NOTE: This report was written by a participant in Institute for Applied
Behavior Analysis’ Summer Institute (http://www.iaba.com) on
“Assessment and Analysis of Severe and Challenging Behavior.”
All identifying information has been changed. This report is
presented as an example of the type of report that participants will
be able to write after completing the course.
COMPREHENSIVE FUNCTIONAL ASSESSMENT REPORT
AND RECOMMENDED SUPPORT PLAN
Client Confidential
Date of Report: July 26,
Referral Date: June 27,
Period of Report: July 26 – July 28,
IDENTIFYING INFORMATION
Name: Mike Jones
Date of Birth: November 5, 1966
Address: 456 Any Boulevard
Any town
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© 2002, Institute for Applied Behavior Analysis, All Rights Reserved
REASONS FOR REFERRAL
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Mike was referred by Sims and Sims Services, Inc. (SSS) – Corie
Brown for an evaluation. The purposes of the evaluation were to assist Mike in
securing the services and programming which would enable him to develop
and to use his capabilities, to get the most out of the educational opportunities
that can be made available to him and to enable him to develop and to use his
capabilities for more independent, normal living and more productive activity
than his behavior problems presently permit. Accordingly, it was requested
that the evaluation focus on these behavior problems, which were
characterized as Physical Aggression, and the type(s) of behavioral services,
support strategies, programming, professional competencies and skills, and
environments required eliminating, minimizing, or managing them.
Specifically, Mike has engaged in hitting his peer at the work site with a
broom and has tried to hit his peer in the face by engaging in the action of
“snapping” a cloth at his peer’s face.
DESCRIPTION OF ASSESSMENT ACTIVITIES
This assessment is based on information obtained from the following
sources:
A.
Interviews with Mike Jones (consumer) July 26, (20 min.). Micki
Smith (SSS Job Coach) July 26, (1.5 hours.), and Missy Allen
(Sr. Employment Specialist.) July 26, (45 minutes);
B.
Direct Observations of Mike (consumer) in the following settings;
The Steamer Restaurant, work site July 26, (1.75 hours);
C.
Review of the following records provided by SSS;
D.
i.)
Local Area Cooperative Education Program, Case Study
Summary, 1985.
ii.)
DEF Regional Center - I.P.P. Person Centered Plan, 1999
iii.)
Developmental Disabilities Center – Assessment, 1986
iv.)
SSS Individual Service Plan, 1999
A Reinforcement Survey completed by the writer through
information obtained through interviews and records review.
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E.
Telephone Conferences; Cathy Jones (Mother) July 26,
minutes)
(30
BACKGROUND INFORMATION
I.
Brief Client Description.
A.
General. Mike is a 33 year old Caucasian male of medium,
stocky build. He weighs approximately 210lbs and is 5 foot 9
inches in height. Upon meeting Mike I noticed that he was clean
shaven and his hair was neatly combed. He has been diagnosed
as having a mild level of learning disability with Autistic like
tendencies and possible emotional deficits. Mike has blue eyes
and blond hair and has no apparent physical disabilities. His
gross motor skills appear to be within normal range and he is fully
ambulatory, and walks slowly moving side to side. Mike has
difficulties with tasks that require fine motor skills such as tying
his shoes.
B.
Language and Communication Skills.
Mike communicates
through use of verbal English language although at times is
difficult to understand as he often speaks quickly and has
difficulties with articulation of some sounds. Mike at times stutters
and exhibits echolalia and preservative speech. Mike is
spontaneous in his use of speech and uses sentences with up to
7 words in them. He can initiate conversation with others
although does not do this consistently. He participates in simple
conversations and can relate personal experiences through “I”
statements. Mike can understand basic to moderate
conversations and can follow 2 step directions.
C.
Cognitive and Academic Abilities. At the age of nineteen, Mike
was the given the Weschler Adult Intelligence Scale, with results
as follows:
Verbal Subtests
Information
Digit Span
Vocabulary
Arithmetic Comprehension
Similarities-4
Verbal IQ=59
-1
-1
-2
-2
-3
Performance Subtests
Picture Completion
-3
Picture Arrangement -4
Block Design
-4
Object Assembly
-3
Digit Symbol
-1
Performance IQ=59
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Full Scale IQ=57
Mike can read his name and some safety words. He can print
single letters and his name legibly, although is inconsistent with
printing his name at times. Mike can recognize coins and bills
and knows that money is needed to purchase items, but cannot
typically make change or count out right amount to make a
purchase. Mike does not appear to have a solid concept of
measurement at this time. Mike can distinguish between day and
night and his concept of time is based upon the consistency of
his daily schedule. Mike can name the present day of the week
and can differentiate between today and tomorrow. He can state
his own birthday and knows the birthdays of those important to
him. Mike can also state the present year.
D.
Self Care Skills. Mike can eat with all eating utensils i.e.: spoon,
fork, knife although at times requires prompting to do so. He
drinks with ease from a glass and uses a napkin to wipe his
hands and face. Mike can independently dress himself and is
unable at this time to tie his shoelaces. Mike is independent at
toileting himself and washing up after elimination. Mike urinates
frequently at times, with the average being approximately 2x an
hour. Mike is independent with washing with soap and applying
deodorant with respect to his bathing skills and requires
assistance with regulating water temperature. He requires verbal
reminders to wash and comb his hair. Mike can independently
complete all steps in oral hygiene routine. He requires verbal
prompting to blow his nose with a tissue and requires physical
hand over hand assistance to shave using a razor and shaving
crème.
E.
Domestic Skills. Mike is able to do many household chores with
varying degrees of assistance. He empties the garbage, sweeps
the floor and wipes the counters with verbal prompting to begin
task. He rinses his dishes and places them in the sink after
meals. He does not load the dishwasher or wash dishes. With
verbal prompting Mike can make his bed, hang up clothes and
place clothes in drawers. Mike is also capable of vacuuming
floor, dusting and polishing, and cleaning windows with
prompting. With varying degrees of assistance, Mike is capable
of cleaning the bathroom and doing his laundry. Mike participates
in some outdoor maintenance tasks such as watering the lawn
and plants with hose and taking the trash out. He does not mow
the lawn or trim the hedges and shrubs. Mike participates in meal
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© 2002, Institute for Applied Behavior Analysis, All Rights Reserved
prep such as peeling carrots and potatoes and can prepare
simple snacks and meals independently. He requires assistance
with following recipes and using the oven.
F.
Community Skills. In the community skill domain, Mike will use
the telephone to take a social call however he does not ask to
use the phone to place a call nor does he answer the phone
when it rings. He does not know his phone number and requires
someone to dial the phone for him. Mike carries his identification
card and bus pass with him at all times. He takes the bus
independently but has, on occasion, became confused and was
unable to locate the correct bus. There was limited records
pertaining to Mike’s community mobility skills. Mike enjoys
shopping and requires assistance with the shopping process of
picking out items and paying for them. While he can identify bills
and coins and understands that money is needed to purchase
items, he does not posses the skill to count out the correct
amount of money.
G.
Recreation and Leisure Skills. Mike spends his indoor rec. and
leisure time watching TV shows and movies. He enjoys listening
to music and playing his Nintendo 64. He also enjoys
participating with the preparation of meals. Mike enjoys going out
to a show at the movie theatre and has gone to see professional
sporting events at community arenas ex: NHL hockey. He
attends the community center approximately once a week to
access exercises facility and enjoys going shopping.
H.
Social Skills. Mike’s interaction with others, although limited, is
usually friendly, respectful and focuses around his great sense of
humor and ability to make people laugh. He has a positive and
caring relationship with his parents and older sister, Micki. Mike is
well known by local firemen and city workers and he will
exchange greetings with these acquaintances. Mike has 2
friends, Marnie and Jason that join him at his work sites. Mike
has many assets and/or talents in the area of socialization that
include his comedic nature and ability to make people laugh with
his imitations of characters from TV shows. He likes to joke
around and tends to be a “newscaster” of sorts. He does
experience difficulties with initiating and maintaining friendships
due to his lack of conversation and undesirable social skills such
as: inappropriate humor – name calling, and phrases like “I’m
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going to kill you” and also inappropriate sounds – passing gas
and loudness in tone of voice.
II.
Living Arrangement and Family History. Mike lives with his mom and
dad in a nice neighborhood in Ennytown, CA. The house is a two-story
house and Mike has his own room. They have a family pet, a Himalayan
cat that resides with them as well. Mike has lived with his parents his
entire life and has an older sister, Micki that he maintains regular
contact with. Micki is married and has a child and Mike’s mother stated
that Mike enjoyed being an uncle. Mike maintains a very positive, caring
relationship with his parents and sister. At the time of this assessment, a
home visit was scheduled but was canceled by Mrs. Jones. It was not
rescheduled.
III.
Daytime Services Received and Day Service History. Presently, Mike is
attending the SSS – behavioral day management program with the
focus being on job training and community skills. He attends from
Monday – Friday from 0800-1350. He entered this program on
December 6, 1993 and receives a 3:1 staffing ratio. There are 3
participants in his program, himself included. Mike is employed at The
Steamer Bar and Grill and makes $5.25 hr. His mode of transportation
to and from the work site is by city bus. Areas of concern noted at the
day program are off task behavior, dumping of items ex: salt, pepper
and sugar, loud vocalizations and inappropriate name-calling. At
present Mike’s schedule at the day program is as follows
MONDAY: 800-1100 The Steamer Bar and Grill – duties include setting
up chairs, windows, set tables i.e.: silverware, sugar,
menus, wiping chairs and booths. 1200-1330 Community
Training: activity in community
TUESDAY:
800-1100 The Steamer Bar and Grill – duties same as
above 1200-1330 Community
Training:
department
store
WEDNESDAY: 800-1100 The Steamer Bar and Grill – duties same as
above 1200-1330 Community Training: Borders
Bookstore
THURSDAY: 800-1100 The Steamer Bar and Grill – duties same as
above 1200-1330 Bi-weekly – banking 1200-1330 Biweekly – Community Center – workout
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FRIDAY: 800-1000 Community Training: Border Bookstore 1030-1115
Lunch Out 1130-1330Community Training: Movie at theatre
Mike graduated from school in 1988 and attended the Career
Assessment and Placement Center in Whittier. He received vocational
and mobility training and worked at Rockview Dairy. Due to funding
issues, in 1993 Mike was referred to other programs. Since December
of 1993, Mike has been supported by SSS.
III.
Health, Medical and Psychiatric Status. Mike is generally in good
health. He has high blood pressure but monitors his diet as a way of
keeping it under control. He takes no medication at this time and has no
known allergies. Mike’s hearing is within the normal range and he has
mild impairment with his vision. Mike does not appear to have any
physical disabilities although is overweight and this appears to have
bearing on the physical exercise that he is willing to participate in.
Mike’s last medical examination was in 1999 however which month was
unclear. Mike does not appear to have any cardiovascular or respiratory
problems at this time, nor were any genito-urinary or musculo-skeletal
concerns noted.
Although there is no recorded problems with
gastrointestinal, it was noted that Mike eats very quickly at times and
this can cause vomiting after a meal. There have been no recent
hospitalizations with the last one occurring when Mike was a child to
have his tonsils removed. Mike had been on various medications to
control hyperactivity but has not taken medication for behavior control in
over 15 years. Psychological testing indicates congenital
maldevelopment of the brain manifesting in extreme hyperactivity, delay
in speech, mental retardation with possible emotional deficits. Autistic
mannerisms noted were namely self-stimulatory behaviors, difficulties in
pragmatic use of language and the tendency to remain aloof and alone.
It is unknown as to whether Mike is receiving psychiatric services at this
time.
IV.
Previous and Current Treatments. There was no available data on
previous treatments for the target behavior of aggression before May
1999. Currently Mike is on a Differential Reinforcement of Other
Behavior (DRO) for aggression and property defacement with the
objective being 2 or less incidents a work shift. For each shift during
which less than 2 incidents occur, Mike earns a certificate. Certificates
can be exchanged as follows: One certificate for a gum ball, Two
certificates for a $0.25 pop at Ralph’s, Three certificates for a
hamburger. At this time, Mike is successfully meeting the objectives of
the DRO reinforcement schedule. Prior to August 31, 1999, the
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Focused Support Strategy was a DROP schedule and it was not
deemed appropriate after changing the focus of the target behavior
during Mike’s work shifts.
FUNCTIONAL ANALYSIS OF PRESENTING PROBLEMS
A functional analysis was conducted for Physical Aggression. The
behavior of Property Defacement is also a concern however due to time
constraints it was not possible to address this behavior and it is recommended
that it is addressed in the future. Accordingly, this analysis endeavored to
identify the events that control the emission and non-emission of these
clinically important problems. It is therefore organized around six specific
subcategories of analysis: (1) Description of the Problem. This analysis
attempts to describe the presenting problems in such detail that they can be
objectively measured. It presents the topography of the behavior, the cycle
(beginning and ending) of the behavior (if applicable), and the strength of the
behavior (e.g., frequency, rate, duration, intensity). (2) History of the Problem.
This analysis presents the recent and long-term history of the problem. The
purpose here is to better understand Mike's learning history, and the historical
events that might have contributed to the problem(s). (3) Antecedent Analysis.
The antecedent analysis attempts to identify the conditions that control the
problem behaviors. Some of the specific antecedents explored include the
setting, specific persons, times of the day/week/month, and specific events
that may occur regularly in Mike's everyday life. (4) Consequence Analysis.
The consequence analysis attempts to identify the reactions and management
styles that might contribute to and/or ameliorate the presenting problems. It
also focuses on the effects that the behaviors might have on the immediate
social and physical environment, on the possible function(s) served by the
problem behaviors and on the possible events that might serve to maintain or
inhibit their occurrence. (5) Ecological Analysis . The ecological analysis
attempts to identify the critical mismatches that may exist between the
physical, interpersonal and programmatic environments and Mike's needs and
characteristics. (6) Analysis of Meaning. The analysis of meaning is the
culmination and synthesis of the above analyses and attempts to identify the
functions served by the problem behaviors. The functional analysis of
Aggression, organized around these headings, follows.
A.
Description of Behavior and Operational Definition.
1.
Topography. The hitting or attempted hitting of others with an
object ex.: broom, and the “snapping” of cloths at others bodies
with in a 3-foot radius.
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B.
2.
Cycle. The cycle of the behavior starts with the swinging of the
object and the snapping of a cloth at another person’s body with
the intent to hit and the cycle stops when there has been a period
of two minutes without an occurrence of the above behaviors.
3.
Course. The course of the above behaviors begins gradually
with precursor behaviors noted. The precursor behaviors noted
are rapid physical movement, walking away from peers,
verbalizing that he is upset and loud, inappropriate name-calling
and property defacement. Property defacement includes throwing
rocks at vehicles, pulling at flowers or plants, pulling the cord on
the bus and kicking dirt. There may be one cycle of precursor
behaviors or there may be several cycles of precursor behaviors
with a period of calm in between. Mike then engages in one or
more of the target behaviors and is remorseful after, vocalizing to
self “ Why did I do that” “ I shouldn’t of done that”.
4.
Strength.
a.
Rate. The rate of behavior occurs approximately 2 or less
times a year.
b.
Duration. The duration of the episode in which the target
behavior is occurring is short and fast, lasting
approximately 5 sec. The precursor behavior period can
go on for long periods of time, up to several hours.
c.
Severity. The severity of the target behaviors is that the
object comes in contact with the body and leaves a red
mark or bruise lasting longer than 5 seconds. For Mike the
severity of the target behavior is that he has internal
feelings of remorse and is regretful for actions. At this time
the external or physical damage is minimal as there has
been no physical injuries incurred from the target behavior.
The internal injuries experienced by the recipient of the
target behavior are emotional trauma and are believed to
be severe.
History of the Problem. The first appearance of the target behavior is
believed to have occurred in 1994, and the first reported incident found
was in June 1998. There have been only a few incidents of the target
behavior. The target behavior has been under the control of a daily
DRO schedule until the recent Job Coach gave her notice for
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termination of employment and an increase in precursor behaviors have
been noted.
C.
Antecedent Analysis. In an antecedent analysis, one tries to identify the
events, situations and circumstances that set the occasion for a higher
likelihood of the behavior and those that set the occasion for a lower
likelihood. Further, in both categories, one tries to identify both the
more distant setting events and the more immediate triggers that
influence the likelihood of the behavior. Below is firstly an analysis of
those setting events and triggers, i.e., those antecedents, that increase
the likelihood of Physical Aggression and their escalation and secondly
an analysis of those that decrease the likelihood. Detailed examples
substantiating each of these, based on actual incidents, are also
included.
The setting events that may occur before the behavior that might impact
Mike’s daily behavior are events that Mike finds upsetting that are
happening on the news ex: plane crashes, the death of JFK Jr. and
motor vehicle accidents. A sudden change in his daily schedule for ex:
the city bus being late to pick him up and take him to work and the
moods of his peers at the work site are also setting events for Mike. His
perception that his peers are upset with him or if his peers, in Mike’s
mind, are not doing their share of or a good enough job at the work site
also effect his daily behavior. Non-occurring setting events that affect
Mike’s behavior are that one of his peers is absent from the work site or
did not greet him in the morning when they arrived at work. The target
behavior is more likely to occur at the work site, as there have been no
incidents at home of the target behavior. The target behavior is more
likely to occur when Marnie, his peer at the job site is present as she
appears to be targeted during the behavior episode. The target behavior
is more likely to occur during the morning hours 0800-1130, between
Tues.- Thurs as this is when Mike is at his work site with Marnie.
Activities or events that are more likely to increase the likelihood of the
target behavior occurring include a news cast that Mike finds upsetting,
his peers moods and behaviors at the work site and witnessing an
accident on the way to work. Activities or events that are more likely to
decrease the likelihood of the target behavior are positive interaction
and communication with Marnie.
D.
Consequence Analysis.
When the target behavior occurs, staff
removes the object from Mike and asks him to “Stop”. They redirect him
away from the area and outside to calm down. They use the phrases
“Why are you mad”; “Who are you mad at” “ Are you mad at Marnie,
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Jason, staff”. The staff try to encourage Mike to calm down and to open
up and discuss what is upsetting him. On one occasion when the target
behavior occurred, staff needed to call in a second staff to talk with Mike
as she was upset with the nature of the incident. Staff notifies Mike’s
parents of any incidents of the target behavior and his parents will talk
with him about staying in control. Marnie, who is Mike’s friend and is
also targeted when the aggressive behavior is occurring, becomes
upset emotionally when the behavior occurs and thus Mike feels very
remorseful and bad for engaging in the target behavior. The target
behavior may be maintained by the lack of communication and self
control skills that Mike has.
E.
Ecological Analysis.
There are a number of ways in which
understanding the ecology surrounding and how it may conflict with
Mike's needs and characteristics, may be helpful in understanding the
meaning of his behavior and in understanding the ecological changes
that may be necessary to provide the necessary support for him. The
brief discussion addressing this ecological analysis is organized below
around the physical environment, the interpersonal environment and the
programmatic environment.
When Mike is at the work site, which is where the target behavior occurs
most often, he is easily distracted by settings and activities that are
going on around him. While working at The Steamer Bar and Grill, there
are several TV’s that are on throughout the establishment and I noted
that Mike was easily distracted by the TV’s and would frequently stop
working and watch. I also noted that when he was engaging in a job
duty that was near a window he would often become distracted by the
traffic and would stop working.
At this job site Mike is joined by two of his peers and at times is
distracted by their activities and what they are doing. As Mike’s mood is
directly affected by their moods, I noted that Mike, at times, would cease
working to seek them out. The Steamer Bar and Grill is closed while
Mike and his peers are working there as it is in the morning. Mike does
have an opportunity to interact with the manager and other employees
as others are in the environment doing their daily prep work.
Mike’s routine at the job site consists of work, break, work, and break
which aides him in completing the various tasks that he has at this site. I
did observe that Mike would try to move on to the next task before the
current task at hand was completed.
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F.
Impressions and Analysis of Meaning. In considering this functional
analysis and the background information summarized above, there are
a number of factors that are helpful in trying to understand the meaning
of Mike's behavior. It is my impression that Mike engages in the target
behaviors as a way to communicate his feelings of anger and
frustration. This is evident by the precursor behavior “name calling” that
he does when he becomes upset and when the precursor behavior is
not addressed he continues to try and express that anger and
frustration. Mike is very sensitive in regards to others perception of him
and of others behavior that are occurring around him. He becomes
upset and frustrated when he perceives his peers may be mad at him
and the target behavior is directed towards his friend Marnie. While
Marnie is targeted with the aggressive behaviors, she is also the one
who is able to calm him down when he becomes upset and frustrated.
Another function of the target behavior is that he is unable to maintain selfcontrol. After Mike becomes upset and engages in the target behavior, he is
remorseful and talks to himself stating “Why did I do that” and “I shouldn’t have
done that”. He is unable to maintain self-control over his feelings and the target
behavior is, I feel, is a way of expressing that inability to self regulate.
MOTIVATIONAL ANALYSIS
A motivational analysis was carried out to identify those events,
opportunities and activities that Mike enjoys and that may be used to enhance
his quality of life and provide him with incentives to improve his behavior and to
enhance his academic progress. The results of the analysis showed a number
of events that could be used effectively as positive reinforcement in a well
designed support plan to reduce the identified behavior problems. These
events include, but are not limited to wrestling, baseball, miniature golf, and
football. Other potential reinforcers include fire station, police stations, planes
and watching TV and movies. Mike’s favorite foods are burgers, fries, hot
dogs, cake, popcorn and tacos. He also enjoys shopping. These reinforcers,
and others, should be used in a variety of ways, the least of which would be
through the contingencies of formal reinforcement schedules.
MEDIATOR ANALYSIS
A "Mediator Analysis" was conducted for the purposes of identifying
those persons who might be responsible for providing behavioral support for
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Mike, their abilities to carry out the recommended support plan, given the
demands on time, energy, and the constraints imposed by the specific
settings, and motivation and interest in implementing behavioral services as
recommended. This analysis showed the following:
Mike’s parents and SSS staff are those who will be responsible for
carrying out the recommended support plan. While I was unable to assess the
level of motivation or cooperation directly with Mike’s parents, staff advised me
that his parents are very involved with Mike and his program and that SSS staff
have received high levels of cooperation and motivation from them before. The
support staff at SSS has positive interactions with Mike and I feel that this
interaction could promote an atmosphere and conditions under which a
recommended support plan could be implemented. Factors addressed that
may constrain staff’s ability to carry out the recommended support plan are
lack of training in area of the recommended support strategies. It is my
observation that the staff at SSS are motivated to carry out a recommended
support plan.
RECOMMENDED SUPPORT PLAN
A.
Long-Range Goal. The long-range goal for Mike is to establish enough
self control over his behavior that he will be able to live and work in the
least restrictive setting possible that is capable of meeting his
developmental and behavioral needs. The goal of his educational plan
is to provide him with the academic and other skills necessary to meet
his needs, while eliminating those behaviors that tend to stigmatize and
isolate him from full community and social presence and participation.
Additionally, the goal is to transfer the control of Mike's behavior from
external mediators (parents and staff) to internally generated controls.
The plans and objectives presented in the following paragraphs are
intended to increase the likelihood that the following specific outcomes
will occur: Mike would like to move out of his parents and into his own
apartment with people he is familiar with. Mike would also like to
continue to maintain employment in the
field of his interest.
B.
Operational Definition(s).
Physical Aggression.
1.
Topography. – The hitting or attempted hitting of others
with an object ex. Broom, and the snapping of cloths at
others bodies within a 3-foot radius.
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2.
C.
D.
Cycle. The cycle of the behavior starts with the swinging
of the object and the snapping of a cloth at another
person’s body with the intent to hit and the cycle stops
when there has been a period of two minutes without an
occurrence of the above behaviors.
Short Term Measurable Objectives. The following objectives and plans
are suggested on the assumption that Mike has the opportunity to
continue to attend the SSS behavioral day management program. It is
unlikely that they would be realistic if he did not have these
opportunities. These objectives were also selected as being most
reflective of Mike's priority needs and as being the most realistic given
his level of functioning at this time. Further objectives may be
established as a function of the success or failure of the recommended
strategies.
1.
By November 1, Mike will reduce the incidents of Physical
Aggression from baseline rate of 1 or less a month to 0 incidents
a month.
2.
By August 1 next year Mike will have maintained a rate for
Physical Aggression at 0.
Observation and Data Collection Procedures.
1.
Methods.
Behavior – Physical Aggression the SSS job coach will
observe Mike for each hour of the program day. Each
incident of the target behavior as defined in topography
shall be recorded on an A.B.C form (See A.B.C. Form)
indicating the following:
1.) Date of incident
2.) Start and stop time of incident (Duration)
3.) Setting and activity at time of incident
4.) Immediately preceding antecedent events
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5.) Description of actual behavioral topography
6.) Description of consequences or actions taken by staff
The following information should be summarized on an
“Individual Data Summary “ form (See Individual Data Summary
Form).
2.
Observational Reliability.
Behavior – Physical Aggression
Once a week, at weekly contact meeting, the SSS
manager will do a Records Check to make sure that all
occurring incidents have been recorded on all required
forms i.e.: A.B.C. form, Daily Progress Notes, and if
applicable Incident Report. If Observational reliability is
less than 100% then action should be taken to review the
Plan and method of data collection.
E.
Intervention Procedures. In the following paragraphs, a summary of
possible strategies to support Mike is presented. These are by no
means meant to be comprehensive or exclusive of other procedures.
They simply represent a set of starting points that would be elaborated
and modified as services are provided. Support is organized around
four primary themes: Ecological Strategies, Positive Programming
Strategies, Focused Support Strategies, and Reactive Strategies.
1.
Ecological Strategies. Many behavior problems are a reflection
of conflicts between the individual needs of a person and the
environmental or interpersonal context, in which the person must
live, go to work or otherwise behave. As part of the above
evaluation, several possible contextual (ecological) conflicts were
identified. It is possible, that by altering these contextual
conflicts, that Mike's behavior may change and his progress may
improve, thus eliminating the need for consequential strategies.
In the following paragraphs, a number of "Ecological
Manipulations" are presented with the intention of providing a
better mesh between Mike's needs and the environments in
which he must behave:
a) To reduce the number of distractions at the work site by
turning the televisions off in the work site so that Mike can
focus on the task at hand. As Mike can become distracted by
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the TV’s being on, and was observed engaging in off task
behavior to watch the TV, it would be a better fit between Mike
and the work site if that distraction were eliminated.
b) Mike should also increase his level of exercise to aid him in
relaxation. Exercising tends to result in greater reduction or
displacement of anxiety. I feel that if Mike increased his
exercise level it would assist him in increasing his feeling of
well being and will, in hopes, decrease his feelings of anxiety
and frustration.
c) Implementing a scheduled interaction time each morning with
his peers will benefit Mike in that it will start the day of with
positive interaction and promote a positive work environment.
As Mike’s mood and behavior is directly affected by the
moods and behaviors of others, establishing a positive
interaction time to check in establish that no one is angry with
each other would benefit Mike.
2.
Positive Programming. Challenging behavior frequently occurs in
settings that lack the opportunities for and instruction in adaptive,
age-appropriate behavior. It is our assertion that environments
that provide instruction to promote the development of functional
academic, domestic, vocational, recreational, and general
community skills is procedurally important in our efforts to
support people who have challenging behavior. To the extent
that Mike exhibits a rich repertoire of appropriate behaviors that
are incompatible with undesired behavior, the latter should be
less likely to occur. Positive programming, therefore, should not
only result in developing Mike's functional skills, but also
contribute to reducing the occurrence of problematic behavior. At
the very least, a context of positive programming should make it
feasible too effectively and directly address Mike's physical
aggression. In the following paragraphs, several initial thrusts for
positive programming are presented:
a.
General Skills.
1)
Rationale/Logic. – Making independent purchase of
choice. I feel that Mike would enjoy going to the
store and purchasing items that he enjoys ex. CD
or movie with his money that he has earned. I feel
that this would give Mike a feeling of
independence, choice and control over his life.
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2)
Objective. – By Feb. 1 next year the objective is for
Mike to independently, without staff assistance and
upon being given a $20.00, go into a store, choose
the item of his choice, take the item to the till, and
complete purchasing transaction of paying for and
waiting for change, and leaving store.
3)
Method. – To teach Mike this skill, whole task
presentation should be used.
a) Take Mike to the store of his choice
b) Assist Mike in picking out the item of his choice
c) Assist Mike in paying for the item
d) Leave the store
e) Praise Mike for a job well done
f) Fade staff out as Mike’s independence and
confidence in the steps of the skill increase
b.
Teaching Functionally Equivalent Skills. People engage in
seriously challenging behaviors for perfectly legitimate
reasons. They use these behaviors to communicate
important messages, to assert themselves, to manage
unpleasant emotions, to escape unpleasant events, and to
gain access to events and activities. One important
strategy for helping people overcome their challenging
behaviors is to provide them with alternative ways of
achieving the same objectives, alternative ways of
satisfying their needs. These alternatives are defined as
functionally equivalent skills because they achieve the
same goal as the challenging behavior or communicate
the same message.
The above analysis of Mike's
behavior concluded, among other things, that Mike needs
another way to express his feelings.
1)
Rationale / Logic . – Derived from the Functional
Analysis of the target behavior, it is felt that the
function of Mike’s behavior is a means of
communicating his feelings. I feel that a program to
assist Mike in finding more appropriate ways of
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expressing his feelings will empower Mike in feeling
more in control of his feelings and social
environment.
2)
Objective. By Nov. 1, , Mike will be able to, without
staff prompting, initiate and express his feelings
using the statement: “I am feeling (angry, happy
etc.). I am (angry, happy etc.) because…..”
3)
Method. – Implement a social story describing how
to appropriately express our feelings.
a)
Create social script detailing how to express
our feelings.
b)
Staff is to sit with Mike and role-play the
social script, aiding him in understanding and
using the social script.
c)
To be done 2x a week for 10-15min a
session. Staff should also take advantage of
any incidental opportunity to engage in this
script.
Carol Gray has written books on “Social
Stories” that may be of some use. 1-800489-0727
c.
Teaching Functionally Related Skills. There are many
skills that if learned by the person, may have a direct
impact on the person's behavior. For example, a person
who is taught the difference between demeaning criticism
and well-intended feedback may start acting differently to
the feedback he receives from others. The purpose of this
category of strategies, again, is to empower the person; to
give the person greater skills. In the following paragraphs,
skills are identified which are thought to be related to
Mike's aggression.
Identifying Feelings
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d.
1)
Rationale / Logic. – In order for Mike to express his
feelings, he needs to be able to identify them
correctly. If Mike were able to correctly identify his
feelings, it would make expressing his feelings
easier thus reducing his level of anxiety and
frustration around communicating his feelings.
2)
Objective. By Nov. 1, , Mike will be able to, without
staff assistance, identify the 3 feelings of anger,
frustrated and sad, 3 out of 3 trials. After this
objective has been met, the 3 additional feelings of
happy, confused and embarrassed can be
implemented to increase Mike’s repertoire of
feelings.
3)
Method – To use a card system, with 3x5 flash
cards.
a) Have the word of each objective feeling on
separate flash cards.
b) Have the definition and picture of each
objective feeling on flash cards.
c) Have Mike pair the picture/definition cards with
the word feeling cards.
d) Complete this trial at least 3x a week for 10-15
min a session.
Teaching Coping and Tolerance Skills. Many of Mike's
seriously challenging behaviors are a reflection of his
inability to cope with aversive events such as delay in
gratification, denial, the need to perform a non preferred
activity, etc. While some of these behaviors can be
avoided by positive programming, aversive events are also
naturally occurring. Especially if he is to lead a full life,
from time to time, he will face the disappointments we all
have to face, for example, not getting something that he
wants, when he wants it and having to wait for it, i.e.,
delay; not getting something he wants, at all, i.e., denial;
being told by somebody that a relationship is not possible;
being criticized or reprimanded; etc. In the face of these
events and the emotions they understandably arouse,
Mike's coping responses have not had the opportunity to
develop much beyond the primitive responses of a young
child; nor is he likely to develop much beyond this level
through "natural consequences."
Rather, it will be
necessary to be systematic in applying sophisticated
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instructional technology, with the objective of teaching him
these very important coping and tolerance skills. The
following is a recommendation for how to proceed in this
important area of skill development, with the initial focus
being on Mike's establish boundaries.
1)
Rationale / Logic. – As Mike’s mood and behavior is
directly affected by the behaviors and moods of
those around him and by those events that are
happening in the news that he perceives as
distressing, helping him establish and understand
boundaries between his feelings and others
feelings would be beneficial. I feel that this would
be beneficial in that it would assist Mike in
decreasing his feelings of responsibility and anxiety.
2)
Objective. – By Nov 1, , Mike will be able to, with
confidence and independence identify the
boundaries between his feelings and those of
others.
3)
Method – Use a comic strip conversation script to
help Mike establish boundaries between his
feelings and those of others.
a)
Explain to Mike about the comic strip
b)
Show him the feeling comic strip
c)
Identify the people and the feeling circles
d)
Visually show Mike how his feeling and those
of others over lap but do not control or
consume.
e)
Praise Mike for a job well done
Carol Gray has written articles in the Morning
News on Comic strip conversations that will
be informative. 1-800-489-0727.
3.
Focused Support Strategies. Some of the ecological strategies
that were recommended above, depending on their complexity
and/or difficulty, may take time to arrange, and positive
programming will require some time before new skills and
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competencies are mastered. Although these ecological and
positive programming strategies are necessary to produce good
long-term quality of life outcomes for Mike, it is also necessary to
include focused strategies for more rapid effects; hence the
inclusion of these strategies in our support plans. Specific
recommendations for the limited but important need for rapid
effects are made below.
ANTECEDENT CONTROL:
Implement an “interaction time” at the beginning of each day
between Mike and his peers at the work site. This interaction time
will allow Mike and his peers to exchange positive interaction and
create a positive work environment in hopes of increasing Mike’s
social skills and decreasing his feelings of anxiety and sense of
responsibility of others moods.
The “interaction time” will be facilitated by the SSS job coach and
will maintain a positive tone. All topics of conversation MUST be
positive and interactive between all 3 peers. Some examples of
positive conversation are:
- how nice the weather is
- pay a compliment on what the other is wearing
- pay a compliment on the great work the other did
yesterday at the job site.
- Talk about a desired activity that all 3 individuals will be
participating in
- Talk about that days activities
At present, Mike is on a daily DRO schedule for the target
behavior, which is at this time, meeting the objective of the
reinforcement schedule. I suggest that Mike continue on this
schedule as long as it proves effective in maintaining the
objective of 2 or less occurrences of the target behavior a day.
I would also suggest that a time based, non-contingent
reinforcement schedule be implemented where once an hour,
every hour Mike receives verbal praise for being at the work site.
This may assist Mike with increasing his self-esteem and
promotes a positive work environment.
4.
Reactive Strategies. Efforts to manage the antecedents to
Mike's physical aggression are likely to have a considerable
impact on the rate of their occurrence, as will a daily DRO
schedule. However, these behaviors are still likely to occur, at
least to some degree, especially during the initial stages of the
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implementation of this support plan, as the necessary
adjustments to the plan are identified and made. Therefore, staff
may need measures for dealing with these behaviors when they
occur. Such reactive strategies have an even more limited role
than the focused strategies recommended above. Specifically,
reactive strategies are designed to produce the most rapid
control over the situation, in a manner that keeps both Mike and
staff as free from risks to injury as possible and that keep Mike
free from risks of exclusion and devaluation as much as possible.
Accordingly, reactive strategies are not intended to produce any
change in the future occurrence of Mike's challenging behavior.
Both rapid and durable changes, instead, are being sought by the
Ecological Strategies, Positive Programming Strategies, and
Focused Support Strategies described in the preceding sections.
These proactive strategies are also expected to prevent any
counter therapeutic effects that might accrue from the
nonaversive reactive strategies being recommended here. The
following procedures are suggested as initial strategies that fit
within SSS's "Emergency Management Guidelines." They, along
with other strategies that fall within the guidelines, which may be
considered in the future, are expected to preclude the need for
the physical management of Mike's behavior, including the need
for physical restraint.
a.) At the first sign of the topography, staff should provide
undivided attention to Mike and proceed to implement
the current reactive management plan that is in place
for the above target behavior which is as follows:
b.) If Mike becomes hurtful or engages in the topography
of aggression toward another person, ask him to
please stop and encourage the other person to move
out of his way. Use active listening to reflect his
feelings until he is somewhat calmer. Once he is calm,
help him develop a solution to his problem. Remind
him that you are there to help him be successful at his
job.
c.) In addition to the above strategy, redirect Mike to his
identifying and expressing feelings program.
Encourage him to express his feelings and praise him
for any attempts at the appropriate expression of such
feelings.
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5.
Staff Development and Management Systems. Key elements
that will determine the degree of success of this support plan are
staff competence and management systems that assures staff
consistency in providing services to Mike. The following is
recommended:
a.
Procedural Protocols.
Each strategy and procedure
described above should be broken down into teachable
steps.
b.
Three tiered Training.
c.
1)
Each staff person would be required to show
"verbal competence" for each procedure. That is,
they would need to describe each and every step in
the specific procedure. Each staff would be scored
using a "+/O" system for each step of the
procedure. A 90% criterion is considered passing.
2)
Each person would be required to show "role play
competence" for each procedure. That is, they
would need to demonstrate each step of a
procedure to another member of Mike's support
team. The scoring system would be the same as
for "verbal competence," as described above.
3)
Finally, each staff person would need to
demonstrate "in-vivo" procedural reliability; that is,
the ability to carry out each program component of
Mike's support plan for which they are responsible.
This would require the designated person to
observe each staff person as they provide services
and to see the degree to which what they do agrees
with the written protocols. The scoring procedure
described above would be used again, and 90%
consistency should be considered as minimally
acceptable. For those procedures that do not occur
frequently, such as the need to react to infrequent
behavior, role-play competence should be
reconfirmed on a regular schedule.
Periodic Service Review. Mike's entire support plan
should be operationalized into a series of performance
standards to be met by the support team and integrated
into a Periodic Service Review. Monthly (initially, weekly)
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monitoring should be carried out by the designated
coordinator and the status of the support plan's
implementation should be quantified as a percentage
score. This score should be summarized on a graph and
kept visible to staff as an incentive to achieve and
maintain a score of 85% or better. This should be
reviewed regularly by management and feedback should
be provided. More information on how to develop and
implement a Periodic Service Review system can be
provided on request.
COMMENTS AND RECOMMENDATIONS
1.
Revisions are certain to be necessary during the initial stages of
implementation and as Mike's responsiveness to this new support plan
are observed. Early revisions and fine tuning are necessary in the initial
implementation of any support plan, especially one as comprehensive
as this one attempts to be.
2.
It is recommended that Mike remain in SSS program and continue to
work at current job placement, The Steamer Bar and Grill in Ennytown
with a 3:1 ratio. Mike appears to have to have adjusted well to this job
placement and appears to enjoy being there.
3.
It is recommended that Mike participate in an expressing feelings
program to assist Mike in becoming more confident and fluent in
expressing his feelings and emotions in a calm and appropriate manner.
4.
It is recommended that Mike participate in an identifying feelings and
emotions program to assist Mike in being able to identify his feelings
and to feel more in control of his feelings
5.
It is recommended that the positive programming strategies presented
above be provided at least 1.0 hours a week at the SSS program. Given
the nature of Mike’s behavior difficulties, it is felt that this level of service
delivery will be needed to improve Mike’s social and self-control skills.
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_______________________________________
Writer
_______________________________________
Clinical Director
_______________________________________
Associate Director
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SSS
IDENTIFYING FEELINGS PROTOCOL
MIKE JONES
Initial Implementation Date: August 3,
Dates Revised:
1.
Step by Step Method:
a) Create three 3x5 flash cards with the words “angry, frustrated, sad”,
with one of these feelings on each card.
b) Create three 3x5 flash cards with a face picture depicting the above
3 feelings and accompanying definitions on separate cards. That is,
on a 3x5 card is a picture of what the feeling looks likes and the
definition of that one feeling.
c) Choose a quiet area with little to no environmental distractions ex:
no TV’s on or in view of open windows/blinds and obtain Mike’s
attention.
d) Present the 3x5 flash cards that have the faces of and definitions of
the feelings on them to Mike. Discuss with Mike the 3 pictures and
definitions of each feeling.
e) Ask Mike to show you each feeling face. Use the verbatim “ Show
me the angry face” “Show me the sad face” “Show me the frustrated
face”.
f) Allow Mike the opportunity to chose on his own. Give him 10-15
seconds then move the right feeling card closer to him and ask him
again to “ Show me the anger card”.
g) Praise Mike for a job well done.
h) Show Mike the 3 feeling cards with the word of each feeling on them.
i) Explain the definitions for each feeling. Use verbatim “ Anger is
when you feel ….” Give examples that pertain to Mike.
j) Ask Mike to show you the different feeling word cards. Use verbatim
“ Show me the angry card” “Show me the frustrated card” “Show me
the sad card”.
k) Allow Mike the opportunity to chose on his own. Give him 10-15
seconds then move the right feeling word card closer to him and ask
him again to “ Show me the sad card”.
l) Praise Mike for a job well done.
m) Place one face feeling cards in front of Mike and the 3 word feeling
cards directly above the face card. Ask Mike to place the face feeling
card on top of the matching word card.
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n) Allow Mike the opportunity to match on his own. Give him 10-15
seconds the move the correct word card closer to the face card and
ask him again to place the face card on the correct word card.
o) Praise Mike for a job well done. Keep the session positive, upbeat
and fun!
p) Complete one full trial 3x a week for approximately 15 minutes each
session.
2.
Once a month, a management staff from SSS will go out and observe
the Job Coach carrying out this trial and will document on a Procedural
Reliability form whether or not it is being carried out according to the
protocol.
3.
If the Procedural Reliability is less than 85% then action should be taken
to review the protocol and the method of deliver.
4.
Bi – weekly observations by the management staff from SSS will occur
until the Procedural Reliability of 85 % or greater has been reached.
5.
Each trial will be recorded on an “Identifying Feeling Chart” and at the
end of each week, all information from that week’s chart will be
summarized on an Individual summary chart.
6.
Once a week, during weekly contact meeting, the SSS manager will
review the records of the “Identifying Feeling Chart” and the Individual
summary chart
7.
Once a month, a management staff from SSS will go out and observe
the Job Coach carrying out this trial and will document on an “Identifying
Feeling Chart” what is observed.
8.
If the Observational Reliability is less that 85% then action should be
taken to review the protocol and scoring criteria.
9.
Bi weekly observations by the management staff at SSS will occur until
the Observational Reliability of 85% or greater has been reached.
10.
A Pass criteria is scored when Mike can identify and match 3 out of 3
feeling cards for 3 consecutive trials/sessions. Once the Pass criteria
has been meet, the next step is to add more “feelings” one at a time.
11.
A Fail criteria is when the Pass criteria has not been met within 3
months. If a Fail criteria has been met, then review method and
decrease the number of feeling cards in the trial to two.
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12.
Variations to these protocol requirements should either be because of
non- applicability or explained and documented on the appropriate PSR
Variations Form.
Protocol prepared by:
Approved by:
Signature
Signature:
Date
Date:
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MIKE JONES
IDENTIFYING FEELINGS CHART
SCORING CRITERIA –
Score a ‘+’ for independently, with no prompting or staff assistance
Score a ‘0’ for required prompting from staff
DATE;
IDENTIFIED
FACE CARD
FEELING
WORD CARD
MATCHED