+ IMPLEMENTING PBIS AT THE INTENSIVE LEVEL Bob Putnam Margaret L. Walsh May Institute May Institute National Technical Assistance Center for PBIS N E W E N G L A N D P B I S F O R U M N O V E M B E R, 2 0 1 4 N O R W O O D, M A S S A C H U S E T T S
+ Thanks to Bob Putnam, PhD, BCBA-D Rachel Fox, BCaBA Tom Stanton Jessica DeChellis Shameshia Holmes Adam Hawley
CONTINUUM OF AGENCY-WIDE INSTRUCTIONAL & POSITIVE BEHAVIOR SUPPORT Primary Prevention: UNIVERSAL Agency Wide Systems for All Individuals, Staff, & Settings FEW SOME Tertiary: INTENSIVE INDIVIDUALIZED PBS plans for Individuals with High-Risk Behavior Secondary Prevention: TARGETED Specialized Group/Standard Protocol Systems for Individuals with Lower-Risk Behavior ALL
Emphasize: 4 Integrated Elements Supporting Quality of Life and Prosocial Skills OUTCOMES Supporting Staff Behavior Supporting Decision Making PRACTICES Supporting Individual Behavior
+ Intensive Tier 3 Systems Team VS. Intensive Tier 3 Individual Team Intensive Tier 3 Systems Team Purpose Brief data based monthly review of individuals receiving intensive supports. Composition Administrative and senior clinical and other representative staff of the agency Intensive Tier 3 Individual Team Purpose Conducting Functional Behavior Assessments (FBA) and developing positive behavior plans and are responsible for implementing the BSP. Composition Clinical, staff, family, who know the individual best and the individual where feasible.
+ Building Intensive PBS Systems Intensive Systems Team Team meets once per month for 1 hour. Who is in this meeting? Program Director (Overall Administrator) Senior Behavior Analyst Clinical Director Representative House Director Representative Assistant House Director
+ Using Data Based Decision Making to determine Who Needs Intensive Services We make data based decisions to determine who needs intensive services by reviewing: All individuals that engage in high risk behavior. n Aggression n Severe Property Destruction n Self-Injury n Pica All individuals who have Level II plans.
+ What is in place at the intensive level? PBS Modified Benchmarks of Advanced Tiers for Intensive Level (2013) to examine what: Systems are in place. Evidence based practices are used. Data systems are in place. Empirically validated instrument Completed by the Intensive Team on a quarterly or annual basis until all systems are implemented. Can be used to: Baseline what is in place Build an action plan Progress monitor on a quarterly/annual basis.
+ Benchmarks for Advanced Tiers (BAT) Universal: Implementation of Universal Interventions Universal/Targeted: Foundations Integration with all Tiers Intensive system identification Direct care staff and family involvement. Intensive Intensive support systems. Assessment and plan development Monitoring and evaluation.
Benchmarks of Advanced Tiers March 2013, October 2013 vs. October 2014 Percent 100 90 80 70 60 50 40 30 20 10 0 Universal Targeted/Intensive Foundations Intensive Individual Supports
+ The Intensive Systems Meeting Once per month for 1 hour. Review intensive systems Build an action plan to improve systems. Review each individual s data to determine: Overall effectiveness of interventions. Effectiveness of interventions for all individuals receiving Tier 3 support. Need for further individual review by individual s own clinical team.
+ Intensive Systems Meeting Team Roles Facilitator Time Keeper Data Analyst Minute Taker
+ Intensive Team Meeting Each individual receiving Tier 3 supports is reviewed. Progress is determined by examining the three most problematic behaviors. Three simple line graphs are presented for each individual. Each graph represents the last sixty days of data for each individual reviewed. It looks like this
+ Intensive Team Meeting Head Hitting Severe 4 3 2 1 0 Monday, May 10, 10 Wednesday, May 12, 10 Friday, May 14, 10 Sunday, May 16, 10 Tuesday, May 18, 10 Thursday, May 20, 10 Saturday, May 22, 10 Monday, May 24, 10 Wednesday, May 26, 10 Friday, May 28, 10 Sunday, May 30, 10 Tuesday, June 1, 10 Thursday, June 3, 10 Saturday, June 5, 10 Monday, June 7, 10 Wednesday, June 9, 10 Friday, June 11, 10 Sunday, June 13, 10 Tuesday, June 15, 10 Thursday, June 17, 10 Saturday, June 19, 10 Monday, June 21, 10 Wednesday, June 23, 10 Friday, June 25, 10 Sunday, June 27, 10 Tuesday, June 29, 10 Thursday, July 1, 10 Saturday, July 3, 10 Monday, July 5, 10 Wednesday, July 7, 10 Friday, July 9, 10
Intensive Team Meeting Head Hitting Mild 20 18 16 14 12 10 8 6 4 2 0 Monday, May 10, 10 Wednesday, May 12, 10 Friday, May 14, 10 Sunday, May 16, 10 Tuesday, May 18, 10 Thursday, May 20, 10 Saturday, May 22, 10 Monday, May 24, 10 Wednesday, May 26, 10 Friday, May 28, 10 Sunday, May 30, 10 Tuesday, June 1, 10 Thursday, June 3, 10 Saturday, June 5, 10 Monday, June 7, 10 Wednesday, June 9, 10 Friday, June 11, 10 Sunday, June 13, 10 Tuesday, June 15, 10 Thursday, June 17, 10 Saturday, June 19, 10 Monday, June 21, 10 Wednesday, June 23, 10 Friday, June 25, 10 Sunday, June 27, 10 Tuesday, June 29, 10 Thursday, July 1, 10 Saturday, July 3, 10 Monday, July 5, 10 Wednesday, July 7, 10 Friday, July 9, 10
+ Intensive Team Meeting 7 6 5 4 3 2 1 Head Banging 0 Monday, May 10, 10 Wednesday, May 12, 10 Friday, May 14, 10 Sunday, May 16, 10 Tuesday, May 18, 10 Thursday, May 20, 10 Saturday, May 22, 10 Monday, May 24, 10 Wednesday, May 26, 10 Friday, May 28, 10 Sunday, May 30, 10 Tuesday, June 1, 10 Thursday, June 3, 10 Saturday, June 5, 10 Monday, June 7, 10 Wednesday, June 9, 10 Friday, June 11, 10 Sunday, June 13, 10 Tuesday, June 15, 10 Thursday, June 17, 10 Saturday, June 19, 10 Monday, June 21, 10 Wednesday, June 23, 10 Friday, June 25, 10 Sunday, June 27, 10 Tuesday, June 29, 10 Thursday, July 1, 10 Saturday, July 3, 10 Monday, July 5, 10 Wednesday, July 7, 10 Friday, July 9, 10
+ Intensive Team Meeting The review is two minutes long for each individual. As a team the data is examined to ascertain: Is the data up to date? Yes or No Is the individual making progress by looking at the data trend analysis over the past 60 days. Making progress (+) Staying the same (0) Getting worse (-)
Name: Ted Date of Meeting: 8/18/14 Data up to date and graphed? Target Behavior 1 Target Behavior 2 Target Behavior 3 Treatment Integrity Date: Percent at Criteria? BSP Update Date: Mild Head Hitting Severe Head Hitting Yes + Yes 0 Head Banging Yes - 7/18/14 70% 2/4/14 Last FBA Date: 2/2014 Improving (+), Staying the Same (0), Getting Worse (-)
+ Data Based Decision Making If the target behavior is Improving (+) may refer to individual s clinical team to determine if plan could be reduced in intensity or eliminated. Not progressing (0) may refer to individual s clinical team to determine if the plan may need to be changed or treatment integrity checked. Worsening (-) may suggest to the individual s clinical team that treatment integrity be checked, other assessments to be conducted, or a new FBA be completed to determine a new BSP.
+ Are our Intensive Interventions working? Each month the data from the Tier 3 meeting is summarized. % of target behaviors graphed and up to date (by the end of the previous month). % of target behaviors showing improvement? % of individuals Responding to interventions? Partially responding to interventions? Not responding to interventions?
Percent of Primary Target Behavior Graphs Up to Date 100% 90% 80% 70% 60% Percent 50% 40% 30% 20% 10% 0% June 2013 Aug. 2013 Sept. 2013 Oct. 2013 Nov. 2013 Dec. 2013 Jan. 2014 Feb. 2014 Mar. 2014 April 2014 July 2014 Aug. 2014 Months
+ Responders to Intensive Interventions Responders All major target behaviors show decreasing trend. Partial Responders Some of the major target behaviors show decreasing trend. Nonresponders None of the major target behaviors show decreasing trend.
Intensive Systems Review (n= 11) August 2013 45% 45% 9%
Intensive Systems Review (n= 11) August 2014 9% 46% 55%
+ Summary When developing PBS programs it is important to focus on systems development as well as individual PBS behavior planning development. PBS systems development has shown to increase the effectiveness of individual behavior support plans."