Generalization and Sustainability in Positive Behavior Support

Positive behavior support is most effective when used as one type of framework or theory for understanding social and emotional feelings and behaviors. A theory is an idea that is created using a scientific method to help explain our reality. However, most theories are incomplete and tend to focus on understanding one element of the human experience. Relying on only one theory to understand challenging behavior may not be enough tomay explain the complicated issues occurring with a person's life. Using function-based thinking and the principles of behavior in a plan of support is paired with other theories in order to improve a child or adult's quality of life.

Because evidence-based practices are all based on different kinds of theories, it can be helpful to consider more than one type of positive support practice when helping a child or adult improve the quality of their life. For example, using the principles of both operant and respondent learning can help explain how the environment as well as the internal physical arousal levels within a child or adult can interact in everyday situations and settings.

Positive supports are evidence-based practices that are implemented using person-centered and culturally responsive values with data that can show improvements occurring over time.

Some Examples of Positive Supports

Applied Behavior Analysis (ABA)

• An example of a positive support. People use this practice to change social behavior and improve lives. For instance, parents can use ABA to help their children learn new social skills. Teachers use ABA in classrooms with groups of students or with one child who needs more help to improve academic outcomes. ABA can help adults with disabilities who are living on their own in the community. Businesses organize work settings using ABA so that employees can get more work done. Applied Behavior Analysis can be used to prevent challenging social interactions and improve quality of life. In fact, ABA can be used by people of all ages who want to change behavior in some way. It is important to ask people how they use ABA since it can be used in so many different ways.

Assertive Community Treatment

• Assertive Community Treatment (ACT) improves outcomes for people with severe mental illness and may be more likely to be at-risk of hospitalization and other negative life outcomes including possible involvement in the criminal justice system. The practice involves forming a multidisciplinary team including community outreach and action planning.

Dialectical Behavior Therapy

• A type of cognitive behavioral treatment originally used to support people with borderline personality disorder. Over time, this practice has been expanded to support people with a range of issues that are related to self-regulating behavior. People who learn to self-regulate can recognize and cope better with strong emotions. Dialectical Behavior Therapy or DBT has been used to address a number of mental health issues including post-traumatic stress, binge eating, depression and substance misuse. The main goal of dialectical behavior therapy is to learn four strategies: 1) develop skills to regulate emotions, 2) practice mindfulness skills that help people to live in the moment, 3) increase the ability to tolerate distress, and 4) expand relationship-building skills. Therapeutic settings for Dialectical Behavior Therapy involve working in groups to learn new behavioral skills, meeting for individual therapy, and engaging in coaching sessions.

LifeCourse (Charting the LifeCourse)

• A person-centered planning process is a framework with tools that can be used to help people organize ideas, values, and goals in order to problem solve and improve quality of life over time. Parents, case managers, mental health professionals, teachers, family members and friends, and anyone interested in exploring ways to problem solve, navigate their life, advocate for changes in supports can use Charting the LifeCourse.

Person-Centered Practices

• Three elements of person-centered practices:
  • Person-Centered Strategies that everyone can use to help people learn about what brings joy to someone and makes life worth living. These tools are also used to find out what is important to a person as well as understanding their needs for health, safety, and well-being.
  • Person-Centered Planning is a process that is used to create a plan for a positive and meaningful life for someone by building on their interests and strengths. There are different methods that can be used to help a person create their dreams for a better future.
  • Person-Centered Organizational Changes address how services and supports are planned and delivered. Changes that are made include fixing policies, adding ongoing opportunities for learning, and building community supports. Services for people across the lifespan are changed in ways that improve quality of life outcomes.

Mindfulness

• A therapeutic strategy that involves focusing one's awareness on the present moment. Mindfulness helps people to accept thoughts and feelings and observe these thoughts without judgment. Over time, mindfulness can help people manage strong emotions, and decrease anxiety, stress, and depression.

Motivational Interviewing

• Motivation interviewing is an evidence based practice that provides a collaborative and goal-oriented approach for communicating with someone with a focus on the language of change. This approach helps a person strengthen a personal motivation for working on a specific goal. The focus is on helping people explore their own reasons for change while creating a setting that creates a sense of acceptance and compassion.

Positive Behavior Support

• A framework used to improve the quality of a person’s life and prevent or decrease challenging social interactions. The tools and strategies used in positive behavior support encourage social and communication skills and involve changing social settings to prevent challenging behaviors. Positive behavior support is based on research from areas including biomedical and behavioral science. Research also guides how positive behavior support is implemented in education and human service settings using a tiered model with interventions that gradually increase based on each person's unique needs. The universal level, or tier one, includes interventions for improving the quality of life and social interactions for everyone within a provider setting. The second tier involves monitoring HCBS data to identify problems that a person might have as early as possible and to intervene when challenges are still minor. The third tier is used to create individualized plans for each person who needs more intense supports.

Wraparound Planning

• A process created to support parents of children and young people with mental health needs and challenging behavior are often expected to communicate with a number of different service systems. Each of these services require parents to complete forms, attend meetings, and respond to requests related to services. Juvenile justice, children and family services, special education, mental health, and developmental disabilities are all examples of these different services. The wraparound plan is mean to help youth and their parents by improving service coordination. Wraparound planning is a team-based approach that is child and family driven. Team members include natural supports (friends, family members, and people who know the child or young person well). Individuals from formal supports might include a parole officer, counselor, psychiatrist, or special education teacher. The goal of wraparound is to assess the child and family strengths in order to build a plan of support that will improve quality of life.

Response to Intervention or RTI

• An educational practice that involves early identification of the academic and social supports needed for all students in school. An increasing continuum of interventions is provided to students needing more educational and behavioral support to ensure academic success. The RTI model has three tiers of academic interventions that increase in intensity across each tier. RTI involves effective instruction for all students and universal screening in general education classrooms. Students struggling with academic goals are provided with interventions based on what they need to improve learning outcomes. Student progress is monitored on an ongoing basis with each child receiving the needed intensity and duration of instruction based on the data that are being collected to monitor and improve progress.

Trauma-Informed Support

• Trauma-informed support is a practice that is meant to help people understand the widespread impact that trauma has had on people and to:
  • Teach people to become more aware of signs that trauma may be having an impact on a person
  • Understand and support pathways for recovery from trauma for people in need of support
  • Recognize signs of trauma in people around us
  • Integrate trauma-informed language and supports into organization-wide policies and procedures.

Trauma-Informed Cognitive Behavior Therapy.

• Traumatic life experiences such as child or domestic abuse, natural disasters, or other negative life events can have a lasting impact on a person’s health and emotional wellbeing. Trauma-Informed Cognitive Behavior Therapy is an evidence-based practice that addresses this issue. Trauma-Focused Cognitive Behavior Therapy is a positive support that teaches children and adults skills to recognize negative or unhealthy thoughts associated with past experiences and to engage in stress management and coping strategies when these thoughts occur. This approach can also include teaching new skills for parents and caregivers of children involved in therapy. A family therapy approach is used to help recognize family dynamics, teach new parenting skills, support stress management for both child and family members, and work on improving communication skills.

Systems of Care

• A system of care is a coordinated network of community-based services and supports designed to meet the challenges of children and youth with serious mental health needs and their families. These partnerships of families, youth, public organizations and private service providers work to more effectively deliver mental health services and supports that build on the strengths of individuals and fully address children’s and youths’ needs. These systems are also developed around the principles of being child-centered, family-driven, strength-based and culturally competent, engaging youth and involving interagency collaboration.