BEHAVIOR GUIDANCE
Keystone believes that a positive approach to behavior management is essential in programs providing services to the developmentally disabled. In this regard the term “behavior guidance” will be used in place of more traditional terms as a way of indicating an approach and attitude that stresses a proactive rather than a reactive model. Staff members are trained to use a variety of behavior guidance techniques to ensure the positive growth and development of those we serve. These techniques are based on the premise that our individuals are treated as valued human beings with respect to their rights as well as basic human dignity.
We also believe a normalized environment that offers sufficient living space, clean and safe conditions, a nutritious diet, personal possessions, the opportunity for structured activity, positive interaction with staff, the dignity of risk and individual responsibility is essential to promoting and facilitating adaptive behavior.
It is imperative that each person in our care be treated as an individual with consideration given to his or her specific traits and characteristics. Staff’s verbal or non-verbal redirection, prompting or guidance is done in a constructive manner that facilitates personal growth and enhances the individual’s self esteem or self image. Our goal is to foster independence rather than to condition our individuals to be dependent on others. Essential to the process is setting realistic and attainable goals.
It is of utmost importance to remember that our individuals’ perception of themselves is largely a function of how staff reacts to them. If we provide too much assistance in performing tasks or interaction, we convey to the individual that we feel he or she is unable to do these things him or herself. Listen and watch. Our individuals, especially those who are non-verbal, rely on body language to express themselves. Alert observation is necessary to identify and understand our individuals’ needs and feelings.
Staff should never use a condescending or patronizing tone of voice when interacting with our individuals. Avoid ordering our individuals to perform, and maintain a non-threatening voice pattern at all times. Additionally, it is important for staff to remember to separate the behavior from the person. Praise or constructive criticism should be directed at a specific behavior rather than the personality of the individual.
Behavior guidance approaches, when used correctly, are very effective in teaching basic skills as well as developing the individual’s overall adaptive behavior. The staff person must be observant, patient, and consistent in his or her approach. Simply stated, our behavior guidance techniques are used to encourage desired behaviors by using positive reinforcement strategies. We select a behavior that we want modified or shaped, such as putting on a shirt, cashing a paycheck, or crossing a street safely. We break the behavior into smaller steps which the individual can master, providing positive reinforcement as each step in accomplished or approximated. The reinforcer most commonly used is praise, however, extra privileges, special privileges, etc. are also used. It is essential that staff key in to individuals’ positive behavior since this attention is, in itself, a reward or acknowledgment. Generally, limited attention should be given to maladaptive behavior since attention will only act as reinforcement.
PROMOTING ADAPTIVE BEHAVIOR
PROGRAM STRATEGIES
Keystone Community Living believes a nurturing, normalizing environment that offers sufficient living space, a nutritious diet, personal possessions, the opportunity for structured and meaningful activity, positive interaction with staff, the dignity of risk, and individual responsibility is essential to promoting and facilitating adaptive behavior.
We also believe that our staff must be properly trained to use a variety of techniques to ensure the positive growth and development of our individuals. These are based on the premise that our individuals are treated as valued and respected human beings.
With this in mind, Program Strategies are used to promote the acquisition of skills needed for greater independent functioning. These strategies are based on sound teaching methodology and positive rules of human interaction. Program Strategies are included in the individual’s IHP and reviewed and monitored by the individual’s Interdisciplinary Team, (IDT).
It is important to note that for those individuals who demonstrate a consistent pattern of maladaptive or inappropriate behaviors, an Individual Behavior Guidance Program will be developed and incorporated into the individual’s IHP as specified in Keystone’s Behavior Guidance Manual.
Program Strategies include the following:
1. Positive Reinforcement
2. Shaping
3. Proximity Control
4. Providing Options
5. Pointed Praise
6. Redirection
7. Time Out From Positive Reinforcement
8. Sensory Stimulation
9. Extinction
10. Differential Reinforcement
Revised 7/14
JM
PROGRAM RULES
At Keystone, we believe that accepting responsibility for one’s actions is essential in becoming more independent. If our individuals are to become responsible and productive citizens, we must provide a normalizing environment based on fair rules and consequences, for both appropriate and inappropriate behavior.
Staff persons assigned to supervise each of the programs are responsible for the development, implementation, and monitoring of program rules. Our individuals will be involved to the extent possible in developing rules for their programs.
Consequences for compliance with program rules may include but not be limited to:
1. Verbal Praise
2. Positive Recognition
3. Special Privileges and Activities
4. Additional Responsibilities and/or Privileges
Consequences for non-compliance with program rules may include the following:
1. Verbal Correction
2. Counseling
3. Interdisciplinary Team Meeting (IDT)
4. Time Out From Positive Reinforcement (not to exceed 15 minutes)
5. Conflict Resolution
The concept is that our individuals are earning praise and social reinforcement for following program rules. We are not punishing nor do we emphasize losing something for not following rules.
GENERAL PRINCIPLES & DEFINITIONS OF PROMOTING ADAPTIVE BEHAVIOR
1.BASIC PREMISES
-- All staff must have respect and regard for our individuals.
-- Adults should not be treated as children. Always be conscious of providing
age-appropriate activities, thereby treating our individuals with the respect and dignity they deserve.
-- Look and listen! Our individuals, especially those who are non-verbal, may rely on body language to express their needs and feelings. Alert observation is necessary to identify and understand individuals’ needs.
-- Enthusiasm and a positive attitude are vital characteristics. Get and stay involved. Let our individuals know you enjoy their company, and become an active participant in their lives. Show our individuals that you are aware of and appreciate their achievements.
-- Everyone responds better to warmth and affection. Translate your care feelings into warm, non-threatening, physical contact (e.g. pats on the back, hand shakes)
-- Maintain emotional control in “emotionally charged” situations. This will indicate that you are in control. It will also reassure individuals who are in danger of losing control that limits will be provided from external sources.
-- Encourage individuals to work to their potential, but be certain that your expectations, and those of the individual, are realistic and attainable. Discourage unrealistic expectations by focusing on what is attainable, setting realistic goals, and praising successful performance.
-- Remember that the individuals’ perceptions of themselves are largely a function of how staff reacts to them. If we provide too much assistance in performing tasks, we convey to the person that we feel he or she is unable to do things for him or herself. The goal of our program is to facilitate growth and development. While it may take less time for us to complete a task for one of our individuals, we should allow the extra time to be taken, providing necessary guidance but letting the achievement belong to the individual. Self-worth and self-esteem will grow accordingly.
-- Recognize attention-seeking behaviors (e.g. repetitive questioning, name calling, noise making) as such and ignore it (verbally, visually, and emotionally). No reaction is sometimes the most effective tool in discouraging maladaptive behavior.
-- Maintain a good sense of humor. Look for the “bright side” in otherwise unpleasant situations. Teach and encourage our individuals to do the same.
2. VERBAL CONSIDERATIONS
-- Maintain a pleasant tone of voice with moderate volume. Never yell or scream. This creates a negative or tense environment and often causes anxiety. If you are in one area and wish to speak to someone in another area, do not shout for them to come to you. Rather, you should go to them. Face-to-face contact is much more effective when providing direction. Even when dealing with behavioral difficulties, tone of voice is very important. Correct, set limits, or state contingencies in a calm yet firm, moderate tone of voice. Your message will be effective if you deliver it while maintaining direct eye contact and speaking in a slow, clear manner.
-- Never use a condescending or patronizing tone of voice. Likewise, malicious teasing and sarcasm should never be used.
-- Remember, we are family. Be sure to refer to our individuals by their first names or designated nicknames. Last names and “unorthodox” nicknames should not be used.
-- Speak clearly and at an even, understandable rate when interacting with our individuals.
-- Use inflection and animation when speaking so that our individuals are easily able to differentiate positive from negative interactions. Facial expressions are important. Smiles or frowns are often more powerful than words.
-- Whenever possible, pair verbalizations with visual or gestural cues to facilitate understanding.
-- Make requests. Do not “order” to comply. Maintain a non-threatening tone of voice at all time.
-- Never threaten. State contingencies in a “matter-of-fact” way and be prepared to follow through with the contingencies if the individual fails to comply. Similarly, do not promise reinforcing events that you are not prepared to provide. Consistency and limits are extremely important when interacting with our individuals.
-- Acknowledge expressions of needs or wishes even if you are not able to deal with these immediately.
-- Avoid why questions. They tend to cause irritability and convey a negative message.
-- Do not avoid verbal interaction with non-verbal individuals. All have receptive language and benefit from interaction.
3.IMPORTANCE OF BEING POSITIVE
-- Always look for and accentuate the positive. Negative behavior should be handled in such a way as to minimize its attention-getting potential. Remember, staff set the tone. A tense, negative environment will only bring out the worst in others. The key is to consistently direct positive behavior by being positive. Your reactions to negative behavior should be as low key as possible, and such that the individual does not feel embarrassed, which in turn may cause secondary problems.
4.STRUCTURE, CONSISTENCY AND COMMUNICATION
-- Knowing your “game plan” and ensuring that all know what is expected is an effective means of maintaining positive behavior. The key is to positively direct behavior while providing an enriching and motivating environment. This is the meaning of structure, and an essential component of our program.
-- Consistency in programming is essential. This is provided by following established procedures, schedules, and programs. If there is a change in the routine, communicate this to the individuals involved in order to avoid causing stress or anxiety, which may in turn cause behavior problems. Consistency in all aspects of the individuals’ lives can not be stressed enough! Consistency facilitates growth. Inconsistency may cause confusion, frustration and acting out behavior.
-- Communication is vital in maintaining consistency. Talk to your fellow staff. Let them know what works and what doesn’t work in regard to each individual. You will be working with the best interests of our individuals in mind if you communicate regularly with other staff.
5.SEPARATING THE PERSON FROM THE BEHAVIOR
-- Never use the word “bad” when describing behavior. Never tell an individual that he/she is or was “bad”. Let the individual know that he/she is a good person but that his/her behavior is inappropriate.
6.PROVIDING ALTERNATIVES TO NEGATIVE BEHAVIORS
-- Offer the individual the option of choosing an appropriate behavior or taking the logical consequences of his/her actions. Options should be phrased in a positive, non-threatening, matter-of-fact way. Example: “When you stop talking to strangers, you’ll be able to go independently in the community”.
7.OBSERVATIONAL LEARNING
-- Our individuals learn by observation and modeling. Behavior displayed by staff influences the behavior displayed by our individuals. New behaviors displayed may have been acquired through observation of these behaviors in other people, including staff. Our individuals will be more likely to display appropriate behaviors and responses when they have observed the appropriate behaviors and responses of others.
8.PROGRAM STRATEGIES
-- These are teaching techniques based on positive rules of human interaction and used by staff to facilitate the growth and development of our individuals.
9.PROGRAM RULES
-- Rules are established by staff and the individuals of each program to facilitate a positive, normalized environment. These rules are based on the premise that each individual accepts responsibility for his or her own actions.
10.POSITIVE REINFORCEMENT
-- Reinforcement contingent upon a certain response or behavior is provided when that response or behavior occurs.
A. Positive verbal or non-verbal reinforcement is provided by staff whenever an individual exhibits a targeted adaptive behavior.
B. Praise will be given when targeted behavior occurs or immediately thereafter.
C. Praise will be given in a clear, concrete manner in order to be fully understood by the individual.
D. Praise will be directed at specific behavior(s), not at the personality of the individual.
E. Positive reinforcers will include but not be limited to verbal praise, a smile, a pat on the back, special attention, favorite activities, or extra privileges, as well as special treats (provided that they do not conflict with the nutritional requirements of the individual).
11.POINTED PRAISE
-- This technique involves ignoring a negative behavior while praising other individuals who are demonstrating adaptive behavior.
12.POSITIVE RECOGNITION
-- Appropriate behaviors and accomplishments are identified and reinforced through verbal feedback, gestures and other rewards.
13.PRIVILEGES
-- Established reinforcers such as independent activities, special pre-planned community outings, etc., are used to facilitate the acquisition of adaptive behavior.
14.REDIRECTION
-- This technique involves redirecting the individual’s attention to an activity which is conducive to adaptive behavior when he or she is exhibiting maladaptive behavior or indications of its possible onset.
15.CORRECTION
-- An individual who has disrupted a social or physical situation is required to restore that situation to its appropriate state. Staff uses verbal, gestural or physical prompts.
16.PROXIMITY CONTROL
-- This is a non-verbal technique, using your proximity to the individual. Mere physical presence of a staff person can have a positive impact on an individual’s behavior or attention. It can involve establishing eye contact with the individual, placing a hand on his/her shoulder, or physically guiding an individual through the appropriate behavior.
17.SHAPING
-- New behaviors are taught by rewarding successive approximations of that behavior. The criterion for reinforcement is gradually raised so that ultimately, only the correct behavior is reinforced.
18.PHYSICAL PROMPT
-- Also called “Physical Guidance”, this technique involves using constant and continuous physical contact to lead an individual to attain a desired adaptive behavior.
19.SENSORY STIMULATION
-- This technique is designed to reduce the opportunity and need for an individual to engage in self-stimulating behavior. An alternate, more appropriate, way of meeting that need is provided to the individual.
20.TIME OUT FROM POSITIVE REINFORCEMENT
-- An individual engaging in a maladaptive behavior is removed from the activity for up to fifteen (15) minutes. Situations warranting this technique could include disruption of an activity by repeated interference to others, non-compliance, excessive noise-making, etc. In most cases, time out from positive reinforcement should be preceded by offering the individual the option of choosing a more appropriate behavior. (See #6)
21.EXTINCTION
-- This technique involves withholding reinforcement that has been sustaining or increasing a maladaptive behavior, often unwittingly or unintentionally. An example of
extinction would be not reacting or attending to an inappropriate behavior such as burping, name calling, etc.
Revised 7/14
JM
INDIVIDUAL BEHAVIOR GUIDANCE PROGRAMS
For the individual who demonstrates a consistent pattern of maladaptive or inappropriate behavior, an Individual Behavior Guidance Program will be developed and incorporated in the individual’s Individual Habilitation Plan. All Individual Behavior Guidance Programs shall be designed in accordance with professional ethical standards and practices of normalization. Maximum respect for the individual’s rights and personal dignity shall be reflected.
The need for a Behavior Guidance Program will be ascertained during the regularly scheduled quarterly behavioral review meeting or during a special meeting called to discuss a specific incident of maladaptive behavior. The behavioral review will be an interdisciplinary meeting, including apartment/house staff as well as program support staff, at least one of whom has experience in developing Behavior Guidance Programs. A clear description of the presenting problem will be made using operationally defined terms.
Individual Behavior Guidance Programs will be written by a member of the Interdisciplinary Team as determined when the need for a plan has been decided. The author of the Behavior Guidance Program will have a bachelor’s degree in psychology, special education, sociology, guidance and counseling or social work and at least one year of experience working with developmentally disabled persons involving behavior modification. The author will be responsible for obtaining the necessary approvals.
Records are maintained of significant incidents of maladaptive behavior and of action taken by staff as consequences of such behavior, i.e. incident reports, behavioral logs, comment sheets, and individual files. The central file for Behavior Guidance Programs is maintained by the Director of Support Services.
Prior to the development of an Individual Behavior Guidance Program, a complete environmental assessment will be made to ascertain that the individual’s environmental needs are being met, as well as to rule out the presence of environmental reinforcers that may be maintaining or facilitating the maladaptive behaviors. The individual’s medical status will also be discussed. If deemed appropriate, a complete medical assessment will be accomplished to rule out the presence of any medical condition contributing to the individual’s maladaptive behavior.