Positive Behavioral Support for
Employment Specialists
(PBSES)
Bret Vaks, MBA
Executive Director
Autism Family Services of New Jersey
732-337-4071
bvaks@autismfamilyservicesnj.org
Introductions
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Name
Role
Employer
City-State
PBSES
• The Main Reason People
with Disabilities and
People with Severe
Mental Illness (SMI) Lose
their Job
PBSES
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Key Points
– We do not use FBA
– We do not Bring the Behaviorist or Clinician on the Job
– We do not Implement “Formal” Behavior Plans
– We do not Pass Judgment on Behavior-Instead we Attempt to
Understand Behavior
– We Rely on Instructional Interventions and Coping Skills
– Challenging Behaviors may happen because Individuals cannot
Communicate-Therefore we Rely on Technology and Augmentative
Communication when Appropriate
Five Step Process-Investigating the Behavior
1. Is there a Known Setting Event
2. What is the Antecedent
3. What is the Behavior
4. What is the Function of the Behavior
5. Save the Job
PBSES
– People with
Intellectual/Developmental
Disabilities
– People with Autism Spectrum
Disorders
– People with SMI
– Individuals with Criminal
Background
– Persons who are Forensically
Involved
PBSES Instructional Interventions
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Teach Communication Skills
Teach Soft Skills
Teach the Person how to
Transition from one Job Task to
the next
Teach/Create Structure-Routine
Encourage Co-workers to
Create Mentoring Relationships
and Teach them what the
Individual may be
Communicating by
Understanding Certain Precursors to Potential Behaviors
PBSES Coping Skills
• Teach People to
Cope with
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Anger
Stress
Boredom
Change
Disappointment
Fear/Anxiety
PBSES Coping Skills
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Improves self-confidence and self-esteem
Decreases Instruction and Correction Time
Improves independence and Empowerment
Helps individuals to be more Assertive
Decreases the time it takes to Deal with
Crises and Conflicts
• Improves Behaviors
• Improves Problem Solving
PBSES Coping Skills
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Teach the Person to Self Monitor
their Emotions by Developing Self
Awareness
Teach Individual to Identify and
Label Feelings
Use Visual Tools-Apps on the
IPOD-IPAD
Assistive Technology
The Investigation of a Behavior
What is the Function of Behavior
• Sensory
– or Historic/Institutionalized
Behavior
– Satisfies a Need or Impulse with
Internal Triggers, and Internal
Rewards
• Escapes or Avoid Demands
• Gains Attention
• Gets Something
– Obtains Tangible Items or
Opportunities to something the
person Prefers
What is the Function of Behavior
Lack of Social Skills
– Misunderstanding of
Social Cues
– Awkward
Circumstances that
Resemble Behaviors
with Equally Negative
Outcomes
• Inadvertent Sexual
Harassment
Social Skills
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Understanding
Workplace Culture
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Workplace
Gossip…What is real and
when do you Laugh and
Walk Away?
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Office Kitchen Rules etc.
– Can the Individual
Engage and Initiate
Conversation
What is the Function of Behavior
Has Something Changed
– Is there a Medical Issue?
• Does the person need new glasses?
• Hearing Aid?
• Med Changes?
• Dental Problems?
– Is there a new Supervisor or Co-worker?
– If the Person has SMI-what is happening with Treatment?
– Is there an Environmental Factor such as Noise, Poor Lighting or
Distractions that are causing the Individual Problems.
– Is there a New Work Task?
• Did the person Forget what to do or is the Behavior
Occurring During a Secondary Task?
• Did he or she Actually Learn the Task in the First place
The Investigation of a Behavior
1. Is there a Known Setting Event
Examples: history of task avoidance problems, boredom,
illness, stress, exhaustion, mental illness, disability-autism,
lack of sleep etc.
The Investigation of a Behavior
2. What is the
Antecedent
Examples: requests, told “no,”
rude comment, target for
teasing
The Investigation of a Behavior
3. The Behavior
• This is the Phone Call!
The Investigation of a Behavior
4. What is the Function of the Behavior
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Sensory
Lack of Social Skills
Has Something Changed
Escapes or Avoids Demands
Gains Attention
Gets Something
The Investigation of a Behavior
5. Save the Job
– Develop Instructional
Interventions/Coping
Skills to Address the
Behavior
Example of a Diagram Summary Statement of Problem Behavior
Something
gets me ready
to have a
problem…
sets me up…
Something then
sets me off…
Setting
Event
Antecedent
Learning or
doing new tasks
Susie’s
supervisor
asked her to
take out the
new trash can
in the kitchen
area of the
cafeteria to the
outside
dumpster
So I…
Problem
Behavior
Susie screams
obscenities at
her supervisor in
front of her coworkers and
customers and
runs out of the
cafeteria
And I…
Get/Avoid/Delay
What is the
Function?
Function
Susie gets out
of taking the
new trash can
to the
dumpster
Has Something Changed?
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Yes
– You have Trained Susie on how to Empty the Trash Cans in the Dining Room
which are out in the Open
– Not on how to empty the Trash Cans in the Kitchen that are tucked away in
Strategic Locations
• One is under the Serving area where the wait staff Pick up their meals, and
the other is under the Rack Attached to the Commercial Dish Washer
Susie has Never Emptied these Cans Before
– It may be a bit Challenging-It is somewhat Different as there is at least one
Additional Step
We know Susie has a Potential Setting Event of Learning New Tasks!
Supporting Adults with SMI
What Is SMI?
• A Medical Condition that
Disrupt a person’s
Thinking, feeling, Mood,
or Ability to Relate to
others, and Creates
Patterns that Interfere
with Daily Living and
Working
– Need a Job Coach!
What Is Mental Illness?
• Stigma
the Shadow Job Coach
The Shadow Job Coach
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The Role of the Job Coach
Changes from Teacher to the
Person’s Daily Support System
Helping them Get Through their
Day Especially During a Phase of
the Illness when Symptoms
Reappear
Job Coaching without ever
Stepping into the Person’s Place
of Work
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By Phone
By Texting
By Email
By Meeting before the Work Day Starts
and at the end of the day to Debrief
Reviewing Coping/Support Strategies
• Journaling
 Often Recommended as part of Counseling
 Helps put Experiences in Perspective
 For those who can’t Write, use other forms of Communication:
Photos or Icons
• Relaxation
 A need everyone, many people have trouble relaxing, SMI or
not
 Strategies that work:
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Breathing, Meditation and Visualization
Exercise
Long walks with breathing and/or meditation during walking time
Listening to music
Integration with Mental Health Treatment
 The Employment Specialist or Provider Agency
Coordinates Plans with an Entire Treatment Team and
Meets Regularly or as Treatment and Severity of
Symptoms Fluctuate
 Members of the Team may Include
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The Individuals Case Manager/VR Counselor
A Psychiatric RN
A Clinician or Staff Psychologist
A Psychiatrist
A Neurologist
Supporting Adults with Severe Mental Illness
• Coordinate the
Individual’s Care
– For Example, an Individual on the
Job begins to Exhibit Paranoia, the
Employment Specialists brings this
to the Team for possible Solutions
and Coordination
– In Turn, if a Psychiatrist Adjusts
medications, this is relayed to the
other members of the Team
including the Employment
Specialist
The Experts…Evidenced Based
• National Resource
 Individual Placement and
Support Model (IPS)
Dartmouth IPS Supported
Employment Center
- Dr. Gary Bond
- Deborah Becker, M.Ed.
www.dartmouth.edu/~ips
Criminal Backgrounds
Criminal Backgrounds
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Petty Offense
– Infractions that Typically don’t
Warrant Jail Time
– A person who commits a petty
offense will usually get a Ticket or
Citation
– Typically some of these can be
Expunged
Misdemeanor
– Is the lesser of Crimes and is
Punishable in a county jail of one
year or less
Felony
– Is Punishable by Over a year in
State or Federal Prison
Convicted Felons
• A Convicted Felon is someone who has committed a serious
criminal offense such as:
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Assault in the first degree
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Assault that causes serious bodily injury
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All degrees of murder, rape or sexual abuse in the first degree
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Grand theft
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Kidnapping
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Embezzlement of large amounts of money serious drug crimes, and
racketeering
Facts about Felons
• Felons cannot:
– Practice certain
Professions such as
Teaching
– Own Guns
– Hide their Criminal
Record when Applying
for a Job
Forensic Supports
• Follow Specialized Psyche Eval or
Behavioral Risk Assessment with
Forensic Protocols
• Typically done by a Forensic
Psychologist
• The Individual’s Probation/Parole
Office, DD/DMH Case Manager, or
VR Counsel Should have Access
to these Reports
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VR Green Report
• Do not Start Working with an
Individual Until you Read these
Reports
• Will Specify Level of Risk to the
Community
Specialized Psyche Eval or Behavioral Risk Assessment
 May Include
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Social History
Behavioral/Criminal History
Medical /Psychiatric History
Current Behavioral Issues
Substance Abuse History
Attitude to Treatment
Denial and Minimization of
Offense
Coping Skills/Anxiety Triggers
Sexual Knowledge
Arousal Pattern
Age at onset of behavior
Frequency
Use of Force
Victim Characteristics
Prior Offenses
Method (s) of Treatment
Forensic Supports
• Individuals Should Not be with
an Employment Specialist that
Matches his or her MO
• Do not Meet them in their
Home Alone…Cannot Step
Over the Threshold
• Maintaining/Establishing
Professional Boundaries
Forensic Supports
• Keeping the Individual Safe while at the Same Time
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Promoting Dignity & Person Centered Planning
Refrain from Passing Judgment
Promoting Pro-Social Behaviors
Celebrating Successes
Keeping them out of the System
Helping the Individual be Active Participants in their
Preferred/Prescribed Method of Treatment
Sex Offender Tier Notification
NJ Regs Similar Around Country
Check with your Prosecutor’s Office or
Attorney General’s Office for State Specific Regs
• Sex offenders who Reside in the Community are Classified in one of
three "tiers" based on the degree of risk they pose to the Public:
– Tier 3-High Risk
– Tier 2-Moderate Risk
– Tier 1-Low Risk
• Neighbors are Notified only of High Risk Offenders
• Schools, select community organizations involved in the care of
Children or Women, and certain area Businesses are Notified of
Moderate and High Risk Offenders
• Law Enforcement Agencies are Notified of the presence of all Sex
Offenders
Sex Offender
Tier Notification
Tier 1
• Law Enforcement
likely to encounter
offender
Tier 2
Tier 3
• Law Enforcement
likely to encounter
offender
• Law Enforcement
likely to encounter
offender
• Schools & Community
Groups likely to
encounter offender
• Schools & Community
Groups likely to
encounter offender
• Members of the public
likely to encounter
offender
In Your Groups
• Analyze Each Situation
• What may be Causing the Behavior?
– What is the Antecedent?
– What is the Function?
• Create a Plan of Correction/Support Strategies
that may Include Either Coping Skills or
Instructional Interventions
Case 1-The Friendly Food Prep Worker
• John is a 27-year-old male that has Down Syndrome. John is
a very pleasant and positive. He is very social and friendly.
Those who know John describe him as a hard worker who is
always eager to please. John reads at an 9th grade level and
is able to comprehend basic mathematical computations
using addition and subtraction. He has been working as a
Food Preparation Aid in an employee cafeteria for a local
pharmaceutical company for the last 2 months. John works in
the cold food prep department.
Primary Responsibilities
Small Salad Preparation
1. Remove and weigh quantities of mixed greens, mushrooms, carrots,
ham, and cheese.
2. After measuring each item to appropriate weight using calibrated
scale, place salad items into bowl, remove shrink-wrap from role
dispenser and cover salad bowls tightly.
3. Place 8 bowls on a tray and bring them out to the front end display
counter in the employee dining area.
4. Remove bowls from tray and place on top of bed of ice in the salad
section of the cold food display case.
Problem Behavior
• John’s manager, Mr. Jennings, has recently contacted John’s
support agency stating that since his job coach has faded
away, John’s work productivity and accuracy have become
inconsistent over the past several weeks. Mr. Jennings stated
that John sometimes tends to rush which causes him to weigh
salad items inaccurately. He added that John forgets to place
all the required salad items into the bowls and that John has
developed a habit of talking excessively to employees when
he goes out to stock the salad display case. Mr. Jennings
asked that his job coach come in to provide some job
coaching services to help John improve his job performance.
Case 2-The Busy Business Administrative Assistant
• Lisa is a 34-year-old female with General Anxiety
Disorder and Major Depression. Lisa is in a Shadow
Role as she is afraid to inform her employer about her
illness. Lisa is currently on medications and is attending
weekly individual and group therapy sessions. Lisa is
very introverted. She experiences poor concentration,
which sometimes affects her organizational skills and
short-term memory. Based on her past work experience,
she has demonstrated the ability to work well if her job
tasks are clearly outlined and organized. Lisa has a B.A.
in Business Administration and is currently working as a
Administrative Assistant for a large accounting firm. She
has been working there for approximately 6 weeks. This
is tax season.
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Problem Behavior
• She initially started well, adjusting appropriately to her new
job. She described to her Job Coach how difficult this job has
become at one of their debriefing sessions at the local coffee
shop where they meet. She stated that over the past several
weeks the accounting volume has increased significantly. As
a result of this increased work volume, she is having difficulty
performing her primary job functions which include typing,
filing, and answering of telephones. She described to her Job
Coach that the stress is becoming so severe that she wants to
quit and “just get away from it”.
Specific Problem Behaviors
1. She has been flustered at times when she answers the
phone, putting people on hold and forgetting to get back to
them and transferring calls to the wrong extensions.
2. Misfiling forms and documents.
3. Falling behind on typing of daily memo requests and letters.
4. She thinks her co-workers are talking behind her back.
5. She thinks at least one of her co-workers stole her phone
and put it back in her purse when she wasn’t looking.
Case 3-The Case of the Selective Video Stocker
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Ryan is a 42-year-old male with a diagnosis of Fragile X Syndrome and
Attention Deficit Hyperactivity Disorder (ADHD). Ryan sometimes has
limited patience and can be a bit short tempered. He does not accept
constructive or corrective feedback, typically internalizing it as an attack on
his intelligence. Testing shows that Ryan reads at a 5th grade level. His
letter recognition is good but his reading comprehension is relatively poor.
He is able to compute basic addition and subtraction. In his spare time,
Ryan loves to watch movies and listen to talk radio shows. He has an
uncanny memory for faces and places especially as it pertains to actors and
movies. Not surprisingly, he is more of a visual learner, but benefits from
verbal and hands-on instruction as well. Ryan has recently begun working
at a video store in his hometown. His primary job task is to re-shelve
returned videos. Ryan received some initial onsite support from his job
coach when he began his new job. However, his employer suggested they
facilitate training for him since they provide that to all new employees. Ryan
was happy with this suggestion since he was reluctant to have a job coach
with him at the job site.
Problem Behavior
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Two weeks later Ryan’s manager called and stated that he would like to have a
job coach in to assist with some of the training.
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The manager stated the following:
1. Ryan has been observed shelving videos in the wrong location.
2. Ryan responded somewhat defensively to a co-worker when a more
efficient method of shelving videos was suggested, Ryan’s response
was, “I know how to do this. I don’t need your help. Leave me the hell
alone.” This outburst occurred in from of customers.
3. Lastly, Ryan was found on several occasions returning adult videos to
the adult video movie section. At this time he was also observed
leisurely walking around this section perusing the video selections.
When Ryan was first hired he was told that he would not be returning
those videos to this section since the night shift workers do this.
In Your Groups
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Think of a Behavioral Situation you are Currently Facing
What is the Behavior?
What is the Antecedent?
What is the Function of the Behavior?
Create a Plan of Correction/Support Strategies that may
Include Either Coping Skills or Instructional Interventions
In Your Groups
• How Would you feel if you
Received a Referral for a
Convicted Sex Offender?
• Would you take the Case?
• What Supports would you
and your Agency Need?
– Do you feel Supported?
THANK YOU
QUESTIONS