Functional Behavioral Assessments

1. Functional Behavioral Assessments Brandy Kreisler, MA, LLP, QMRP Board Certified Behavior Analyst Shiawassee County Community Mental Health Authority

2. Learning Objectives • Understand the basic components of a FBA • Understand the common functions of behaviors • Identify various tools to utilize when conducing FBA • Understand the importance of utilizing the outcomes of the FBA to guide in creation of an effective treatment plan

3. What is Applied Behavior Analysis? • Field within psychology that encompasses many principles and procedures • Basic philosophy: The effects of our actions determine whether we will repeat them • Priority is teaching new skills/ behaviors by altering the environment and replacing undesired behaviors with more appropriate behaviors • Data driven: Scientific demonstration that intervention was the cause of the behavior change

4. What is a Functional Assessment? • It is an analysis of the variables that maintain inappropriate behaviors or problem behavior. • The ultimate purpose is to identify the function of the behavior and then use this analysis to create a behavior intervention plan. • There are three methods one can use, • Informant assessments • Descriptive assessments • Experimental functional analysis

5. Why should we conduct a Functional Assessment? • It directly addresses the individual’s motivation for engaging in the behavior instead of ignoring it. • It facilitates the teaching of replacement behaviors. • It diminishes the reliance on aversive, intrusive or restrictive procedures. • It helps staff and family understand how their interactions and behaviors affect the behaviors of the person engaging in problem behaviors.

6. Basic Components of FBA • Relevant Background Information • Description of the problem behaviors or behaviors of concern • Assessment Plan • Assessment Results • Treatment Data • Recommendations

7. Relevant Background Information • This information is gathered via interviews with staff, supports coordinator, family, guardian, consumer and other important people in the consumer’s life. • Basics: • Demographics • Physical health conditions and diagnoses • Mental health conditions and diagnoses • Medications • History of problem behaviors and/or baseline data • Communication skill level • Previous cognitive and/or psychological testing if available • Learning history

8. Description of the Behaviors of Concern • Provide a descriptive definition of the behaviors of concern for that consumer • Use language that is clear and easy for staff to quickly identify when it occurs • Examples: • Self injurious behaviors is defined as sticking fingers under the eyelids and applying pressure to the eye with fingers and/or applying pressure to the closed eyelid or to the eyebrow bone. • Self Injurious behaviors is defined as physically harming herself by scratching her skin, particularly on her face, and/or punching, slapping, or pinching her face and/or bodywhich results in redness of the skin or an open wound. • Self injurious behavior is defined as audible or forceful slapping/hitting her head and face for approximately 60 to 90 seconds resulting in redness, bruising and/or bleeding of the skin.

9. Assessment Plan • Informant Assessment • Unstructured behavioral interviews • Functional Analysis Screening Tool (FAST) • 2005 The Florida Center on Self-Injury • Functional Behavioral Assessment Inventory • 2002 The Florida Center on Self-Injury • Motivation Assessment Scale • 1996 V. Mark Durand, PhD • Vineland Adaptive Behavior Scales • 1984 American Guidance Services, Inc. • Adaptive Behavior Assessment System II (ABAS) • 2000 Western Psychological Services

10. Assessment Plan Continued • Descriptive assessment • Conduct multiple direct observations in the natural environment • During times in which behavior is more likely to occur • Transitions, meals, day program, school, and/or community outings • Staff meetings and/or trainings • Conduct as many observations until you have seen the behaviors in multiple situations • Review Antecedent-Behavior-Consequence data collection from staff and/or family • Review data collection on sleep, bowel movements, urination, doctor visits, medication treatments, illness etc.

11. Assessment Results Environment • Describe where the behavior is more likely to occur • Describe the times of day it is more likely to occur • Describe who has witnessed the behaviors Reinforcers (Likes, strengths, desires) • Favored activities, items, food, social activities, colors, sounds, sensory activities, hobbies • Favored staff and/or personalities who work well with consumer • Post this information in the consumer’s house book for staff to reference on a daily basis

12. Assessment Results Continued Antecedents • Describe what typically occurs immediately before each problem behavior occurred • Look for trends in • Activities (ADLs, community outings, transitions) • Environment (loud, chaotic, quiet, background noise, crowds) • Staff or family’s interactions with consumer (too many demands, staff’s anxiety, personal space, told to wait, confronting/authoritative approach, favored item removed, unclear instructions) • Consumer’s level of frustration, communication and motivational state prior to the problem behavior • Review medical conditions that may effect the behavior (sleep, constipation, pain, seizure, diabetes, ear infections, GERD, allergies, premenstrual syndromes)

13. Assessment Results Continued Consequences • Describe what occurs immediately after the behavior occurred • What does the consumer receive for engaging in the problem behavior? • Look for changes in • environment (crowd was removed, lights turned off, more staff in area) • staff/family interactions (attention by asking what’s wrong, staff walked away, demand terminated, time out given, sympathy given, desired item given) • consumer’s frustration level , communication, and motivational state after the behavior (calmer, desired item given, given pain medication, desired activity provided, consumer’s now alone, hunger decreased)

14. Function of the Problem Behavior • Problem Behaviors maintained by Attention from others • Access to preferred items, people, or activities • Problem Behaviors maintained by Escape • Demand or instruction is terminated, postponed or avoided • Problem Behaviors maintained by Self-Stimulation • Sensory or perceptual feedback including vestibular sensations, visual patterns, repetitive sounds, tactile or kinesthetic sensations • Problem Behaviors maintained by Pain Attenuation • Mediates pain or distracts from pain

15. Treatment Data • Create data collection sheets that are easy for staff to use • ABC data collection sheets • Frequency tables and charts • Scatter plots • Track each problem behavior separately • Use behavioral data sheets to track sleep, bowel movements, urination, and use of PRN pain medication • Present data in charts or graphs for easy reference • Summarize the environmental or personal changes the consumer experienced over the year that may affect the frequency of problem behaviors(new roommates, deaths in family, change in housing/schooling)

16. Recommendations • The purpose of this section is to determine the necessity of a Behavior Intervention Plan as well as identify other treatment modalities. • Identify • needs that are outside scope of practice that will benefit consumer (OT, PT, Speech, or Nursing ) • environmental issues that need to be changed (living arrangements, guardian involvement, creation of visual tools) • new skills for consumer to learn (anger management, relaxation) • Specific trainings and/or education for staff and family • Make referrals • Individual or group therapy, social skills groups, DBT groups • Psychiatric evaluation to determine a possible mental health need • Medical evaluation to determine or rule out a possible health issue

17. Now that we have information about the function of the behavior, How do we use this information to create an effective treatment plan?

18. Why is it important to match the Intervention to the Function? • If we understand what motivates a person to engage in problem behavior, we can then rearrange the environment so that person will obtain the same result when engaging in a more socially appropriate behavior. • This in turn allows us to more thoroughly identify techniques to utilize that will be the most beneficial for that consumer.

19. Remember the 4 common functions? • Problem Behaviors maintained by Attention from others • Problem Behaviors maintained by Escape • Problem Behaviors maintained by Self-Stimulation • Problem Behaviors maintained by Pain Attenuation

20. Problem Behaviors maintained by Attention from others • The goal for this function is to rearrange the environment so the person can obtain attention/needs more appropriately. • Suggested Interventions • Noncontingent Reinforcement • Extinction • Functional Communication Training • Positive Reinforcement for Specific Social Behaviors • Visual cues or rule cards to prompt desirable behaviors

21. Problem Behaviors maintained by Escape • The goal for this function is to rearrange the environment so the task is not as difficult and/or provide the person the opportunity to escape or avoid the aversive situation only when engaging in more socially appropriate behavior. • Suggested Interventions • Task analysis and use forward/backward chaining to teach the difficult task • Functional communication training • Contingent Breaks • Visual timers and clocks • Picture schedules • Visual cues for desirable behaviors • Intersperse easy tasks between hard tasks • Provide choices

22. Problem Behaviors maintained by Self-Stimulation • The goal for this function is to rearrange the environment so the person obtains similar sensory input or sensations from a more socially appropriate behavior • Suggested interventions • Referral and collaboration with an OT • Noncontigent reinforcement • Sensory extinction • Teaching/strengthening leisure skills • Differential reinforcement of alternative behavior • Differential reinforcement of incompatible behaviors • Visual cues or rule cards for desirable behaviors

23. Problem Behaviors maintained by Pain Attenuation • The goal for this function is to ensure the person has the best medical treatment for their condition and rearrange the environment so the person obtains pain attenuation from a more socially appropriate behavior • Suggested interventions • Referral and collaboration with medical staff • Education and training to staff on pain management • Continuous monitoring of sleep, constipation, diet, pain, exercise, medications side effects • Funcitonal communication training

24. Changing Behaviors • The purpose of a behavior intervention plan is to change a behavior. • In order to change a behavior, we have to change the environment. • In order to change an environment, we also have to change the responses of the people in that environment. • Ultimately, a behavior intervention plan for problem behaviors is for the staff and family, not the consumer. • Therefore, as the creators of the BIP, we also have to structure the environment for staff and family to effectively implement the plan as written.

25. Monitoring Success • One of the most important but often overlooked aspect of assessments and behavior intervention plans. • Staff/family spend the most time with the consumer and often know them best. • Utilize their input as much as possible. • Tailor the data collection and intervention to their skill level. • Provide support, education and modeling as often as necessary. • Provide praise and encouragement to reinforce their behavior change. Only then, will we be effective in changing a consumer’s problem behavior.

26. Any Questions?

27. References • Carr, J.E. & LeBlanc, L. (2003). Functional Analysis of Problem Behavior, in Cognitive behavior therapy, Applying empirically supported techniques in your practice. • Iwata, B. A., et al., (1994). The functions of self-injurious behavior: An experimental-epidemiological analysis. Journal of Applied Behavior Analysis, 27, 215-240. • Martin, G. & Pear, J. (1999). Behavior Modification: What it is and How to do it6th Edition, Prentice Hall, New Jersey. • Malott, R., Malott, M. & Trojan, E. (2003). Elementary Principles of Behavior 4thEdition. • Functional Analysis Screening Tool (FAST), 2005 The Florida Center on Self-Injury. • Motivation Assessment Scale, 1986 Mark Durand, Ph. D. • Adaptive Behavior Assessment System II 2nd edition, 2000, Western Psychological Services.