THE SUCCESSFUL REPLICATION OF D-PBIS ACROSS MULTIPLE CENTERS SERVING ADULTS WITH I/DD Leeann Haffner, MS – DPBIS Project Coordinator PA Adult Services Michelle Lipchock, DSW, LCSW Clinical Director, Devereux New Jersey Michelle Wonders, Psy.D – Clinical Director, Devereux Pocono 2 PROPRIETARY AND CONFIDENTIAL
PRESENTATION OBJECTIVES Participants will be able to define the components of D- PBIS and describe the framework for implementation. Participants will learn how the D-PBIS framework has been successfully implemented across multiple centers and how it can be adapted to fit individual programmatic needs. Participants will be able to describe measures necessary to sustain D-PBIS in programs servicing adults with I/DD. 3 PROPRIETARY AND CONFIDENTIAL
DEVEREUX-POSITIVE BEHAVIOR INTERVENTIONS AND SUPPORTS (D-PBIS I/DD) Scope Implementation Issues The Devereux organization All centers are rolling out the D- operates in 13 states PBIS I/DD framework w/ modifications There are 8 Centers across the United States serving Coordination across/within I/DD centers Centers are located in (NY, Focus on implementing with NJ, PA (2), MA, Florida, fidelity Texas, California) Necessary to develop measures that ensure sustainability 4 PROPRIETARY AND CONFIDENTIAL
TERTIARY PREVENTION 3 TIERED APPROACH Comprehensive FBA Positive Behavior Support Plans Increased Supervision Individual and Family Therapy Trauma-Focused CBT Modified PE ~5% SECONDARY PREVENTION Check-in/Check out Mentoring ~15% Peer support Group Therapy Specialized Group Skills Training PRIMARY PREVENTION Behavioral Assessment & Consultation Clear expectations Proactive Focus Skills Training Data Based Decision Making Self-Management Safe and Positive Environment Lesson Plans Corrective Instruction Staff and Individual Acknowledgements ~80% ? of Clients 5 PROPRIETARY AND CONFIDENTIAL
Devereux Organizational FWPBIS Steering Committee Meets quarterly Center-based FWPBIS Leadership Team Meets monthly Program Components Teaching for Positive Self- Level of Learning Management Performance Based Safety Acknowledgements Teaching Matrix Guided Self- Feedback and Lesson Management Plans 6 PROPRIETARY AND CONFIDENTIAL
SYSTEM-SELF MANAGEMENT Self Monitoring – Once lesson plans are written, models for self monitoring will be developed Must take into account various levels of intellectual disability and communication Program Components Teaching for Self- Positive Level of Management Learning Performance Based Safety Acknowledgements Guided Self- Teaching Matrix Feedback Management and Lesson Plans 7 PROPRIETARY AND CONFIDENTIAL
CORRECTIVE INSTRUCTION Step 1: GET THE PERSON’S ATTENTION Step 2 ACKNOWLEDGE THE PERSON’S EMOTION Step 3 STATE THE SKILL THAT CAN BE PRACTICED IN THE MOMENT Step 4: PRACTICE THE SKILL Step 5: REVIEW AND PRAISE Program Components Teaching for Positive Self- Level of Learning Management Performance Based Safety Acknowledgements Teaching Matrix Guided Self- Feedback and Lesson Management Plans 8 PROPRIETARY AND CONFIDENTIAL
ACKNOWLEDGEMENTS Center-wide celebrations Checklist of unit likes/Reinforcement Inventories Employee Appreciation Committee interface Rewards packet for students and staff Program Components Teaching for Positive Self- Level of Learning Management Corrective Safety Acknowledgements Teaching Matrix Guided Self- Instruction and Lesson Management Plans 9 PROPRIETARY AND CONFIDENTIAL
LESSON PLANS Scripts were revised to remove incorrect model of the skill or behavior Lesson Plans will be develop for two levels of learners: Mild to Moderate level of disability Severe to Profound level of disability 9 Essential Signs Program Components Teaching for Positive Self- Level of Learning Management Corrective Safety Acknowledgements Teaching Matrix Guided Self- Instruction and Lesson Management Plans 10 PROPRIETARY AND CONFIDENTIAL
TEACHING MATRIX 11 PROPRIETARY AND CONFIDENTIAL
LEVEL OF SAFETY Universal List of Major and Minor Infractions was revised to include adult issues and concerns. Language was revised to positive and adults terminology and was expanded to include enhanced medical and wellness concerns Teach skills vs intervention Program Components Teaching for Positive Self- Level of Learning Management Corrective Safety Acknowledgements Teaching Matrix Guided Self- Instruction and Lesson Management Plans 12 PROPRIETARY AND CONFIDENTIAL
REPLICATION OF D-PBIS 13 PROPRIETARY AND CONFIDENTIAL
OVERVIEW OF D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS • 2012 mandate for all Devereux programs to implement PBIS • Goal to develop D-PBIS models (EBD, I-DD and Autism) National Board • Balanced scorecard for all centers of Directors • Creation of D-PBIS models • Assigned consultants to work with centers on specific implementation of PBIS • Ensure fidelity of all implementing centers D-PBIS Fidelity Advisory • Measuring progress the same manner—same data collection Committee across all centers • Team of center specific staff charged with D-PBIS Implementation including center leadership • Meet once a month to review center implementation (fidelity, Center Leadership data analysis, and problem solving) Teams 14 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS Center Leadership Team The primary goal is to ensure implementation of D-PBIS with integrity and to ensure positive gains of staff and the individuals we serve. In partnership with corporate liaisons, the leadership team is composed of representatives from various disciplines in the center. Provides oversight of implementation of D-PBIS across center. Ensures our D-PBIS implementation maintains a high degree of fidelity through on-going data based decision making. 15 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS Center Leadership Team Monthly meetings are held to review and trend various data sets, create or alter permanent products for the programs and problem solve any issues or obstacles that may arise. Charged with maintaining further implementation of D-PBIS programs across the center. Consultation between Centers Data collection is embedded in the Electronic Health Record 16 PROPRIETARY AND CONFIDENTIAL
D-PBIS DATA ANALYSIS ACROSS IMPLEMENTING CENTERS 17 PROPRIETARY AND CONFIDENTIAL
D-PBIS DATA ANALYSIS ACROSS IMPLEMENTING CENTERS 18 PROPRIETARY AND CONFIDENTIAL
D-PBIS IMPLEMENTATION ACROSS MULTIPLE CENTERS Individual Direct Care Staff Management and Clinical Staff Leadership Team Fidelity Committee 19 PROPRIETARY AND CONFIDENTIAL
HOW D-PBIS CAN BE ADAPTED TO FIT INDIVIDUAL PROGRAM NEEDS Baseline data from observations of staff Active Engagement (materials and positive interactions) Preference assessments for individuals: motivators and activities that are specific to each program Use of sign language (9 basic signs) Customized teaching matrix: expected behaviors for each setting that D-PBIS is used: home, work and the community and the categories for expected behavior of the individual Lesson plans: instructional scripts to teach the individuals appropriate prosocial behaviors: the instructional process uses an errorless learning approach to teach the skills to the individuals with a minimal amount of errors . 20 PROPRIETARY AND CONFIDENTIAL
SUSTAINABILITY OF D-PBIS 21 PROPRIETARY AND CONFIDENTIAL
SUSTAINABILITY Why is it important? Reduce challenging behavior Increase independence and use of prosocial behavior Provide structure and acknowledgments Increase/sustain satisfaction Improve quality of life How to Sustain Develop a plan and build an infrastructure Monitor compliance Analyze data for fidelity Determine impact on outcomes 22 PROPRIETARY AND CONFIDENTIAL
TOOLS FOR SUSTAINABILITY Contingency Plan Acknowledgements D-PBIS Certification Home Visit Spot Check Satisfaction Surveys Leadership Meeting and Compliance Data Peer Mentoring 23 PROPRIETARY AND CONFIDENTIAL
CONTINGENCY PLAN Crucial for sustainability as there will always be staff turnover, vacancies, and leaves of absence. Ensures D-PBIS implementation, oversight, and consultation occurs when there is an open position in any role. – Home visit spot check – Direct observation, data consultation, and performance feedback schedule – Acknowledgement procedure Monitors compliance of implementation through data analysis 24 PROPRIETARY AND CONFIDENTIAL
CONTINGENCY PLAN 25 PROPRIETARY AND CONFIDENTIAL
ACKNOWLEDGEMENTS When desired behaviors are observed, staff provide individuals with acknowledgement cards, paired with verbal behavior specific praise. Weekly or bi-weekly drawings for individuals and monthly drawings for staff to receive a prize (gift card, dinner, outing, DVD, etc.). 26 PROPRIETARY AND CONFIDENTIAL
D-PBIS CERTIFICATION Certified clinical staff are responsible for certifying supervisors 27 PROPRIETARY AND CONFIDENTIAL
HOME VISIT SPOT CHECK Completed once per month by clinical staff and operational staff Information and Implementation scores analyzed to identify trends 28 PROPRIETARY AND CONFIDENTIAL
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