Positive Behavioral Supports

Introduction

Within the Positive Behavioral Supports priority area, the Waisman Center works to promote healthy social and emotional development. We support positive behaviors for individuals with developmental disabilities and special health care needs, including co-occurring mental health conditions. Emotional health, expression of positive behaviors, and social skills are foundational to an individual’s success, beginning in infancy and progressing across the lifespan. When not addressed, challenging behaviors such as aggression, destruction, or self-injury can result in a greater restriction of life opportunities.

Research and practice demonstrate that a blend of positive practices systematically implemented increases the success of individuals with developmental disabilities who are experiencing complex behavioral and mental health challenges. With proper support across settings, individuals who exhibit challenging behaviors can successfully live, be educated, work, and recreate in the community.

Areas of UCEDD activity focus are: infant and early childhood; family mental health and outreach; and consultation for challenging behaviors for people with developmental disabilities and special health care needs.

Challenges and Opportunities

Identification and Intervention for Mental Health Needs. Identifying and accessing appropriate interventions at the earliest signs of mental health and behavioral challenges can be daunting for both families and the health and educational professionals providing supports to children, youth, and adults with these challenges. There is increased recognition of mental health disturbances in very young children including disturbances in mood; difficulties in regulation of feeding, sleep, or attention; sensory or relational difficulties; and withdrawn or aggressive behavior (Clark, 2010). For individuals with developmental disabilities and other special health care needs, the social and emotional needs associated with healthy development are often overlooked until these challenges escalate into behavior challenges.

How do we go about assuring that all providers and agencies have the proper screening tool and strategies as well as effective training protocols?

Relationship-Based Context for Intervention. All learning, behavior, and socialization occur in the context of relationships. The promotion of healthy social emotional development begins in infancy and continues throughout the lifespan. Early onset of severe and persistent emotional and behavioral issues in children with developmental disabilities can sometimes prevent the development of these important relationships. The development of strong and healthy relationships in early childhood lays the foundation for all later relationships. For adults, the therapeutic relationships across the various providers is a key component to a successful supported lifestyle.

How can family members and providers be educated and supported effectively and in a timely manner in order to establish and maintain these essentials emotional bonds?

Bias toward People with Disabilities. The belief that people with developmental disabilities and challenging behaviors cannot participate in community life with appropriate supports is a common occurrence. This notion is compounded by those who also have mental health issues. It is imperative that families recognize potential trajectories for their children within community life, regardless of the level of support that may be needed. Too often, professionals and community members prepare families for a more limited future based solely on a diagnosis and observable behaviors, rather than a combination of possibilities within the child, family, and community. For families with young children, this often begins in the early childhood years. Their children are not accepted into child care settings due to behavioral or other special needs, and these types of exclusions continue throughout the school years. For adults in supported living, “Severe Reputations” may emanate from past incidents that may have only occurred a few times and within the context of poorly-planned supported lifestyles.

How do we go about educating families, professionals as well as attitudes within communities to how people with disabilities and mental health challenges can thrive in the community, with proper support; and furthermore, how communities can be enriched though the participation of people with disabilities and mental health challenges?

Safety. Assuring safety for individuals with challenging behaviors, providers, and citizens is an essential component of a well-crafted community support plan. When safety issues are not properly addressed, children are at risk for out-of-home placement or segregated education. A growing number of preschoolers are expelled from child care settings each year due to challenging behaviors (Gilliam, 2005). Schools struggle with providing individualized special education in the least restrictive environment and recognizing parent and child rights while also looking out for the safety of all children. Children struggling with emotional regulation issues that are not addressed often continue to experience emotional volatility in adult years. Adults are at risk for arrest, unnecessary psychiatric stays, or institutionalization. In developing programs that assure safety, Community Support Teams sometimes need to incorporate more intensive strategies. These approaches sometimes need to also include what are termed Restrictive Measures. When developed properly and incorporated within positive behavioral supports, Restrictive Measures can protect individuals, providers, and the community from those low frequency and high intensity behaviors that may include aggression, destruction, or self-injury.

How do we assist these teams in considering whether to use restrictive measures, and if so, how they can be used for the purpose of safety and not as a form of punishment or potential abuse?

Education and Training of educational and healthcare professionals, including those in mental health fields, as well as direct support providers and families is a key component to successful school and community life for people with challenging behaviors. Many professionals earn their degrees and practice without specific knowledge of very young children or people with developmental disabilities who also have mental health and behavioral needs. Without appropriate training, disparities in access to appropriate services will continue throughout the lifespan. In the early childhood years, this means increasing the capacity of early care and educational providers from diverse programs (e.g., child care, Head Start, schools, Birth to 3, home visiting, family resource centers) to address the emotional and learning needs of all children. The challenge is to create a coordinated, cross-system professional development system that reaches all people who touch the lives of children. This cross-system attention to professional development is also necessary for professionals working with adults. In both early childhood and supported community programs for adults, direct care positions are typically under-funded, which results in low wages and leads to high turnover rates. Additionally, provider agencies often do not have access best practice training strategies related to challenging behaviors and/or do not have the resources to properly educate the direct providers.

How do we go about assuring that there are an adequate number of providers who are educated, adequately compensated supervised, and remain in their positions over time?

Key References

Infant, Early Childhood and Family Mental Health

  • Zero to Three Organization
  • Zeanah, C. H., Jr. (Ed.). (2009). Handbook of infant and mental health. (3rd edition). New York, NY: The Guilford Press.
  • Landy, S. (2002). Pathways to Competence: Encouraging Healthy Social and Emotional Development in Young Children. Baltimore, MD: Paul H Brookes Publishing Co.

School Age Children/ Youth and Adults

Influences on positive behavioral supports

Foundational:

Current:

Our Programs

Community TIES Psychiatric Clinic
TIES Clinic provides psychiatric care and consultation to individuals with developmental disabilities who are unable to obtain psychiatric care from other providers due to financial situation, behavioral issues, or medical complexity. Patients seen in the TIES clinic are also supported by the Community TIES Program.

Crisis Response Program
Crisis response services for adult Dane County residents with developmental disabilities are designed to prevent or shorten stays in more restrictive settings.

Growing Together
A program for school age children and their families that offers children, teens and their families a partnership with our experienced clinicians to work together to practice effective strategies to support positive behavior and healthy relationships.

Rhythms Program
A cooperative effort between the Waisman Center and Dane County Human Services to further enhance the lives of individuals who experience complex sensory and movement differences and those who support them.

Waisman Early Childhood Program (WECP)
The Waisman Early Childhood Program offers unique learning opportunities in a creative and supportive environment for children ages 1 through 5 year-round, as well as for children who have completed 4K and 5K in our summer Meteor Program.

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