96

Positive Behavior Support

Introduction

Positive behavior support (PBS) is a therapeutic intervention that involves the administration of behavior strategies to increase quality of life by decreasing maladaptive behaviors and increasing positive behaviors (Wheeler & Richey, 2010). Specifically, by reducing and preventing maladaptive behaviors, as well as, by reinforcing and teaching appropriate behaviors, occupational therapists can play a role in increasing functional behaviors and decreasing occupationally-hindering behaviors. Individuals with obesity engage in maladaptive behaviors, such as overeating, eating junk food, and engaging in a sedentary lifestyle, which can be replaced by more positive behaviors, such as eating healthy and engaging in physical exercise. Through By administering PBS, occupational therapists can reduce and prevent unhealthy behaviors, as well as, reinforce and teach healthy behaviors to promote a higher quality of life in individuals with obesity (Wheeler & Richey, 2010).

Theory

Positive behavior support (PBS) uses education and environmental change to enhance quality of life and minimize problem behaviors. Positive behaviors increase chances of success and personal satisfaction in the person’s academic, work, social, recreational, community, and family settings. Support encompasses all those educational methods that can be used to teach, strengthen, and expand positive behavior and all those systems change methods that can be used to increase opportunities for the display of positive behavior. The primary goal of PBS is to help an individual change his or her lifestyle in a direction that gives all relevant stakeholders (e.g., teachers, employers, parents, friends, and the target person him- or herself) the opportunity to perceive and to enjoy an improved quality of life. An important but secondary goal of PBS is to render problem behavior irrelevant, inefficient, and ineffective by helping an individual achieve his or her goals in a socially acceptable manner, thus reducing, or eliminating altogether, episodes of problem behavior. (Citation already below)

Case Study:  Rosa is a 52-year-old woman with type II diabetes who weighs 265 lbs and has down syndrome. She reports that she likes eating junk food. Rosa also states that she would like to change her junk food eating behavior for one that can help her lose weight or not gain any more weight (Cypress, 1999).

Evidence

There is evidence that supports the use of PBS by occupational therapists when treating people with intellectual disabilities. In a study, 10 occupational therapists agreed that their clients’ occupational engagement improve when they combine their occupational approaches with positive behavior support strategies (Perez et al, 2012). In addition, a systematic review about the outcomes of positive behavior support training on staff and services users, found positive impact on knowledge, emotional responding, attributions of staff, and decreased challenging behaviors from service users (MacDonald et al, 2013).

Intervention Plan

Problem Statement

• Client has difficulty maintaining a healthy weight secondary to eating unhealthy snacks.

Long Term Goals

• Client will use token economy strategy to decrease consumption of unhealthy snacks 5/5 times a week in 10 weeks.
• Client will use preferred activities as reinforcement to decrease consumption of unhealthy snacks 5/5 times during the week in 10 weeks.
• Client will abstain from eating snacks past 9pm 5/5 times in order to decrease consumption of unhealthy snacks in 10 weeks.

Short Term Goals

• Client will use token economy strategy to decrease consumption of unhealthy snacks 2/5 times within 2 weeks.
• Client will use preferred activities as reinforcement to decrease consumption of unhealthy snacks 2/5 times during the week in 2 weeks
• Client will abstain from eating snacks past 9pm 2/5 times in order to decrease consumption of unhealthy snacks in 2 weeks.

Intervention format:

• Individual

Setting

• Outpatient

Supplies

• None

Agenda

• Therapist meets and builds rapport with Rosa (10 min)
  Therapist educates Rosa on positive replacement behaviors for her eating behaviors (10 min)
  Therapist and Rosa discuss positive reinforcement behaviors (10 min)
  Therapist discusses methods for Rosa to change her environment (10 min)
  Therapist will provide a summary of the session and elicit feedback (5 min)

Documentation

S: Client states, “I can’t stop eating after I get home from work. I go through a half pint of ice cream every two days.”

O:  Client arrived to session with food journal documenting the meals and snacks she ate since the last session two days ago. Client and therapist reviewed the journal for 10 minutes, and discussed when the client feels the need to eat ice cream the most. Client identified her eating behaviors are most prevalent after a shift at her job. Client engaged in an activity for 15 minutes to identify 5 replacement behaviors that they felt they would be most successful in implementing, and discussed with therapist methods by which to carry out those behaviors.

A: Client continues to struggle with replacing eating behaviors, despite increased awareness of the maladaptive nature of those behaviors. Client was receptive to PBS plan, and voiced her confidence that she could follow the plan.

P: Client will continue twice daily treatment sessions, and at next session the PBS plan will be re-assessed for effectiveness and congruency to their occupations and meaningful activities. Client was provided local resources for dietitians, and fitness coaches to expand treatment options.

References

Carr, E.G., Dunlap, G., Horner, R.H., Koegel, R.L., Turnbull, A.P., Sailor, W., Anderson, J., Albin, R.W., Koegel, L.K., & Fox, L. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavioral Intervention, 4(1), 4-16. http://dx.doi.org/10.1177/109830070200400102

Cypress, M. (1999). Case study: A 52-year-old woman with obesity, poorly controlled type 2 diabetes, and symptoms of depression. Clinical Diabetes, 17(3), 143.

Perez, M., Carlson, G., Ziviani, J., & Cuskelly, M. (2012). Contribution of occupational therapists in positive behaviour support. Australian Occupational Therapy Journal,      59(6), 428-436. doi:10.1111/j.1440-1630.2012.01036.x

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

MacDonald, A., & McGill, P. (n.d). Outcomes of Staff Training in Positive Behaviour Support:   A Systematic Review. Journal Of Developmental And Physical Disabilities, 25(1), 17-33.