Running head: POSITIVE SUPPORT PLAN - JD

Positive Support Plan for JD at Home

Tracy Pham & Kripa Chitrakar

The University of British Columbia

POSITIVE SUPPORT PLAN - JD

Positive Support Plan for JD at Home

Introduction

JD is an affectionate, cheerful 5 year old boy who lives at home with his maternal

grandparents, mother, father, baby sister and maternal aunt and uncle. He is diagnosed with

autism spectrum disorder. He occasionally suffers from undiagnosed rashes on his skin. He

enjoys putting his hands in bins of small items such as beads, beans, and pasta. He loves physical

affection (e.g., hugs, rubs, tickles, kisses) and enjoys sweet treats. He currently uses his PECS

very well and can exchange up to 15 symbols on his own. He also communicates his needs very

well by using gestures (i.e., head shakes, pushing things away) or leading the person to the

item/action that he wants. This behaviour support plan is needed because JD has a history of

problem behaviour at home and the family would like more support in the home. This plan is

based on a comprehensive functional assessment and family ecology assessment. The plan was

developed in collaboration with JD’s parents, behaviour consultant, behaviour interventionists.

This plan includes a summary of the functional assessment and a description of a comprehensive

behaviour support plan.

Family Goals for JD

The family’s overall goals for JD is to teach him more communication skills, independent

play skills and social skills. The main goals of the family are for JD to interact with the family

more during family time, to eat more vegetables during meal times and to learn how to play

independently during leisure time, all without engaging in problem behaviour. These are the

three activity settings that will be targeted for initial intervention and support in the home.
POSITIVE SUPPORT PLAN - JD

Caution

This comprehensive behaviour support plan includes many elements. This is because the

functional assessment revealed many aspects to JD’s problem behaviour. To overcome the

problem behaviour, the environmental aspects that set the stage for problem behaviour, trigger

problem behaviour, or reinforce problem behaviour need to be attended to. Therefore, the plan

may initially appear overwhelming but please keep in mind the following three points. First, not

all strategies in the plan need to be implemented at the same time for JD’s behaviour to improve.

Second, if the proactive strategies are put in place first, there will be a lesser need to use

consequent strategies to address the problem behaviour. Finally, as JD’s behaviour improves,

only a small list of “core strategies” will be implemented to maintain the improvements in

behaviour.

Functional Assessment Summary

Behaviours of Concern: Spitting, crying/yelling, physical Aggression (i.e., pinching, biting,

scratching), physical resistance (i.e., pushing you away, flopping to the ground), elopement

(bolting, walking away from area)

Functions of Problem Behaviour: JD’s problem behaviour serves three separate functions or

purposes. First, JD engages in problem behaviour to avoid or escape aversive demands, tasks and

interactions. Second, JD engages in problem behaviour to get more time with a preferred item.

Third, JD engages in spitting to get automatic positive reinforcement.

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Person Factors: There are three person-specific factors that set the stage for problem behaviour

in which JD wants to escape an aversive event, get a preferred item or activity, or engage in

automatic positive reinforcement.

1. Skill deficits: JD communication skill deficits wherein he’s not always able to

communicate his needs and desired, which may result in him to more likely engage in

problem behaviour to escape demands or to spend more time with desired items or

activities. JD also has independent play skill and cooperative play skill deficits that make

it harder for him to play on his own or play with others, which may result in him

engaging in problem behaviour to escape demands of interacting with others or engaging

in spitting instead of playing independently. JD has poor receptive understanding so

when given receptive instructions, he may not understand and may engage in problem

behaviour to escape the demands/requests asked of him.

2. Rashes on his skin: On days where JD has a rash on his skin on any part of his body, he

may be less cooperative with demands/requests and engage in more problem behaviour.

3. Limited repertoire: JD has a limited communication repertoire wherein can request for

tangibles/desired activities/foods using some gestures or PECS but he currently is not

able to appropriately request for actions, such as “break”, “more time” or “no”. This may

result in him to more likely engage in problem behaviour to escape demands or to spend

more time with desired items or activities. JD also has a limited food repertoire and

currently eat lots of carbohydrates (e.g., cookies, chips, roti) but not any vegetables and

only a couple fruits (e.g., apples, bananas), which makes it harder for him to try new
POSITIVE SUPPORT PLAN - JD

foods and may engage in problem behaviour to escape requests to eat non-preferred

foods.

Environmental/Quality of Life Factors: There are 2 main environmental/quality of life factors

that set the stage for spitting in which JD wants to engage in automatic positive reinforcement.

1. Carpeted areas: JD is more likely to spit on areas that are carpeted.

2. Unstructured activities: During activities that are unstructured and have no clear

expectations, JD is more likely to engage in spitting.

Triggers: There are specific events in JD’s immediate environment that usually trigger problem

behaviour. They are listed below according to function of the problem behaviour.

1. Triggers for escape-motivated problem behaviour are: a) difficult demands b) request to

eat non-preferred food items b) request to play with peers or family members

2. Triggers for item-activity motivated problem behaviour are: a) taking back desired

item/activity after less than 30 seconds b) blocking access from desired items

3. Triggers for automatic positive reinforcement problem behaviour are: a) when JD is left

alone b) transitioning between rooms/activities with JD standing or walking upright

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Appendix 1

Competing Behaviour Pathways Diagram

Setting Event Strategies Preventive Teaching Consequence

Strategies Strategies Strategies

POSITIVE SUPPORT PLAN - JD

1. Always set up 1. Avoid leaving JD Give praise, tangibles,

structured activities for alone in a room if 1. Teach JD to play physical affection and

JD to engage in possible with other desired treats

2. Do not have JD play in 2. When playing on activities on his contingent on JD

or near carpeted areas his own, have JD own for an playing independently

3. Teach functional seated in a chair at extended period without spitting

communication skills a table (not of time using When JD spits

using Picture exchange standing upright) modelling and in the toilet,

communication system 3. NCR: Set a timer most to least give praise

(PECS) and using an for an adult family prompting Minor PB:

Alternative member to take JD 2. Teach JD to spit prompt JD to

Augmentative to the washroom to in the toilet using ask to go to

Communication device spit in the toilet modelling. the washroom

4. Schedule a family every 10 minutes Eventually teach to spit in the

member to be in the 4. When transitioning JD to go to the toilet/sink

same room as JD so JD to new activity toilet to spit by Major PB: JD

that he is not left alone. or room, give him himself when the must wipe up

a chewie to put in timer goes off. area he spat

his mouth on
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POSITIVE SUPPORT PLAN - JD

Setting Event Preventive Teaching Consequence

Strategies Strategies Strategies Strategies

1. Teach functional 1. Visuals: Provide 1. Teach JD to 1. Give JD praise,

communication a first/then visual engage in an tangibles, physical

skills using indicating family activity together affection and desired

Picture exchange time and alone with his family treats and a 5 minute

communication time with iPad using modelling break contingent on

system and using and use a timer and most to least JD following through

an Alternative to switch between prompting with demand/request

Augmentative family and alone 2. Teach JD to eat (e.g., interact with

communication time. Use visuals non preferred family, eat non-

(AAC) device. to indicate healthy food preferred food)

2. Teach interactive first/then for non- using the steps without engaging in

and cooperative preferred and for systematic any PB

play skills at ABA preferred food desensitization 2. When JD requests

sessions item. 3. Teach JD to for a “break” or “no”,

3. Make sure to 2. Provide JD with request “no” or give him praise and

have cream to choices using “break” using a 3 minute break

relieve itchiness choice board of PECS and AAC from demand/

of rash preferred device request

4. Offer more activities or food. 3. Minor PB: prompt JD

choices for food 3. JD to be seated to ask for a “break”

against the wall or “no” - give him 2

where he is not minute break from

able to leave the demand/request if he

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table during asks

family time or 4. Major PB: Redirect

meal times JD back to desired

setting and

physically prompt JD

to follow through with

demand/ request. If

he can follow

through without

engaging in any

problem behaviour,

he earns a 1 minute

break from the

demand/ request
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POSITIVE SUPPORT PLAN - JD

Setting Event Preventive Teaching Consequence

Strategies Strategies Strategies Strategies

1. Teach functional 1. Use positive 1. Teach JD to give 1. Give social praise

communication contingency visuals item back right and physical

skills using Picture such as first/then away when asked affection when JD

exchange board using modelling gives back desired

communication 2. Increase and most to least item right away

system and using predictability by prompting without engaging in

an Alternative using a count down 2. Teach JD to any PB. Give him

Augmentative or a timer to show request for “more access to even

communication JD how long he has time”, “Give”, “my more preferred item

(AAC) device. until he needs to turn” or “put away” for 5 minutes.

2. Teach receptive give item back using PECS or 2. When JD requests

communication 3. Allow JD to have AAC device for “more time”, “my

skills access to preferred turn” or “give”, give

3. Make sure to have items for at least 30 him praise and give

cream to relieve seconds before him 2 minutes more

itchiness of rash taking it back with desired item

3. Minor PB: prompt

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JD to ask for “more

time”, “my turn” or

“give”. If he’s able

to, give him 30

seconds more with

desired item.

4. Major PB: Wait until

JD has calmed

down and carry on

with tasks at hand.

Do not give him

access to desired

item.
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Positive Behaviour Support Plan

Ecological/Lifestyle Strategies

1. Include reinforcers/preferred items in all tasks/activities: During dinnertime, leisure time

and family time routine, include preferred food, activities, types of interactions and toys

into the task, activity or routine. This may include: a) preferred food during dinner time

(for JD to eat, after he has consumed some non-preferred food item) (e.g., Indian sweet,

cookies, chips), b) highly-preferred toys and activities during leisure time (e.g., iPad,

sensory bins) c) highly preferred activities to engage with family during family time (e.g.,

sand, puzzles, bubbles).

2. Use PECS and AAC device consistently to teach JD more communication skills: Always

have PECS binder and/or AAC device (e.g., Touch Chat app on iPad) with JD at all times

for you to use to communicate with him and teach him to communicate back to you using

the PECS and AAC device consistently. This includes using PECS and the AAC app to

teach JD to request for: a) desired items/activities/foods in all routines b) a ‘break’ from

family time or eating non-preferred food during dinner c) ‘more time’ with desired

items/activities.

3. Set up new area for leisure time: The area/room JD engages in leisure time at should not

have carpet if possible. This may help decrease the extend of spitting JD engages in when

he is left alone during leisure time. The area for leisure time should also have a table and

chair for JD to sit in, as he is less likely to spit when he is engaged in a task and seated.

4. Respite Care Schedule: Create a schedule of respite care among family members to

ensure everyone is getting a break from taking care of JD.

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5. ESL classes: All family members should enroll in ESL classes to help increase

participation in JD’s intervention strategies.

6. Translation of PBS Plan and training: We will translate this PBS plan into Punjabi for all

family members to understand the plan better. Implementation support will be provided

by a behavior interventionist who can speak Punjabi. JD’s aunt can also serve as the

translator during the planning process and implementation support meetings.

Preventative Strategies

1. Visual schedule and calendar: Provide more structure and predictability in JD’s day by

using a visual calendar on the wall with a sequence of events for the day. Go over the

calendar with JD every morning before starting his day. Before every difficult demand

during dinner routine and family routine, incorporate a first/then visual for JD to

understand a positive contingency statement, which is a statement stating what he needs

to do first before JD does/receives a preferred item/activity. For example, “first

cucumber, then candy”.

2. Choice board: Create a choice board with all his preferred items and activities and give

JD the opportunity to choose a preferred activity to do during alone time. During

mealtimes, provide options of non-preferred edible items and preferred edible items.

3. Seating: When he is by himself on the iPad before dinner time, place him in an area

where he is within visibility and supervision of an adult. Help him to sit down either on a

chair with a table, or on the couch. Similarly, during meal times, seat him against a wall

to block easier access to elope or flop on the floor.

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4. Transitions: Give JD a chew toy of his choice to chew on and prevent his spitting before

switching from one activity to another or standing up to walk from one location to

another.

5. Timer and countdown: Use a timer and countdown to indicate how long he has access to

his preferred activity/item.

6. Schedule for spitting: Take JD every 15 minutes to the restroom to provide him with

opportunities to spit in the sink or toilet every 15 minutes. Once the spitting decreases

this can be prolonged to every 30 minutes.

Teaching Strategies

1. Communication: Continue the use of picture exchanges using real pictures to mand for

preferred tangibles and gradually expand his vocabulary by teaching JD to communicate

using PECs pictures to mand for items as well as actions such as “no”, “more”, “break”,

“help” and “all done”. Eventually teach JD communication using an AAC device such as

an iPad with the help of Touch Chat (app using PECs). Due to difficulty with basic

imitation skills using his arms and hands, sign language is not the most feasible means of

communication for JD at the moment.

2. Play skills:

a. Play with infant sister: JD’s behaviour interventionist (BI) will teach him basic

play skills during his behavioural intervention sessions to help him engage with

his infant sister. Teaching him skills such as shaking a maraca or hugging a doll

with help him interact with his infant sister and play with her more appropriately.
POSITIVE SUPPORT PLAN - JD

Use modelling and most-to-least prompting (i.e., full physical prompt and fade

out to gestures) to teach JD these skills.

b. Play with adult family members: Teach JD to participate in group activities with

family members while doing an activity of JD’s choice and ability, such as simple

puzzles, blocks, bubbles, sand box. Use modelling and most-to-least prompt to

teach JD how to play with family members.

3. Receptive skills: Teach JD to understand and follow vocal instructions such as “give” and

“put away” during behaviour interventions sessions. JD’s BI will provide more

opportunities for following simple but basic instructions and teach him how to respond

by physically helping (i.e., physical prompts) him to follow instructions and perform the

actions. The physical prompts will be faded leading to the point where JD will follow

instructions without requiring any physical help or reminders.

4. Spitting in appropriate places: Teach JD where it is appropriate to spit. Teach him to spit

only in the washroom, in the toilet or the sink using modelling. Begin by taking JD every

25 minutes to the restroom and when he spits in the toilet or the sink, reinforce by

praising and giving physical affection. As he learns to spit exclusively in the toilet or

sink, prolong the interval to every 30 minutes.

5. Expanding food repertoire: Introduce more healthy food options to JD’s food repertoire

and teach JD to eat more fruits and vegetables.

a. Systematic Desensitization: Starting with a small group of fruits and vegetables

such as cucumbers, berries, and carrots, teach JD to touch a small piece of

cucumber without engaging in problem behaviour. Once he is able to complete

this step without engaging in problem behaviour move on to the next step where
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he has to touch the piece of cucumber to his lips, followed by licking, putting it

inside his mouth, chewing, and eventually swallowing.

b. Reinforcement for systematic desensitization: Every time JD completes a step

without physical resistance, provide reinforcement with physical touch paired

with verbal praise and preferred edible tangible. Praise him if he tries to do it but

needs additional help, or reminders to complete the step. Praise him and give him

a 5 minutes break

Effective Consequences

1. Give JD praise (“good job”, “wow” “awesome”), physical affection such as back rubs

and hugs, preferred tangibles contingent (immediately after) to:

a. Playing by himself without spitting

b. Playing with his sister or family members appropriately for a considerable amount

of time without engaging in problem behaviour (also give 5 minute break from

play with family)

c. Participates in a family group activity for a considerable amount of time without

engaging in problem behaviour (also give 5 minute break from group activity)

d. Follows through with the instruction is given when a piece of non-preferred food

item is presented to him (also give 5 minute break from eating non-preferred

food)
POSITIVE SUPPORT PLAN - JD

e. Gives up tangible item and follows instructions, and requests for item without

engaging in problem behaviour (in this case use a more preferred tangible item

than the one he gave up).

Try your best to not give him praise, physical affection, tangible, or a break when he is

engaging in problem behaviour.

2. Give JD a 3 minute “break” or follow-through with his request for “no” and give him a 3

minute break contingent to asking for “break” or “no” respectively using PECs. If he asks

for break and engages in problem behaviour at the same time do not give him a break.

Also praise him for “using his words”, or asking nicely (“wow you asked so nicely”,

“great job using your words”)

3. When JD engages in minor problem behaviour

Escape/avoid- Prompt him to exchange a picture of “no” or “break” and if he does so

without engaged in escalated problem behaviour give him a 2 minute break. This applies

to interaction with sister, family members, and presentation of non-preferred food items.

Tangible- Using a hand-over hand prompt to get JD to give up the item and get him to

ask for “more” or the item using PECS.

Automatic- When JD shows signs of accumulating saliva in his mouth, quickly lead him

to the restroom where he can spit either in the toilet or the sink. If he begins to spit

anywhere else, do not give attention to it and give him a chewy toy to block the spitting,

while leading him to the restroom.

POSITIVE SUPPORT PLAN - JD

4. When JD engages in major problem behaviour

Escape/avoid- When JD runs away, bring him back and help him interact with other

family members using physical prompts. If he follows through with the demand without

physical resistance or other problem behaviour give him a 1 minute break.

Tangible- Wait till JD calms down without giving him any access to the item and follow

through with the task at hand. Do not give back the item to JD.

Automatic- When JD engages in more spitting episodes than usual anywhere other than

the toilet, prompt JD to wipe the area he spat first, then give him a chewy toy and take

him to the restroom more often, such as every 5 minutes or if necessary every 3 minutes.

Evaluation

Implementation Checklist for home: JD’s family members will complete an implementation

checklist to self-evaluate and self-monitor. The checklist will help them evaluate and monitor the

implementation of the PBS plan in three different areas, a) the level of implementation of the

PBS b) the level of problem behaviour c) the level of social validity of the PBS plan (i.e., the

acceptability and importance of the PBS plan’s goals, procedures, and outcomes). The family

will fill out the checklist on a daily basis until the implementation of the plan is firmly in place.

The family will then fill out the checklist once every week.
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Positive Behaviour Support Plan

Implementation checklist

JD

April 2019

Date:_______________ Person using checklist :____________________________

Instructions: The purpose of the implementation checklist is to help you implement JD’s plan

at home. Before using this checklist it is important for you to read the behaviour plan so that

you have a good idea on how to implement the strategies. On the right is a place to evaluate

your level of implementation. A “1” indicates that the strategy is not in place (you have not

used it yet), and a “5” indicates that the strategy is fully in place (you are using it). The

checklist can be used to a) remind you of what to do, b) help you plan what you will do,

and/or c) self-evaluate your level of plan implementation. The checklist also provides a

place to assess levels of problem behaviour and to evaluate the acceptability of the plan.

Not in In

Place Place

QUALITY OF HOME LIFE SUPPORT

Including reinforcers/preferred items in all tasks and activities 1 2 3 4 5

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Ensure that PECS is always accessible to JD and reinforce the use of 1 2 3 4 5

PECS for communication

PREVENT PROBLEM BEHAVIOUR

1. Before hard demands, use visual schedule to visually show what is 1 2 3 4 5

expected of JD (e.g., “first cucumber, then cookie”)

2. Use choice board during meal times and family time to allow JD to 1 2 3 4 5

picked preferred food (to eat after unpreferred food) and family

time activity

3. Consider appropriate seating for JD during activity (e.g., meal time 1 2 3 4 5

= seated against a wall; leisure time = seated in view of adult and

in a chair at a table/on couch)

4. Give JD a preferred chew toy to chew on before physically 1 2 3 4 5

transitioning to new environments/activities

5. Use timer/countdown to countdown time with preferred 1 2 3 4 5

activity/item

6. Take JD to bathroom every 15 minutes to spit in toilet/sink 1 2 3 4 5

TEACHING NEW BEHAVIOURS AND SKILLS

POSITIVE SUPPORT PLAN - JD

1. Use PECS to teach JD to ask for actions such as “more time”, “no” 1 2 3 4 5

or “break”

2. Use modelling and most-to-least prompting to teach JD how to 1 2 3 4 5

play with sister and other family members. This will be taught by

the behaviour interventionist

3. Use most-to-least prompting to teach JD receptive skills. This will 1 2 3 4 5

be taught by the behaviour interventionist

4. Use modelling to teach JD to spit in the toilet or sink. 1 2 3 4 5

5. Use systematic desensitization to introduce unpreferred foods to JD 1 2 3 4 5

REINFORCE POSITIVE BEHAVIOUR

1. When JD follow through with difficult demands (i.e. eat 1 2 3 4 5

unpreferred food, interact with family during family time, give

back desired item) without engaging in problem behaviour, give

him praise, physical affection (e.g., back rubs, hugs), preferred

item to play with and a 5 minute break from the demand

2. When JD asks you for a “break” or “no” from difficult demands be 1 2 3 4 5

give him a 3 minute break from the demand/activity

3. When JD asks you for a “more time” with desired item give him 2 1 2 3 4 5

minutes more with desired item

POSITIVE SUPPORT PLAN - JD

4. When JD plays independently without spitting, give praise, 1 2 3 4 5

tangibles/treats and physical affection

5. When JD spits in the toilet, give praise 1 2 3 4 5

REMOVE AND REDUCE REINFORCERS FOR PROBLEM

BEHAVIOUR

1. For minor problem behaviour: a) prompt to ask for “more time”, 1 2 3 4 5 NA

“break”, “no”, “washroom” b) if JD is able to request, give him 2

minutes of what he is requesting for

2. For major problem behavior a) neutrally prompt JD to follow 1 2 3 4 5 NA

through with demand b) prompt JD to request for “more time”,

“break”, “washroom” c) if JD is able to request, give him 1 minute

with requested action

Problem behaviour

1. Spitting 0 1 2 3 4 5 or more

2. Elopement (run away) 0 1 2 3 4 5 or more

3. Physical resistance (push away, flopping, crying, 0 1 2 3 4 5 or more

yelling)

3. Physical aggression (pinching, biting, scratching) 0 1 2 3 4 5 or more

POSITIVE SUPPORT PLAN - JD

Social Validity

Disagree

Agree

1. The goals of the PBS plan are acceptable and important 1 2 3 4 5

2. The PBS strategies are useful and effective 1 2 3 4 5

3. The strategies are difficult to use 1 2 3 4 5

4. The PBS plan is supportive to all family members and team 1 2 3 4 5

members
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Implementation Support Plan

JD

April 2019

Introduction and Rationale:

We have developed a comprehensive behaviour support plan for JD. The plan includes multiple

components and strategies. There are two reasons for developing a PBS plan. First, the

functional assessment showed that JD’s problem behaviour served at least 3 functions-

escape/avoid demands, access to tangible, or automatic positive reinforcement. Strategies need to

address all of these purposes of problem behaviour. Second, your insights during the assessment

revealed several setting events that set the stage for problem behaviour (such as language

barriers, communication skill deficits) and various antecedent events that triggered problem

behaviour. Each of these features need to be addressed in the plan. Implementation support and

parent training is necessary for the successful implementation of a PBS plan. The plan defines

training and support activities that will be provided at home to all family members and includes

support activities, roles and responsibilities, and a time-line.

Support Activities

1. Support and training to you and other family members

a. Weekly in-home support and train you (1 hour per week)

b. Work on one problematic routine at a time

c. Design routine specific support plans

d. Role playing, modelling and coaching you on how to implement strategies

e. Engage in problem solving discussion

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f. Teach you how to conduct functional assessments and design behaviour support

plans

g. Schedule bi-weekly meetings with you to discuss progress, celebrate success and

solve problems

2. Support and training to ABA clinic behaviour interventionists

a. Bi-weekly onsite support and training to JD’s BIs (2 hours every 2 weeks)

b. Build plans that including strategies to teach pre-requisite skills

c. Model and coach BI on how to implement strategies

Roles and Responsibilities

1. Plan Implementation:

a. Home: Parents, aunt and uncle

b. Clinic: BB and KC

2. Respite Care Coordination and Training: Respite is provided by all family members

(including grandparents) living in the same house. We will provide orientation to and

translations of the PBS plan, provide minimal training necessary (review plan, give copy of

implementation checklist, help with problem solving) so that you are successful with JD.

3. Core Training Team: In-house and clinic Behaviour Consultant to provide orientation and

training to family members, respite care providers, and behaviour interventionists (who

works 1:1 with JD).

Timeline : 3 months