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Introduction

Positive behavior support is a theoretical model and intervention used to help an individual change his or her lifestyle in a direction that gives all relevant stakeholders the opportunity to perceive and to enjoy an improved quality of life (Carr et al., 2002). This intervention targets three factors that affect behavior such as a person’s biological needs, their developmental stage, and their social experience. In order to describe the behavior, it looks at four major characteristics. The four characteristics are the following: the setting where the event or bad behavior occurred, the antecedent which is what triggered the behavior, what the behavior was, and what the consequence of the behavior was in order to truly understand the behavioral problem. Additionally, it provides four methods for changing behavior which includes preventing the challenging behaviors, reinforcing appropriate behaviors, teaching replacement behavior, and reduce challenging behaviors. Although positive behavior support is very similar to ABA therapy, it is more generalizable and can be applied by OTs to people with developmental disabilities.

Theory

The behavioral frame of reference, in regards to occupational therapy, looks at  a person’s maladaptive behaviors and focuses on changing them into adaptive behaviors. A person’s behavior is affected by all the feedback and stimuli they receive from the environment. Occupational therapists can work with individuals with maladaptive behaviors by using techniques such as shaping, teaching, and reinforcement. These techniques are utilized during positive behavior support interventions by providing the skills and support individuals need to change their behavior (Sames, 2015).

Evidence

An article by Schall (2010) looks at the process of providing positive behavior support in the workplace for individuals with Autism. This article also discusses some of the evidence-based antecedent strategies used by providing a situation with an individual named “DJ.” These strategies include making sure that the job is a good match for the individual, designing a workstation to increase task completion, providing written or picture schedules of tasks, assigning tasks that are routine, but complex, and communicating information concretely, and following-up with written or picture feedback. One of the steps to positive behavior support is to teach the individual new behaviors. It is important to replace the maladaptive behaviors with adaptive behaviors. With all these strategies and steps, article showed that an “DJ” was able to reduce the frequency of his maladaptive behaviors at work through the use of positive behavior support (Schall, 2010).

Case Study

Sam is an 18-year-old boy who is diagnosed with autism spectrum disorder. He lives at home with mom, dad, and sister. He is a freshman at a local college studying marine biology. Sam has been working at an electronic store part-time for 6 months. At work his tasks include answering customers questions about products, checking out customers when purchasing items, maintaining his work space clean, restocking shelves, and helping keep the break room clean. He is independent in almost all aspects of his job. He does require prompting and correction when is the appropriate time to take out the garbage. He wants to take out the garbage whenever he checks the receptacles. Taking out half empty garbage bags is too expensive. If he is unable to take out the receptacle when he would like, he has behavior outbursts and becomes very upset. He also demonstrates these behavioral outbursts when collaborating with other co-workers and opinions of colleagues. He is successful at his job, except for his behavior problem which is a barrier to being fully independent at work.

Intervention Plan

Problem Statement

Client is unable to be independent at work secondary to his inability to control his behavior

Long term goals

1- Sam will be able to self monitor his behaviors to determine when to receive positive reinforcement, 5 out of 5 days to improve independence at work in 10 weeks.

2- Sam will display no behavioral outbursts 5 out of 5 days for independence at work in 10 weeks.

Short term goals

1-  Sam will display no behavioral outbursts 3 out of 5 days while at work,  to be independent at work within 5 weeks.

2- Sam’s boss will implement the token economy when he displays no behavioral outbursts at work 3 out of 5 days to be independent at work in 5 weeks.

3- Sam will role-play scenarios to determine what is the appropriate behavior to receive positive reinforcement to begin self- monitoring skills for independence at work within 5 weeks.

Intervention format

Individual

Setting

Sessions will be in his natural work environment including Sam’s boss into the treatment sessions

Supplies

None

Agenda & description

• Educate Sam and his boss on positive behavior support, specifically using the token economy strategy and social reinforcers (15 minutes)
• Introduce Token economy and provide scenarios using strategy (15 mins)
• Introduce Social reinforcers and provide scenarios using strategy  (10 mins)
• Role- play with Sam and his boss situations that have happened in the past, now implementing PBS strategies (15 mins)
• Summary of session (5 minutes)
  • Answer any questions Sam or his boss may have regarding PBS

Documentation

S-  Sam and his boss participated in a 1 hour OT session at their job. His boss expressed Sam is a great employee but would like to reduce his behavioral outbursts since he has caused problems with colleagues in the past.

O-  Sam and his boss were introduced to positive behavior support, specifically using the token economy strategy and social reinforcers. Sam expressed behavioral outbursts  2 out of the 5 times when implementing PBS. Sam was unable to properly control his behavior in an effective way.

A- Sam’s lack of control of his outbursts demonstrates his need for OT services focusing on positive behavior support strategies. His outbursts at the workplace are due to his lack of ability to adapt to his work schedule. As this is the first session introducing PBS with Sam, he demonstrates the ability to be able to regulate his own behavioral reinforcement to attain his long term goal within 10 weeks. During today’s session, Sam responded well and preferred the token economy as it was immediate, tangible feedback on his behaviors.

P- Sam will benefit from 1 hour OT sessions, twice a week to improve his behavioral outbursts. We will continue to work on achieving the goal of having Sam be able to regulate his own PBS and social reinforcers to improve his independence at work.

References

Sames, K. M. (2015). Documenting occupational therapy practice. Upper Saddle River, NJ:
      Pearson Education.

Schall, C. M. (2010). Positive behavior support: Supporting adults with autism spectrum

disorders in the workplace. Journal of Vocational Rehabilitation, 32(2), 109-115.