Using Positive Behavior Support in a Home-Based Program
for Children with Autism
This home-based program is a United States-Mexico collaboration that uses Positive Behavior Support. Teachers and therapists provide programming in the home and a parent support and training group (in English and Spanish) are provided. Both the home-based and parent group emphasize the coordination of the application of Positive Behavior Support in home, community, and school settings.
Use of Positive Behavior Support
One of the major obstacles to the inclusion of children with disabilities in both school and the community, is behavior that is inappropriate and disruptive. For children with severe disabilities, behaviors such as tantrums, aggression, or self-injury are challenging beyond what regular education settings are prepared to handle. Families of children with severe disabilities are also looking for assistance beyond the traditional manipulation of consequences offered by most behavior management programs.
If we are to accomplish inclusion, it will be necessary not only to identify treatment methods that work, but ones that will be acceptable in the context of inclusive environments. The three concepts of social validity identified by Wolf (1978) are important considerations in reaching this goal. These are feasibility - are we able to use the strategy?; desirability – are we willing to use the strategy?; and effectiveness – does the strategy make a difference for the individual in increasing inclusion opportunities? In other words, we need treatment strategies that both parents and teachers are able and willing to use and that make a real difference for the individual and their opportunities to participate in school and in the community.
him or her by quickly eliminating the challenging behavior, PBS views such things as settings and lack of skill as parts of the “problem” and works to change those. As such, PBS is characterized as a long-term approach to reducing the inappropriate behavior by teaching a more appropriate behavior, and providing the contextual supports necessary for successful outcomes (ERIC, 1999).
Effective behavior change must not only reduce inappropriate behaviors it must also teach suitable alternatives. These changes should not only help the child in the immediate environment, or the short term, they must also be important for their life after school, or the long term. The key concept of PBS was then determined to be to change a problem behavior, it is first necessary to remediate deficient contexts. Deficient contexts were found to come in two varieties, those related to behavior repertoires and those related to environmental conditions. Behavior repertoires means that the individual does not have the necessary behaviors to be successive. Communication skills, social skills, self-management are all found to be inadequate for the demands of their day-to-day existence, whether in school, home, or community. Environmental conditions means that the stimuli in any particular environment are not conducive to appropriate behavior for this individual and contributes to the emergence of problem behaviors.
In applying PBS, the research review completed by Carr and his colleagues found two categories of intervention: stimulus-based and reinforcement-based (Carr, et al., 1999). When environments are deficient it is when there are too few stimuli to support positive behavior and that changes in this environment are necessary as part of the effort to help children with disabilities exhibit more appropriate behavior. On the other hand, from a reinforcement perspective, the existence of positive behaviors competes with or makes negative behaviors unnecessary because the positive behaviors provide an alternative for accessing the available reinforcement. In sum, PBS tries to change the environment so that the conditions for appropriate behavior and its reinforcement are available and to teach appropriate behaviors as a substitute for accessing reinforcement in the environment.
Positive behavior support appears to be best suited for long-term change and is proactive to the extent that it attempts to teach behaviors and impact the environment that surrounds these behaviors. This is contrasted to aversive or punitive approaches that seem best suited to a crisis management mode. From the perspective of the family, and in keeping with the principles of social validity, PBS would seem to be the appropriate choice because of its good fit with a family environment. Parents are able to work with their children using techniques that are effective and at the same time part of a normal pattern of interaction. From the perspective of the school, PBS is a good match because of its suitability for use in inclusive settings and because it is primarily a teaching method. Positive behavior support is a procedure more likely to encourage the inclusion of children with disabilities in regular classrooms.
Redirective Therapy was developed as part of a training program in a university clinic for parents and families of children with pervasive developmental disabilities (Swartz, 1994). Parents had reported that though some techniques currently available appeared to be effective, they were too harsh and too unusual as a pattern of parent-child interaction. They felt that the treatment became an aversive to both parent and child because of its intensity and that its suitability for the community or an inclusive school setting was an issue. The criteria used in the development of Redirective Therapy (RT) was that it must allow for a positive interaction between parents and their children and that it must be suitable for use in all settings. Using research in nonpunitive techniques (Donnellan, et al., 1998), the strategy focused on a simple pattern of redirection with teaching an appropriate behavior as the end goal. Similar in this regard to the strategy identified as differential reinforcement of alternative behavior (DRA), Redirective Therapy diverged by electing to use only social rewards. It was felt that since one of the primary goals for most children in the program was increased socialization, the use of social rewards would be the first important step in teaching social skills.
Therapists using RT were taught to interrupt the undesired behavior and redirect the child to an appropriate behavior. They were instructed to do this interruption in the least intrusive way possible (for example, a word or a gesture would be a preferable interruption to a physical cue). Social reinforcement (praise or touch, or both) would immediate follow the interruption and redirection. In this way, the concern about limited availability of reinforcement in the use of differential reinforcement of other behaviors (DRO) could be resolved. This pattern was repeated until the child stayed on the new task and exhibited an appropriate behavior. Parents reported that their good feeling about this strategy was that they could use it at home and on any trips into the community. In another words, it met both the social validity criteria of feasible (I can use it) and desirable (I will use it).
The Imperial County, California Program for Children with Autism
The Imperial County Program for Children with Autism is an after school program and parent support group that provides services to children with autism and their families. These services include direct work with children to increase socialization, communication, and appropriate behaviors, training activities for parents and siblings, and a support group for parents.
The program uses a model that recognizes the complexity of providing appropriate programs for children with autism and the need for collaboration with all service providers. The program is designed to provide an individually developed behavioral/socialization program for children with autism to support their maximum inclusion in school and community activities. The program is supplemental in nature and coordinated with any other programs currently in place.
The Imperial County Program for Children with Autism includes various programmatic elements to ensure a high level of parent support, collaboration with teachers and other professionals, and a seamless program design that is carefully coordinated.
The Level 1 is an in-home and community-based program. The program consists of one-to-one intervention to improve behavior, socialization, and communication skills of participants. Parents receive instruction on the use of the strategies employed in this program. Each child has an individual therapist.
Parents are supported with in-home consultation based on individual needs. Programs are developed for in-home use on problems directly related to successful participation in the program. Techniques are modeled by program personnel and parents are directly trained in the use of effective strategies. This program element is directed at parents (or caregivers), siblings, and other family members. Information collected during in-home visits, particularly videotaped behavior patterns, can be used to modify programs and monitor program success.
The Level 2 program is a center-based program. The program provides a small group (up to 3) intervention with a two or three-to-one student, staff ratio to children who make good progress in the one-to-one program. Children in Level 2 are trained in the higher level socialization and communication skills considered to be prerequisite to successful participation in small group instruction. The Level 2 activities are considered a necessary preparation for transition to more inclusive settings.
Parent Support Group
Parent support and training are an integral part of the program for each child. Participation in the support group is required for participation in the program to promote effective coordination of strategies used at home with those employed in the program. Emphasis is on helping parents develop more effective methods of behavior modification and in establishing a workable daily routine for the participation of the child in the home. The support group focuses on various personal and family issues associated with raising a child with autism. This support group meets weekly and is facilitated by a trained psychologist. The support group is conducted in both English and Spanish.
All referrals to the program receive a twelve-hour intake assessment. This includes an in-home parent interview, videotaping of behavior samples, a school visit, and a functional analysis of disruptive and inappropriate presenting behaviors. The results of the functional assessment of behavior and parent treatment priorities are used to develop the individual program and to identify the initial target behaviors.
A baseline of behaviors exhibited in the After School Program are developed during the first month, approximately 12 hours over 4 sessions. A preliminary goal of 5% increase in appropriate behaviors and an accompanying 5% reduction in inappropriate behaviors is established. This progress is reviewed quarterly with reports documenting progress in meeting goals submitted on a semiannual basis to determine program progress continuation.
Parent Support Group participation is evaluated by parent report and the clinical impressions developed by the group facilitator. Continuation is by mutual agreement regarding both the progress of their child and the usefulness of the support group.
Unique Aspects of the Program
Imperial County, California is a rural, agricultural area with sparse population that borders Mexicali, Mexico, a major metropolitan area of more than three quarters of a million people. A large percentage of United States citizens and their families are originally from Mexico and a large number also speak Spanish.
This program is challenged both by language and availability of personnel. The origin of this collaboration was a faculty exchange program between California State University, San Bernardino and the Universidad Autonoma de Baja California, Mexicali. The development of a graduate program in special education in Mexicali helped create the personnel resources to staff this program. All of the therapists in the home-based program are Mexican psychologists and all fluent in Spanish and some also fluent in English. The facilitators of the parent group are both fluent in English and Spanish and the group is translated in both languages.
This program is also unique in its attempts to coordinate the use of Positive Behavior Support as the intervention of choice in home, school, and community settings. The inclusion of school personnel continues to be a major challenge for the program.
Carr, E.G., Horner, R.H., & Turnbull, A.P. (1999). Positive behavior support for people with developmental disabilities. Washington, DC: American Association on Mental Retardation.
Donnellan, A., LaVigna, G., Negri-Shoultz, N., & Fassbender, L. (1988). Progress without punishment. New York: Teacher’s College Press.
ERIC Research connections in special education (Winter, 1999). Positive behavior support. ERIC Clearinghouse on Disabilities and Gifted Education.
Swartz, S.L. (1994). Redirective therapy: Guidelines for use in school and home.
Swartz, S.L. (1998). Inclusion of children with disabilities in regular school programs. In Z. Jacobo & M. Villa, Sujeto, educacion especial e integracion, Mexico: Universidad Nacional Autonoma de Mexico.
Wolf, M.M. (1978). Social validity: The case for subjective measurement, or how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.