Journal of Positive Behavior Interventions

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Review of the Positive Behavior Support Training Curriculum : Supervisory and Direct Support Editions Don Kincaid, Heather Peshak George and Karen Childs Journal of Positive Behavior Interventions 2006 8: 183 DOI: 10.1177/10983007060080030701 The online version of this article can be found at: http://pbi.sagepub.com/content/8/3/183

Published by: Hammill Institute on Disabilities

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EDITORS’ NOTE: The Forum section of the Journal of Positive Behavior Interventions is presented to encourage communication among readers and provide for an exchange of opinions, perspectives, ideas, and informative personal accounts. We welcome brief articles from family members, professionals, friends, advocates, administrators, researchers, and other individuals who are concerned

with behavioral support issues. The purpose of the Forum is to facilitate a constructive dialogue among many stakeholders regarding important issues in practice, research, training, program development, and policy. Submissions to the Forum undergo an expedited review.

Review of the Positive Behavior Support Training Curriculum: Supervisory and Direct Support Editions

 Don Kincaid Heather Peshak George Karen Childs University of South Florida

Abstract: In the past several years, the values and practices of positive behavior support (PBS) have had a significant impact on services provided to adults and children with disabilities. Evidence of this impact can be seen in federal grants and laws such as the Individuals with Disabilities Education Act Amendments of 1997 (IDEA, 1997), a professional journal (the Journal of Positive Behavior Interventions), and an established organization (the Association for Positive Behavior Support). With this emergence comes a continued need for clearly defining PBS, identifying the skills evident in a competent practitioner, and effectively teaching those skills to supervisors, teachers, direct support staff, and other professionals. It is with these concerns in mind that we will review the training materials Positive Behavior Support Training Curriculum: Supervisory and Direct Support Editions (PBS-TC).

Critical Features of PBS Training Carr et al. (2002) delineated a number of key features of positive behavior support (PBS) training, which include comprehensive lifestyle change, prevention, partnership, collaboration, multicomponent interventions, and systems change. These key features draw heavily from the work of several collaborators who had previously delineated the essential elements of in-service training in PBS (Anderson, Albin, Mesaros, Dunlap, & Morelli-Robbins, 1993; Anderson, Russo, Dunlap, & Albin, 1996; Dunlap et al., 2000). These seminal articles on training in PBS not only identified the essential content areas of PBS training but also described some of the key features of a national in-service training model that was implemented by the Rehabilitation Research and Training Center on Positive Behavior Support (RRTC-PBS).

This national training model produced more than 20 state-level training teams and had a profound impact on the values and skills of thousands of parents and professionals across the country. The PBS training model identified the following seven essential elements to include in curriculum content: 1. a collective vision and goals for intervention; 2. collaboration and team building among families and professionals; 3. functional assessments and gathering of information and data; 4. hypothesis-driven, multicomponent support plans; 5. intervention strategies that include prevention, teaching, appropriate consequences, and lifestyle enhancements;

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6. monitoring and evaluation of intervention outcomes; and 7. addressing broader system issues. The RRTC collaborators also emphasized five key features that were considered essential to the provision of inservice training in PBS. These features include (a) training a multidisciplinary audience in a manner that promotes collaboration; (b) using a case study format; (c) providing a dynamic training process that is practical and generalizable; (d) providing a comprehensive range of topics; and (e) promoting community building and systems change. Although the field continues to grow, we believe that these curriculum elements and training features still reflect best practice in PBS training. These elements and features form a foundation on which current training materials can be developed and evaluated. Therefore, we will use these key elements and features as criteria for our review of the Positive Behavior Support Training Curriculum: Supervisory and Direct Support Editions (PBS-TC; Reid & Parsons, 2004). Because the authors have described an earlier version of their training materials in a previous issue of the Journal of Positive Behavior Interventions (Reid et al., 2003), we will not describe all of the key features of the curriculum in detail. Rather, we will address the target audience, content, organization, and effectiveness of the curriculum and point to some future directions for consideration in providing in-service training in PBS.

Target Audience Reid and Parsons (2004) clearly indicate that the target audiences for the materials are human services personnel (supervisors and direct support staff). In addition, many of the examples are drawn from the adult developmental disabilities field (references to group homes, supported employment settings, etc.). This specificity of focus is appropriate and consistent with the content and organization of the curriculum. However, individuals who may be interested in using the materials, in whole or in part, for other audiences (parents, school personnel) may need to consider supplementing or replacing many of the case examples. In addition, the narrow focus of the intended audience does not allow for training a multidisciplinary audience in a manner that promotes a collaborative teaming approach.

Content The content is organized into a series of 26 training modules, with each module targeting a specific knowledge base and/or performance skill (Reid et al., 2003). Each module provides trainees with learning objectives, methods, and a skills check, whereas trainers are provided with the estimated amount of training time, overhead transparencies,

training activity sheets, and a list of training materials needed (e.g., overhead projector, participant snacks, pens). Furthermore, both trainers and trainees are provided with supplemental resource guides that correspond to the training format and allow for additional reference following conclusion of the training. As described earlier in this article, the RRTC-PBS identified seven essential elements that are critical to building capacity in PBS. Although these elements are interdependent, each element will be discussed as it relates to the PBS-TC curriculum content.

Establishing a Collective Vision and Goals for Intervention By applying the principles of positive behavior support, team members can establish a shared purpose or goals for intervention. Effectively addressing problem behavior requires a thorough understanding of the function of behavior, as well as the physical and social environment within which the individual interacts. Dunlap et al. (2000) recommend person-centered planning as a process to identify lifestyle outcomes, discuss behaviors of concern, and begin initial team building. Although the PBS-TC states that person-centered values are important, the curriculum does not establish a foundation or a process for embedding those person-centered values within the ongoing support provided to individuals with problem behavior. For example, person-centered planning is briefly discussed, but skill-building activities are not provided to the trainee to assist with this process. As a result, the curriculum tends to provide a more generic approach: how to interact with everyone, rather than with a unique individual. The infusion of a person-centered planning approach might help the trainee learn how to support lifestyle changes for the individual and suppress any tendency to see the person as a set of behaviors that need to be changed.

Collaborating and Building Teams With Families and Professionals By nature, individuals interact with several people daily, some more often than others. For individuals with developmental disabilities and problem behaviors, these people tend to be family members or caregivers, employers or job coaches, and, possibly, behavior specialists or psychologists. Although collaboration is not always a natural process, realizing that several individuals with diverse backgrounds interact with the same individual can present a valuable opportunity for team building. A basic tenet of positive behavior support is this team-based approach (Anderson et al., 1993, 1996), which is not emphasized in the PBS-TC curriculum. The content is arranged to focus on ways an individual staff member deals with behavior.

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Such a focus may communicate to trainees that they are responsible for developing a behavior support plan, with limited input from the person with problem behaviors and the important people in his or her life. This is contrary to a collaborative positive behavior support approach. Content on creating a team (membership, contribution) and working as a team (value of collaboration, mutual participation) would be a necessary addition to a comprehensive PBS curriculum.

Conducting Functional Assessments and Gathering Information and Data This is the “information-gathering process” in PBS, which assists in accurate identification of variables and broader lifestyle issues that affect an individual’s behavior. The PBS-TC provides a module on functional assessments that includes activities to help the trainee practice identifying functions of the behavior. On completion of the PBS-TC training, the trainee should be better able to identify and define the antecedents, behaviors and consequences (ABCs) in a person’s life. However, the PBS-TC does not emphasize hypothesis generation and testing, and as a result, the curriculum is missing the second half of functional assessments: the formulation and testing of hypotheses. The trainee is taught how to collect data but not how to interpret the data to better understand the person’s environment and behavior. The purpose of a functional assessment is to generate hypotheses or “educated” guesses regarding why a behavior occurs. As Dunlap et al. (2000) stated, “These hypotheses become a foundation from which interventions can be designed” (p. 25). The PBS-TC does not provide the vital link between identification of function and development of interventions.

Designing Hypothesis-Driven, Multicomponent Support Plans The purpose of this element is to design multifaceted behavior support plans that are based on the results of functional assessments (i.e., information collected, data analyzed, hypotheses generated and tested, etc.). As mentioned previously, PBS-TC trainees are taught how to collect data, but the curriculum does not sufficiently describe what to do with the data once collected, nor does it tie the results of data collection to intervention. For example, trainees are taught how to graph and analyze data, but there is no mention of what to do with the results derived from that analysis. Without hypotheses, functional assessments are considered only partially complete and may produce a great deal of meaningless data. However, we recognize that the purpose of the PBS-TC materials is to teach human services personnel not to become behavior analysts, psychologists, or behavior specialists, but rather

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to be comfortable and skilled at evaluating and implementing the components of a PBS plan.

Implementing Intervention Strategies: Prevention, Teaching, Appropriate Consequences, Lifestyle Enhancements Once a collective vision and team goals have been identified, data are collected for the purpose of developing strategies that may address many or all of the identified goals. The resulting multicomponent support plans generally contain interventions that emphasize proactive, educative, functional, and lifestyle strategies. The PBS-TC provides several modules to assist the trainee in developing specific skills to better implement intervention strategies. It also provides good information on preventive or proactive strategies, including the role of choice for the individual, the power of basic interactions with individuals, the use of prompting and modeling, how to problem solve, and the importance of environmental setup as it relates to the problem behavior. In terms of educative or teaching strategies, the PBSTC spends a considerable amount of time discussing what to teach, why skills should be taught, and how the teaching environment should be arranged. The curriculum reemphasizes the importance of teaching functional skills and relates this premise to some of the tenets of PBS, such as promoting the dignity of the individual. Although functional skills are discussed along with such critical skills as error correction, positive and negative reinforcement, chaining and shaping, and providing feedback, the concept of functional skills is not connected to the function of behavior as identified through the functional assessment process. The curriculum fails to emphasize the importance of lifestyle enhancements and provides little mention of making lifestyle arrangements and adaptations that may significantly affect an individual’s problem behavior by improving quality of life. These major lifestyle arrangements may include addressing such issues as the person’s home environment, work, and social and recreational activities. These major issues are often neglected when providing behavior support, but they may contribute significantly to the person’s problem behavior and quality of life.

Monitoring and Evaluating Intervention Outcomes PBS is an evolving process. Once skills are acquired, performance needs to be continually monitored so that new skills can be built on mastered skills. Through careful monitoring of the established behavior support plan, adjustments can be made to the plan as needed to maintain

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appropriate behavior and quality of life. The PBS-TC devotes separate modules to evaluating a behavior support plan, analyzing data, and analyzing performance. Although the curriculum adequately addresses these issues, it would be important for the trainer to understand that data-based decision making is a component of every step of a PBS approach and needs to be embedded in multiple training modules.

Addressing Broader Systems Issues Addressing broader systems issues is a basic tenet of PBS. Examination of the various contexts in which the individual interacts (e.g., work environment, home, community) allows for a multicomponent behavior support plan to be developed that promotes lifestyle change. A plan would be limited if it did not address broader aspects of an individual’s life, thus reemphasizing the importance of personcentered planning. Although the PBS-TC reviews the dignity of the individual and the role of the environment and interactions, it does not discuss how newly developed behavior support plans relate to broader systems issues. A training module that addresses the impact of agency policies and systems issues on the provision of effective behavior supports would be a valuable enhancement. Often, it is more important to have someone skilled in the “art” of operating within human services systems than to have someone skilled in the science of PBS. It is the difference between knowing what to do and how to get it done. In summary, the PBS-TC provides content that covers a wide range of PBS topics. While no PBS training can be exhaustive on all of the possible PBS topics, it is likely that additional training in the areas of person-centered planning, collaborative teaming, hypothesis generation and testing, linking interventions to functional assessments, lifestyle interventions, data-based decision making, and systems change would greatly expand the skills of trainees.

Training Format and Organization The content of the PBS-TC is presented in a manner that is visually pleasing and user-friendly. The font size, spacing, page layout, and overall wording provide for easily readable text. The three-ring binding makes it possible for trainers to insert additional resources and materials to supplement the training over time. The overhead transparencies follow best practices for the amount of text and type of content needed to provide the audience with clear and understandable information. Each module follows a similar well-organized format that creates a sound foundation for trainers. One of the most valuable features of this format is the module overview, which includes objectives, activity descriptions, skills checks, time allocation, and

materials that promote effective delivery. Each module also includes a comprehensive presentation outline, with explicit trainer notes and directions. These features increase the likelihood that training conducted using these materials will not vary from trainer to trainer. To advance the physical presentation of this material, we suggest enhancing the presentation of content by including multimedia. Putting the overhead into a Microsoft PowerPoint format provided on a CD would allow for the use of color and open the door to the integration of video demonstrations, which would further expand the opportunities for trainees to observe modeling of the strategies presented. According to the authors, the design of the training format was shaped in accordance with widely accepted principles of adult learning and performance-based staff training (Reid et al., 2003). The curriculum provides a variety of learning experiences, including paper-and-pencil tasks, role plays, personal responses to information, and on-the-job demonstrations. There is a sufficient balance of activities to address participants’ various learning styles. An additional positive feature of this training is the frequent assessment through quizzes and skill checks. This ongoing evaluation creates opportunities for trainers to verify that trainees have mastered the skills being addressed before advancing to the next skill. The content of each individual module is effectively organized and presented. Objectives are well defined, the rationale for using the skill is provided, information on performing the skill is clearly presented, and trainers can evaluate skill mastery. In addition, the on-the-job demonstrations allow for generalization of the skills to routine work sites. The materials do an excellent job of providing a mechanism for teaching several discrete skills often used in PBSs. However, despite the excellent training on individual skills, several of the fundamentals of PBS are lost. As indicated earlier, critical elements of PBS not addressed in this training curriculum include collaborative teaming, person-centered planning approaches, data-based decision making, linking interventions to the function of behavior, and lifestyle change for individuals. However, simply creating additional discrete modules to address these “skills” would not be adequate. To effectively train these elements, they must be integrated into an overall approach to using PBS. Anderson et al. (1993, 1996) emphasized a problem-solving approach to broad-based intervention. This was an intentional shift away from standard technique-oriented approaches in favor of more assessment-based, individualized, and contextually relevant approaches (Dunlap et al., 2000). Given this standard in PBS training, improvements to the PBS-TC must go beyond the creation of additional skill modules to address the omitted critical elements. An integration of the discrete skills into the broader PBS process is required. The format of the curriculum under review does not lend it-

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self to addressing PBS as a process without significant redevelopment.

Effectiveness Reid et al. (2003) conducted an experimental evaluation of the precursor to the current training materials and found that supervisors exhibited competence in targeted skills during role plays and on-the-job probes. In addition, 85% of all supervisors completed the training by performing at mastery criterion. Ninety-five percent of trainees also rated the training as extremely useful or very useful, and 99.6% reported that they would recommend the training. The authors’ commitment to evaluating both satisfaction with the training and the behavior change the training produces is commendable and surpasses the evaluation standard for most in-service training curricula.

Discussion The Positive Behavior Support Training Curriculum: Supervisory and Direct Support Editions is intended for a specific audience (direct support staff and supervisors) and for a specific purpose (to provide a general knowledge of some of the skills necessary to practice PBS with adults with developmental disabilities). As a result, the authors acknowledge that other aspects of PBS (collaborative teaming, goal identification, person-centered planning processes, and systems change) are addressed only at a general level, if at all. If users of these materials are concerned about these or other areas, they will need to supplement the reviewed curriculum with additional content and activities. Although the PBS-TC provides information and skills in a number of PBS “domains,” it is more likely to assist with developing a basic understanding of and comfort with an array of behavioral strategies. The training participant may learn an array of PBS skills, yet lack a clear understanding of the PBS “process.” Although the PBS-TC is not intended to teach participants to become experts in PBS, the materials do not provide a clear picture of a complete PBS process. Will participants, on completion of the training, know how to support an individual with problem behaviors through a process of identifying goals, understanding the person’s life and behavior, and developing and implementing a behavior support plan? It is likely that the developers did not envision the PBS-TC materials as being capable of developing highly skilled and competent behavior analysts or PBS practitioners. Nonetheless, a comprehensive training in PBS should prepare participants to understand and participate in a collaborative PBS process. The PBS-TC teaches many of the skills necessary for participation in a PBS process but does not adequately teach the process itself. The PBS process can best be taught from a case study or in a hands-on format in which team mem-

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bers from different disciplines observe and perform each step in supporting individuals with problem behaviors. As a supplement to the PBS-TC training, we would advocate for helping the trainees participate in a real PBS team supporting an individual with problem behaviors. This case study could occur concurrently with the PBS-TC but would probably be most effective as an application activity following the completion of the PBS-TC. If such an approach were used, trainers would need to provide additional curricula covering critical issues either within or following the PBS-TC. In locations where PBS training has been directly or indirectly implemented, state and local training team members may be able to help agencies supplement the PBS-TC with additional training and support as trainees proceed through a PBS process. Trainers may also want to develop additional aids or training modules to help trainees link the interventions to the data gathered during the person-centered planning and functional assessment processes. Simple charts or tables that record summary information on lifestyle, antecedent, behavior, and consequence issues could serve to direct the identification of the most appropriate interventions to match the unique characteristics of any individual. Such an approach may result in the data and information clearly driving the development of interventions and application of skills trained in the PBS-TC. If the curriculum is to be used most effectively, trainees should receive follow-up training and technical assistance in applying the PBS-TC skills in a longitudinal PBS process with an identified consumer. A number of additional multimedia resources may be available to assist teams in learning how to proceed through a PBS process. The Kansas Institute for Positive Behavior Support (http://www.kipbs.org/home.aspx) has 10 modules developed to train behavioral consultants in the PBS process. There is considerable overlap in content with PBS-TC material, but the KIPBS Web site more extensively addresses person-centered planning, systems change, and emotional and behavioral health issues. In addition, Florida’s PBS Project (http://flpbs.fmhi.usf.edu/) has four short Web-based trainings to help team members prepare to participate in a PBS process for school-age children. These 90-min training modules address the following topics: collaborative teaming and person-centered planning, functional behavior assessment, instructional issues and strategies, and behavior support plan development, implementation, and evaluation. These and other online resources may be useful for adapting the PBS-TC materials for other target audiences or expanding the PBS-TC curriculum to address other critical features of PBS. Although it is impossible for any PBS curriculum to address every targeted audience and teach every skill necessary for the practice of PBS, the PBS-TC effectively trains an array of skills that can support the PBS process. However, the PBS-TC does not lay a foundation on which to

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build a comprehensive PBS “process” that meets the needs of a variety of constituencies. To the degree that practitioners and trainers are successful at developing PBS training programs that (a) create collaborative teams, (b) follow an effective problem-solving process, (c) work with longitudinal issues in the lives of real people, and (d) develop comprehensive supports that change the environment, community, and support system, PBS will continue to have a significant impact on our service system and the lives of individuals with problem behaviors. ABOUT THE AUTHORS

Don Kincaid, EdD, is a research associate professor at the University of South Florida and principal investigator on several positive behavior support projects. Heather Peshak George, PhD, is a research assistant professor of child and family studies and co-principal investigator and coordinator of Florida’s Positive Behavior Support Project at the University of South Florida. Karen Childs, MA, is an assistant in research at the University of South Florida, where she coordinates research and evaluation for Florida’s Positive Behavior Support Project. Address: Don Kincaid, University of South Florida, CFS, 13301 Bruce B. Downs Blvd., MHC2312, Tampa, FL 33612.

REFERENCES Anderson, J. L., Albin, R. W., Mesaros, R. A., Dunlap, G., & Morelli-Robbins, M. (1993). Issues in providing training to achieve comprehensive behavioral support. In J. Reichle & D. Wacher (Eds.), Communication alternatives to challenging behavior: Integrating functional assessment and intervention strategies (pp. 363–406). Baltimore: Brookes. Anderson, J. L., Russo, A., Dunlap, G., & Albin, R. (1996). A team training model for building the capacity to provide positive behavioral supports in inclusive settings. In L. Koegel, R. Koegel, & G. Dunlap (Eds.), Positive behavioral support: Including people with difficult behavior in the community (pp. 467–490). Baltimore: Brookes. Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., et al. (2002). Positive behavior support: Evolution of an applied science. Journal of Positive Behavior Interventions, 4, 4–16. Dunlap, G., Hieneman, M., Knoster, T., Fox, L., Anderson, J., & Albin, R. (2000). Essential elements of inservice training in positive behavior support. Journal of Positive Behavior Interventions, 2, 22–32. Individuals with Disabilities Education Act Amendments of 1997, 20 U.S.C. § 1400 (26). Reid, D. H., & Parsons, M. B. (2004). Positive Behavior Support Training Curriculum. Washington, DC: American Association on Mental Retardation. Reid, D. H., Rotholz, D. A., Parsons, M. B., Morris, L., Braswell, B. A., Green, C. W., et al. (2003). Training human service supervisors in aspects of PBS: Evaluation of a statewide, performance-based program. Journal of Positive Behavior Interventions, 5, 35–46.

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Action Editor: Glen Dunlap