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Introduction

Positive Behavior Support is a behavioral  approach based on principles emerged from three major sources, applied behavior analysis (ABA), the normalization/inclusion movement, and person-centered values. Positive behavior support (PBS) is an applied science that uses educational and systems change methods (environmental redesign) to enhance quality of life and minimize problematic  behavior.

Theory

The Applied Behavior Theory (ABA) focuses on improving specific problem behaviors, such as, social skills and academics. ABA is known to be effective for children and adults with problem behaviors in a variety of settings. These setting include but are not limited to:  the home, school, and workplace. It also has been shown that consistent ABA can significantly improve behaviors and skills.

Evidence

A Method Outcome study was conducted, which met specified criteria for PBS was selected for review. The study encompassed 423 cases. The outcome study concluded  that PBS was effective with both severe and high-rate behavior problems. These behavior problems included self harm, harming others, and substance abuse. PBS was found to be cost-effective. The review  used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community.  The major implication of this review is that practitioners find PBS to be effective when faced with the need to develop a plan of support for high rate behavior problems.

Case Study

Gloria came to the United States 3 years ago to live with her daughter after escaping the cartel. In the escape Gloria was the only one of the family in Venezuela to make it to the U.S embassy. Yolanda, her daughter has brought her to occupational therapy because she is concerned because she has been seeing Gloria with cuts on her arms as the anniversary of the trauma grows closer. Yolanda is worried because the cuts are becoming a source of strife for the family as they don’t want Gloria, who babysits the children, to reinforce negative coping behaviors in them. As a result, Yolanda has stated that Gloria can no longer see the children until she gets help.

Intervention Plan

Problem Statement

Client is demonstrating self injurious behaviors secondary to maladaptive coping mechanisms.

Short Term Goals

1. Client will identify replacement behaviors w/ VC for self harm behaviors by next session.
2. Client will identify social triggers that cause a desire to self harm by the second session.
3. Client will rid her environment of reminders of trigger events by the 4th session.

Long Term Goals

1. Client will successfully integrate replacement behaviors in replacement of self harm behaviors in 1 month.
2. Client will complete one month without demonstrating self harming behaviors, independently, in 1 month.

Intervention Format

Individual

Setting

Gloria will meet with the occupational therapist at her home for 30 minutes, 2x/week for 6 weeks.

Supplies

Journal and pen/pencil

Agenda

• Meet Gloria and develop rapport to establish trust (2 mins)
• Converse with Gloria about why she thinks she can’t see her grandchildren and evaluate her insight into the effect it has caused (10 mins)
• Have Gloria write down what triggers her and how she thinks she can avoid it (6 min)
• Have Gloria list what behaviors she thinks she can replace her negative ones with (8 min)
  • Allow Gloria time to ask questions (2 min)
• Provide a summary of the discussion (2 min)

Documentation

S: Client states that she would like to be able to be apart of her family’s lives again and that she really misses her grandchildren.

O: Client participated in a 30 minute session in which she identified the reasons she cannot see her grandchildren at the current time. She expressed that she finds cutting herself a relief from the pain she feels from the trauma she experienced in her home country. Client became teary eyed when discussing her trauma and expressed she did not know how to stop cutting herself. Therapist provided the client coping strategies to implement when she feels like cutting herself. Client wrote down what triggers her to cut herself and how she can avoid it. With the help of the therapist, the client then wrote down 3 behaviors that can replace her cutting behavior.

A: Client demonstrated deficits in executive functioning as she was unable to come up with replacement behaviors for cutting herself, independently. Client also demonstrated deficits in emotional regulation, as she still becomes upset when talking about her trauma and is unable to regulate her emotional pain in a healthy manner. The client’s need for help when coming up with positive replacement behaviors for her cutting demonstrates the need for continued occupational therapy. Client will benefit from positive behavior support to help her cope with her emotional pain, eliminate her self harming behaviors and improve her family dynamics.

P: Client will continue with OT sessions for 30 minutes, 2x/week for 6 weeks to focus on reinforcing positive coping behaviors and eliminating self harming behaviors.

References

Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., … & Fox, L. (2002). Positive behavior support: Evolution of an applied science. Journal of positive behavior interventions, 4(1), 4-16.

Lavigna, G. W., & Willis, T. J. (2012). The efficacy of positive behavioural support with the most challenging behaviour: The evidence and its implications. Journal of Intellectual & Developmental Disability, 37(3), 185-195.