The purpose of this Story from the Field is to illustrate a real experience with Positive Behavior Support through a case study example. The theme of this story is how collaborative teaming is essential in the PBS process.
Britney is a very loving and beautiful 8-year-old child with Down Syndrome. Her close and supportive family consists of her parents, older sister Jan, younger sister Sally, and a large extended family. While Britney is very verbal and uses language to communicate her wants and needs, she does have a moderate delay in expressive language and significant delays in social and communication skills. Her challenging behaviors consist of refusing to complete tasks, saying no, leaving her seat, running around the classroom and hitting others. She enjoys playing outside with her sisters, reading books, listening to music, going to the library, and working on the computer.
Currently, Britney is fully included in a first grade classroom. She displays challenging behavior when she is faced with difficult academic tasks, new skills, math concepts, fine motor activities, age-appropriate social skills, and communication skills. Furthermore, Britney does not seek out or initiate attention from her peers. Britney's school team sought support and guidance from Florida's Positive Behavior Support Project in order to facilitate effective team meetings and to provide the team with technical assistance in addressing Britney's challenging behaviors.
Obstacles and Resources Encountered
Members of Britney's team included the classroom teacher, classroom assistant, ESE consult teacher, speech therapist, the school principal, and her parents. This was a nice representation of those people who were important in Britney's life and their membership on the team served as a significant resource. Furthermore, all team members were very familiar with Britney, and thus were able to quickly reach a consensus on the challenging behaviors to be targeted. During a team discussion, school personnel reported intense challenging behaviors that involved (1) hitting (e.g., Britney would hit the classroom assistant in the face when she was upset or frustrated), and (2) refusal to complete a task (i.e., says no, gets out of her seat, runs around the classroom).
Similarly, the setting for intervening was quickly identified as being primarily the classroom setting. The family reported that while on rare occasion Britney would hit her sister, for the most part the behaviors identified by the school did not occur at home. The family expressed concerns that Britney had become increasingly dependent on the classroom assistant. The family indicated that they would like for Britney to engage in socially appropriate behavior, stay included with her peers, and stay on grade level. Specifically, they would like to see her seek out peer attention appropriately. The team reported that while children in her classroom liked her and tried to interact with her, she did not initiate or respond to most interaction attempts.
A number of major barriers to this team's success, all relating to their ability to work collaboratively, became apparent to the PBS project member supporting this team. The first obstacle encountered was that while some key players on the team (including the school principal and Britney's parents) were very supportive of Britney's inclusion in the general education classroom, others were not. Thus, committing to a process of working towards solutions that would allow Britney to remain fully included in this teacher's classroom was a major obstacle to this team's success.
The second obstacle related to the fact that there were disagreements between family and school team members regarding Britney's IEP. The family requested that every first grade general education benchmark be written as an attainable goal on the IEP. This produced a 37 page IEP for Britney. The school was very concerned about the IEP, feeling it was unrealistic and would set Britney up for failure if she were unable to meet all of these goals.
The third identified obstacle to team collaboration was disagreement over the conducting of psychological assessments (IQ test) in reference to Britney's cognitive and developmental level. Britney's family refused to have these assessments conducted due to their concerns regarding the relevance of such information. On the other hand, the school felt that their ability to effectively adapt the curriculum and instruction for Britney would be hampered without this information.
Lastly, it became clear that while the school and family had similar specific goals regarding the reduction of Britney's challenging behaviors, they disagreed on the importance of these specific goals as compared to broader goals. Specifically, the school placed primary importance on her behavioral challenges, while the family's primary concerns focused more on issues surrounding socialization and inclusion, viewing the behavior issues as secondary in importance.
Assessment and Support Strategies
The team began this process with only three months remaining in the school year, and so was operating under some severe time constraints. Due to these time constraints, the team decided against beginning a goal setting process by conducting a formal person-centered plan for Britney. A person-centered planning process may have helped the team to incorporate more of the goals that were important to the family. Although this process did not occur, the family and school goals were shared through informal discussions during the first meeting.
Although not patterned after a formal person centered planning process, this discussion afforded an opportunity for team participants to openly share their concerns and visions for Britney. This initial discussion allowed the team to consider a wider array of goals for Britney that included: (1) expressing frustration appropriately; (2) moving on to second grade with peers in an inclusive setting; (3) increasing independence (i.e., academic seat work, lunch time, large group instruction); (4) having a friend at school, (5) resolving hearing (ear) problems; and (6) living a healthy life. This process did allow the team to come to an agreement on a number of goals that had previously not been considered by the team.
When the functional assessment process began, the team had a difficult time understanding the rationale and importance of data collection. However, once this information and data was collected and summarized, the team was able to see its relevance for developing a comprehensive support plan that was tailored specifically to Britney's needs. For example, after conducting an interview with the family, an important health condition was revealed that previously had not been known to the rest of the team. The interview revealed that in the past Britney had experienced a build up of fluid in her middle ear that caused her to have an acute hearing loss in both ears.
In addition to the functional assessment interviews, scatter plot information was also obtained. The classroom aide and teacher were able to collect scatter plot data for approximately three weeks in order to see a pattern in Britney's behavior. The scatter plot information confirmed that Britney's refusing to complete tasks occurred primarily during math, fine motor, and independent tasks. By identifying specific times and setting in which the problem behaviors were occurring, the team was able to target times to conduct observations to collect the more detailed data that looks at antecedents to, and consequences following, behavior to determine the function of the behavior(s) in question.
The team then moved on to collect more intensive ABC data during the times and settings identified by the scatter plot where Britney's problem behaviors were most likely to occur. Due to the demands such data collection would make on the teacher and aide, the team arranged for other team members to come into the classroom and conduct these observations. In summarizing the data generated from these observations, the team was convinced that the main function of Britney's behavior was attention seeking. However, the ABC data also indicated that her behaviors might allow her to escape the task at hand. The team was not yet open to the possibility of multiple functions for Britney's behavior. Since Britney, for the most part, was able to be easily redirected to complete her task, the team did not see "escape" as a possible function to her behavior. This "missing" function would later cause problems in the development and application of the PBS plan.
Based on the information revealed from the functional assessment process, the team began to design the behavior support plan. While the team was able to generate a number of antecedent-based strategies, they had a difficult time understanding the importance of teaching replacement skills and identifying specific skills that would allow Britney to achieve the same function (attention) with a more appropriate behavior. As a result, the team facilitator spent some time leading a team discussion on the advantages to focusing on replacement behaviors in addition to antecedent modifications and consequence strategies, such as avoiding extinction bursts, teaching new, functional skills and promoting maintenance and generalization.
While the functional assessment revealed that Britney would benefit from immediate reinforcement in the form of positive praise and attention for appropriate behavior prior to the occurrence of problem behavior, it was difficult for some team members to understand the importance of immediately reinforcing Britney following instances of appropriate behavior. The classroom teacher and assistant were initially reluctant to make additional adaptations for just one child and, as they had little experience making such adaptations, required some additional skills and guidance from the rest of the team in making those adaptations. During this planning stage, the family was able to share some of Britney's favorite things to do and work for. They were also able to share with the team how Britney is reinforced for appropriate behavior at home. The family was willing to provide Britney with these reinforcers at home if she had a successful day at school.
Thus a plan was developed that included antecedent-based strategies (e.g., adapting the curriculum, developing peer buddy supports, etc.), alternative skills (e.g., appropriately requesting assistance from others, etc.), consequence-based strategies (e.g., providing positive praise for engaging in appropriate behavior, ignoring inappropriate responses, etc.), and strategies for addressing Britney's lifestyle goals (e.g., increasing social interaction by teaching Britney to initiate social interactions in her ballet class , etc.).
Outcomes and Plans for Ongoing Support
Once the interventions were developed, the team then developed an action plan consisting of a timeline and team members responsible for implementation, ongoing communication as a team, and data collection. There was also a follow-up meeting scheduled to review and discuss the current plan.
On the action plan, the teacher and assistant agreed to take frequency data on a scatter plot sheet to show if there had been a decrease in the target behaviors since the behavior support plan was implemented. While this plan for ongoing data collection was not carried out, anecdotal reports from team members indicated that the intervention had been successful over the initial three-week period following the development of the support plan.
According to reports from school personnel, after this three-week period, Britney's hitting behavior toward the classroom aid resurfaced and increased in intensity. Examples of this increase in intensity included an instance of stabbing the assistant with a pencil and hitting her in the face. Unfortunately, some of the team members were not notified of Britney's increasingly intense behaviors until the day of the follow-up meeting, five weeks after the development of the plan and two weeks after these intense behaviors began to reappear. It was apparent that this change in Britney's behavior and lack of communication among team members had caused the team to become increasingly frustrated with Britney and had caused more tension between the family and school personnel. Thus, the follow-up meeting was not as successful as previous meetings, as team participants began to cast blame for Britney's behavior. Because of the violent outburst towards the classroom aide, the aide requested that she be moved into another classroom for the remainder of the school year. The administrator felt this was an appropriate request as she felt that Britney had become increasingly dependent on the current assistant who had worked with Britney for almost two years.
During the follow-up meeting the teacher was able to show the team ABC data that had been collected following the increase in challenging behavior. This data again revealed that Britney's challenging behaviors were serving both an attention-seeking and an escape function. Yet, many of the team members continued to have a difficult time understanding how Britney's behaviors could be functioning to delay engagement in academic tasks, since she could so easily be redirected back to her task in just a few minutes. Unfortunately, the team failed to reach a consensus that Britney's behaviors were also serving an escape function. Thus the team did not develop any replacement behaviors that would allow Britney to appropriately request a momentary delay in her work (e.g., requesting a break). While the team briefly discussed this idea, team members who did not feel Britney's behavior served an escape function felt it was not appropriate, and so did not incorporate it into the plan.
While the team focused more on consequences-based interventions than on replacement skills for Britney, it became apparent to the team facilitator that Britney was not receiving immediate reinforcement for appropriate behavior. She was given one star, which served as a token to be exchanged later for time in the library. Although this was a motivating reinforcer for Britney, as she very much enjoyed time in the library, she was required to behave appropriately for an entire morning prior to receiving a star, and then again for an entire afternoon. Since Britney's behaviors were occurring more frequently than once every three hours and she was not earning many stars, it appeared that Britney was not making the connection between engaging in appropriate behavior and experiencing positive outcomes. Yet, identifying a reinforcer that could be given to Britney on a more frequent basis was also difficult for the team. Prior to this meeting the family had completed a "reinforcer inventory" for the school indicating that "food" items were most reinforcing for Britney. However, the team was not comfortable using food as a reinforcer since the other children in the classroom could not have the same. Thus, reinforcers that could be delivered on a more frequent schedule were not incorporated into the plan. The follow-up meeting ended with an action plan and a scheduled date for the next meeting to address the IEP.
During the IEP meeting, a plan was developed to address Britney's current needs and consisted of the following strategies: remove and replace the current assistant; train the new assistant on Britney's plan; begin looking for a second grade teacher; and, revise her IEP to reflect themes generated from her support plan, rather than listing every first grade goal. Following this meeting, the team did communicate progress on the action plan to all team members. They reported that once the classroom assistant was moved and a new assistant was brought in, Britney's behaviors began to decrease. Currently, the team is scheduled to continue meeting to address the IEP plan, continue with direct observations in Britney's class, and review the current plan in detail with the new assistant. Furthermore, Britney's problem behaviors continue to decrease. The team is aware that this may only be a "honeymoon" period for Britney, but at this point they are happy with her improvements and are looking to begin second grade with a fresh start and a plan in place.
Summary and Lessons Learned
Although this process was intense and complex for some of the team members, they were able to identify a number of appropriate goals for Britney, address most of Britney's needs, and develop a plan to address those needs. Many lessons were learned throughout the process for the school, the family members, and the PBS project facilitator.
The school personnel began to see the importance of a "team" process and the importance of data collection. Although they found both to be time consuming, they did see that important information was discovered through conducting a functional assessment of behavior. They were also able to see beyond their basic perceptions of Britney's behaviors. For quite some time, most all of the team members believed her behaviors occurred strictly to get adult attention. After going through this process a few team members were beginning to understand some of the other issues affecting Britney's challenging behavior, such as frustration with difficult directions and curricula.
The school administrator began to identify that some teachers had experience and knowledge in how to make inclusion work and that others did not. As a result, she has become more selective about the experiences and skills required for Britney's second grade teacher. The administrator is also searching for ways to provide teachers at her school with additional training and resources with regards to special education and inclusive environments.
Through this process, the family was able to identify that their negative comments and remarks to school personnel directly affected their likelihood of responding appropriately to Britney's needs. Furthermore, they were also able to see the commitment of time and effort that the school personnel were putting towards improving Britney's success in the classroom. Throughout this process they became more appreciative of the work the school had been doing for their child.
As for the PBS project, it was important for the facilitator to allow the team to clearly speak their minds and express their goals for Britney. However, in this case it was difficult to guide the team towards the adoption of effective strategies and not to simply impose the use of such strategies on the team, knowing that imposing strategies could create poor contextual fit and team buy-in. Thus, while the facilitator was able to guide teams towards the adoption of a number of effective strategies, some important strategies were not incorporated. Yet through engaging in this process, the team was able to identify a number of the critical variables impacting Britney's behavior. This provided them with a sense of accomplishment and allowed them to take ownership of the final support plan developed for Britney. As a result, they were more inclined to consistently follow through with the plan and take responsibility for any successes or failures.
Britney's team is already planning her transition to the second grade and is excited about their future collaboration. They are looking forward to working together to complete a person-centered planning process to start Britney's second grade year. They are also committed to continued, yet less intensive, support from Florida's PBS project as they work to build their own capacity to implement positive behavior support for Britney.