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Positive Behaviour Support Plan for Z.

Introduction and Rationale Z. is a loving and affectionate 6-year-old boy. Z. is a healthy, happy and curious 6 year old who is very affectionate and loving with his Mother and Father. He acquires new skills quickly and has recently developed an inclination toward imaginative play and invites a familiar adult to share in his play. He lives at home with both his Mother and Father and is an only child. Z. has been diagnosed on the Autism Spectrum. He attends a regular Grade 1 classroom in Richmond and works with two educational assistants (e.g. one in the morning and one in the afternoon.) Z. has good relationships with the adults in his life and has many positive interactions with them. Z. receives one to one intervention three times per week with two different interventionists. He is currently on a verbal behaviour plan and is making good progress in his communication and academic goals. This behaviour support plan is necessary because Z. has a history of problem behaviours at home. The plan is based on a comprehensive functional assessment and was developed in collaboration with Z.’s Mom and his early behaviour intervention team. The plan includes multicomponent strategies.

Functional Assessment Summary
Behaviours of Concern Screaming, falls to floor, swiping (e.g. clears things off surfaces with hand), throwing dy into the walls, objects, or other people. Functions of problem behaviour Problem behaviours mentioned above serve two purposes. Z. engages in problem behaviours to escape or avoid a non-preferred demand, task, or interaction. He also engages in problem behaviours to gain his mother’s attention. Setting Events 1. Limited communication skills: Z.’s limited communication skills make it challenging for him to effectively communicate his preferences and non-preferences. His comprehension of spoken language is weak as well. As a result of these two factors he engages in problem behaviour.

2. Tiredness: If Z. does not have a good night’s sleep or is tired after a long day at school he will likely exhibit problem behaviours when asked to partake in a nonpreferred activity. 3. Illness: When Z. is sick or recovering from an illness he is more likely to display problem behaviours when he is asked partake in a non-preferred activity. 4. Lack of predictability: When Z. is unaware of the sequence of events that will take place when in the community he is likely to display problem behaviours. 5. Self-management skill deficit: Z. is unable to regulate his emotions when asked to partake in a non-preferred activity or a demand is placed on him. 6. Limited food preference: Z. has a very restricted food repertoire and shows reluctance to try new and unfamiliar foods. He will likely exhibit problem behaviour when new foods are introduced to him.

Antecedent Triggers 1. Triggers for escape-motivated problem behaviours: (a) demand to do non-preferred task, and (b) having to wait while Mom is looking at items in a store, or waiting in a line up. 2. Triggers for attention-motivated problem behaviours: Mom’s attention is focused on another person or activity. Maintaining Consequences and their Functions 1. Maintaining consequences for escape-motivated problem behaviours: (a) the demand is removed so that he does not have to engage in the non-preferred task, and (b) Mom leaves the store and returns home. 2. Maintaining consequences for attention-motivated problem behaviours: Mom reprimands and gives Z. a stern look (i.e. provides attention).

Positive Behaviour Support Plan
Setting Event Lifestyle/ Ecological Strategies 1. Visual Supports: Use visual schedules to enhance predictability of tasks and activities by illustrating the steps from task onset to completion. Before beginning a non-preferred activity, get Z.’s attention, show him the strip and go through each step with him. End the non-preferred activity with a reinforcing item or activity, which should be represented on the strip. 2. Nap/Quiet time: When Z. has not had a good night of sleep or is tired from a long day at school give him 30 minutes of quiet time to nap or play alone. Keep the environment calm, quiet, and limit stimulating interactions.

3. Reduce or Modify Demands: When Z. is tired or ill, decrease the number of requests and demands placed on him when asking him to engage in non-preferred tasks or activities (e.g., Z only needs to eat 2 bites of non-preferred food rather than 5 bites). 4. Reinforcement schedule: Keep the schedule of reinforcement frequent at first when teaching Z. a new task. Reduce the schedule of reinforcement as he becomes more successful and comfortable with tasks. 5. Give him attention beforehand: When Mom knows ahead of time that she will be engaged in an activity or socializing with a visitor, spend 15 minutes interacting with Z. in an activity of his choice and then provide him with a highly preferred activity that he can independently engage in (e.g. play Thomas the Tank Engine and praise every 2 minutes for playing nicely).

Preventive Strategies 1. Positive Contingency Statements: Use first/then statements to promote cooperation when asking Z. to engage in non-preferred task or activity (e.g., “First eat your broccoli, then you get juice.” “First buy apples, then you get a gummy bear.”). It is important to have Z.’s attention when delivering the positive contingency statement. Kneel down and wait to get eye contact from Z. and deliver the statement. 2. Give Z. Choices: Allow Z. to make choices within an activity (e.g., “Do you want DVDs or trains?”) Offer Z. a choice of 2 preferred items or activities rather than the open-ended question, “What do you want?” Z. should also be allowed to make choices regarding the reinforcers he will receive for following through with activities (e.g., what he will get after completing a three-part visual countdown, etc.). 3. Pre-corrects: Prompt Z. to use a desired alternative behaviour (e.g., to say, “I want to go home.” or “Mom, come with me”) and respond accordingly to the behaviour to teach Z. that using this alternative behaviour gets him his desired response. Reinforce him with praise and affection for using the appropriate behaviour. After a few demonstrations remind Z. of what to do or say at the beginning of a non-preferred activity and prompt him to use the alternative behaviour if there are whispers of problem behaviours.

4. Visual Countdown as a Safety Signal: a) use a countdown strip to visually show Z. how much more of a task or activity he needs to complete (e.g., At mealtime when asking Z. to eat non-preferred foods, put 3 tokens on a strip and remove a token for each bite Z. takes. When the 3 token are gone reward him with a preferred food. Reset the strip and repeat). Tell Z., “2 more bites then you can play,” while showing him the countdown strip. The strip can be used to teach Z. to wait while Mom grocery shops. Each token can represent a short unit of time. Gradually increase the number of tokens as Z. builds tolerance for the non-preferred activity. Always reinforce him when all the tokens are gone; and b) Set the Time Timer for the length of time Z. has to engage in an activity. Have Z. look at the red on the timer and tell him how long he needs to engage in the activity.

Teaching Strategies 1. Teach Z. to communicate his preferences and non-preferences: Teach Z. to use language to communicate his wants and needs. a) Teach Z. to ask for a break or help during tasks b) Teach Z. to ask to “leave now” when in the community c) Teach Z. to ask for attention when Mom is busy. 2. Teach visual countdown strip: Teach Z. how to use a visual countdown strip by showing him a strip with three numbers on it and the removal of all three numbers is contingent on a reward or preferred activity. For example, when teaching Z. to eat a non-preferred food, each number is removed after a bit of non-preferred food, when all three are removed from the strip a reward (e.g., a preferred food) is given to Z. 3. Teach Z. to refer to the Time Timer: Start teaching with short amounts of time during activities at home that Mom is able to do at her own pace so that she can reinforce Z. at short intervals (e.g., Z. will wait for 2 minutes while Mom is folding laundry) and increase the length of time as Z. builds tolerance. Get Z.’s attention and show him the red on the timer, tell him how many minutes he has to wait and what he will get after waiting (e.g., “wait for 2 minutes, then big hugs.”) When the timer dings it is important to immediately give Z. your attention and reinforce him for “nice waiting.” Play with him for a few minutes and then you can practice using the timer again. The Time Timer strategy should only be used in situations where the adult is able to leave the activity they are engaged in as soon as the timer is up. It is not ideal for unpredictable situations like grocery shopping where you cannot accurately determine how long Z. will have to wait. A countdown strip is more appropriate for that situation (see above). The Time Timer can

be used while Mom is having a social visits so Z. knows she will check in on him every 10 or 15 minutes. 4. Teach Z. self-management skills: Teach Z. how to control his emotions by modeling and practising with him a relaxation strategy. Z. will be taught a relaxation routine whereby he will take three deep cleansing breaths and relax his whole body as an alternative to problem behaviour. He will use this technique when he feels frustrated, anxious or upset. The best time to teach these skills is when Z. is calm and he is in a controlled situation. 5. Teach Mom to positively praise Z. every 10 minutes: Mom will wear a Motivaider to remind herself to positively praise Z. when he is independently playing appropriately while she is engaged with another activity. For example, “Nice playing by yourself Z!” Effective Consequence Strategies 1. Provide praise and preferred items or activities contingent on desired behavior: Provide Z with continuous praise and attention contingent on desired and appropriate behaviour. Provide Z. with descriptive praise for his cooperation and or his success. Behaviours that should be regularly praised include waiting patiently, playing independently while Mom is occupied, sitting at the dinner table and eating non-preferred food. For example; “You did such a good job waiting for Mom.” 2. Provide attention or a break or leave situation contingent on using language: a) If Z. asks for a attention (e.g. “come here, Mama”) provide him with attention and interact with him. b) If Z. asks for a break, help, or to leave a situation (e.g. “Mama, help me,” or “leave now”), honour his request and provide him with relief from that activity. 3. De-escalation strategies for minor problem behaviour: a) For minor attention motivated behavior (e.g. makes eye contact and swipes, short scream) Prompt Z. to use appropriate language and honour his verbal request. For example, if Z. starts to engage in disruptive behaviour to get your attention, tell him to say “Mom, come here please.” Then give him the attention he has asked for. b) For minor escape motivated behavior (e.g. leaves dinner table, flops to the floor), prompt Z. to say “break,” or “help” so that he can get a break or help. Redirect Z. back to the activity with a countdown strip showing him how many more times he has to engage in the activity (e.g. “two more bites, then gummy bear”).

4. Consequence strategies for major problem behaviour (e.g. tantrum, throwing, swiping, and loud screaming and crying) that minimize, or withhold reinforcement: a) When Z. engages in major problem behaviour that is attention-motivated it is important to minimize the attention you give Z. while keeping everyone safe. If necessary remove any objects in his vicinity or block Z. from swiping any items. If Z. approaches you and tries to climb onto you or hug you physically block him while remaining neutral. You can say in a neutral tone, “get down.” It is very important that you remain calm, keep language to a minimum and avert eye contact as much as possible. Keep a distance from Z. but for safety reasons it is very important that you stay in the same room and can keep an eye on him without giving him direct attention. When Z. calms down you can direct him to the activity he was engaged in or a medium-preferred activity, such as puzzles or coloring. Provide positive verbal feedback for him engaging in the activity (e.g. “good coloring”) and do not discuss the problem behaviours that had occurred. Prompt him to use his words if he wants more attention from you. b) When Z. engages in major problem behaviour that is escape-motivated it is important that you do your best to redirect Z. back to the activity at least one more time without allowing him to escape from it entirely. It may be necessary to temporarily remove Z. from the environment in which he is demonstrating the problem behaviours. Using minimal language lead Z. to a quiet area where you can establish control and allow him to calm down safely. When he has calmed down show him the visual countdown with only one token on it (you will remove any other tokens because we want him to return to do only one more of the activity). Give Z. the contingency statement reminding him of the reinforcer he will receive for following through with the activity. Take Z. back into the target environment, do one more of the activity (keep it very short), reinforce him and let him leave. For example, when at the grocery store, Z. flops to the floor and screams. Mom will take Z. outside to a quiet corner or to the car. Wait for him to calm down and then show him the countdown strip with one token. Tell him, “one more minute shopping, then gummy bear.” Take him back into the store for one minute, leave and tell him “great grocery shopping” and reinforce him immediately with his chosen reinforcer. It is important that you keep the last activity very brief because the aim is to end the activity and be able to reinforce Z. before he escalates into problem behaviour again.

Comprehensive Positive Behavior Support Plan Implementation Checklist for Z

Date: ______________________________ Completed by: ______________________

The purpose of this implementation checklist is to help you implement Z.’s Positive Behavior Support Plan. It is important to read the plan so that you have a good idea of how to implement the strategies below. On the right is a place to evaluate your level of implementation. Please circle the number that best describes your level of implementation for each statement (1 = Not in Place, 5 = Fully in Place). This checklist can also be used to a) remind you of what to do to support Z. better, b) help you plan what you will do to support Z., c) self-evaluate your and the team’s level of plan implementation. This checklist will also provide a place to assess the level of problem behavior and to evaluate the importance of social validity.

Not in Place

Fully in Place

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Provide a visual schedule, countdown strip, or time timer to increase predictability and endurance during difficult tasks. a) review pictures sequence of routine, b) countdown strip for number of tasks left before preferred activity, c) time timer as a safety signal to increase endurance during difficult tasks. Use positive contingency statements to motivate Z. (e.g., “3 bites of dinner first, then computer time”). Promote cooperation by offering choices within the visual schedule, number of tasks on the countdown strip, and amount of time on the timer. Provide praise and preferred items/activities contingent on desired behavior. Reinforce the use of language. a) When Z. asks for attention, provide him with positive attention and engage with him. b) When Z. asks for help or to leave, follow through with his request.

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Team Z. self-management skills to enable him to maintain control over his emotions. Read and practice the dinner/shopping time script with Z. before commencing the activity so Z. knows what is expected of him. 7. Teach Z. to follow the visual schedule: a) use a visual time-timer, b) use safety signals to build endurance (e.g., just 2 more bites when computer time), and c) model the task and provide her prompts to follow the schedule. 8. For minor problem behaviors a) actively ignore and redirect him to desired behaviors, and b) prompt Z. to use language that matches his purpose and honor his request. 9. Wear the Motivaider and intermittently reinforce Z. when he is playing independently while Mom is engaged and cannot provide immediate attention (e.g., reinforce every 5 minutes). 10. For major escape motivated problem behavior, a) Decrease task intensity (i.e. number of tasks left or amount of time) and show Z. the visual schedule and/or timer and use positive contingency statements (e.g., “one more minute of shopping then gummy bear”). b) Redirect Z. back to the task and reinforce when it is completed. 11. For major attention motivated behavior, a) Withhold attention (i.e., no eye contact, minimal speech, neutral tone of voice, no physical contact), b) When Z. is calmer, redirect to a medium preferred activity and reinforce with attention for complying.

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Level of Problem Behaviors

1) Screaming 2) Falls to the floor 3) Throws body or objects at Mom 4) Swipes object off surfaces

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Social Validity Agree 1. The goals of the behavior support plan are appropriate for my child. 2. The goals of the behavior support plan are acceptable to me. 3. The goals of the plan are consistent with my family’s goals, values and beliefs. 4. The strategies are difficult to carry out in the home or community. 5. The strategies used are effective at improving my child’s behavior. 6. The outcomes of the plan’s use are positive for my child. 1 2 3 Disagree 4 5

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Implementation Support Plan for Z. April 2011 Introduction and Rationale Z.’s behaviour support team has developed a comprehensive positive behaviour support (PBS) plan based on information gathered through a functional assessment interview and observation of family-based routines. The information gathered revealed that Z.’s problem behaviours serve two functions; to escape from non-preferred tasks and to seek attention, primarily that of Mom. The team will work on one routine at a time, starting with the routine most valued by the parents. The PBS plan identifies strategies for reducing or eliminating the problem behaviours and will serve as a guide for Z.’s parents and others implementing it. This implementation support plan will serve to outline the support activities and training that will be provided to those implementing the PBS plan, the roles and responsibilities of members of the behaviour team and parents, and a time line. Support Activities Support and training activities will be provided for parents and Z.’s support team at home (behaviour interventionists, babysitters, future respite care workers). 1. 2. 3. 4. 5. 6. 7. 8. Prepare visual supports and identify potent reinforcers Biweekly support and training sessions (1.5 hour sessions) Develop routine-specific behaviour support plans Demonstrate the use of the strategies and supervise the implementation of the strategies by the parents and support workers Role play strategies Teach Mom to praise Z. every 10 minutes Problem solving discussions during a regularly scheduled meeting Monitor and revise plan if problems occur

Roles and Responsibilities 1. Plan Implementation: Parents, behaviour interventionists, babysitters 2. Preparation of Materials: Lead behaviour interventionist 3. Training in PBS strategies: Behaviour consultant and Lead behaviour interventionist

Timeline 3 months