Positive behavior support refers to a set of tools and processes that are used to help a wide range of children and adults both with and without disabilities improve their quality of life and to decrease the likelihood of problem behavior. The first step in the planning process is to form a team of individuals who live with and support the person. Together the individual and her team will identify strengths, build on social and communication skills, and make changes in settings that are associated with problem behavior.
Examples of Community Services Implementing Positive Behavior Support
Biomedical and behavioral evidence-based research provides the foundation for interventions that will directly address the underlying cause of problematic behavior. The planning process is evaluated to ensure that an individual’s quality of life increases and that there is evidence that the person’s problem behaviors are decreasing. An important part of the evaluation process includes assessing the extent to which the positive behavior support plan is a good fit for the individual and his team by reflecting cultural norms, values, and skills, and by assessing whether sufficient resources are available for implementation.
A wide variety of community agencies are involved in positive behavior support. These community agencies serve many different types of children and adults in different stages of life.
The types of agencies that use positive behavior support vary with respect to populations of people and age ranges of the individuals who are served. For instance, positive behavior support is often implemented in community agencies supporting individuals with intellectual and developmental disabilities (IDD). Positive behavior support plans are used to assist individuals with IDD in improving their quality of life by implementing interventions across home, school, work, and community settings.
Mental health center professionals facilitate positive behavior support plans for children and adults in home and community settings. Some mental health center professionals are involved in positive behavior support within educational settings as well. A growing number of mental health professionals are involved in implementing school-based mental health interventions in collaboration with districts and schools that are implementing positive behavior support at a systems level.
Children and family service professionals are also implementing positive behavior support as part of family preservation efforts and as set of strategies that can be helpful for foster care families. Positive behavior support can be a helpful tool in supporting individuals with dual diagnoses including mental illness and IDD.
A growing number of early childhood organizations are now implementing positive behavior support across the United States. Preschool settings, Headstart, and other early childhood organizations use systems change research in order to expand the implementation of positive behavior support across a larger number of settings. The goal of these systems change efforts is to implement interventions that will prevent problem behavior and decrease the need for individualized and intensive positive behavior support plans by designing positive and proactive environments for young children.
Positive behavior support planning processes are also used to support children and adults with traumatic brain injury who are living, working, going to school, and participating in community activities. The positive behavior support process helps individuals with TBI identify and work on social and communication skills, modify situations and settings they find problematic, and as way in which they can improve quality of life.
Juvenile justice-related systems are another type of community agency that implements positive behavior support. Juvenile correctional facilities use positive behavior support within residential and educational contexts to prevent serious problem behavior. Positive behavior support plans are also used to assist a child or youth as he transitions from a more restrictive setting back into his home and community.
Acute care hospitals and psychiatric treatment facilities that provide short-term residential support for children and youth with a history of serious problem behavior have increasingly turned to positive behavior support as a problem-solving framework for transitioning children and youth back into their homes and communities and as a strategy for preventing future recidivism.
The community settings described on this page are common examples of organizations and services that have embraced the use of positive behavior support. In the next section, we will describe how community agencies have adopted a public health model for preventing problem behavior. Despite the difference in types of community agencies and the population of individuals served, larger systems change efforts in positive behavior support tend to focus on similar themes.
“It’s a whole shift in paradigm of fighting fires to building capacity within the organizations--whether it is a contracted service provider or residential or day treatment program....I see our role as...helping people build capacity...”
Community agencies implementing positive behavior support design interventions that focus on teaching, prompting, and practicing social and communication skills. Positive social and communication skills are reinforced and multiple opportunities are provided within everyday situations and settings to practice these new skills. Creating a consistent response to the occurrence of problem behavior when it does occur by individuals within an organization or setting is another important feature of prevention.
The goal of positive behavior support is to create an environment where there are naturally high levels of reinforcement for positive social interactions among all individuals. Improving the quality of life for everyone within a social setting is an important outcome for any positive behavior support effort.
Person-centered Planning is a team-based action-planning process that is directed by the individual and her family to improve quality of life and create a plan for her future. The plan is designed based on the individual’s strengths, capacities, preferences, needs and desired outcomes. The individual is directly involved in leading the planning process, often with support from family members, friends, and community advocates. Strategies for documenting ideas and identifying important goals are often done in visual manner with notes taken during meetings so that everyone can see the decisions made and make contributions to the planning process.
Wraparound Planning refers to a philosophy of care that includes a clearly defined planning process that is used to build constructive relationships and support networks for children and youth and their families. Wraparound planning is community based, culturally relevant, individualized to a individual’s strengths, preferences, and needs, and person and family centered in nature. Team meetings are driven by the individual and his family and focus on the strengths of the individual and her family. Together, the team creates long-term goals for improving the person’s quality of life across life domains including living/home environment, basic needs, safety, and social, emotional, educational, spiritual, and cultural values.
As you can see, person-centered planning and wraparound planning share many similar features. Community organizations facilitate person-centered planning or wraparound as a first step in the positive behavior support process. Person-centered planning tends to be used in the IDD field while wraparound is more common in mental health, juvenile justice, and children and family services. Some organizations use a combination of person-centered planning and positive behavior support. Person-centered strategies are used as a first step in positive behavior support to empower individuals and their families and to establish a clear vision for improving quality of life.
Evidence-based practice in positive behavior support is defined as the integration of rigorous science-based knowledge with applied expertise driven by stakeholder preferences, values, and goals within natural communities of support. Positive behavior support is often implemented with other evidence-based practices that are unique to the population of individuals served and the settings where services are provided.
Schools, mental health centers, IDD organizations and other systems implementing positive behavior support at a systems level use a multi-tiered prevention model that was borrowed from a public health model for disease prevention. This three-tiered public health model is based on a triangle that shows universal or primary prevention as the first level or tier.
Primary prevention includes interventions for promoting healthy lifestyles, as well as social and emotional learning for everyone served within the organization or community. The next level, secondary prevention emphasizes the early identification and intervention for individuals who are at risk for more serious problem behavior. The third level, tertiary prevention is used to establish planning processes for children or adults in need of intensive and individualized positive behavior support.
“Since we have started using PBS, our organization no longer has to use physical restraint and has significantly reduced restrictive interventions.” -Director of a Developmental Disability Community Services Provider
An increasing number of community organizations are now using the three-tiered conceptual model as a way in which to organize the prevention of problem behavior at a systems level. Each system applies the basic features of primary, secondary, and tertiary prevention to the unique issues related to the individuals who are served, how services are provided, and the environmental features of each type of setting.
Aaron 2: http://www.apbs.org/Aaron.htm
PBS Practices are brief fact sheets that describe effective practices in Positive Behavior Support. Each Practice includes a rationale, overview, examples, issues and needs, and frequently-asked questions on a designated topic. The purpose of the series on PBS Practices is to provide information about important elements of positive behavior support. PBS Practices are not specific recommendations for implementation, and they should always be considered within the larger context of planning, assessment and comprehensive support.
The following vignettes come from peer-reviewed research articles or chapters found in the literature. These summaries are intended to provide ideas that are related to validated intervention strategies that are implemented in the field. While these vignettes are helpful in learning more about positive behavior support and behavior intervention strategies, they are only intended to be examples. All PBS plans should start with person-centered or wraparound plan and functional behavioral assessment. The functional behavioral assessment is used to identify interventions that are based on the function maintaining the behavior and that are individualized for the person receiving support. Please gather valuable information from these vignettes, while being cautious not to over-generalize to all individuals who engage in challenging behavior.
Intervention Case Study: http://www.apbs.org/Files/replacingaggressive.doc
Barry, L. M., and Singer, G. H. S. (2001). A family in crisis: Replacing the aggressive behavior of a child with autism toward an infant sibling. Journal of Positive Behavior Interventions, 3(1), 28-38.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy2.pdf
Dunlap, G. and Fox, Lise (1999). A demonstration of behavioral support for young children with autism. Journal of Positive Behavior Interventions, 1, 77-87.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy16.pdf
McGee, G. & Daly, T. (1999). Prevention of problem behavior in preschool children. In A.C. Repp and R.H. Horner (Eds.), Functional analysis of problem behavior: From effective assessment to effective support (pp. 171-195). Belmont, CA: Wadsworth.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy3.pdf
Todd, A., Horner, R., Vanater, S., & Schneider, C. (1997). Working together to make change: An example of positive behavioral support for a student with traumatic brain injury. Education and Treatment of Children, 20, 425-440.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy6.pdf
Clarke, S., Dunlap, G., & Vaughn, B. (1999). Family-centered, assessment-based intervention to improve behavior during an early morning routine. Journal of Positive Behavior Interventions, 1, 235-241.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy13.pdf
Reichle, J., Drager, K., & Davis, C. (2002). Using requests for assistance to obtain desired items and to gain release from nonpreferred activities. Implications for assessment and intervention. Education and Treatment of Children, 25, 47-66.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy14.pdf
Davis, C.A., & Reichle, J. (1996). Variant and invariant high-probability requests: Increasing appropriate behaviors in children with emotional-behavioral disorders. Journal of Applied Behavior Analysis, 29, 471-482.
Intervention Case Study: http://kipbsmodules.org/Word-PDF-PPT/casestudy15.pdf
Stiebel, D. (1998). Promoting augmentative communication during daily routines: A problem solving intervention. Journal of Positive Behavior Interventions, 1, 159-169.
Intervention Case Study: http://www.pbskansas.org/files/Building_an_Ecology_of_Support.pdf
Lucyshyn, J.M., Olson, D., & Horner, R.H. (1995). Building an ecology of support: A case study of one young woman with severe problem behaviors living in the community. Journal of the Association for Persons with Severe Handicaps, 20(1), 16-30.