies the contexts (events, times, and situation) that predict when behavior will and will not occur, and identifies consequences that maintain the behavior. It also summarizes and creates a hypothesis about the behavior, and directly observes the behavior and takes data to get a baseline. The positive behavior support process involves goal identification, information gathering, hypothesis development, support plan design, implementation and monitoring.

The criteria for treatment methods that work include: feasibility, desirability, and effectiveness. Treatment strategies are needed that teachers and parents are able and willing to use and that make an impact on the child’s ability to participate in community and school activities. Positive behavior support has increasingly been recognized as a strategy that meets these criteria. By changing stimulus and reinforcement in the environment and teaching the child in their deficit skill set areas the student's behavior changes in ways that allow him/her to be included in the general education setting. The three areas of deficit skills identified in the article were communication skills, social skills, and self management skills. Re-directive therapy as positive behavior support is especially effective in the parent child relationship. Where other treatment plans have failed re-directive therapy allows for a positive interaction between parents and children. Positive behavior support is successful in the school setting because it is primarily a teaching method (Swartz ,1999).

PBS in Schools
Schools are required to conduct FBA and use positive behavior support with students who are identified as disabled and are at risk for expulsion, alternative school placement, or more than 10 days of suspension. Even though FBA is required under limited circumstances it is good professional practice to use a problem solving approach to managing problem behaviors in the school setting (Crone & Horner 2003).

The use of Positive Behavior Intervention Supports (PBIS) in schools is widespread (Sugai & Horner, 2002). A basic tenet of the PBIS approach includes identifying students in one of three categories based on risk for behavior problems. Once identified, students receive services in one of three categories: primary, secondary, or tertiary. To help practitioners with differences in interventions used at each of the levels the professional literature refers to a three-tiered (levels) model (Stewart, Martella, Marchand-Martella, & Benner, 2005; Sugai, Sprague, Horner & Walker, 2000; Tobin & Sugai, 2005; Walker et al., 1996). Interventions are specifically developed for each of these levels with the goal of reducing the risk for academic or social failure. The interventions become more focused and complex as one examines the strategies used at each level.

Primary prevention strategies focus on interventions used on a school-wide basis for all students (Sugai & Horner, 2002). This level of prevention is considered “primary” because all students are exposed in the same way, and at the same level, to the intervention. The primary prevention level is the largest by number. Approximately 80% to 85% of students who are not at risk for behavior problems respond in a positive manner to this prevention level (Sugai et al, 2000). Primary prevention strategies include, but are not in limited to, using effective teaching practices and curricula, explicitly teaching behavior that is acceptable within the school environment, focusing on ecological arrangement and systems within the school, consistent use of precorrection procedures, using active supervision of common areas, and creating reinforcement systems that are used on a school-wide basis (Lewis, Sugai, & Colvin,1998; Martella & Nelson, 2003; Nelson, Crabtree, Marchand-Martella, & Martella,1998; Nelson, Martella, & Marchand-Martella, 2002).

Secondary prevention strategies involve students (i.e., 10% to 15% of the school population) who do not respond to the primary prevention strategies and are at risk for academic failure or behavior problems but are not in need of individual supports (Nelson, et al., 2002). Interventions at the secondary level often are delivered in small groups to maximize time and effort and should be developed with the unique needs of the students within the group. Examples of these interventions include social support such as social skills training (e.g., explicit instruction in skill deficit areas, friendship clubs, check in/ check out, role playing) or academic support (i.e., use of scientifically-validated intervention programs and tutoring). Additionally, secondary programs could include behavioral support approaches (e.g., simple Functional Behavioral Assessments [FBA], precorrection, self-management training). Even with the heightened support within secondary level interventions, some students (1% to 7%) will need the additional assistance at the tertiary level (Walker et al., 1996). Tertiary prevention programs focus on students who display persistent patterns of disciplinary problems (Nelson, Benner, Reid, Epstein, & Currin, 2002).

Tertiary-level programs are also called intensive or individualized interventions and are the most comprehensive and complex. The interventions within this level are strength based in that the complexity and intensity of the intervention plans directly reflect the complexity and intensity of the behaviors. Students within the tertiary level continue involvement in primary and secondary intervention programs and receive additional supports as well. These supports could include use of full FBA, de-escalation training for the student, heightened use of natural supports (e.g., family member, friends of the student), and development of a Behavior Intervention Plan (BIP).

Although comprehensive services are important for all students, a critical aspect of the three-tiered model is the identification of students at one of the three levels. One method of identifying students in need of interventions is to analyze office disciplinary referrals (ODR) taken at the school (Irvin et al., 2006). ODRs may be a means of both identifying students risk level for antisocial behavior and school failure (Walker et al., 1996). Researchers have advocated analyzing this naturally occurring data source as a relatively cheap, effective, and ongoing measurement device for PBS programs (Irvin et al., 2006; Putnam, Luiselli, Handler, & Jefferson, 2003; Sprague et al., 2001; Sugai et al., 2000; Tidwell, Flannery, & Lewis-Palmer, 2003; Walker, Cheney, Stage, & Blum, 2005).

ODRs have also been shown to be effective in determining where students fall within a three-leveled model (Sugai et al., 2000), developing professional development as well as help coordinating school efforts with other community agencies (Tobin & Sugai, 1997; Tobin, Sugai, & Colvin, 2000), predicting school failure in older grades as well as delinquency (Sprague et al., 2001), indicating types of behavior resulting in referrals (Putnam et al., 2003), and determination of the effectiveness of precorrection techniques (Oswald, Safran, & Johanson, 2005). Analyzing discipline referral data can also help school personnel identify where to improve ecological arrangements within a school and to recognize how to increase active supervision in common areas (Nelson, Martella, & Galand, 1998; Nelson et al., 2002)

Functional Behavioral Assessment
Functional behavior assessment (FBA) emerged from applied behavior analysis. It is the first step in individual and cornerstone of a Positive Behavior Support plan (see ). The assessment seeks to describe the behavior and environmental factors and setting events that predict the behavior in order to guide the development of effective support plans. Assessment lays the foundation of PBS. The assessment includes:

• a description of the problem behavior and its general setting of occurrence

• identification of events, times and situations that predict problem behavior

• identification of consequences that maintain behavior

• identification of the motivating function of behavior

• collection of direct observational data.

Identification of alternative behavior that could replace the child's problem behavior (i.e., what the normal child does). Often this is measured through direct observation or standardized behavioral assessment instruments.

In some cases, the problem behavior identified in the functional behavior assessment is further analyzed by conducting a behavior chain analysis- in which the sequences of behavior that build up to the problem behavior become the focus.

The results of the assessment help in developing the individualized behavior support plan. This outlines procedures for teaching alternatives to the behavior problems, and redesign of the environment to make the problem behavior irrelevant, inefficient, and ineffective.

Another avenue of functional behavior assessment is growing in popularity- it is called Behavior Chain Analysis. In behavior chain analysis, one looks at the progessive changes of behavior as they lead to problem behavior and then attempts to disrupt this sequence. Where as FBA is concerned mostly with Setting-Antecedent-Behavior-Consequence relations, the behavior chain analysis looks at the progression of behavior. Such as first the child may fidget, then he might begin to tease others, then he might start to throw things, and then finally hit another student.

Behavioral strategies available
There are many different behavioral strategies that PBS can use to encourage individuals to change their behavior. The strong part of functional behavior assessement is that it allows interventions to directly address the function (purpose) of a problem behavior. For example, a child who acts out for attention could receive attention for alternative behavior (contingency management) or the teacher could make an effort to increase the amount of attention throughout the day (satiation). Changes in setting events or antecedents are often preferred by PBS because contingency management often takes more effort. Another tactic especially when dealing with disruptive behavior is to use information from a Behavior chain analysis to disrupts the behavioral problem early in the sequence to prevent disruption [see ]. Some of the most commonly used approaches are:

• Modifying the environment, antecedents (such as curriculum) to behavior, or routine

• Tactical ignoring of the behavior

• Distracting the child

• Positive reinforcement for an appropriate behavior

• Changing expectations and demands placed upon the child

• Teaching the child new skills and behaviors

• Modification techniques such as desensitization and graded extinction

• Changing how people around the child react

• Time out (Child)

• Medication.

Behavior management program
The main keys to developing a behavior management program include:

• Identifying the specific behaviors to address

• Establishing the goal for change and the steps required to achieve it

• Procedures for recognizing and monitoring changed behavior

• Choosing the appropriate behavioral strategies that will be most effective.

Consequential management
Consequential management is a positive response to challenging behavior. It serves to give the person informed choice and an opportunity to learn. Consequences must be clearly related to the challenging behavior For example, if a glass of water was thrown and the glass smashed, the consequence (restitution) would be for the person to clean up the mess and replace the glass. These sorts of consequences are consistent with normal social reinforcement contingencies.

Providing choices is very important and staff can set limits by giving alternatives that are related to a behavior they are seeking. It is important that the alternative is stated in a positive way and that words are used which convey that the person has a choice. For example:

Coercive approach “If you don't cut that out you'll have to leave the room.”

Positive approach “You can watch TV quietly or leave the room.”