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Introduction

Adolescence is a unique and dynamic period in our lifespan that involves a lot of factors that impact each individual. Their lifespan requires involvement of developmental and motivational aspects that supports and promotes healthy behaviors (Issner, Mucka & Barnett, 2017). Positive behavior support is an approach that has proven to be effective towards reducing challenging behaviors with children and youths with or without disabilities (Nietzel, 2010). Involving positive behavior support interventions for a group of children in the foster care system would be beneficial in terms of consistency and promoting self-regulating behaviors.

Theory

The theoretical model that promotes positive approaches towards behavioral changes is positive behavior support. Positive behavioral support is an extension from applied behavioral approach, or ABA. Both approaches promote socially relevant behaviors. In addition, positive behavioral supports rely on client-centered planning to enforce positive behavioral changes(Wheeler & Richey, 2010).

Evidence

Evidence for the use of positive behavior supports (PBS) as an intervention for children in the foster care system is lacking. However, a meta-analysis of 20 articles published over a period of 16 years shows support for the effectiveness of PBS when used with children in an educational setting to reduce aggressive behavioral problems. (Solomon, Klein, Hintze, Cressey, & Peller, 2012). Similarly, a 4-year long longitudinal randomized controlled trial of PBS showed a 33% reduction in student office discipline referrals in a school setting (Bradshaw, Waasdorp, & Leaf, 2012). Evidence from the research indicates positive outcomes for the use of PBS with school aged children however, further research is necessary to evaluate the effectiveness of PBS specifically in foster care.

Case Study

An OT is providing services to an organization that supports children in the foster care system. They have requested OT services due the challenging behaviors presented by the children in residential house 22. The residential house consists of 10 males between the ages of 11-17, from various backgrounds and developmental stages. There is a house parent on staff and a residential supervisor. Frequently, the kids present with various challenging behaviors including punching, kicking, stealing from other housemates, fighting, and yelling at one another. These behaviors often present in the afternoon and change based on the staff that is present. The residential supervisor and the house parent agreed to receive OT services and implement the intervention plan.

Intervention Plan

Problem Statement

• The adolescents from House 22 are exhibiting challenging behaviors due to the staff’s lack of knowledge of evidenced based behavioral interventions and the kids inability to self-regulate and respond appropriately.

Long Term Goals

• House 22 will be able to participate in house outings and activities without displaying any challenging behaviors, independently in 1month.
• The residential house parent will be able to successfully implement behavioral interventions in the residential home independently, whenever challenging behaviors arise, within 1 month.

Short Term Goals

• The residential house parent will be able to successfully implement 2 behavioral interventions in the residential home, independently, whenever challenging behaviors arise within 2 weeks.
• The residents in house 22 will be able to address staff in appropriate manner, 50% of the time  by acknowledging appropriate boundaries, within 2 weeks.
• The resident in house 22 will be free of problematic behaviors such as use of explicit language, kicking and testing limits, within 3 weeks.

Intervention Format

• Group

Description of setting

• The session will take place in House 22 twice a week for 1 hour

Supplies

• None

Agenda

House Wide Evaluation:

• Evaluate foster care program, framework.
• Observe foster children with exhibiting challenging behavior.

Educate on Positive Behavior Support (PBS) to administrators and foster children

• Set up training session with administrators
  • Educate on PBS
  •  Demonstrate video on PBS
  • Provide handout and worksheet with scenarios to identify antecedent, behavior and consequence
• Set up meeting with foster children
  • Identify desired reinforcers
  • Educate on appropriate behaviors
• Evaluate Learning Outcomes
  • Ask for return demonstration
  • Provide written hand-out with scenarios

SOAP

S: Administrators expressed their concern for challenging behavior in residential house 22. They are concerned about the hostile environment that does not foster growth and respect needed for the transition to the real-world.

O: Residents of house 22 displayed hostility toward each other, use of explicit language and disruptive behavior. Staff workers for house 22 disregarded problematic behaviors,  acknowledge friendly bond with residents by excusing behavior with gestural social cues.

A: Administrators were educated on on strategies of how to address problem behaviors. The house parents and supervisor were receptive to education on how to provide appropriate boundaries and feedback to students. Residents of house 22 were able to demonstrate appropriate behaviors as evident in the return demonstration session concluding session however generalization outside of therapy will be challenging. Administrators will be shown techniques to ensure consistency on progress and generalization after therapy sessions.

P: Residents of house 22, supervisors and house parents will benefit from PBS training to address problem behaviors 2x/week for two months provided by occupational therapist.

References

Bradshaw, C. P., Waasdorp, T. E., & Leaf, P. J. (2012). Effects of school-wide positive behavioral interventions and supports on child behavior problems. Pediatrics, (5), 1136. Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.318039355&site=eds-live

Issner, J., Mucka, L., & Barnett, D. (2017). Increasing Positive Health Behaviors in Adolescents with Nutritional Goals and Exercise. Journal Of Child & Family Studies, 26(2), 548-558. doi:10.1007/s10826-016-0585-4

Neitzel, J. (2010). Positive Behavior Supports for Children and Youth with Autism Spectrum Disorders. Preventing School Failure, 54(4), 247-255.

Solomon, B. G. 1., Klein, S. A. 1., Hintze, J. M. 1., Cressey, J. M. 1., & Peller, S. L. 1. (2012). A meta-analysis of school-wide positive behavior support: An exploratory study using single-case synthesis. Psychology in the Schools, 49(2), 105-121. 10.1002/pits.20625 Retrieved from http://ezproxy.fiu.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=eue&AN=70359537&site=eds-live

Wheeler, J. J., & Richey, D. D. (2010). Behavior management: Principles and practices of positive behavior supports. Pearson.