BEHAVIORAL SUPPORTS

 

POLICY STATEMENT

 

A full and active life supported by caring relationships should minimize the occurrence of problem behaviors[1] in people with mental retardation and related developmental disabilities[2].  When problem behaviors occur, people with mental retardation and related developmental disabilities should have access to positive behavioral supports that focus on improved quality of life as well as reductions in the behaviors. 

 ISSUE

 Our constituents often lack the positive supports and caring relationships necessary to develop full and active lives. As a result, many haven't yet learned appropriate responses to many life situations.

 Further, many of these constituents have been frequently subjected to aversive[3] procedures and deprivations[4] that may cause physical and/or psychological harm and inhibit appropriate alternative skills and behaviors. These are dehumanizing, result in a loss of dignity, and inhibit full participation in and acceptance by society.

 As more of our constituents move into or remain in the community, many have not been able to access positive behavioral supports in natural settings including the family home. Training and support for families and care givers are woefully lacking and need to be significantly increased.        

 POSITION

 A full and active life supported by caring relationships should minimize the occurrence of problem behaviors in people with mental retardation and related developmental disabilities.  When problem behaviors occur, our constituency should have access to positive behavioral supports that focus on improved quality of life as well as reductions in the behaviors. 

 Behavioral supports should be individually designed and positive, emphasize learning, offer choice and social integration, be culturally appropriate, and allow for modifying or replacing the environment. 

 Aversive procedures are not consistent with positive, proactive approaches or best practices and must be “avoided.”

 Preliminary Considerations before applying a positive behavioral intervention: 

bulletPerspectives from the individual, his or her family, their social/cultural background, and the circumstances in which the behavior occurred.
bulletContributing factors such as physical or medical conditions, social and environmental influences.
bulletThe completeness and accuracy of information from other agencies.
bulletThe nature, extent, and frequency of the perceived problem behavior and what the person is trying to communicate through this behavior. 

Considerations for acceptability of a positive behavioral invention: 

bulletPotential secondary effects and risks associated with the intervention.
bulletLegal, social, and ethical implications.
bulletEase and practicality of implementation.
bulletConsistency with values of the individual’s culture.

Consideration for designing positive behavioral supports: 

bulletDesigned in a person-centered process involving the individual. Determined within the broader context of providing quality medical, psychological, educational, and habilitative services.
bulletApproached systematically, based upon a formal functional analysis[5], a thorough assessment of each individual’s unique abilities and contributions, an understanding of how previous interventions worked, the least restrictive strategy and described in a written plan.
bulletGrounded in evidence-based procedures adequately documented in the clinical and educational research literature that will (a) prevent problem behaviors, (b) teach new skills that may replace problem behaviors, (c) involve consequence strategies for preventing the on-going reward of problem behavior, (d) create individually appropriate positive consequence for pro-social behavior, (e) ensure safety (when appropriate), and (f) monitor systemically both the extent to which the support is administered and the extent to which the support is effective.

 Considerations for implementing positive behavioral supports: 

bulletApplied with informed consent[6] in a humane and caring manner respecting individual dignity.
bulletImplemented in positive, socially supportive, and culturally appropriate environments, including the home.
bulletCarried out by individuals (staff, family members and others) who have been trained and are qualified to effectively apply positive, non-aversive approaches.  Positive interventions for behavioral change should include adaptations to the environment and reinforcers that our constituents and their families identify as "extraordinarily" positive.  Interventions must not withhold essential food and drink, cause physical and/or psychological pain, use drugs as restraints, or produce humiliation or discomfort.
bulletMonitored continuously and systematically to ensure that support is implemented as proposed, and that the support is consistent with individual needs, positive in its methods, successful in achieving established goals, and changed in a timely fashion if success is not evident or occurring at an appropriate rate.

  

The Arc’s Congress of Delegates:  2004

 

[1] Problem behaviors are behaviors that function as a direct barrier to active, self-determined participation in typical learning, work, social and leisure activities.

 [2] “People with mental retardation and related developmental disabilities” refers to our constituency, i.e. those defined by the AAMR classification and the DSM IV. In everyday language they are frequently referred to as people with intellectual, cognitive, or developmental disabilities although the professional and legal definitions of those terms both include others and exclude some defined by DSM IV.

 [3] Aversive refers to noxious, painful, or intrusive stimuli or activities applied in response to behavior that results in physical or psychological pain, as illustrated by, but not limited to, ammonia spray, electric shock, water spray to the face, pinches and deep muscle squeezes, etc. Psychological pain results from verbal abuse, including the ongoing use of stigmatizing language and outwardly aggressive interactions, including tone of voice and body posture.

 [4] Deprivation refers to such actions as withholding, withdrawing, or delaying visitation or private communication with family and friends, adequate sleep, shelter, bedding, bathroom facilities, and food or drink, or subjecting the person to prolonged periods of isolation and seclusion.

 [5] A functional analysis involves the observation of how a behavior is affected by both internal (e.g. illness) and external (e.g. social interactions) influences. Such analyses should include an evaluation of factors contributing to the occurrence of the behavior and the consequences resulting from the behavior. The intent of such an analysis is to identify environmental, medical, social, and psychological factors which point to the origin, contribute to the exhibition, and maintain the behavior.

  

[6] See Position Statement on Healthcare for a discussion of “informed consent.”