Brief Description of PBS Related to Developmental Disabilities (Focus on Adults)
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The first research studies evaluating the effectiveness of positive behavior support (PBS) focused on improving the lives of children and adults with disabilities who engaged in problem behaviors. These early research studies focused on developing a better understanding of the relationships between behavior and the environment while emphasizing the importance of team-based strategies to improve an individual's quality of life. PBS refers to a set of strategies meant to reorganize or modify the environment in such a way that problem behavior is prevented. In addition, new skills are identified and taught in order to make problem behaviors unnecessary.
In many cases, an adult with a disability who is engaging in problem behavior is doing so in order to achieve a desired social outcome. Behaviors that occur repeatedly often serve a useful function for the person. Two major types of functions that can result from problem behavior include escaping from something unpleasant or obtaining something desirable. Problem behaviors may occur when someone is trying to escape from an unpleasant situation. For example, a man who dislikes his current employment setting may throw chairs across the room because he knows that he will be sent home for misbehaving. Problem behavior can also occur in order to avoid specific people, or to escape internal stimulation such as physical pain, or illness. Some individuals engage in problem behavior to gain attention from their friends or other adults nearby. In other cases, problem behavior may occur in order to obtain preferred items or events. A person's problem behavior can be maintained in order to access internal stimulation, as is the case when a person repetitively engages in a behavior (rocking back and forth, poking an eye) in order to obtain sensory or tactile stimulation.
Once the function of a problem behavior is identified, PBS strategies are used to make problem behavior irrelevant, inefficient, and ineffective for the individual. The process for identifying why a person is engaging in problem behavior is called Functional Behavioral Assessment.
Functional Behavioral Assessment (FBA)
The functional behavioral assessment (FBA) process involves gathering information about what is maintaining an adult's problem behavior. A variety of assessment tools are used to conduct the FBA. Interviews with people who know the person well are usually a first step for gathering information. Observing the individual in his natural environment provides further evidence regarding the function of a problem behavior. The team working with the individual systematically observes the person in different settings to see if there are certain environmental variables triggering problem behavior. A functional behavioral assessment is considered complete when the following outcomes are accomplished:
- there is a clear description of the problem behavior,
- the events, times, and situations that predict both the occurrence and nonoccurrence of problem behavior are identified,
- events immediately following problem behaviors are identified,
- one or more educated guesses (hypotheses) about the function maintaining problem behavior are developed, and
- direct observation data identifying and confirming the function of the problem behavior is complete.
Comprehensive Multi-component Interventions
The team that comes together to support an adult naturally include the people who are actively present in the situations and settings that are part of the person's life. Information that is gathered from the FBA helps the team develop and implement behavior support plans that are positive, proactive, educative, and based on the function maintaining problem behavior. PBS plans often include a number of interventions that are implemented across home, work, and community settings. These interventions include: 1) proactive strategies for changing the environment so triggering events are removed, 2) teaching new skills that replace problem behaviors, 3) eliminating or minimizing reinforcement for problem behavior, and 4) increasing reinforcement for appropriate behavior. A hallmark of PBS planning is its emphasis on improving overall lifestyle quality (relationships, activities, health) as an integrated part of behavior support.
PBS focuses not only on reducing behavior problems, but on enhancing a person's overall quality of life. Outcomes include lifestyle improvements such as participation in community life, gaining and maintaining satisfying relationships, expressing personal preferences and making choices, and developing personal competencies. Such improvements in quality of life are facilitated by establishing a positive long-range vision with the individual and his/her family and establishing natural supports through effective teamwork. Person-centered planning or wraparound strategies are used to launch PBS planning. Both person-centered planning and wraparound involve planning meetings that place the individual and his or her family in the lead role of defining the individual child or adult's strengths and preferred quality of life. Goals and objectives are identified and evaluated over time to ensure that progress is being made in reaching a higher quality of life and that the services provided to the individual and his or her family are effective.