Positive Behaviour Support Plan for DN

PBS Plan for DN’s Morning Routine

Routine: Morning routine

Introduction:

DN is a charming 14 year old girl who lives with her parents, two siblings and her parental grandmother. DN has a diagnosis of global delay that affects her cognitive ability, language and learning. The purpose of this behaviour support plan is to address the problem behaviours that DN is engaging in, in the mornings on school days. The plan is based on a comprehensive functional assessment and has been developed in collaboration with the family and the school team (class teacher and resource teacher).The plan includes the family’s vision of a successful routine, summary of the functional assessment and a description of the multi-component positive behaviour support plan.

Family’s vision of a successful Morning Routine:

The parents expect DN to wake up without any resistance, complete her morning routine and be ready for her school bus on time. The morning routine includes: wake-up, use the toilet, brush teeth, wash face, change into school clothes, eat breakfast, take lunch, backpack and jacket and wait for the bus in the store area. They want DN to talk politely especially when she interacts with her mother in the morning.

Functional Assessment Summary

Behaviours of Concern:

Aggressive behaviour: Aggressive behaviour is defined as any instance of DN engaging in kicking, banging doors, hitting the wall or a person and throwing things.
Bad Language: Bad language is defined as any instance of DN using derogatory words to address her mother (e.g. bitch), saying “f-off” or threatening to do harm (e.g. “I will break you”.)

Function of the problem behaviour:

DN’s problem behaviours serve one function or purpose and that is to escape and delay the demands that are placed on her in the morning (e.g. wake-up, get dressed, have breakfast, take lunch in bag and wait for the school bus)

Person/ecological/lifestyle factors:

There are several ecological or lifestyle factors that set the stage for problem behaviours in which DN wants to escape. A brief description of the factors is given below:

Unsupportive environment: There is no structure and predictability in DN morning routine and bedtime routine. In addition DN is not offered any choices with food, clothes or the sequence of activities that need to get done in the morning.
Receives limited support from adults:DN does not do well in an environment in which she has little control, parents impose demands on her repeatedly and she receives very less encouragement for her efforts. In addition she has a history of conflict with her mother which increases the likelihood of occurrence of the problem behaviours in the morning.
Developmental Disability: DN disability is a pervasive factor that sets the stage for many of the problem behaviours. She takes time to process directives given to her, has limited attention span and has a limited understanding of the expectations of the morning routine.
No private space: DN’s sleeping arrangement (sleeping on the extension of a queen size bed with her grandmother and her younger sister) makes it very difficult for her to have good sleep at night. This further contributes to problem behaviours in the morning.

Triggers:

The specific observable events in DN’s morning routine that trigger the problem behaviour are

(a) Asked to wakeup by mother

(b) Demand is repeated; and

Positive Behaviour Support Plan for DN’s Morning Routine

Ecological/lifestyle Strategies:

Use visual strategies: Use visual strategies to enhance predictability and choice. These include (a) a visual strip of the tasks that need to be completed in the morning routine (b) choice board in which DN is given an opportunity to choose a preferred item or activity (c) picture sequence of the positive contingencies (e.g. get ready by 8.15 and you can earn $1 ) (d) countdown strip to indicate number of times she can ask for delay.

Make bedtime positive for DN: Spend 5 minutes with DN before she goes to bed. During this time talk something positive about the day. Do not insist that she answer your questions about her day. Model sharing by talking about your day. Tell DN that you love her very much. Review the morning routine. Ask her what she would like the next day by presenting the choice board to her. Let her know that her choice item will be put on her schedule. Leave the room by telling DN that you are confident she will do well the next day.

Make waking up pleasant for DN: Use specific steps to achieve this

Sit on her bed and wake her up with a pleasant tone.
Spend 5 minutes engaging in positive conversation with DN. Make sure you place no demand on her at this time. Examples: “DN it looks like a great day today”, “You look very sleepy today”, “I am glad it is Friday” etc. Also, avoid asking her questions as she may experience questions as aversive.
Present her the choice board and ask her to choose a preferred item.
Place the choice item at the end of the visual sequence.
Remind her of the positive contingency.

Create a space for DN that she can call her own:

It will be helpful for Donna to have her own space. This includes a place to sleep and a place to keep her clothes and other personal items. This will help her get undisturbed sleep through the night and will increase her accessibility to things she needs to complete her morning routine (e.g., clothes, backpack, etc.)

Quality of life: To improve DN’s overall quality of life three specific strategies have been identified below. These strategies are critical for long term meaningful gains for DN and her family. By improving DN’s overall quality of life we will bring down the chances of her engaging in problem behaviours.

a)Help DN develop a positive relationship with her mother. Schedule a time during the week for DN to spend time with her mother, engaging in activities that she enjoys (e.g. bowling, swimming ) and build on positive non demanding interaction.

b)Involve DN in household activities that she likes more regularly like cooking in the kitchen with her grandmother. Encourage her and praise her for her efforts.

c)Develop a “circle of friends” for DN. With the help of the school team identify peers with whom DN connects well. Teach DN to talk to them over the phone from home. Use the help of DN’s life skills worker to schedule visits in the community where DN can connect with her peers and participate in fun activities together.

Preventive strategies:

Wake DN up at 7.00am instead of 7.15am:

This will give you enough time so she can request delay and you can honour the request without increasing the pressure of getting her ready for school. Also, consider using an alarm clock with radio station alarm to wake her up in the morning.

Positive Contingency Statements:

Use prompting strategies that promote cooperation:

These include(a) positive contingency statements (e.g. “you get ready by 8.15 and you can earn $1.00”, “Wake up and you can have your favourite snack to eat”.

Pre-correct difficult task (waking up):When you wake DN up remind her that she can use language to ask for 5 more minutes. Provide prompts when needed.

Teaching strategies:

Teach DN to verbally request for 5 more minutes when she is woken up in the morning. When teaching use the following strategies:

The language you want to teach her is: “I want 5 more minutes” or “I want some time”.
Model using verbal language to request for 5 more minutes
Prompt DN to use language to request delay when you wake her up (pre- correct strategy)
Praise her efforts for trying and successful use of language.

Countdown strip:Begin by letting DN know she can ask for delay 3 times. Have a countdown visual strip posted on her wall. Review the countdown visual at night before she goes to bed. Explain to DN that she can ask for 5 more minutes when she is woken up in the mornings. In the morning prompt DN to use words to ask for five more minutes. When she does, honour her request by giving her 5 more minutes.Take away one visuals from the count down strip. Provide DN with descriptive praise followed by a preferred item. If DN makes a mistake, just direct her to use it again and praise her efforts. Once DN is successful in using her words to ask for delay, gradually fade the number of times she can ask for delay to suit what is comfortable to the family (two times)

Teach DN to wake up, follow the morning routine and be ready for the bus on time. When teaching use the following strategies:

Use self monitoring sheet to accompany the visual sequence strip for morning routine

Post the visual sequence strip on the wall in DN’s room.

Review the morning routine with DN.

Introduce a self monitoring sheet and prompt DN to check off as she completes a task on the schedule. Praise her for her efforts and gradually fade the prompts.

Use a time-timer: Help DN see the passage of time visually using a time-timer. It will be better to inform her of the time she has remaining for her to be ready for the bus on time.
Use “safety signals”: While DN is getting ready use safety signals to help DN predict when the task (morning routine) will be done and when she will get access to the preferred item ($1.00). Example: “You just have to get your lunch and your jacket and I can give you your $1.00”

Effective consequences:

Praise DN and give her a preferred item when she wakes up without resistance, completes her morning routine and gets ready on time for her school bus. When you give DN a preferred item provide DN with descriptive praise so she knows why she is getting the preferred item. (For example: “DN I really liked the way you got ready on time today”, “You are ready on time, I am proud of you”. ) The reinforcement must be given to her immediately after she is ready on time and before she gets on the bus. Mrs. N can give her the reinforcement when she is waiting in the store area for the bus.

Allow DN to take an additional 5 minutes when she request delay verbally. If you wake her up and she says “Mommy 5 more minutes” allow her to take 5 more minutes.

For minor problem behaviour (grumbling, shouting, and covering her ear when asked to wake-up ):
Actively ignore and positively redirect the behaviour. Tell DN that she can use words to ask for 5 more minutes. When she uses words,honour her request and provide her with a 5 minute delay in waking up. It is important to tell DN what you would LIKE her to do rather than tell her what you do not want her to do.

If DN engages in moderate to high intensity problem behaviour (e.g., punching the wall, kicking , shouting using bad language directed towards mother, throws things), then immediately tell her in a firm and disapproving tone of voice “That is not okay”. Let her know only once that she did not get her preferred item because of the way she behaved. In a calm and supportive tone let her know that she will have to try again next day to earn her preferred item. Do not engage in a lengthy discussion about the consequences of her behaviour. Also ensure that she does not escape going to school as a result of her behaviour. Mr. N will drop her to school on days she misses the bus.

Reinforcement at school: On days DN has a successful morning routine make sure she is reinforced by her class teacher with praise and access to a preferred item at school. Her success with the morning routine will be communicated to the school by the family by giving DN a sticker in addition to the preferred item at home.

Evaluation:

An implementation checklist will serve as the evaluation tool to monitor progress. Parents will be asked to complete the implementation checklist every day. I will meet with the parents to review progress initially on a biweekly basis and then on a monthly basis.Any modifications necessary will be made. The checklist will include:

Level of Problem behaviour:Parents will record the level of problem behaviour everyday.

Implementation fidelity:The parents will use the implementation checklist provided to them to record data on the use of the strategies outlined in the positive behaviour support plan.

Social Validity:This includes evaluation of goals and strategies outlined in the PBS plan, effort needed to implement the strategies, DN’sparticipation in the morning routine.

In addition DN’squality of life (e.g. relationship with her mother, predictability at home, DN’s“circle of friends”, choices offered to her in activities at home, school and in the community) will be reviewed at 6 month review and at the end of service.

Implementation Checklist

Morning routine for DN

Date ______Person Completing the Checklist ______

Purpose: To help you implement DN’s positive behaviour support plan. It can be used to

Remind you of what to do to support DN.
Help you plan what you will do to support DN.
Self evaluate your level of implementation

Instructions for using the checklist:

Before using the plan it is important to read the detailed plan so you have a god idea of how to implement the strategies listed below. On the right hand side is a place to evaluate your level of implementation. A “1” indicates that the strategy is not in place yet or you were not able to do it. A “5” indicates that the strategy is well in place or you implemented it well.

It also provides a place to assess: (a) levels of problem behaviour and (b) the importance and acceptability of the plan (social validity).

Not in In

place place

Create a space for DN at home. Keep all items that belong 1 2 3 4 5

to DN in her space.

On a weekly basis structure time for DN to spend time with her mother engaged

in preferred activity. 1 2 3 4 5

Structure activities that DN enjoys into her everyday schedule

(e.g., cooking food with grandma.) 1 2 3 4 5

Establish a circle of friends for DN. 1 2 3 4 5

Use visual picture schedule to increase structure, predictability

and choice:(a) Review the schedule (b) offer her choices in clothes

food and activities using the choice board (c) remind her of the positive

contingencies and (d) use countdown strip to inform her of number of

times she can ask for delay. 1 2 3 4 5

Wake DN at 7:00am instead of 7:15 am. 1 2 3 4 5

Use positive contingencies to motivate DN to wake up (e.g.,Get ready

on time and you earn a $1.00). 1 2 3 4 5

Pre-correct DN: Wake her up by reminding her that she can

ask for 5 more minutes in bed. 1 2 3 4 5

Teach DN to use language to ask for 5 more minutes. Let her ask upto 3 times

to begin with (i.e. 15 minutes)Gradually fade the number of times she can ask

for delay. 1 2 3 4 5

Teach DN to follow the visual schedule: (a) use a visual time-timer

(b) Use safety signals to build endurance (e.g., Just get your backpack

and you can $1.00) and (c) model the task and provide her prompts

to follow the schedule. 1 2 3 4 5

Prompt DN to use the self monitoring sheet. Praise her efforts. Gradually

fade the prompts. 1 2 3 4 5

Praise DN and provide her with something she really likes

when she wakes up without resistance and is ready on time. 1 2 3 4 5

When DN use’s her words to ask for 5 more minutes when you wake

her by honouring her request. 1 2 3 4 5

For minor problem behaviours (e.g. covering her ear, grumbling),

actively ignore and prompt her to use language to request for 5

more minutes. Then honour the request. 1 2 3 4 5

For major problem behaviour (e.g., punching the wall, kicking , throwing

things) verbally reprimand her once. “That’s not okay”. Ensure she and others

around her are safe. Do not give her reward that morning. When she is calm,

talk to her in a supportive tone and let her know that she will have to try again

the next day to earn the reward. Make sure she goes to school after that. 1 2 3 4 5

Level of Problem Behaviours during Morning Routine ______

1. Aggressive behaviour Never Rarely Sometimes Often All the time

2. Bad language Never Rarely Sometimes Often All the time

Evaluation of Social Validity Disagree Agree

1. The goals of the morning routine are acceptable and important. 1 2 3 4 5

2. The strategies are useful and effective 1 2 3 4 5

3. The strategies are difficult to use 1 2 3 4 5

4. DN is successfully participating in the routine 1 2 3 4 5

5. We believe the morning routine is successful 1 2 3 4 5

If you have any further questions about implementing or about the plan please call me at ______or email me at ______