Saturday, May 13, 2017

supporting students with behavior problems FBAs

I am reading Lee Kern, Michael P. George and Mark D. Weist's book, Supporting Students with Emotional and Behavior Problems. The book is not an easy read because of the depth of information it contains, but it is an excellent resource for behavioral interventions. The chapter on FBAs (Functional Behavior Assessment) takes me back to my son's elementary days where there was an abundance of behavioral challenges to work with. Unfortunately his experiences highlight what not to do rather than what to do. This book offers advice, guidelines and supportive paperwork to help intervene in behavior appropriately.

The authors suggest that the first step of a tier three behavior intervention is to assemble a team. The team should include staff members with expertise in areas that the child is struggling- in my son's case, his special ed teacher, SLP, OT, PT, classroom teacher and 1:1 aide- someone with expertise in developing behavior plans, and his parents. Parents are often not consulted enough in researching behavior and developing interventions. They bring valuable insights from craziness at home (ex. divorce, late parental working hours, frequent sibling conflict) to issues around home behaviors (ex. does not sleep well, limited diet, homework difficulties) to home perspectives (ex. sees school as boring, cannot complete homework, hates the kids on the bus, is teased a lot). These things have a bearing on school behavior, just as events at school have a bearing on home behavior. Parents are in the unique situation to not have rigid school day time constraints (there is no appointed lunch half hour) and potentially have access to more positive reinforcement (ex. favorite tv/video show, ice cream cone, Friday night movie, night with grandparents). They need to be a part of the team. This may be challenging. Parents often work during the day when school staff want to meet. Not everyone can go in a hour late or participate in a phone conference when it is convenient for staff. Flexibility needs to be used to ensure participation.

In primary school my son's teachers put together a behavior plan around respect. His very caring special education teacher explained to me that what everything boiled down to was a respect issue and thus this focus was perfect for him. I expressed concern. The second step is to identify and prioritize problem behaviors. Lack of respect is not a problem behavior. Yelling at others, taking materials, physical aggression, throwing materials at people, and self-injury are examples of specific problem behaviors. When the behavior is not operationally defined, your opportunity to work as a team to eliminate the behavior is limited. Yes, there can be many problem behaviors, my son actually exhibited the entire list above and more, but you need to prioritize the most important one first. The authors identify three levels of behavior to guide prioritization:
  1. Destructive- harmful or life threatening. (My son picks at his skin. He has had open wounds for months at a time.)
  2. Disruptive- destroying materials, interfering with learning of self or others including mental health issues like depression or anxiety, causing problems with social relationships, preventing participation in events or activities or likely to escalate to destructive. (My son was known for standing up in class and loudly proclaiming that the assignment and the teacher were stupid in not so polite terms followed up by ripping the paper and throwing it or eating it.)
  3. Distracting- impeding social acceptance, affecting self-image, causing minor damage to materials, likely to escalate to disruptive behavior. (My son wrote on himself and his clothing.)  (p. 157)
As you would expect, interventions need to start with destructive behaviors and advance through disruptive ones and finally settle on distracting ones. Although the authors have not yet proposed a number, other sources I have used suggest focusing on no more than three behaviors at a time. My son's teachers picked respect because that was one behavior. Addressing each component would be mind boggling and the time frame for improvement was too long to contemplate. Perhaps, however they would have been more successful in changing behavior if they had defined the problem behavior more specifically and worked on a few aspects at a time.

After the behaviors have been targeted, the real work of the assessment begins. Start with interviews. Staff, parents and the student himself should be interviewed. Strengths and likes are identified and broad concerns are labeled: past trauma, health and physical concerns, academic problems, social problems and general quality of life issues. Attempts are made to pin point when the most undesirable behaviors occur. Suppositions are made regarding antecedents and consequences that trigger and reinforce the behavior. This guides when observations are made.

Observations. The authors recommend observing 15-20 occurrences of the behavior (p. 169). This can be less for highly consistent behaviors, such as every time the fire alarm goes off, he screams and covers his ears. The most my son was ever observed for was his last reevaluation when I specifically asked the psychologist to observe him in different settings- different classes, the hall, and around lunch. Oddly enough we got the most information from that activity than from any other, including the report from his 1:1 aide. A teacher doing teaching cannot perform an adequate observation. Someone else must be on hand to do it. This could be a trained paraprofessional, principal, guidance counselor, behavior specialist, or other staff. What the book does provide is a set of forms for the observation. One is a report form, one a checklist and one a results summary. The report form requires a narrative of events during the observation. The checklist includes a series of sections like the one below for each activity observed. I really like the checklist because it suggests areas to examine as possibilities when the behavior occurs. The summary combines information from the observations, interviews and other sources, identifies consistencies and inconsistencies, and recommends either the development of a hypothesis statement or suggests that further data collection is required. My favorite FBA done on my son said there was no known antecedents for behaviors and suggested that additional supports be put in place to meet his needs. Really??

o   Told to stop or start an activity
o   Working independently
o   Given a multistep direction
o   Denial of preferred item or activity
o   other
o   Noncompliance with stopping or starting an activity
o   Attempting to gain teacher/adult attention
o   Attempting to gain peer attention
o   Noncompliance with directions
o   Minor disruptive behavior
o   Aggression
o   other
o   Redirection
o   Preferred item or activity
o   Encouragement
o   No response
o   Help
o   Time out
o   other
ABC Checklist sample section from p. 171.

Hypothesis. The authors propose the following format to frame the hypothesis:

Given the circumstance when (setting event) _________________ when (antecedent) __________ the student does (problem behavior) ________________ in order to (function) __________________.

For example:
  • "When Jim is given an assignment that takes longer than 15 minutes to complete (antecedent), he engages in disruptive behavior (problem behavior) to escape the task (function)." (p. 178)
  • When Julie feels overwhelmed by her schoolwork (antecedent) she asks to leave the room and cuts herself (problem behavior) to relieve tension (function).

Then an intervention is engaged in. For Jim, at 13 minutes in we ask him to take a break and then return to the task that has been broken into 10-15 minute segments. (Slowly over time we increase the time he needs to work before a break.) For Julie, we teach her to use an anxiety rating scale and how to use a stress reduction technique to intervene without cutting, for example deep breathing paired with positive self-talk.

Then data is taken to see if the intervention is effective and when to start stretching the goal.

The process is long and extensive, requiring lots of staff resources to engage in. FBAs are not for everyone. The authors suggest that perhaps less than 5% of a school population should have an FBA done. This is consistent with the RTI concept of three tiers of intervention- the first is for everyone (good classroom management), the second for a small number who need a little more (ex. checking in paired with goal setting for success), and the third for very difficult behaviors and children who do not respond well to traditional management programs. Tier three is where FBAs fall. They should be the starting point of the intervention. Done well they should be an excellent guide to implementing an intervention and a great tool to determine if an intervention is effective.

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