Using Positive Behavior Support in a Home-Based Program
for Children with Autism
Stanley L. Swartz
California State University
Lilia Lopez and Esther Vazquez
Universidad Autonoma de Baja California
Norma Cruz
Imperial County Program for Children with Autism
Introduction
This home-based program is a United
States-Mexico collaboration that uses Positive Behavior Support. Teachers and therapists provide
programming in the home and a parent support and training group (in English and
Spanish) are provided. Both the
home-based and parent group emphasize the coordination of the application of
Positive Behavior Support in home, community, and school settings.
Use of Positive Behavior
Support
One of the major obstacles to the
inclusion of children with disabilities in both school and the community, is behavior
that is inappropriate and disruptive.
For children with severe disabilities, behaviors such as tantrums,
aggression, or self-injury are challenging beyond what regular education
settings are prepared to handle.
Families of children with severe disabilities are also looking for
assistance beyond the traditional manipulation of consequences offered by most
behavior management programs.
If we are to accomplish
inclusion, it will be necessary not only to identify treatment methods that
work, but ones that will be acceptable in the context of inclusive
environments. The three concepts
of social validity identified by Wolf (1978) are important considerations in
reaching this goal. These are
feasibility - are we able to use the strategy; desirability – are we willing to use the strategy; and
effectiveness – does the strategy make a difference for the individual in
increasing inclusion opportunities?
In other words, we need treatment strategies that both parents and
teachers are able and willing to use and that make a real difference for the
individual and their opportunities to participate in school and in the
community.
Research on the efficacy of
special education is such that the urgency of placement in regular education is
a very real issue for many children with disabilities. Justification for placement in special
education seem unwarranted without some compelling case for its value not only
for academic purposes, but as a larger issue of acceptance and even lifestyle
(Swartz, 1998). The case can be made that the only
obstacle to the inclusion of most children with disabilities is our
preparedness to accommodate their needs, or worse, our willingness.
An increasing body of research in
the use of positive behavior support (PBS) has demonstrated that these
strategies are highly effective for use with the behaviors presented by
children with severe disabilities (Carr, Horned & Turnbull, 1999). In addition, PBS meets the various
social validity criteria in most cases and facilitates inclusion of children
with disabilities. Unlike traditional behavior management, which views the
individual as the sole problem and seeks to “fix” him or her by
quickly eliminating the challenging behavior, PBS views such things as settings
and lack of skill as parts of the “problem” and works to change
those. As such, PBS is
characterized as a long-term approach to reducing the inappropriate behavior by
teaching a more appropriate behavior, and providing the contextual supports
necessary for successful outcomes (ERIC, 1999).
Effective behavior change must
not only reduce inappropriate behaviors it must also teach suitable
alternatives. These changes should
not only help the child in the immediate environment, or the short term, they
must also be important for their life after school, or the long term. The key concept of PBS was then
determined to be to change a problem behavior, it is first necessary to
remediate deficient contexts.
Deficient contexts were found to come in two varieties, those related to
behavior repertoires and those related to environmental conditions. Behavior repertoires means that
the individual does not have the necessary behaviors to be successive. Communication skills, social skills,
self-management are all found to be inadequate for the demands of their
day-to-day existence, whether in school, home, or community. Environmental conditions means that the
stimuli in any particular environment are not conducive to appropriate behavior
for this individual and contributes to the emergence of problem behaviors.
In applying PBS, the research
review completed by Carr and his colleagues found two categories of
intervention: stimulus-based and reinforcement-based (Carr, et al., 1999). When environments are deficient it is
when there are too few stimuli to support positive behavior and that changes in
this environment are necessary as part of the effort to help children with
disabilities exhibit more appropriate behavior. On the other hand, from a reinforcement perspective, the
existence of positive behaviors competes with or makes negative behaviors
unnecessary because the positive behaviors provide an alternative for accessing
the available reinforcement. In
sum, PBS tries to change the environment so that the conditions for appropriate
behavior and its reinforcement are available and to teach appropriate behaviors
as a substitute for accessing reinforcement in the environment.
Positive behavior support appears
to be best suited for long-term change and is proactive to the extent that it
attempts to teach behaviors and impact the environment that surrounds these
behaviors. This is contrasted to
aversive or punitive approaches that seem best suited to a crisis management
mode. From the perspective of the
family, and in keeping with the principles of social validity, PBS would seem
to be the appropriate choice because of its good fit with a family
environment. Parents are
able to work with their children using techniques that are effective and at the
same time part of a normal pattern of interaction. From the perspective of the school, PBS is a good
match because of its suitability for use in inclusive settings and because it
is primarily a teaching method.
Positive behavior support is procedure more likely to encourage the
inclusion of children with disabilities in regular classrooms.
Redirective Therapy
Redirective Therapy was developed
as part of a training program in a university clinic for parents and families
of children with pervasive developmental disabilities (Swartz, 1994). Parents had reported that though some techniques currently
available appeared to be effective, they were too harsh and too unusual as a
pattern of parent-child interaction.
They felt that the treatment became an aversive to both parent and child
because of its intensity and that its suitability for the community or an
inclusive school setting was an issue.
The criteria used in the development of Redirective Therapy (RT) was
that it must allow for a positive interaction between parents and their
children and that it must be suitable for use in all settings. Using research in nonpunitive
techniques (Donnellan, et al., 1998) the strategy focused on a simple pattern
of redirection with teaching an appropriate behavior as the end goal. Similar in this regard to the strategy
identified as differential reinforcement of alternative behavior (DRA),
Redirective Therapy diverged by electing to use only social rewards. It was felt that since one of the
primary goals for most children in the program was increased socialization, the
use of social rewards would be the first important step in teaching social
skills.
Therapists using RT were taught
to interrupt the undesired behavior and redirect the child to an appropriate
behavior. They were instructed to
do this interruption in the least intrusive way possible (for example, a word
or a gesture would be a preferable interruption to a physical cue). Social reinforcement (praise or touch,
or both) would immediate follow the interruption and redirection. In this way, the concern about limited
availability of reinforcement in the use of differential reinforcement of other
behaviors (DRO) could be resolved.
This pattern was repeated until the child stayed on the new task and
exhibited an appropriate behavior.
Parents reported that their good feeling about this strategy was that
they could use it at home and on any trips into the community. In another words, it met both the
social validity criteria of feasible (I can use it) and desirable (I will use
it).
The Imperial County,
California Program for Children with Autism
An Intervention Program for
Children with Autism and a Parent Support Group
Program Design
The Imperial County Program for Children with Autism is an
after school program and parent support group that will provide services to
children with autism and their families. These services include direct work
with children to increase socialization, communication, and appropriate
behaviors, training activities for parents and siblings, and a support group for
parents.
The program uses a model that
recognizes the complexity of providing appropriate programs for children with
autism and the need for collaboration with all service providers. The program
is designed to provide an individually developed behavioral/socialization
program for children with autism to support their maximum inclusion in school
and community activities. The program is supplemental in nature and coordinated
with any other programs currently in place.
The Imperial County Program for
Children with Autism includes various programmatic elements to ensure a high
level of parent support, collaboration with teachers and other professionals,
and a seamless program design that is carefully coordinated.
In Home Program
The Level 1 is an in-home and
community-based program. The
program consists of one-to-one intervention to improve behavior, socialization,
and communication skills of participants. Parents receive instruction on the
use of the strategies employed in this program. Each child has an individual therapist.
Parents are supported with
in-home consultation based on individual needs. Programs are developed for in-home use on problems directly
related to successful participation in the program. Techniques are modeled by program personnel and parents are
directly trained in the use of effective strategies. This program element is
directed at parents (or caregivers), siblings, and other family members. Information collected during in-home visits,
particularly videotaped behavior patterns, can be used to modify programs and
monitor program success.
The Level 2 program is a
center-based program. The
program provides a small group (up to 3) intervention with a two or
three-to-one student, staff ratio to children who make good progress in the
one-to-one program. Children in
Level 2 are trained in the higher level socialization and communication skills
considered to be prerequisite to successful participation in small group
instruction. The Level 2
activities are considered a necessary preparation for transition to more
inclusive settings.
Parent Support Group
Parent support and training are
an integral part of the program for each child. Participation in the support group is required for participation
in the program to promote effective coordination of strategies used at home
with those employed in the program.
Emphasis is on helping parents develop more effective methods of
behavior modification and in establishing a workable daily routine for the
participation of the child in the home.
The support group focuses on various personal and family issues
associated with raising a child with autism. This support group meets weekly and is facilitated by a
trained psychologist. The support
group is conducted in both English and Spanish.
Assessment
All referrals to the program
receive a twelve-hour intake assessment.
This includes an in-home parent interview, videotaping of behavior
samples, a school visit, and a functional analysis of disruptive and
inappropriate presenting behaviors. The results of the functional assessment of
behavior and parent treatment priorities are used to develop the individual
program and to identify the initial target behaviors.
A baseline of behaviors exhibited
in the After School Program are developed during the first month, approximately
12 hours over 4 sessions. A
preliminary goal of 5% increase in appropriate behaviors and an accompanying 5%
reduction in inappropriate behaviors will be established. This progress will be reviewed
quarterly with reports documenting progress in meeting goals submitted on a
semiannual basis to determine program progress continuation.
Parent Support Group
participation is evaluated by parent report and the clinical impressions developed
by the group facilitator.
Continuation is by mutual agreement regarding both the progress of their
child and the usefulness of the support group.
Unique Aspects of the Program
Imperial County, California is a
rural, agricultural area with sparse population that borders Mexicali, Mexico,
a major metropolitan area of more than three quarters of a million people. A large percentage of United States
citizens and their families are originally from Mexico and a large number also
speak Spanish.
This program is challenged both
by language and availability of personnel. The origin of this collaboration was a faculty exchange
program between California State University, San Bernardino and the Universidad
Autonoma de Baja California, Mexicali.
The development of a graduate program in special education in Mexicali
helped create the personnel resources to staff this program. All of the therapists in the home-based
program are Mexican psychologists and all fluent in Spanish and some also
fluent in English. The
facilitators of the parent group are both fluent in English and Spanish and the
group is translated in both languages.
This program is also unique in
its attempts to coordinate the use of Positive Behavior Support as the
intervention of choice in home, school, and community settings. The inclusion of school personnel
continues to be a major challenge for the program.
References
Carr, E.G., Horner, R.H., &
Turnbull, A.P. (1999). Positive
behavior support for people with developmental disabilities. Washington, DC: American Association on
Mental Retardation.
Donnellan, A., LaVigna, G.,
Negri-Shoultz, N., & Fassbender, L. (1988). Progress without punishment. New York: Teacher’s
College Press.
ERIC Research connections in special
education (Winter, 1999). Positive behavior support. ERIC Clearinghouse on Disabilities and Gifted Education.
Swartz, S.L. (1994). Redirective
therapy: Guidelines for use in school and home.
San Bernardino, CA: California
State University.
Swartz, S.L. (1998). Inclusion of
children with disabilities in regular school programs. In Z. Jacobo & M. Villa, Sujeto,
educacion especial e integracion, Mexico: Universidad Nacional Autonoma de
Mexico.
Wolf, M.M. (1978). Social validity: The case for subjective measurement, or
how applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.
Stanley L. Swartz, Ph.D.
Professor of Education
California State University
5500 University Parkway
San Bernardino, CA 92407-2397
and
Director of the Imperial County
(CA) Program for Children with Autism
Telephone: 909.880.5601
Fax: 909.862.4045
Email: stanley_swartz@eee.org
www.stanswartz.com
Lilia Lopez
Professor of Human Sciences
and Associate Director of the
Imperial County (CA) Program for Children with Autism
Universidad Autonoma de Baja CA
Facultad de Ciencias Humanas
Boulevard Castellon y Lumbardo
toledano
Colonia Agricola Esperanza
Mexicali, Baja CA 91350
Telephone: 011.52.68.65.57.59.64
Email: llopez_arriaga@hotmail.com
Esther Vazquez
Professor of Human Sciences
and Associate Director of the
Imperial County (CA) Program for Children with Autism
Universidad Autonoma de Baja CA
Facultad de Ciencias Humanas
Boulevard Castellon y Lumbardo
toledano
Colonia Agricola Esperanza
Mexicali, Baja CA 91350
Telephone: 011.52.68.65.57.55.39
Email: morestherv@hotmail.com
Norma Cruz
Teacher, Calexico (CA) School
District
and
Parent, Imperial County (CA)
Program for Children with Autism
Norma Cruz
932 Sunset
Calexico, CA 92231
Telephone: 760.357.6337