Behavior Management �Protocol

Positive Aspired Learning’s

Behavior Management Protocol (BMP)

Purpose:

• PAL has a Behavior Management Protocol (BMP) in place in order to reinforce our core values of “growth/development” and “integrity”. This BMP presents a flow in which all clinicians at PAL can respond to maladaptive behaviors so that the behaviors can be addressed in a uniform and systematic manner based on evidence-based strategies from applied behavior analytic (ABA) literature. When problem behaviors are not addressed using positive antecedent and consequence procedures then the maladaptive behaviors (e.g., noncompliance) interfere with the acquisition of various skills such as social skills and academic base skills (Speights Roberts, et al., 2008).
• Also, the clinical purpose of PAL’s BMP is to decrease problem behaviors emitted by PAL clients and to increase the use of research based strategies by PAL clinicians. The BMP  strengthens the core value of “growth/development” by providing and training all clinicians with a more systematic way that they can implement and add to their ABA clinical repertories. PAL’s BMP strengthens the core value of “integrity” by reinforcing the extent to which all behavior management procedures across the organization are implemented in alignment with best practices which further allows for consistent and uncompromising adherence to quality service tied to ethical principles.

Behavior Management Protocol (BMP)

Flow Chart:

Behavior Management Protocol (BMP)

• Ensure that the client is motivated by making sure a reinforcer is in place. What is the client earning? Does the client still want to work for that item? Think about the types of reinforcers: Edibles (gold fish, mini cracker, etc.), Activities (e.g., playing ball, breaks, watching videos), Tangible (e.g., books, toys, etc.), Social (e.g., praise, high fives, etc.), and Sensory (e.g., spin top, silly putty, etc.)  (EATSS). Prior to introducing new reinforcers or edibles consult with the client’s lead clinical supervisor first. Consider doing a forced choice preference assessment by presenting the client with items in pairs (e.g., 2 items at a time)  and allowing the client to select which one they’d prefer either by using their voice, just reaching, or pointing. As shown in the Cole and Levinson (2002) study, creating conditions in which a client can make a “choice” decreases the likelihood of challenging behaviors when clients are completing tasks. During the forced-choice preference assessment, allow the client to functionally communicate their wants/needs at the time in case there is a basic need that needs to be met (e.g., bathroom, water, tired, sick) or another type of reinforcer (outside of the items you are presenting) that the client may want. As stated in the Shukla and Albin (1996) study, functional communication training (FCT) along with extinction strategies are found to decrease all topographies (i.e., severe to less severe) of maladaptive behaviors.

Behavior Management Protocol (BMP)

• Think about the possible function of the problem behavior. There are 4 functions to behavior: Attention, Escape, Access to Tangible, and Sensory. Determining or hypothesizing the function of the problem behavior allows you to ensure that you are not engaging in any behaviors that could inadvertently reinforce the problem behavior. For example, if a kid is running towards the toy he has not earned yet then the possible function is “access to tangible”. In this case scenario the clinician would do their best to response-block access to the car as best they can.

Behavior Management Protocol (BMP)

Redirection Prompt: A redirection is a verbal communication that directs an individual

back to the demand at hand. Redirections can be delivered in either vocal form, gesture form,

or picture form. For example if you want your client to sit in his chair you redirect vocally by

saying “sit in the chair”, you redirect gesturally by pointing to the chair/signing chair in ASL,

and you can redirect visually by holding up a picture of a child sitting in a chair.

After presenting the redirection wait 10-15 seconds with minimal eye contact to allow

the client a chance to respond and to minimize attention. Maintain a neutral tone of voice and

a neutral facial expression.

Model Prompt using First-Then language: Model what the client has to do in order to access the reinforcer and remind the client of what they're earning (e.g., reinforcer). You can remind a client of what they are earning by either placing a visual of the item in view, vocally stating the name of the reinforcer item, or placing the actual reinforcer item in view but out of arm’s reach of the client. You can say statements such as “remember we’re earning _silly putty__ but first _stand up like me_ then __silly putty__” or “First _pick up cup like me__ then _bubbles__; I can’t wait for you to earn _time with the bubbles__”. Wait 10-15 seconds with minimal eye contact to allow the client a chance to respond. Maintain a neutral tone of voice and a neutral facial expression.

Physical Assistance: Attempt to see if you can help the client complete the demand by offering physical assistance. You would do so by delivering the antecedent or discriminative stimulus (Sd) "let me help you ____" while implementing hand-over-hand or by simply extending your hand toward the client to offer physical assistance with completing the demand. For example, you can offer “hand-over-hand” to pick up an item or you can offer to hold a client’s hand to prompt them to stand up if they are dropped on the floor. Maintain a neutral tone of voice and a neutral facial expression. If the client refuses the physical assistance, refrain from further engaging the client. The clinician should wait 10-15 seconds with minimal eye contact and then return to step (a) for R.M.P.

Review of 3 step prompting….

Review of BMP…..

Flow Chart:

Behavior Management Protocol (BMP)

• Track behavior: Record data in real time as best as possible. You can use a clicker for frequency data, data sheet/pen, online behavior data tracker, timer for duration data, etc. There’s a saying, “If there’s no data then it didn't happen”.

Behavior Management Protocol (BMP)

• Deliver Immediate Reinforcement: Once the client is on task, deliver immediate reinforcement (e.g., behavior specific praise) with an enthusiastic tone  (e.g., deliver praise with tokens, high fives, tickles, etc.). The praise being delivered is contingent upon the client engaging in the desired behavior. The instance that the client demonstrates compliance in completing the original demand or the moment the client engages in observable approximations towards the desired behavior, do not delay delivering the contingent reinforcement. Deliver the praise immediately in order to maintain the desired behavior. As shown in the Speights Roberts, et al. (2008) study, contingent praise is a positive consequence strategy that increases compliance when paired with positive antecedent strategies.

Review of BMP…..

Flow Chart:

�Thank you!!

Review Questions &

Additional Questions/Comments

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Behavior Management Protocol (BMP)�Review Questions!

• What does the “R” in the three-step prompting stand for?

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Type your answer into the chat.

Behavior Management Protocol (BMP)�Rapid Questions Time!

• Once the client is on task when should reinforcement be delivered?

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Type your answer into the chat.

Behavior Management Protocol (BMP)�Case Scenario Time!

• Case Scenario 1: The client John does not like writing. The BT has reached a point in the session where it is time to work on John’s writing goal.
• BT: The BT places a pencil in John’s hand, gives him a sheet of paper and says “write the letter J”
• Client: John says “no” while sliding down to the floor from his chair and remaining there.
• BT: The BT then holds out the reinforcer in front of the client which was an ipad and the client attempts to reach for it which confirms that the motivation to earn the item is established. The BT hypothesizes that the function of the behavior is “escape” so the BT makes sure to “keep the demand on” and not allow for an opportunity to escape (e.g., break). BT starts a timer to record duration of the drop behavior and rotates through the 3-step prompting (RMP) 4 times until the client is finally back in his seat. Once the client returned to his seat the BT stopped the duration timer and immediately praised the client for sitting nicely while giving him a high five.
• According to our Behavior Management Protocol, did the BT miss any steps in the process?  Type “Yes” or “No” in the chat.

Behavior Management Protocol (BMP)�Case Scenario Time!

• Case Scenario 2: The client Daisy needs to use the bathroom and begins crying and hitting her fist on the table. The BT is in the middle of running the receptive ID goal “point to picture in array of 3” with the client.
• BT: The BT places 3 pictures in front of the client (one being a chair) and says, “point to the chair”.
• Client: Daisy begins crying and hitting her fist on the table while staring at the bathroom door.
• BT: The BT hypothesizes that the function of the behavior is “escape” so the BT makes sure to “keep the demand on” and not allow for an opportunity to escape (e.g., break). BT uses a clicker to record the occurrences of the “fist slamming behavior”. The BT rotates through the 3-step prompting (RMP) 3 times however, the client’s non compliance with the task increases and the client then elopes to the bathroom while crying.
• According to our Behavior Management Protocol, did the BT miss any steps in the process?  Type “Yes” or “No” in the chat.

Behavior Management Protocol (BMP)�Case Scenario Time!

• Case Scenario 3: The client Nate just learned about fidget spinners and now wants to earn spinners instead of play-doh. The BT has the client earning play-doh on his token board because the client has been requesting and earning play-doh for 4 consecutive days. The client only needs one more token in order to earn play-doh.
• BT: The BT presents the client with a picture of a girl running and presents the question “what is she doing?”.
• Client: Nate is smiling while attending to another child across the room playing with a fidget spinner and does not answer the BT’s question despite glancing at the picture and despite the BT re-presenting the question 3 more times.
• BT: The BT believes that the client wants to earn the play-doh and so she does not present Nate with a forced-choice or ask if there’s something else he wants to earn. The BT hypothesizes that the function of the behavior is “avoidance” so the BT makes sure to “keep the demand on” and not allow for an opportunity to escape (e.g., break). BT starts a timer to record duration of the non compliance behavior The BT rotates through the 3-step prompting (RMP) 3 times and the client eventually said, “she is running” in which the BT praised the client for responding correctly and gave him his last token. The client refused to play with the play-doh and continued to watch a peer play with spinners.
• According to our Behavior Management Protocol, did the BT miss any steps in the process? Type “Yes” or “No” in the chat.