Best Practices Behavioral Consultation: Lessons Learned Along the Way.NWPBIS Conference

Vanessa Tucker, Ph.D., BCBA-DPacific Lutheran UniversityTucker Consulting, LLC

Short Session Agenda

• Brief Introductions• Advanced Organizer: What is behavioral

consultation?• Lessons From the Road• Lessons Redefined• 1) Expectations • 2) Assessment Practices• 3) Planning Practices• 4) Intervention• 6) Data Collection and Review

What is Behavioral Consultation?• I’d like you to explore the following:

• What are the best, and worst practices in behavioral consultation, in your experience?

• Take a few minutes to turn to your neighbor and answer this question.

• Be prepared to share this with the larger group.

Possible Consultation Roles

Any of the following are possible:Role Description

Problem Solver You are in the position to provide support to solve difficult problems of practice, such as complex and challenging behaviors.

Mentor You are in the position of training someone who is “new” or at least new to a position. Ongoing support is provided.

Trainer You are in the position of training someone or a team on a new or unknown technique, such as ecological assessment or task analysis.

Organizer You are working to bring a team together and build capacity to solve difficult problems through a trans-disciplinary model.

Outside 2nd Opinion

You are an “outside” consultant who has been asked in by a parent or other to give an opinion regarding a child’s program.

Assessor You are assessing the child, the environment, or other factors in order to inform a program’s practices, etc.

Triad and Dyad of Consultation

Priorities with Behavioral Consultation• Behavioral consultation should:• 1. Be cost effective,• 2. Result in behavior change,• 3. Build capacity within school teams,• 4. Generalize to other cases,• 5. Lead to better services for children,• 6. Create partnerships with families,• 7. Create habits of data collection and analysis

of treatment,• 8. Be consistently evaluated for social validity,• 9. Lead to good feelings about skills and

possibilities,• 10. Not burden or present an unworkable

demand on anyone.

20 Lessons Learned Along the Way

Lessons from the Consultant’s Path

• 1. You can’t fix things instantaneously. • 2. You aren’t an expert in everything.• 3. You cannot be in 50 places at once.• 4. You will not be loved by everyone.• 5. You will be perceived as a walking, talking task

demand.• 6. Some people will be offended by your presence.• 7. You cannot assume anything!• 8. You don’t have to observe for hours and hours in

order to get a good idea of a behavioral situation.• 9. You can get others to help you collect data.• 10. You need buy-in to get things done.• 11. One-shot trainings or consults do not work.

Lessons, Continued

• 12. What worked with one person may not work with another.

• 13. Sometimes you have to “work around” certain barriers.

• 14. You have to be careful about what you communicate and how.

• 15. Your “worth” is not measured so much by your likeability (although that’s nice and all…) but by the ultimate treatment outcomes.

• 16. Saying NO is a very good thing.• 17. Developing a tool kit is a time saver.• 18. Pairing yourself with reinforcement doesn’t hurt,

either.• 19. Get to know the people you are supporting. Learn

the social system (ecological perspective).• 20. Time and perspective matter.

Strategies for Effective Behavioral Consultation

Strategy One: Defining Your Approach (or Approaches)

• You have to define how you will structure each consult case.

• 1. Have a systematized approach. (See handout)

• 2. Determine goal(s) for intervention.

• 3. Determine timelines.

• 4. Make sure team knows your role.

• 5. Make sure team knows their role.

Your background and “lens” need to be a match to the situation. If you

have a behaviorist background, you

need to make that clear at the outset. The team needs to

know what to expect. For example,

you won’t be measuring “anxiety”

if you are a behaviorist unless

you can operationalize this as an observable, measurable set of

behaviors.

What will your professional behaviors look like?

• I generally follow these rules:

• 1. I return phone calls and emails within 24 hours, maximum, except for weekends unless I’ve made prior arrangements.

• 2. I require records as a part of a file review including the cumulative file and sometimes video, to avoid observer effects.

• 3. I keep emails brief, to the point and devoid of emotional affect.

• 4. If a get angry communication, I cease email and pick up the phone or make a visit.

• 5. I never recommend something I’m not willing to do myself.

Strategy Two: Overcoming the magic wand expectation right away…• You can generally expect one of two reactions:• 1. This person needs to fix things and I want to see them

fixed, NOW.• OR• 2. This person isn’t going to be able to fix anything. We’ve

tried everything and we know this child best.

• If you see someone ascribing to #1, the “set up” is: • You can’t fix things quickly. Behavior change, for the most

part, takes time, even in a clinical setting with control. • Temporarily, most behavior change makes things worse,

called an “extinction burst.”

• The best thing we can do is to be honest about this at the outset of the consultative relationship.

Develop a Structure

Strategy Three: Devising your assessment plan• This is the key to beginning your consultation off

correctly. • 1. Explain (why do you need x, y and z?)• 2. Provide tools. Train on how to use them. • 3. Operationalize the behavior(s) of concern. • 4. Prioritize behaviors. Not everything on the

laundry list is critical.

• Don’t forget:• A) Assess the environment. It may be a

contributing antecedent and part of your intervention recommendations.

• B) Attempt to find out any hidden barriers, difficult situations, or other things that may inadvertently alter your plans.

Observation Planning

• Should be “fly on the wall.”

• Many teachers will want you to “work with” the student. The initial observation should be a “pure” sample of behavior without intervention.

• Note that many times you will encounter the “taking the car to the mechanic” scenario. You come, the kid acts like a perfect angel, or the group is well behaved. Don’t worry about this! Video when you aren’t there is helpful.

• Note: Some teachers become very nervous when you observe. If that is the case you can terminate the observation and have an honest conversation.

Strategy Four: Devising your treatment plan• Write an observation report in the following

manner:• 1. Introduction, indicating purpose, child

background, educational setting, and records reviewed/tools used for assessment.

• 2. Description of observation.• 3. Description of assessment data.• 4. Goals for intervention. Include measurable

goals for consideration.• 5. Suggestions for implementation.

• Warning: Often teams want you to stop here, and it is very tempting and accepted to do so. The “give us the plan and let us handle it” can work, or not work, depending on the team.

Suggestions

• Consider prevention first.• Environment should include:• 1) Structure, implicit and explicit.• 2) Positive to negative praise-high ratio and age

appropriate.• 3) Differentiated instruction, appropriate

academic press, and engaging teaching style.• 4) Instructions that are effective, understandable

and generally followed by others. • 5) PBS system is in effect for the classroom and

focuses on reinforcing target behaviors, shaping and feedback.

• 6) Opportunities to get up and move rather than expectations to sit in one place all day.

Intervening here is highly effective and efficient.

Interventions• Based upon function of target behaviors:• E.g. Time out might work well for a child whose behavior is

attention-maintained, but will not work well for a child whose behavior is maintained by escape.

• Socially valid-acceptable to those who will intervene.

• Treatment fidelity-everyone is intervening in the intended manner.

• Should be implemented for a minimum of 10 working days unless there is an ethical problem (e.g. higher frequency of SIBs after short extinction burst period).

• Goal 3: Implement interventions.

Keep these things in mind:

• Avoid the “it didn’t work so we discontinued it” phenomenon:

• 1) # of days to implement• 2) Call me after day 2 and we will talk about why

it is getting worse,• 3) Set up # of days check in: 2, 5, 7 and 10.• 4) Set up discontinue rule (e.g. self injury).

• Observe interventions in effect. • Be prepared to model at this point so that

everyone knows what you want. • Be prepared to “shape” the behaviors of adults. • Train to collect data in order to check in later.• Goal 4: Write up a comprehensive consultation

report.

Also be prepared for:• Defensiveness: When recommending changes, you may

get push back, defensive postures, excuses or hurt feelings. This is common, and sometimes unavoidable, especially if there are real problems with teaching, management or attitudes.

• Ways to mitigate this:• 1. Use yourself as a case in point.• 2. Talk about the good things that you saw.• 3. Use real examples that you saw.• 4. Be prepared to have a hard conversation. You are not

there to have a tea party. You are there for purposes of behavior change.

• 5. Be prepared to realize that it might be you-something you said, or did, etc. It has happened to me many times!

• One helpful phrase: “Help me understand…” vs. “Why did you?” This puts the onus off of the teacher and their intentions.

Strategy Five: Developing Capacity

• One of the issues in the consultation literature is a problem with generalization of skills on the part of the consultee or buy-in to the plan.

• Part of this is “ownership.”

• Possible Barriers and their Underlying Dynamics:

• “It is her plan-if it fails it is her fault. It isn’t my/out plan.”

• “It is too hard to implement this. I need a para with this child all day. Then it will be alright.”

• “This would work better in a self-contained classroom.”

Issues with Generalization

• A teacher may over-use a procedure because the behavior is topographically similar to the last procedure.

• Example:• One child gets out of their seat a lot. A system is

put into place using “cost response.” Once that is implemented, the behavior drastically decreases and maintains.

• Another child gets out of their seat. The teacher implements the same procedure, and the child’s out of seat behavior increases astronomically, to the point of disruption during most of the day.

• Note, the teacher says “but they both have the same behavior.”

• What is missing here?

We can go along way by teaching…• How to assess for function, or the maintaining

consequences of a behavior.• Also, we should always pay attention to:• 1) Reinforcement system in the classroom. Is it

being used effectively?• 2) Schedule of reinforcement. Is it frequent

enough, powerful enough? Does it need to be thinned, and how?

• Is feedback being given? Most “flip the card” systems are devoid of this and do not change behavior for long. Changes are temporary and do not work for every child. We sometimes have to focus on the forest before the trees.

Strategy Five Cont’d: Providing Training• Your consultee (individual or team) may need

training in order to increase their own capacity.• There are a wide variety of ways to do this:• 1. Develop a bank of exemplary classrooms

where you would encourage observations for specific purposes. Arrange for the school to acquire subs and send teachers on field trips.

• 2. Develop a relationship with outside agencies who can either provide opportunities for observation or training.

• 3. Develop PLC’s (Professional Learning Communities) for teachers using mutually agreed upon books and articles. Pair this with reinforcement (cookies, chocolate, coffee and clock hours).

• 4. Provide didactic training, but keep in mind that “one shot” will not be effective. Follow up is imperative.

Strategy Six: Data Collection

• You will need to decide on tools the team will use for collecting data to determine the effects of intervention.

• Consider the purpose of the tool:• A) Frequency? (How often something occurs)• B) Latency? (How long it takes to start after a

cue to begin)• C) Duration? (How long it lasts)• D) Intensity? (How intense/impactful is the

behavior)• Train on tools and prescribe their use. • Be prepared for:• “I can’t do this because I don’t have time.” • Attempt to make it as unobtrusive as possible.• Use other resources in your building. • Check back frequently.

Strategy Seven: Revise Plan/Check In• Use data to show whether or not your treatment

suggestions are working.• Also use social validity-how do staff feel about

the interventions?• Make changes as needed.• Put yourself on a check-in schedule.• NOTE: Many times teams will not check in for

months. Meanwhile…things are falling apart. You want to avoid this!

• Schedule out emailing in your planner.• Email every Monday, or Friday, etc.

Not there yet…

• The consultant’s job is never perfected.• Things change-work, home and time

commitments.• Don’t be afraid to say no, or to cut back when

needed.• Get continuing education.• Read journal articles-new and old.• Develop a network of other consultants.• Ask for help when you feel a case isn’t

something you can handle.• Don’t worry if you haven’t read every latest book

out there. Stick with basic behavioral principles.

Practice Situation

• Let’s practice!• I will give you a particular situation.• In your small group develop a plan. • How will you go about this consultation?