Behavior Assessment Report and Recommended Support Plan

Comprehensive Functional Behavior Assessment Report and Support Plan

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NOTE: This report was written by a participant in Institute for Applied Behavior Analysis’ Summer Institute() 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 27, this year (draft)

Referral Date: July 1, this year

Period of Report: July 26 – August 4, this year

IDENTIFYING INFORMATION

Name: Jane Doe

Date of Birth: July 2, 1976

Address: Any Lane, Apartment 2

Any Town

Referral Source: Tina Timmons, Manager, Supported Employment Service

REASONS FOR REFERRAL

Jane was referred for an evaluation by Tina Timmons, manager of the Supported Employment Service, Inc (SESI) program, a behavior management day service that is a division of the Alphabet Program (ABCD). The purposes of the evaluation were to assist Jane in securing the services and programming which would enable her to develop and to use her capabilities, to get the most out of the educational opportunities that can be made available to her and to enable her to develop and to use her capabilities for more independent, normal living and more productive activity than her behavior problems presently permit. Accordingly, it was requested that the evaluation focus on these behavior problems, which were characterized as physical aggression, verbal aggression, anger management and problem solving, and the type(s) of behavioral services, support strategies, programming, professional competencies and skills, and environments required to eliminate, minimize, or manage them.

Specifically, Jane has engaged in aggressive behavior on an average of approximately once per month over the past year. In March and April this year she verbally and physically assaulted a member of her SESI-ABCD group on three separate occasions, resulting in the other client’s withdrawal from SESI as he feared future attacks. This was also followed by a period of sporadic attendance at work her subsequent resignation to avoid losing her job. She also moved from a group home setting to supported independent living in March this year and started a new job July 5, this year with a new job coach. Concern from SESI-ABCD staff seems to be that future episodes of similar behavior could jeopardize her placement in the program and her current job. Staff members supervising her supported living arrangement have not noted any instances of aggression and are not concerned with this behavior at the present time.

DESCRIPTION OF ASSESSMENT ACTIVITIES

The assessment is based on information obtained from the following sources on July 26, this year:

A.Interviews with Jane at her workplace (60 min.) and over the phone (15 min.); with Mary Whitten, Jane’s current Employment Specialist with SESI (20 min.); Charlie Quinton, Jane’s former Employment Specialist with SESI (75 min.);and Kim Chow, SESI Supervisor (90 min.);

B.Direct Observations of Jane in her place of work (Wiener's are Us) with job coach present (60 min.);

C.Review of the SESI-ABCD case file and field notebook (180 min.);

D.A Reinforcement Survey completed by Jane (obtained from SESI file);

E.Telephone Conference with Ginger Bertrulano, Manager for Help Me (15 min.);

BACKGROUND INFORMATION

I.Brief Client Description.

A.General. Jane is a 24 year-old Caucasian female with light brown hair and blue eyes. She is short (approximately 62 inches tall) and heavyset. She indicates that she wears size 20 clothing and she appears to be about 200 pounds. She was wearing her Wiener's are Us uniform at the time of the interview. It was clean and properly fastened. Her face and hair were also clean. No identifying marks or physical disabilities were visible or indicated in the files. Jane was friendly and pleasant when interviewed.

Jane was diagnosed with Post-Traumatic Stress Disorder and Mild Mental Retardation in May 1993 by Dr. William Webster, psychologist at Saturn Hall. Documents in her SESI-ABCD file indicate that she is also currently diagnosed with either Schizoaffective disorder or Schizophrenia, although no documentation was present supporting the either diagnosis. Indeed, previous reports indicate that her reality testing was not impaired and that her thinking was not disordered. A Counselor’s Report from County Regional Center for Developmentally Disabled Persons (August 20, 1984, when Jane was 8 years old) indicates that Jane also carries a diagnosis of aphasia.

Language and Communication Skills. Jane’s primary method of communication is the spoken English language. Her speech is clear and easily understandable. It is reported that she has a repertoire of approximately 20 signs using conventional sign language, which she learned while residing with her foster mother, Snow White. All verbal and written reports indicate that Jane’s communication skills are well developed, including the ability to emit complex sentences. The writer observed that she is able to articulate her likes and dislikes. She is also able to clearly describe her job duties. Charlie Quinton, Jane’s former Employment Specialist, told the writer that he sometimes observes Jane using complex words out of context. He was unable to give a specific example but stated a general belief that her vocabulary exceeds her level of comprehension. The writer also observed in the interview that sometimes when asked a question, Jane would fail to respond. When the question was broken down into shorter sentences and repeated, Jane would respond to the question, suggesting that she did not understand the question when it was first asked. It was also noted that Jane thought that she had responded to the question when she had not. For example, when the writer asked her why she had discontinued counseling with Dr. Anything, Jane responded “I quit”. With further verbal prompting she was able to tell the writer that she left the counseling because she did not think she needed any more help.

Jane agreed to discuss her aggressive episodes with the writer but told the story from a different point of view than staff reports. In general, staff indicate that her descriptions of emotionally charged situations are quite different from that of her peers or staff. For example, there was a situation where she assaulted another member of her SESI group. She acknowledged that she slapped him with an open hand. When asked about the sequence of events, Jane indicated that she observed this man touching her friend in “the chest area”, she told him to stop, he tried to retaliate and she hit him. She then says she left the area but heard him talking about her and returned to slap him in the shoulder. In the opinion of staff, however, no inappropriate touching had occurred.

With respect to the aggression, it should be noted that numerous messages are attributed to the cluster of aggression, tantrums, and/or verbal or physical threats. Some staff believe that the behavior is triggered by memories of childhood abuse and communicates desire for person to stop activity that is bothering her. Others hypothesize that the aggression is an expression of frustration at the inability to have her needs met: “When she has no other way out”. It should also be noted that an episode of minor self-injury (picking at scabs on back of hand) seemed to be an expression of anger towards a staff member who had refused to comply with a request made by Jane.

C.Cognitive and Academic Abilities. Formal testing conducted by Dr. William Webster in 1993 placed Jane in the mildly mentally retarded level of functioning. At the time, Jane’s Verbal IQ was 67, and her Performance and Full Scale I.Q.’s were both 66. Her impairment was most severe on subtests measuring distractibility from stimuli presented auditorily and anticipation of consequences of social behavior. A psychological summary completed by Dr. Hightower in August 1993 mentions earlier psychological testing completed by Dr. Bully (no date or affiliation noted). According to Dr. Bully, a large discrepancy was noted between Jane’s verbal IQ (50) and performance IQ (80), resulting in a full scale IQ of 63. This discrepancy was attributed to “receptive and expressive developmental language deficits”. A report written by Jennifer Tilley (Counselor) in August 1984 reports that Jane had been diagnosed with aphasia, defined as “diminished ability to correctly use and comprehend language” in the Dictionary of Developmental Disabilities Terminology (p. 20; Accardo, P.J. & Whitman, B.Y., 1996). The documentation supporting that diagnosis was not available.

Jane graduated from Pumpkin High School with her high school diploma. All available records indicate that she was in special education classes for the majority of her tenure at school. She was registered in classes at local Community College last year but attended for just a few days before dropping out. She is not currently expressing interest in further academic pursuits.

Jane can sign her name independently, address an envelope and mail a letter. She can usually complete a job application independently, but may require some verbal prompting. She can read simple recipes and instructions and has used the want ads to do a job search. Reading is not a pastime for Jane. Charlie Quinton estimated that she can read at a grade four or five level. No formal testing was available in this regard.

Verbal reports indicate that Jane can add, subtract and multiply but cannot perform division. According to Charlie Quinton, Jane has difficulty making change and relies on a calculator to assist her with most math functions. Regarding measurement skills, Jane did indicate that she has recently lost weight, suggesting that she weighs herself. The writer, however, was not able to determine how accurate she is in weighing herself. Recipes that she prepares independently would probably not involve measurement (e.g. ground beef with peppers and onions). Jane knows what time she needs to catch her bus, what time she needs to transfer, and what times she starts & finishes work. When asked to describe what she does on the weekend, however, Jane began to describe her weekly activities. She is able to differentiate between the days that she is and is not required to be at work.

D.Self Care Skills. Verbal and written reports from staff indicate that Jane is completely independent in her self-care abilities. It is worth noting that at the last reported dental examination Jane had 23 cavities, suggesting that she has or had some difficulty brushing her teeth. The residential support services manager indicated that in-home staff check to ensure that her grooming is completed but previous reports indicate that she is completely independent in this area.

E.Domestic Skills. Verbal and written reports from staff indicate that Jane can complete all indoor maintenance tasks independently. The writer was not able to verify her skill level as her home was not directly observed. Jane completes her laundry independently. There are laundry facilities at her apartment. She spontaneously informed the writer how much it costs for her to wash and dry her laundry. Jane is able to prepare her own meals. She described the SESIs to prepare a fried egg sandwich, one of her favorite quick meals to prepare. Written reports describe that she is able to prepare complex meals independently but residential support staff indicate that she requires verbal prompting to prepare a novel or complex recipe.

F.Community Skills. Jane takes the bus to work independently from her apartment. She was able to describe the routes and schedules of the two buses she takes to get to work. The bus ride takes approximately one hour each way. A progress report from Map, the agency that operated Jane’s former group home, dated February 1, this year indicated that she was using public transportation independently. However, one of the learning objectives established by Help Me was to teach her the route to work, which she successfully learned. The type of instruction used was not specified. The writer hypothesizes from this information that Jane requires some assistance to learn novel bus routes. She has walked from her job to her SESI group when her bus pass was not available.

Residential support staff accompany Jane to complete her grocery shopping. The purpose of the assistance is primarily to provide verbal prompts to ensure that Jane remains within her budget for groceries.

Jane currently completes an emergency skills checklist on a monthly basis as part of her SESI-ABCD behavior support plan, which includes ensuring that she is carrying her identification. Jane has consistently been meeting the criteria in the checklist for the last 6 months.

Money management is consistently identified as an area of difficulty for Jane. Budgeting skills were targeted by Map as an opportunity for learning for Jane and are currently targeted by the SESI-ABCD program as well. Jane consistently states that she does not require assistance in this area and no formal protocol is currently in place. Previous reports from residential care services indicate that she gives money away freely and has incurred debts of over $1000.00. Since resuming employment, she reports that she has opened a bank account. She was able to report to the writer the amount of money that is set aside from her social assistance check each month for rent ($420.00 paid by direct deposit), for groceries ($150.00) and for laundry ($20.00). She was able to report how much she had earned on her first paycheck from Wiener's are Us ($214.00) and how much she had spent from her paycheck (e.g. $25.00 to purchase a kitten). When asked by the writer how much money she had left over from her paycheck, she did not respond. When prompted she indicated that she did not know but was sure that she would have enough money. She also stated “When I go shopping, if I see something I like, I buy it”. She did not show recognition, even when prompted, that she might have to consider how much money she had left in her budget before purchasing a particular item. According to Charlie Quinton, former Employment Specialist, Jane would also ask other members of her SESI group for money, sometimes even threatening them to obtain it.

G.Recreation and Leisure Skills. Jane indicates that she enjoys shopping, going to movies, watching television, and going to church. She attends church at Rolling Hills Covenant Church every Sunday and describes this as a good opportunity to socialize with non-consumers. She also goes to swap meets to shop on the weekends. Jane also indicated that her friends Bruce Lee and Brandon Lee occasionally come to visit her on the weekends. However, none of the staff interviewed have met these friends. By her description, she spends most of her evenings and several hours on the weekend watching television. Some of her favorite television shows are “Touched by an Angel”, “The Drew Carey Show” and “Twice in a Lifetime”.

Social Skills. Reports about Jane’s social skills are conflicting. Her current job coach, who has worked with her for approximately three weeks, has not observed any difficulty getting along with co-workers. She described an instance when Jane talked with a co-worker spontaneously about what to do with her pet fish when she buys a kitten. The co-worker responded positively by asking her if she could help by taking the fish for Jane. The writer observed Jane saying hello to her co-workers. She smiled, made eye contact and shook hands with the writer when approached for introductions.

Topics of conversation that were not in response to direct questions were expressions of physical concerns (i.e. describing knee problems, describing surgery in February), pets, boyfriend, and favorite television programs.

Reports from her former job coach, Charlie Quinton, are quite different. He describes her as having difficulty initiating and maintaining friendships. Apparently she developed a close relationship with a same-age female co-consumer who was in the same SESI group with her. They worked together at Come-view Video and spent time socializing outside of group time, attending swap meets and movies together. When her friend moved to a different job site the frequency of contact was reduced. No one interviewed could indicate how often Jane currently has contact with this individual, if at all. Some staff interviewed had the impression that Jane emulated this individual. One example cited was that when Jane’s friend left Come-view Video, Jane wanted to leave Come-view Video within one week. Another example given was that when this individual recently became engaged, Jane started to talk about becoming engaged to her boyfriend. It should also be mentioned that the aggressive episode that Jane described to the writer involved this young woman. Jane indicated that she thought that another member of the group was touching her friend “in the chest area”. She claims that she hit this individual in an effort to protect her friend. Some staff interpreted the episode as Jane expressing jealousy at her friend spending time with someone else. Charlie Quinton described Jane as liking “to be the center of attention”.