Positive Approaches to Challenging Behaviors & Non-aversive Techniques

Create environments that are more nurturing, inclusive, and conducive to personal growth. A more humane and effective way to address challenging behaviors while promoting empathy, respect, and long-term positive outcomes.

Overview to Positive Behavior Support

It is important to understand that behavior is a form of communication. This is true for all of us. We all have our own unique ways of communicating how we feel. Some people are “verbal” and tell us what they are thinking and feeling. Some people are non-verbal and will use certain behaviors or “body language” to communicate what they are thinking or feeling. As DSP’s providing direct support to people we need to be aware of both verbal and non-verbal expressions of communication and behavior.

In order to recognize each person’s form of communication and behavior we need to establish positive relationships. How do we do this? The answer is simple.... spend time together. A relationship develops over time. The better you get to know the people you are providing services to, the easier it will be to give them positive support when they need it. In order to be successful in establishing positive relationships you will need to assist in providing a positive environment for the home you work in. This means being part of a “team” with both your co-workers and the people who live in the home.

BEHAVIORS CAN BE INTIMIDATING! How you interact with your co-workers can have an impact on a positive environment. It is important to keep this in mind as you learn more about your work environment and interacting with others. Everyday life can have an impact on a person’s behavior. Small changes in daily routines can impact behavior. It is important to remember that when people have choices in their lives and these choices are honored and respected, the happier they are and less likely they will be to exhibit challenging behavior. Creating a positive environment that respects and values individual preferences and choices will not only make the individuals you work with happier, it will make your job of supporting them easier.

The Goal of Teaching

The goal of teaching is to support individuals with disabilities and/or mental illnesses to live independently and with as much enjoyment as possible. When a DSP has good “teaching skills” they will automatically promote a positive environment for their co-workers and the individuals they provide services to. Every individual is capable of growth and change throughout his or her entire life. We are all lifelong learners and the more we learn, the more opportunities we have for self-expression and self-determination.

It should not surprise us to find out that the more control we have over our own life the more likely we are to be happy and content. Clearly, the most effective strategy for people with challenging behaviors is to help them replace those challenging behaviors with new skills. This is why your role as a “Teacher” when working with people who have challenging behavior is so important. When a DSP can teach skills that encourage more independence and control over their life the individual is less likely to get frustrated and upset.

In your role as a DSP, you are in the perfect situation to assist individuals in learning new skills because you are directly involved in so many aspects of their lives – from self-care through participation in consumer and vocational skills. You can support individuals in learning how to have more meaningful and effective relationships, how to manage their resources, and even how to advocate for themselves.

Many of the individuals you work with need to learn many things. How do we know what skills to teach? Here are some general guiding questions to ask:

1. Is the skill functional? "If the individual does not learn the skill I am attempting to teach, will someone else have to perform that skill for them?" For example, if Sarah could not select her own clothing would someone else have to make the selection? "If Jim could not make himself a snack would someone else need to make it for him?" Individuals need to learn skills that have immediate functional value to them.

2. Is the skill relevant? "Is the skill I am attempting to teach one that this individual will use often in his or her life?" Is it more important for Jill to learn how to wash windows or how to greet someone appropriately? It is important to teach skills that are used frequently.

3. Is the skill age-appropriate? "Is the skill I am attempting to teach one that other people of the same age can use?" Should Mark be learning how to cut pictures out of magazines, or would it be more appropriate for him to learn how to call a friend on the phone? Sometimes individuals choose to do activities that you might not consider age appropriate. For example, because 25-year-old Michael chooses to listen to children’s music during his free time, should you tell him that it is not allowed and not let him listen to such music? If someone wants to do things that are not age appropriate during their free time then that is their choice. However, we can make sure that Michael has the opportunity to listen to music that is more age appropriate and that he is able to interact with other people his age and learn what they like to listen to. If Michael simply enjoys the children’s music, we might be able to find music of a similar style that is more age appropriate.

4. Does the skill support independence? "Is the skill I am attempting to teach one that can help this individual get what he wants or get him out of something he does not want?" Challenging behavior often serves as a way for an individual to get a message across about choices. It is important to teach individuals how to communicate what they want and don’t want. We all like to express our “desires” on how we want to do things. Monica would like to take a shower before going to bed each night. Some evenings, Monica would prefer to watch certain TV shows and take her shower in the morning instead. On these evenings when she is watching her TV show and is asked if she would like a shower, she becomes angry and starts to yell and slap at her housemates. If Monica and the DSP’s that work with her could learn to plan her evening schedule better and provide her with some options, she would have fewer problems with her evening routine.

5. Is the skill going to be naturally reinforced? "Is the skill I am attempting to teach going to result in naturally occurring outcomes for the individual?" Many times, we teach people to do things that do not result in any outcome that reinforces the skill. They learn to do what we request of them. This is especially true for individuals who once lived in an institution. This is a “learned” institutional behavior. For example, if we are teaching Mary money skills by using “play” money, will this help her learn how to use real money independently? If we are teaching Karen her ABC’s but she does not know how to spell, write, or read, will this be rewarding to her? Naturally occurring outcomes result from engaging in meaningful activities. If someone is learning how to make a phone call, the natural outcome is that he speaks to someone he’s called. The natural outcome for learning how to make pizza is that he can eat the pizza when it’s done or even share it with friends. The natural outcome for learning how to count money might be using a vending machine and being able to buy a soda or candy.

6. Rewards are the things we do to reinforce, to make it more likely that an individual will want to do the task again. Handshakes, an arm around the shoulder, high fives, smiles, and laughs are all rewarding. Rewards are genuine and have the most impact when they are delivered with enthusiasm! They should come naturally and be available all the time. The more a DSP can reward “good behavior” the less the person will want to get your attention by doing a challenging behavior. We stress reward and reinforcement because they are basic needs for all people.

If you cannot interact positively, you will have a hard time helping others. Rewards help develop relationships, increase appropriate interactions, refine existing skills, and help teach new skills. People need rewarding environments, not just rewards for “being good”. The more you interact with individuals and are with them, the more relaxed people will become. The better relationship you have with someone the better you are going to be able to teach and they will be more willing to learn!

What about activities just for fun? Does everything have to be functional? 

What an individual chooses to do during their free time is different from skills that he or she is learning to become more independent. We all have the right to choose what we want to do in our “free time”. We usually choose things that make us happy, even if it isn’t considered functional. Your role as a Direct Support Professional is to support people, not to control what they do. If you are concerned about what a person is doing because it causes negative behaviors to happen either with the person or others around them, you might want to encourage other interests and make efforts to expand the individual’s range of choices with “free time” activities.

Teaching During Daily Routines

One of the best ways to support an individual’s ability to learn new skills is to provide the teaching support they need during the times he or she would naturally use those skills. The more a person has the opportunity to practice a skill, the more likely he or she will gain independence in using it. If the skill is important in the life of that individual, it is more likely the skill will be learned and maintained. As a DSP you should be looking for opportunities to teach throughout the day and in all environments. 

When a person is attempting to do something on his own but is having problems....this is your teaching opportunity! When a person is asking for help to do something....this is your teaching opportunity! When you are completing a task you know the person could have done themselves.....this is your teaching opportunity!

These are not “scheduled teaching” times; these are “being there for people when they need you” times! Many opportunities for learning are available throughout the day. Assisting an individual to have an enjoyable life means active participation in that life. We do many things each day that fit this guideline. We get ready for school or work, prepare something to eat, choose our clothing, turn on the radio, clean up the house, and travel to and from our destination, call friends, plan activities, and many other daily routines.

The more we can do these routines independently or feel like we are being included to do them to the best of our abilities, the more control we have over our lives. As a DSP it is important to recognize as many learning opportunities as possible in each person’s daily schedule. The more you can “teach” skills during their own individual daily routines, the more independence and control people will have over their own lives. It is important to find balance between teaching and just letting people enjoy some “free time”. If our whole day was just one big teaching routine, life might be more of a chore and less enjoyable.

Guidelines for Effective Teaching

1. Plan:

2. Build in Variety and Choice:

3. Prevent mistakes before they happen:

4. Make the teaching experience successful:

5. Provide Prompts when necessary:

6. Reward before, during, and after the teaching session.

7. Keep the flow going.

8. Be aware of what is going on during the teaching session.


Most of the time when a person does not seem to be making progress towards “learning the task” it is related to the following:

1. The task is too hard for the person in its present form.

2. There is not enough time made available for “practice”.

3. There are not enough rewards or variety of rewards being given to the person.

Behaviors

What exactly is Behavior?

Behaviors are a form of communication people use to tell us their wants, needs, and feelings. All of us have behavior. Behaviors don’t happen without reason.

What Makes a Behavior Challenging?

Behavior can be considered challenging when it affects an individual’s life in a negative way or the behavior has a big impact on how others relate to them. Behavior is usually considered challenging if it:

Once it has been determined that a behavior is challenging, one of your roles is to observe and try to come up with ideas on what is making the challenging behavior work so well for the individual. They must be getting some kind of satisfaction for the challenging behavior. The Direct Support Professional staff should be working together with the person-centered planning team to determine why the behavior is happening and think of ways to teach more socially appropriate alternatives, or replacement behaviors.

Remember...the challenging behaviors are not happening just to make you mad or to make you work harder! If that is how the behavior is affecting you then maybe you are part of the cause for the challenging behavior. What individuals are doing at the time, where they are in their environment, and who they are with or around have a lot to do with how they choose to behave. When you pay close attention to these factors you should be able to predict when, where, and with whom the challenging behaviors are most and least likely to happen. People who display challenging behaviors usually do them because it has worked for them in the past.

For example, some of the individuals you work with lived in an institution for many years. That type of environment actually “caused” people to display challenging behaviors. They rarely got any type of good attention or rewards so they figured out ways to get attention in a negative way because “any attention” was better than none at all! So...this is how they “learned” to act because they were not taught any other appropriate ways to interact. Their challenging behavior was actually reinforced. When this type of treatment goes on for many years it can have a lasting impact on a person’s life.

Remember, behavior is communication. Sometimes it is easier to figure out what an individual doesn’t want when they are using a challenging behavior. Sometimes these are the behaviors that make it hard for the individual to be with other people. The individual might spit out food they didn’t enjoy or push away the staff person who wants to help. Imagine if you didn’t have words to use. How would you let someone know that something was making you unhappy?

An individual’s behavior usually communicates three things:

What the individual wants.

What the individual doesn’t want.

When the individual wants attention.

How would an individual’s behavior tell you that they want something?

Often, individuals just want someone to pay attention to them. Some people have learned that making loud noises gets the attention of the staff, or when there is a lot of activity going on, they need to wave their arms to get the staff to focus on them. Or an individual may grab or pull on your arm to get your attention. 

The more you spend time “getting to know” an individual the more you will learn about their behavior. Knowing a person’s daily routines, communication style, appearance, moods, and regular physical health will be helpful information to have when something is not going right for the person. You will be able to tell what may be causing the person to be in a bad mood today based on what their usual good behavior is. If you don’t know what is normal for an individual, you won’t know when something has changed. It is important to always do the following when you work with someone who has challenging behaviors:

Antecedents and Precursors

Antecedents

Most of the time people who display challenging behaviors usually give us some kind of “warning” that the challenging behavior is going to happen. This is especially true for the people we know well and who tend to have a pattern to their behavior. A person may show some minor signs that they are about to have a challenging behavior. If the minor sign has something to do with the person’s environment this would be called an “antecedent”. An Antecedent is any occurrence or event that takes place before the challenging behavior happens.

They may or may not be easy to see happen. An example might be if someone we work with is afraid of Thunderstorms and it is getting dark and starting to thunder...the actual Thunder may be an antecedent to the challenging behavior of them starting to hit themselves or strike out at those around them. The key here would be to start giving the person support when we hear the thunder so they may be less likely to start doing the challenging behavior. Antecedents are different for everyone but most people who have a pattern of doing challenging behaviors usually have some type of antecedents to look for and warn us in advance that a challenging behavior may happen soon.

Precursors

A Precursor is also a sign that can happen before a challenging behavior. This time the minor sign comes from the person themselves and it means that there will be a change in the person’s mood. They may or may not be easy to see happen. An example might be if someone is swearing....the swearing may be a precursor to a challenging behavior such as throwing an object at someone. Again, the key here is when we hear the swearing we start to go over to the person and help them calm down before they decide to do the challenging behavior. Precursors are different for everyone. Some people may have antecedents and precursors before actually doing the challenging behavior.

Communication

How we respond to the antecedents, precursors, or the actual challenging behaviors will have a direct impact on how the person will respond back to us. It is not always “what” we say to someone, but “how” we say it that determines what kind of message we are giving to the person and how they will respond back to us. The tone of voice we use when we say something to someone represents 38% of communication. The body language we use represents 55% of communication. The actual words we use only represent 7% of communication. So the tone of voice we use along with the way we express ourselves through body movements has a big impact on the message we are trying to deliver. If we want the person to get the “right” message we need to make sure our tone of voice and body language match what we are trying to say. We all make mistakes in our communication at times. I’m sure we can all think of times when someone caught us at the wrong moment and we may have said something without using a nice tone of voice or good body language. As a DSP it is very important that you stay aware of your communication style at all times. Remember you are a “Role Model” and your behavior can be imitated.

This is important to remember when relating with the people who live in the home and also when relating with your co-workers. Think about how someone may have said something to you that made you not want to do what they requested. If someone says “You need to clean this mess up right now!” and does not consider that you may be busy doing something else, or that it is someone else’s job, or that you need help, you may respond by not being very nice and definitely not wanting to clean up the mess.

This may affect your mood and how you feel about this person. If someone says “I can see a mess here that needs to be cleaned up. Can you do this now or are you busy doing something else? Would you like some help?” You might be much more willing to clean up the mess if you were asked in a nice way to do it. You might even stop what you are currently doing to clean up the mess because you like the way this person treats you and you like to do what they ask of you.

How you make a request of someone or respond to someone’s request has a dramatic impact on whether or not the individual will comply. If you ask someone in a way that is respectful and courteous, they are more likely to do what you want them to do. “Think before you speak!” This is one of the simple things you can practice with your own behavior that will have a very positive impact on your relationships with the people who live in the home and your co-workers. Our goal is to have “Win-Win” responses. 

When you ask someone to complete a task or respond to an individual’s request, it is helpful to consider:

Promoting Positive Behavior

Key Points About Promoting Positive Behavior:

Proactive Options:

After reviewing this material, you will be able to select pro-active options in dealing with challenging behaviors, including:

Often times when we are working on a task with someone, we may keep pushing for the task to get finished without taking notice of an individual’s minor behavior changes or change in mood. Our focus may be more on the task than the person. We may feel pressure to want to get the task done. If a challenging behavior is starting to happen it is a clear signal that we have to change something in our teaching plan. Failure to change our plan may result in a different lesson learned than we intended.

Focusing on the task as the most important outcome may start to have an effect on your relationship with the individual. The person (the learner), may become more frustrated with the task and you (the teacher), since completion of the task is so important to you. Failure to recognize the needs of or mood changes in the learner can cause the challenging behavior to increase to a point where closure in a friendly, trusting atmosphere is impossible. Our failure to adapt or be willing to make changes for the individual may be perceived as wanting too much “control” over the individual trying to learn.

Using proactive options is not about establishing control over someone. The person trying to learn should be included in the planning process from beginning to end. Without some guidelines to assist us in making “on-the-spot” changes, we might end up responding to a challenging behavior with our emotions. When we respond based on our emotions we may respond with poor body language and inappropriate voice tone. We may become more “bossy” and try to take too much control over the person. To avoid this type of reaction we must have a plan of action ready to implement.

If we know the individual well then we should be aware of the type of challenges we typically face with this person. We can plan our actions ahead of time before the teaching session begins. We learn from past experiences and use our experiences to improve and plan better future teaching sessions. Knowing when to use “proactive options” during our teaching sessions will help us identify potential responses to challenging behavior. We will begin to review the 13 proactive options to assist the teacher when challenging behaviors start to occur. The first 7 options will enhance the quality of interaction between the teacher and learner. The other remaining options will help the teacher to reduce the level of demand on the learner.

Proactive Options that relate to the quality of interaction:

Change your energy level: You may need to increase or decrease your level of enthusiasm when giving rewards or prompting an individual. Some individual’s may like their teacher to be “excited” and “perky”. Others may prefer that you lower your energy level...remain calmer in your approach. This will depend on your relationship with the person and what type of task you are doing with them. “How” you interact with individuals should be based on what works best for the individual.

Modify your tone: This option is similar to the first. You may have to raise or lower your tone of voice to a level the learner recognizes as friendly, encouraging and supportive. Too high of a tone of voice may be too harsh to the learner or seem demanding. Too low of a tone of voice may give the message that you don’t care that much if the person does the task or not.

Validate the learner’s feelings: In order to use this option correctly you need to be able to identify the learner’s feelings that are causing the challenging behavior. The better you know the individual on a personal level, the greater chance that you will be able to recognize those feelings when they occur. Validating the learner’s feelings always has a “But” attached to it. That means you will recognize the feelings and their importance to the learner, “but” we carry on. You need to acknowledge their feelings and include them in the shared interaction you are having with the learner while doing the task. For example, “I know you miss being with your friends at work today. I miss some of my friends too. BUT, you and I can have a good time doing this together today!”

Improve and vary rewards: Remember...how you are interacting with the individual can be a rewarding experience. You need to always be thinking about how you can give positive comments and gestures to the individual, before, during, and after completing a task. The learner may be getting tired of just hearing “Good Job”! You will need to be creative in the ways you reward the individual’s correct responses.

Change your expectations: Sometimes you may be expecting more interaction and participation than the learner is prepared to give today. Be prepared to “back off” and lower your expectations of the learner. Maybe today you will have to “help” the learner more than usual. If the opposite is true, where you may expect less and the learner is willing to give more, then you will adjust your teaching methods to meet the learner’s needs and let them be more independent.

Abandon the task to focus on the person: The individual should always be the focus! There may come a point during the teaching session where it is better for the teacher to forget about the task and just “hang out” with the learner. That becomes the “new” focus or task to keep the person’s challenging behavior from escalating. If continued encouragement to do the task just makes the person more frustrated and agitated, then this may be a good option to choose. You can try to teach the task again another time or another day.

Proactive Options that reduce the demand on the learner.

(These options may enhance the quality of the interaction between the teacher and the learner with less time and effort being spent on the task to be done.):

Change the pace of the activity: If you are moving too quickly through the steps of the task or with your prompting, you may cause the individual to become agitated. The more we take our time to do the activity, the longer we get to spend “interacting” with the learner. Going too slow, on the other hand, may not provide the person with enough “activity”. You need to find a good balance to keep the flow going during your teaching session.

Involve choices: You need to get creative in the way you provide choices during your teaching session. Prepare your task ahead of time. Think of ways you can give the learner as many choices in the activity as possible. Where shall we sit? Would you like to put the plates on the table first or the silverware? Would you like to put the plates in the dishwasher first or the cups? Think of creative ways to involve the learner in making choices about the task. The more the learner feels that they have input the more they will want to participate and complete the task. The more choices a person has the happier they usually are. This is true for all of us!

Modify the environment: Is there anything in the environment that is distracting to the learner or making it difficult for them to stay focused on you and the task? There are many factors that could cause problems such as lighting, temperature, noises, other people, certain objects, feeling too crowded, etc. Think about your area before you start the task and during your teaching time and make adjustments so the individual has a good learning environment.

Improve the prompts: When challenging behavior begins think about adding more prompts to the session. “Help” the person complete portions of the task that are giving them problems. Some day’s people need more help than other days so do not be afraid to give extra prompting and assistance when needed.

Take a mini-break: This option is similar to the option of “abandoning the task to focus on the person”. The difference here is the Teacher has decided to just break from the task for a short time. The learner is not able to stay focused on the task no matter what other options have been tried. The key here is to take the break before the challenging behavior increases. Give the person a chance to break away and relax for a bit or do something else for awhile. With this option the teacher will direct the person back to the task after a short break.

Bail out: If the learner’s challenging behavior has not decreased after trying the other options, this one remains an option for the teacher. The teacher can end the task in a nice way before the individual becomes more upset. Nothing is gained if you continue to try to teach an individual who is totally uncooperative. The teacher and learner will both become more frustrated. This does not mean that the teacher ends their interaction with the person completely, but you will “back off” and give the learner some space. Today is not the day to try to teach the person this task. When this option is used the teacher should look at what happened in this teaching session and try to learn from it. That way the teacher will know how to better present the task to the person next time. Remember the goal is your relationship with the person; the stronger and more trusting that becomes the better chance the person will want to try to do the task with you again.

Hang in there: The last option is the opposite of “bailing out” and “abandoning the task to focus on the person.” The option of simply “hanging in there” means to help the person through this difficult time they are having. The better you know the person the better you will be able to make the decision on how long to hang in there with the individual. If the person starts to focus again and shows some signs of participation the teacher can start to give more rewards and encouragement to keep the person on the right track.

If problems continue during teaching times, remember the following “problem-solving” skills that may be helpful:

Positive Behavior Support Plans

If a person has an ongoing behavior treatment plan to assist with their challenging behavior, you need to do exactly what the plan tells you to do. DSP’s should receive specific training for that person’s plan. If at any point during a confrontation you do not feel you can handle the situation you need to call for help from another co-worker. Sometimes you may need to admit that you may not be the best DSP to help this person. The DSP that has the “best” relationship with the person usually has the most success with helping the person calm down.

KEY STEPS IN DEVELOPMENT OF THE PLAN:

1. Develop a Support Team: The support team should include key people in the person’s life. Some of these people may include: Direct Support Professionals, Family Members, Guardians, Mental Health Professionals, School and/or Work personnel, Friends, and anyone else that knows the person well. The team will meet to share information about everything they know about the person. The meetings should be positive and everyone needs to agree to the plan. The team should discuss the person’s strengths and abilities, and be able to help put together a plan that will promote a positive future for the person based on those strengths and abilities. The team needs to be willing to meet and review the plan as needed to fine tune the plan or make specific changes. As a direct support professional you play an important role as a team member. You are a key person in providing information to the team. Never be afraid to “speak up” and let other team members know how you feel about what is going on in the person’s life.

2. The Severe Behavior (s) needs to be clearly defined: A severe behavior is a behavior that causes harm to the individual themselves, others in their environment, or causes severe property damage. Specific information on where, how often, and when the behavior occurs needs to be established so it can be monitored regularly.

3. Everyone involved in the planning process needs to be able to provide extra support to the individual while gathering information about the behavior:

More focus should be given during “good times”. Find new ways of praising the person and giving positive feedback for “good behavior”. Think of ways to provide more “choices” for the individual. People with challenging behavior have little control over whom they live with, what they will have for dinner, when they will get to go out with a friend etc. Most of the time restrictions are put in place for people that may prevent the person from having some choices in their life.

Everyone involved in the plan needs to be creative in how to offer more choices in the individual’s life and still keep everyone safe. Find out what the person likes and dislikes. Observe the person during good and bad times. During times when the person seems to be agitated try not to ask too much of the person. Try to get them involved in another activity they enjoy or change their environment to better meet their current needs. These simple changes in the person’s life and how you relate to them will be helpful with developing a positive support plan.

4. Begin the process of a comprehensive assessment:

As a DSP you will be asked to describe how the person spends their time. Other team members will be asked to do this too. Everyone should take note of the overall quality of life for the person. Do they have community involvement? To what extent? Do they have friends outside of their home  Do they like to be around people? Do they like to have some “alone time”? Do they like a quiet environment or noisy one? Do they like their daily schedule? Do they have input on their daily/weekly schedule? Do they like to go to work/school? What are they good at doing? What things are most important for them to learn? Do they actively participate in their person centered plan? Are the goals in their individual plan encouraging them to learn new things they enjoy? Do they have choices in their life? Do they appear to like where they live? Are there certain DSP’s they “connect” with? Do they have positive role models in their life? Do they like their housemates? Do they have health problems? Do they have an adequate diet? Are they taking medications? Are there side effects of the medications that could have an impact on how they behave? These are just some of the examples of questions that should be looked at to get a clear picture of the person’s life. It is important to remember that quality of life issues are among the most important factors that influence behavior. If someone’s life quality isn’t what it could be, it can affect behavior.

5. Conduct a Functional Assessment: Once all the necessary information is gathered and discussed it is time to conduct a functional assessment of the challenging behavior the person is doing. All behavior that happens regularly serves some purpose for the person. Every person is a unique individual. The best way to help someone change their behavior is to first understand the reasons behind the behavior. Some good questions to consider might be: What does this behavior do for the person? Does the behavior help them get away from something they don’t like or don’t want to do? Does the behavior help them avoid a situation where they are likely to fail or feel threatened by demands being placed on them? What “need” is the behavior trying to communicate? Why does the person feel the need to resort to such extremes to get someone’s attention or to protect themselves from something they see as threatening? So how do we figure out the purpose or function of a behavior? We start with the “A”, “B”, “C’s”. A is for Antecedent (and/or precursor) which occurs before the behavior. B is for Behavior which refers to the specific challenging behavior that can be clearly seen when it occurs. C is for Consequence which refers to what happens after the challenging behavior or as a result of the behavior. As a DSP you will be asked to record the person’s challenging behavior based on the A, B, C’s you have observed happening. There will be a specific data sheet set up for the person for you to record on whenever you see the behavior happening. The support team you are working with will assist you in learning how to best record the data on the challenging behavior.

6. Continue to gather information to evaluate what is going on: The information about the person’s challenging behavior needs to be evaluated regularly. The steps that have been taken to help the person should have a positive impact on the behavior and the overall quality of the person’s life. As information is reviewed it should focus on overall improvements in the person’s life, and not whether the challenging behavior ever occurs.

7. Design a Support Plan (based on the data collected) which should indicate what the team thinks the purpose or function of the behavior is: The plan needs to address the changes needed to reduce the amount of times the challenging behavior happens. The plan should note the conditions present before or during the behavior, and what happens after the behavior occurs. What specific skills can be taught to the person to make the challenging behavior unnecessary? What changes need to be made in the environment or other areas of the person’s life? When making a positive support plan it is important to involve teaching skills that allow the person to have success and encourage independence. This will help teach new, socially acceptable behaviors and skills to replace the challenging behaviors. The plan also needs to include what to do when the person has a bad day and the challenging behavior increases. Hopefully this will not happen, but those situations need to be addressed to promote a safe environment for everyone. Once the support plan is developed the DSP’s that work with the individual should be “trained” on the plan. The DSP’s will be responsible for implementation of the plan when the challenging behavior occurs. The positive support plan is considered “treatment” and is part of the individual’s person centered plan of service. All DSP’s are required to follow the plan and be consistent with how they implement the plan.

8. Regular Reviews of the Plan should occur: A positive support plan is not written in stone. There should be regular opportunities to review what is working and to change the plan to make it more effective. The DSP needs to be sure to chart progress or lack of progress on the data sheets regularly. The review of the data along with daily progress notes should give the team the information they need to report progress or make the appropriate changes to the plan. As with other goals in the person’s plan of service we should not keep doing things that are not working! As a DSP your ongoing input on the plan is important. Don’t be afraid to voice your concerns if the plan is not helping the person to improve. Basic guidelines for improving and modifying support plans to ensure success:

9. The Successes from the Plan do not stop after the challenging behavior decreases: Changing a person’s challenging behavior is never a quick or simple process. Challenging Behavior will begin to increase again if long-term support is not provided. There should be “Guidelines” put in place to guide DSP’s in providing the necessary supports to the individual. Just because the challenging behavior has ended or decreased does not mean your support ends. The person will need continued support to stay on the right track.


Crisis Intervention

You now have a much better idea of how to provide an environment that supports choice, control, quality of life, and healthy relationships for the individuals who live in a residential setting. You know that offering choices is one of the most important things a DSP can do to encourage independence. Effective teaching strategies and developing trusting positive relationships with the individuals you work with will help you to respond to challenging behavior in a caring and supportive manner. Since you have taken the time to get to know the individual you are able to help the individual to learn new coping skills for dealing with fear, frustration, and anger. You have learned that behavior is a form of communication. A DSP must “hear” the behavior and use that information to assist the individual to cope with an uncomfortable situation or environment. Even when DSP staff do everything that is outlined in this unit and know people well there is still a possibility that you MAY NOT be effective in de-escalating a challenging behavior or avoiding a crisis situation. Remember the Individuals that you assist are not always capable of avoiding confrontations with others. The DSP must accept this responsibility- aggressions and conflicts are often related to what DSP staff do and don’t do.

So, what is a crisis situation? A crisis or emergency situation is defined as seriously aggressive, self-injurious or other behaviors that place the individual or others at risk of harm. A more detailed definition is included later in this unit. This is not a typical behavior for the individual. This is the first time the individual has responded in this way or there has not been time to develop a positive behavior support/treatment plan. Remember if the individuals’ you support have a history of challenging behavior this is not a new behavior for them. There should be a positive behavior support/ treatment plan in place. If there is a plan in place you must follow the plan.

A Positive Behavior Support (PBS) plan may sometimes include a “restrictive” component. Plans that include restrictions must be reviewed and approved by the behavior treatment committee to assure that the individual’s rights are not violated in any way by the techniques in the PBS plan. If you are providing support for an individual with a PBS plan that includes restrictive techniques, you must receive training on the plan and techniques before carrying out the plan. The training must be provided by a qualified instructor and documentation of the training must include the following information: date, length of training, type of training, specific techniques covered, and whether the DSP is able to perform the techniques. DSP staff should receive training on the plan any time the plan is revised or modified. Frequent review and practice of the techniques is recommended to assure that the DSP is able to perform the techniques in the PBS plan when/if it becomes necessary. 

If the PBS plan is working and the individual is learning new coping skills the more restrictive parts of the plan will not be used often and eventually will not be needed in the plan. If the more restrictive techniques are used often this usually means that the positive support included in the plan should be reviewed and changed. DSP staff should make the effort to be involved and participate in this process to share their experiences and observations about an individual and to learn what works for others. You know that sometimes the reason an individual may display a behavior is obvious and at other times it may be much harder to determine the reason for the behavior. It may appear as if there is no trigger or precursor. It is very important that DSP staff work together as a team and communicate what they have observed during their interactions in the residential setting and what has been successful. This information should be shared with the case manager and other team members.

Remember to involve the individual as much as possible in the plan development. A good PBS plan allows opportunities for the individual to learn to make “real” choices that are meaningful, and this will help the person gain control and independence! 

IN SUMMARY:

The Direct Support Professionals now have tools that they can use to help them support individual’s they provide services to at the residential facility in which they work.

Everyone who provides support to the individuals needs to be willing to work as a team. We must be willing to change ourselves, the environment, the schedules, the teaching materials, the reinforcers, or whatever support is needed to achieve positive outcomes and improve the overall quality of a person’s life.

To summarize: The best ways to support an individual who has challenging behavior are:

1. Get to know the person. Look at them and listen to them while you do routine jobs. The better you know someone the better you understand them. The better you understand them the better you will be able to deal with the parts of their personality that are not likeable.

2. Remember that all behavior is a form of communication. Challenging behavior sends a message. Ask questions and learn about the individual’s life and what it takes to make that person happy. Learn what causes the person to become unhappy. The challenging behavior may have something to do with what the person is being asked to do (their daily schedules, their goals) and “who” is doing the asking.

3. Help the person with severe challenging behavior develop a positive behavior support plan. Try to include the person in the planning process as much as possible. This will help improve the individual’s relationships with others, community participation, increased choices, skill development, and allow them to make contributions to other team members.

4. Don’t assume the worst about the person. Labels can cause us to underestimate the person’s true potential. Stay focused on the person’s strengths and abilities. Every person can make improvements with adequate support.

5. Relationships make all the difference. Advocate for the person to have positive role models in their life. Many individuals depend on family members or paid staff for their social relationships. Get creative with ideas for including the person in the community and setting up a social support network.

6. Help the person develop a positive identity. Often a person with challenging behavior is labeled as a “behavior problem”. Build a positive identity by helping the person find a way to make a contribution. Put the “person first” when you talk about them. Talk about the “good behaviors” as much as possible. Share news about the good things that you see the person doing.

7. Give choices instead of requiring or demanding the person to do something. Allow the person to make choices as much as possible. This does not mean you give them everything they want. You can set limits with the person as long as you include them and provide some choices with those limitations.

8. Help the individual to have more FUN. Fun and humor are powerful cures for problems. Be a role model for “having fun” and being happy.

9. Establish good working relationships with your co-workers, mental health professionals, family members, guardians, and doctors. Learn as much as you can about the person and who has influence in their life decisions. Being healthy both mentally and physically will have an impact on challenging behavior. This includes things like a balanced diet, good sleep, adequate exercise, and feeling supported by all the people in their life that care about them.

10. Develop a support plan for yourself and co-workers. Help to create a supportive environment for everyone concerned. Direct Support Professionals need support too. The more supportive environment you work in, the less chance for punitive practices to take place.

Your role as a Direct Support Professional has an immediate impact every day on the people to which you provide services. You will experience, over time, the incredible importance and value of relationships. On that amazing journey you will discover that you are building a better and healthier world and community for the sake of humankind. You may also discover that you are helping to take away the isolation in people’s lives, bringing equalities that all citizens have a right to, and offering care and compassion to those who sorely need it. In your work as a Direct Support Professional, you are given the opportunity to help instill in people a sense of value and dignity. This leads to healthier self-confidence and self-esteem and, along with your encouragement as a role model, may inspire others to give rather than habitually take. Finally, you are bringing hope and light to people and their communities; and you will discover that without you the difference might never have been felt.

Now that you have completed the Positive Approaches to Challenge Behaviors module, please proceed to take the test. To successfully complete the course, you must achieve a passing score of 80% or higher.