Behaviour support plan toolkit
Section 4
Useful assessment tools and forms


Behaviour support plan toolkit
Section 4
Useful assessment tools and forms
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© State of Victoria, Department of Health and Human Services April, 2017.
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Contents

Useful assessment tools and forms

What is a restrictive intervention?

Functional behavioural assessment flowchart

Functional behavioural assessment - example

Behaviour recording STAR chart

Frequency recording sheet

Questions about behavioural function (QABF)

Function: Attention

Function: Escape

Function: Non-social

Function: Physical

Function: Tangible

Goal setting

Action plan

BSP QE II review and feedback form

What the disability act asks for in a BSP review and feedback form

Senior practitioner-disability

Questions to ask the doctor

Questions to ask the doctor about prescribing Risperidone to people with ASD

Example Behaviour Support Plan

Useful assessment tools and forms

  1. What are restrictive interventions?
  2. Functional Behavioural Assessment Flowchart.
  3. Functional Behavioural Assessment – example.
  4. Behaviour Recording STAR Chart.
  5. Frequency recording sheet.
  6. Questions about Behavioural Function (QABF).
  7. Goal setting.
  8. Action Plan.
  9. BSP QE II review and feedback form.
  10. What the Disability Act asks for in a BSP review and feedback form.
  11. Questions to ask the doctor.
  12. Questions to ask the doctor about prescribing Risperidone to people with ASD.
  13. Example Quality Behaviour Support Plan.

What is a restrictive intervention?

This is any intervention that is used to restrict the rights or freedom of movement of a person with a disability. Restrictive interventions can be: chemical, mechanical, physical restraint, seclusion or other restrictive interventions.(Refer to Part 7 of the Disability Act for further explanation on the use of restrictive interventions)

(a)Chemical restraint(Disability Act, s. 3 (1)). The use, for the primary purpose of behavioural control of a person with a disability, of a chemical substance to control or subdue the person but does not include the use of a drug prescribed by a registered medical practitioner for the treatment, or to enable the treatment, of a mental illness or a physical illness or physical condition.

(b)Mechanical restraint (Disability Act, s. 3 (1)). The use, for the primary purpose of the behaviour control of a person with a disability, of devices to prevent, restrict or subdue a person’s movement. This includes the following.

•Belt/strap

An item of any material used to restrain any part of the body to a secure fixture. This does not include cuffs, which are reported as a separate category of mechanical restraint.

•Gloves

Any material that is placed on the hand that covers all or part of the hand and/or finger(s).

•Splint

A device that is applied or worn, in its original or a modified form, to a body joint (usually the elbow) that restricts movement of that joint in any way.

•Restrictive clothing

An item of clothing that is applied in full or part, in its original or a modified form, or a specially designed device that is applied to or worn by a person that restricts their movement in any way, including to prevent the person accessing their incontinence/sanitary device or removing their clothing. This does not include gloves or helmets, which are reported as a separate category of mechanical restraint.

•Cuff

A shackle or similar device with a closing mechanism that is applied to the wrist and/or ankle that is in turn attached to a secure fixture. This does not include belts/straps, which are reported as a separate category of mechanical restraint.

•Helmet

Any type of headwear that is worn by the person to limit potential physical damage to themselves.

•Wheelchairs

The application of brakes or the disengagement of the power source of a wheelchair to prohibit a person from independently mobilising. This also includes the placement of a person in a wheelchair who is ambulant in order to restrict their movement.

•Bedrails

The raising of rails on one or both sides of a bed to prevent the person from getting out of bed.

•Tables/furniture

The deliberate placement of furniture in front of a person to prevent them from moving.

Mechanical restraint does not include the use of devices for the following reasons.

•For therapeutic purposes. ‘Therapeutic’ means the use of a device prescribed by a health practitioner for the treatment of a diagnosed medical condition. If such a device is prescribed or suggested by a health practitioner for the purpose of controlling behaviour, this is still considered mechanical restraint.

•To enable the safe transportation of the person. Safe transportation is considered necessary when a person does not remain seated with a seatbelt fastened during the time when they are a passenger in a moving vehicle being used for transportation. If such a device is being used, it must be removed immediately upon the vehicle arriving at its destination otherwise the device becomes restrictive. The use of devices that restrict or modify a person’s behaviour that does not pose a risk to safe transportation is considered restrictive.

(Disability Act, s. 3)

(c)Seclusion (Disability Act, s.3 (1)). The sole confinement of a person with a disability at any hour of the day or night either:

•in any room in the premises where disability services are being provided of which the doors and windows cannot be opened by the person from the inside

•in any room in the premises where disability services are being provided of which the doors and windows are locked from outside

•to a part of any premises in which disability services are being provided, or

•outdoor areas such as back and front yards, verandas, the locking of a person in a vehicle and so on

(d)Other restrictive intervention. Section 58 of the Disability Act requires that a disability service provider must not unreasonably limit or interfere with a resident’s access to his or her room or to the toilet, bathroom or other common areas in the premises that are available for the resident’s use. If a person presents with behaviours of concern that necessitate limiting their access to these areas, these restrictions can only be used in accordance with a Behaviour Support Plan or treatment plan (for compulsory treatment) that has been submitted to the Senior Practitioner. The disability service provider must also implement strategies to minimise the impact on other residents.

(e)Physical restraint – planned emergency response

•Behaviours that are known or can be predicted to occur in a potentially known situation, and where physical restraint is considered as a last resort, and as a planned response to be used in an emergency situation only, should be documented as a ‘physical restraint – planned emergency response’. Physical restraint is not to be used as part of a person’s routine behaviour support.

A physical restraint – planned emergency response for the person must be submitted.

•In developing a physical restraint – planned emergency response, disability service providers must consider all aspects outlined in Appendix 3: in the Senior Practitioner physical restraint direction paper – May 2011: Checklist on the use of physical restraints in an emergency and as a planned response.

Functional behavioural assessment flowchart

  1. Identify the behaviour
  2. Describe the behaviour
  3. Record the behaviour
    Identify settings, triggers, actions, results, when it happens, when it doesn’t

•Use STAR charts

  1. Create a baseline recording for the behaviour

•Use frequency recording sheet

  1. Gather information ‘about the person’
  2. Identify possible function(s) and decide on the final functions

(a)Use information from ‘about the person’

(b)Use patterns from behaviour recording

(c)Use QABF as a guide

  1. Check if the function(s) are correct
  2. Plan positive behaviour supports, complete the behaviours support plan

Functional behavioural assessment - example

Those who support TJ decided to try to find the reasons for TJ’s many behaviours of concern. They conducted a Functional Behavioural Assessment (FBA).

Steps 1 and 2 – Identify and describe the behaviour of concern

Staff looked at incident reports and found that TJ engaged in a number of behaviours. They chose to focus on the kicking as it caused physical harm, it resulted in the use of restrictive interventions, and it happened very often. They agreed on an initial description of this kicking.

TJ can kick people in the legs with enough force to cause injury (bruising and swelling)

Step 3 – record the behaviour

Behaviours recording was completed for one week using STAF charts and a frequency recording sheet (see section 4).

It was found that TJ used the behaviour about eight times a day (frequency). The behaviour could last for up to 10 seconds (duration) and each incident caused injury such as bruising and swelling (impact/intensity).

Patterns that were noticed in the behaviour recording.

  1. The kicking usually occurred when a staff members poke to him and was calling him by names other than ‘TJ’.

•Therefore trigger 1 for his behaviour was; people using names other than TJ and the setting event for this was people not knowing his preferred name.

•Trigger 2 for his behaviour was; people speaking to him, and the setting event for this trigger was people not knowing his preferred way to communicate.

  1. Other important issues: behaviour happened more often with staff member AP, when TJ was ill, it was a hot day, and there were a lot of people and noise in the house.

Step 4 – create a baseline recording behaviour

Staff then wrote a full description of the behaviour with all information on its frequency, duration and impact. This was also used as a baseline recording the behaviour, for example what the behaviour was like before the behaviour support plan and its recommendations were implemented.

TJ can kick people in the legs with enough force to cause injury (bruising and swelling). He does this about eight time a day. The behaviour can last for up to 10 seconds. This has been happening since moving into his new home 3 months ago.

Step 5 – Gather information, about the person’

Staff used the ‘planning guide’ in section 2 of the toolkit to gather information about TJ by contacting those who knew him best and had supported him in the past, and looking though his client file especially for previous behaviours support plans and other reports. Important information that was found included:

•What his intellectual disability was and how interactions and demands on him suit his level of current ability; his communication level, his preferred way to communicate and the best way for staff to understand him and communicate successfully with him, past trauma and the need for professional support, health issues including frequent ear infections, sensory concerns for example sensitive to heat and loud noises, his likes and dreams for his life, and his dislikes (being called names other than TJ).

Information used to decide on triggers and setting events

By talking to people who supported TJ in the past it was found that TJ’s preferred way to communicate was by writing, suing cards or pictures. He never like his Christian name and should only be called ‘TJ’. Staff were then able to complete the behaviour, triggers and setting events sections of the planning guide.

Step 6 – identify possible functions and decide on the functions

Using the information gained through the behaviour recording along with the ‘about the person’ assessment, the staffing team came up with ideas about why the behaviour could be occurring, its function. They then used the QABF to try to put these ideas into sentences (see QABF section 4).

Other functions they considered were ‘TJ engages in the behaviour to get attention’ or ‘TJ engages in the behaviours to avoid having to do something’, however the decided on the following specific functions;

Function 1: TJ kicks other to communicate his protest against being called any other name.

Function2: TH kicks to protest against people communicating with spoken words rather than written or visual communication.

Importantly, the team not only described the basic function, for example ‘TJ wanted to protest’, but also WHY he needed to protest.

Step 7 – checking that the function(s) are correct

Staff checked to see if these functions were correct by introducing some strategies that directly related to them.

•They informed all current and new staff of his preferred name and type of communication and each staff member were given cards, writing pads and pictures to use

•They recorded the frequency of his behaviour and saw that it reduced significantly.

Step 8 - Plan the positive behaviour supports, complete the plan, measure success

Staff completed the behaviours support plan and continued the behaviour recording to ensure the goals of the behaviours support plan were achieved. They compared the baseline behaviours records (step 4) to behaviours recording after the behaviours support plan had been implemented to see if change has occurred for example behaviour incidents reduced from 8 times per day with physical harm to others, to 2 times per day with no physical harm to others. PRN chemical restraint was stopped. A plan to review and reduce the routine chemical restraint was added to the updated behaviours support plan.

New toolkit – Section 4 – Behaviour support planPage 1

Behaviour recording STAR chart

Name:______Location:______

Date / Time / Duration / Setting events
See instructions below / Trigger
What happened immediately before? / Action
What did the client do? / Result
What happened then?How did you respond? / Function/purpose of the behaviour?
12/2 / 4pm / Less 5 minutes / TJ, staff member AP and the other 3 residents were in the house, it was noisy, TJ has an ear infection. / TJ was pacing up and down the hallway holding his ears. Staff member AP called him ‘Tommy’ instead of ‘TJ’. / TJ kicked AP in the leg causing bruising and swelling. / TJ went to his room.AP left the hallway. CA used cards to find out that TJ had an earache and was being called Tommy. / TJ kicks others to protest against being called Tommy because he only wants to be referred to as ‘TJ’. The ear infection is causing him pain

The general conditions which may influence whether the behaviour will happen, some of which may have happened some time before the incident

Setting events / Triggers / Actions / Results
Factors external to the person: e.g. staff changes, level of structure, activity, noise and stress or tension / Factors internal to the individual: e.g. pain, hunger, stress, tension, depression, tiredness, frustration, medical factors (i.e. medical conditions, medication) / The events which occur immediately before which provide a ‘cue’ for the behaviour.The person’s own thoughts and emotions in response to the setting events may also serve as triggers. / The person’s behaviour in response to the trigger. / The events which occur following the behaviour which may achieve an important result for the person: material items (food, preferred items), interaction, escape from undesirable or feared situations, the person’s own emotions.
Atmosphere
•tension
•conflict
•lack of purpose
•high noise level
State
•lack of sleep
•thirst
•pain
•hunger
•depression
•menstruation
•illness / Activities
•uninteresting
•lack of activities
•waiting
•too routine
•lack of routine
•too difficult
•lack of structure
•being hurried
People
•too many
•lack of interaction
•being refused an object/activity
•was reprimanded
•disappointing news / •demands
•tasks
•people
•objects
•sights
•sounds
•unexpected changes / •Write down exactly what the person did / Possible functions:
Wanting something
•recognition
•maintenance of attention
•access to objects
•sensory feedback
Escape or Avoidance
•uninteresting activities
•unending activities
•too difficult tasks
•feared objects, activities or people
Protest
•Expressing views about something

Record the behaviour for 2-3 weeks (less time might be needed if the behaviour occurs every day, more time may be needed if it only occurs weekly). The team can also use the information from recent Incident Reports. At the end of the recording time calculate;

•Frequency (how often the behaviour occurred for the time period eg 3 weeks)

•Duration (how long the behaviour or the incident usually lasts for)

•Impact/Intensity (what was the result of the behaviour eg cut to face requiring medical care)

•Restrictive intervention use (e.g. how often was PRN restraint used in that time)

•Which functions emerged from the recording (see Appendix 3)

Example:

Behaviour description: TJ can kick people in the legs with enough force to cause injury (bruising and swelling). He does this about eight times a day. The behaviour can last for up to 10 secs. This has been happening since moving into his new home 3 months ago. RI use: PRN chemical restraint has been used 5 times in the last 3 weeks.

Function: TJ kicks others to protest against being called Tommy because he only wants to be referred to as ‘TJ’

New toolkit – Section 4 – Behaviour support planPage 1

Frequency recording sheet

Name:____________

This sheet can be used to record behaviour that occurs frequently. List each identified behaviour in a box across the top of the table. Put a tick in the relevant timeslot for every time the behaviour occurred. This recording sheet can be changed from hourly recording to daily or weekly recording.

Date: / Behaviour 1 / Behaviour 2 / Behaviour 3 / Behaviour 4 / Behaviour 5
7.00-8.00am
8.00-9.00am
9.00-10.00am
10.00-11.00am
11.00-12.00pm
12.00-1.00pm
1.00-2.00pm
2.00-3.00pm
3.00-4.00pm
4.00-5.00pm
5.00-6.00pm
6.00-7.00pm
7.00-8.00pm
8.00-9.00pm
9.00-10.00pm

Questions about behavioural function (QABF)

The following questions may assist when deciding on the function or functions of a behaviour of concern. For more detailgo to disability consultants on <

Function: Attention

  1. Engages in the behaviour to get attention.
  2. Engages in the behaviour because he/she likes to be reprimanded.
  3. Engages in the behaviour to draw attention to him/herself.
  4. Engages in the behaviour to try to get a reaction from you.
  5. Does he/she seem to be saying ‘come see me’ or ‘look at me’ when engaging in the behaviour?

Function: Escape

  1. Engages in the behaviour to escape work or learning situations.
  2. Engages in the behaviour when asked to do something (brush, teeth, work, etc.).
  3. Engages in the behaviour when he/she wants to do something.
  4. Engages in the behaviour to try to get people to leave him/her alone.
  5. Does he/she seem to be saying ‘leave me alone’ or ‘why are you asking me to do this’ when engaging in the behaviour?

Function: Non-social

  1. Engages in the behaviour as a form of ‘self-stimulation’.
  2. Engages in the behaviour even if he/she thinks no one is in the room.
  3. Engages in the behaviour because there is nothing else to do.
  4. Engages in the behaviour in a highly repetitive manner, ignoring his/her surroundings.
  5. Does he/she seem to enjoy the behaviour, even if no-one is around?

Function: Physical

  1. Engages in the behaviour because he she is in pain.
  2. Engages in the behaviour more frequently when he/she is ill.
  3. Engages in the behaviour when there is something bothering him/her physically.
  4. Engages in the behaviour because he/she is physically uncomfortable.
  5. Does the behaviour seem to indicate to you that he/she is not feeling well?

Function: Tangible

  1. Engages in the behaviour to get access to items such as preferred toys, food or beverages.
  2. Engages in the behaviour when you take something away from him/her.
  3. Engages in the behaviour when you have something he/she wants.
  4. Engages in the behaviour when a peer has something he/she wants.
  5. Does he/she seem to be saying ‘give me that (toy, item, food)’ when engaging in the behaviour?

Reference: