Feature Issue on Person-Centered Positive Supports and People with Intellectual and Developmental Disabilities

Person-centered positive supports relies on evidence-based practices that are person-centered, promote quality of life, and prevent the use of aversive procedures for children, youth, and adults. This description is consistent with the objectives associated with both applied behavior analysis (ABA) and positive behavior support (PBS). In this article we will provide a brief overview of applied behavior analysis and its relationship to the origin of positive behavior support and person-centered planning (PCP) (see Figure 1).

What is Applied Behavior Analysis (ABA) 

The best definition of ABA was written by the founders of the journal bearing the name of this area of study in an article written by Baer, Wolf and Risley (1968). In it they state that applied behavior analysis:

…is the process of applying sometimes tentative principles of behavior to the improvement of specific behaviors, and simultaneously evaluating whether or not any changes noted are indeed attributable to the process of application – and if so, to what parts of that process. In short, analytic behavioral application is a self-examining, self-evaluating, discovery-oriented research procedure for studying behavior. (p.91). 

The foundations of applied behavior analysis were described by Baer, Wolf, and Risley (1968). They proposed seven criteria that should be included in ABA research when considering procedures for address­ing behavior(s) that may be challenging in nature

These criteria indicate that behavioral interventions should:

• Be socially significant (i.e. applied).
• Indicate a behavior is in need of improvement.
• Be clearly defined.
• Reflect a relationship between the behavior and the environment.
• Permit a demonstration of relationships that are reflective of basic principles of behavior.
• Be implemented with behavior that can be effectively changed.
• Result in lasting change that occurs across a range of environments.

Person-centered planning complements PBS because it helps create a person-centered environment in which socially significant behavioral interventions will be successful. Applied behavior analysis principles can be used within PCP to support goals related to independence, communica­tion, and building relation­ships. It is important to acknowledge from the out­set that there are a number of variables involved in positive supports. Some of those involve internal variables within the indi­vidual and it is important to note that not all of the components of support are easily defined. We embrace eclectic approaches to positive support that are evidence-based and further propose that it does often require a “village” of support components for many individuals with challenges that require a plan of positive supports.

The Role of Applied Behavior Analysis in Positive Support 

Applied behavior analysis has had a signif­icant impact on society and many individ­uals are familiar with at least some of the common terms and concepts. With this familiarity, however, there have also been misunderstandings and reactions both in support of and against ABA.

The idea that behavior can be shaped and changed, for some, is equated with control. Embracing ABA does not automatically mean that control is the only way of un­derstanding behavior. Instead, ABA is one tool set that can assist in explaining why we behave the way that we do in certain situations. Some feel that ABA is just a cookbook used to govern behavior. On the contrary, ABA emphasizes the importance of understanding environmental variables unique to an individual and understanding the function of the behavior that is unique to the individual. Unfortunately, some interventions from ABA’s early history have resulted in a view of ABA as an intrusive approach. While this is true to some degree, the trend by practitioners and researchers in ABA has been to minimize intrusive prompts; when they are used they are faded as quickly as possible.

Person-centered planning should be implemented prior to pbs because it helps create a person-centered environment in which socially significant behavioral interventions will be successful. Applied behavior analysis principles can be used within PCP to support goals related to independence, communication, and building relationships.

Positively speaking, ABA has been associated with fundamental changes in how we view behaviors in a variety of settings and across a variety of behaviors with respect to persons who engage in problem behavior. For example, the principles of ABA form the basis for a number of preventative and proactive strategies aimed at facilitating a balance between empowering individuals to more clearly communicate their wants and needs (Wacker & Reichle, 2016) as well as facilitating improved self-regulatory skills (Reichle & Wacker, 2016). When implemented in combination, these supports have enhanced the contributions to society made by individuals with a propensity to engage in problem behavior.

Professionals implementing ABA now consider the increase in quality of life and socially important outcomes (social validity) a necessary part of behavioral support. Additionally, they are respectful of the values and experience of people who provide support for persons with disabilities. This focus on individual preferences and goals is often referred to as contextual fit, a component of social validity. Lucyshyn (2005) defined contextual fit as, “The extent to which the elements of a behavior support plan are consistent with the values, skills, resources, and administrative support of those individuals who must implement the plan” (p.1). Wolf (1978) first described the importance of evaluating the significance of the goals of an intervention program, the appropriateness of the program’s procedures. Schwartz and Baer (1991) refined the concept of social validity to include a summative intervention satisfaction measure and the feasibility of carrying out the treatment. The authors also concluded that contextual fit is an important aspect of social validity.

Principles and practices associated with ABA were the driving force in the development of PBS. For example, conducting a functional behavioral assessment (FBA), a common tool used in schools and in clinical settings, has been driven largely by ABA research (Reichle & Wacker, 1993; Scott et al., 2005; Shriver, Anderson, & Proctor, 2001). An FBA provides specific strategies used to gather and analyze information about how certain environmental variables influence behavior. It also focuses on observational strategies, which generate information about the way the individual reacts to environmental variables and the way that we, in turn, react to the individual. The results of an FBA shed light on a number of reasons why a person may engage in problem behavior (e.g., the function of the problem behavior) and allow a precise matching of support strategies to an individual’s interests and needs. Together, they better inform how to assist in improving a person’s quality of life.

The basic principles of ABA are easily linked to principles associated with PBS and PCP. All of these areas focus on identifying socially important supports (which can involve individual and/or social partner behavior) that will result in fostering a range of behaviors that can be well maintained and generalized. This is also an important outcome associated with PCP and PBS activities. Identifying the function of a problem behavior, linking results of that assessment to positive sup­port strategies, and evaluating the effects of those support strategies for persons are all important components of PCP and PBS. Many tools useful in the evaluation of PCP and PBS outcomes were developed via ABA research.

There are several underlying values that are critical to ABA, PBS and PCP. These include that:

• The focus person and family members’ views are critical for successful planning.
• The processes used to derive support plans are collaborative and dynamic.
• There is a commitment of all team members to the process.
• The major focus of the planning process is to increase quality of life for the focus person by developing his or her relationships and strengths.
• A balance of supporting what is important to people and what is important for people is critical.

The Role of ABA inPerson-Centered Planning and Mental Health

Similar to ABA and PBS, the ultimate goal of person-centered planning is to help the person live a meaningful life in which the person serves as a valued member of both community and so­ciety, facilitated by enhanced support and community participation. The PCP process focuses on an individual person’s desires and aspirations. It engages the person and other stakeholders, such as the person’s family and treatment profes­sionals, in the ongoing task of designing strategies that support what the person needs in order to live a preferred life with hope for a desirable future. Just as with ABA and PBS, PCP is fluid, reponsive, and ongoing.

PCP processes are designed to discoverand organize information that offers support to the development of a positive behavior support plan. As mentioned previously, ABA, PCP and PBS put the individual at the center of the process and all supports are designed with this in mind. There is a focus on the individual and creating supports to meet their unique needs rather than fitting an individual into existing programs and services.

Future of ABA

Among a large array of areas of growth for ABA is the area of setting events as they relate to many populations that include aged people as well as people with mental health issues. Bambera and Kern (2005) defined setting events as a physiological, cognitive/emotional, social, or environmental condition, past or pres­ent, that heightens the relevancy of an antecedent event that is associated with problem behavior. Better understanding and identifying of setting events, especially physiological and cognitive/emotional, may help to better inform mental health treatment. For example, the tone of voice that one uses in speaking may act as a trigger for problem behavior for a partic­ular person. Altering one’s tone may have a significant impact on the propensity for problem behavior to be emitted. Similarly, not having a first cup of coffee in the morning may make an individual much more likely to become annoyed with a peer. Both of these can be remedied by altering events external to the person who is the focus of a support plan.

It is important to remember that the principles of ABA focus on increasing an individual’s ability to participate meaning­fully in their community by:

• Reducing barriers.
• Teaching self-regulatory skills.
• Enhancing communicative as well as other self-advocacy skills.
• Increasing their overall quality of life.

Summary

Applied behavior analysis, positive behavioral support, and person-centered planning share common goals of:

• Increasing the focus person’s involvement and participation in the community.
• Creating, developing and enhancing meaningful relationships between the focus person and others.
• Expanding the opportunity for the person to express and make choices.
• Creating a dignified life and relationships based on mutual respect and need.
• Developing skills and areas of expertise for team members and the focus person that lead to improved quality of life.

Looking forward, PBS and PCP may be­come better blended. When this occurs it will greatly enhance our support capability with a wide range of persons who currently require a significant improvement in the quality of their lives.