see below

NEW LIFE HEALTH CARE AGENCY, LLC

941 White Horse Avenue

Hamilton, New Jersey 08619

Suite #21

609-807-2900

New Life Health Care Agency

Residential Behavioral

Policies & Procedures

Manual

SECTION I. SCOPE / LIMITATIONS

This policy and procedures manual applies to Embedded behavioral support services being provided under contract through the Division of Developmental Disabilities. It is created to ensure that New Life Behavioral Health is in compliance with NJ Division of Developmental Disabilities Community Care Program and Supports Program standards. To provide guidelines and parameters for the provision of needed behavior supports and services provided by New Life Health Agency.

SECTION II. PURPOSE

To provide guidelines and parameters for the provision of needed behavior management supports and services by providers of Individual Supports, Day Habilitation, Community Based Supports and Respite.

SECTION III. POLICY

A. Only properly credentialed and trained staff will perform the behavior management supports and services directly to individuals in an Embedded capacity.

B. The Provider of Behavioral Supports and Services will establish processes for timely, efficient communication and collaboration with any Support Coordination, IDT / Planning Team, caregivers and other direct service professionals involved with the individual’s services.

C. The Provider of Behavioral Supports and Services will make transparent disclosure to current and prospective service recipients, indicating the categories of behavior management methods and techniques they may utilize, limit, or specifically prohibit. Terminology and categorizations used will be consistent with Division Circular #34. Specific strategies are listed in the sections that follow.

D. Aversive Stimulation, Highly-restrictive Mechanical Restraint, Chemical Restraint and Seclusion / Time-Out Rooms shall not be used, either as components of behavior support plans / strategies, or in a crisis capacity during the delivery of an embedded service. Personal Control Restraint in Emergencies will only be with Division approval consistent with DC#19. All staff members implementing personal control techniques (PCT) will do so following the procedures within their training. Only staff that has successfully completed a training program approved by the Division of Developmental Disabilities shall apply personal control techniques. Personal control techniques will only be utilized in situations that have deemed to be a crisis; and shall be used in order to protect himself/herself or others from harm.

E. The provision of Assessment/Plan Development or Monitoring (described at 17.2) shall be at the direction of the IDT / Planning Team and, when applicable, consistent with the prior authorization as found within the details of the Service Delivery Report (SDR).

a. Services will be consistent with Procedure Codes and the Examples of Behavioral Supports Activities found in the Waiver Manuals at 17.2.4.1 and 17.2.4.2. Multiple behavioral strategies are listed in the sections that follow.

F. Assessment/Plan Development or Monitoring activities shall result in the timely production of tangible work products delivered to the individual’s Support Coordinator for inclusion in the service recipient’s records.

a. New Life Behavioral Health will provide assistance to the IDT/Planning Team in support of any review, approval or dissemination of the Assessment, Behavior Plan / Strategy, and monitoring reports.

b. Expedited timeframes for development and response shall be instituted when there are health / safety concerns or the individual is in jeopardy of losing a needed service, as a result of their behavioral presentation

G. Records will be made available to those persons authorized by the Division of Developmental Disabilities whose responsibility it is to monitor the quality of service being offered to the individual.

SECTION III. PROCEDURE

1. Behavior Support Plan Development Responsibilities

a. New Life Behavioral Health Director or designee will ensure all employees or agents performing the services of Assessment and Plan Development or Monitoring are credentialed consistent with (17.2) for all waiver services they provide. This applies to the services of Assessment / Plan Development or Monitoring delivered as part of Embedded behavioral services, when the individual has been assessed to have Behavioral Acuity (see Waiver section 3.4).

b. New Life Behavioral Health Director or designee will ensure that prior to service delivery, all employees have completed applicable trainings. Training documentation will be maintained for review.

i. Staff shall be trained in accordance with Waiver Appendix E., including Positive Behavior Supports and all agency managed trainings.

ii. Staff or caregivers shall be trained to understand the Behavior Support Plan / strategy, including their implementation and documentation responsibilities, the correct use of methods and techniques, and the limits of their permitted actions. Such training is to be delivered directly by the credentialed individual that created the behavioral support / strategy, or by a designated proxy that they trained and is working under their direction.

c. New Life Behavioral Health will establish a system to maintain updated and accurate documentation of staff credentials and their completion of mandatory trainings. These will be maintained in the employee file and be available for inspection and review.

d. If New Life Behavioral Health makes an arrangement with an outside agency or entity (known as a Temporary Employment Agency), to assist with the provision of Behavioral Supports and Services, the Temporary Employment Agency must be a DDD Medicaid approved provider of Behavioral Supports Services. As such, they must meet all requirements and operate in accordance with the NJ DHS DMAHA / DDD Newsletter, Volume 30, No. 19, dated August 2020.

e. Whether done by a staff person directly employed by New Life Behavioral Health or by a Temporary Employment Agency engaged under contractual arrangement, New Life Behavioral Health acknowledges having responsibility to verify credentials and to oversee the timeliness, quality, appropriateness, and effectiveness of behavior supports and services provided.

f. When an individual or their representative prospectively inquires about New Life Behavioral Health’s provision of behavioral supports and services, they will be provided with information about business practices including the range of behavioral need the agency is prepared to address.

i. New Life Behavioral Health will describe the agency procedure by which a point-of-contact and method of communication will be established. These procedures include a process to address inquiries and respond definitively to a request for service within 5 business days.

ii. New Life Behavioral Health will supply information about any specific forms, processes, or practices (such as assessments, interviews, and/or applications) that are required to initiate services. These will be shared with prospective service recipients at the time of initial inquiry and updates if revised.

iii. New Life Behavioral Health will advise of any usual or customary behavior shaping techniques or behavior management / interventions that are not used, either programmatically or in a behavioral “crisis”, as a matter of agency philosophy or business practice. (refer to DC#34 and DC#19)

g. New Life Behavioral Health procedures will assure that the scope of work performed under Embedded behavior services will be in concert with the IDT, with the intention of assuring safe management of the individual and addressing behaviors that may interfere with their ability to participate and take advantage of the service.

h. For individuals with Behavioral Acuity, the provider of embedded behavior services will establish procedures that utilize the Addressing Enhanced Needs Form (AENF). The AENF will be kept current and reflect the plan to address service needs.

i. Identified behavior concerns, and the approaches used to address them, will be outlined in the AENF. These will be further developed into specific behavior plans / strategies which are trained to staff and instituted in the setting.

ii. New behaviors, ineffectively addressed behaviors, or behaviors with health or safety implications are to be reported to the Support Coordinator. The AENF and the supports it identifies will be revised / updated to remain current.

SECTION IV: ASSESSMENT & PLAN DEVELOPMENT

a. "Assessment” refers to an investigation into the function of the identified behavior and what factors have a causal relationship to the behavior. The assessment, which may entail conducting a functional analysis of the behavior, will serve to inform the behavior-shaping methods and techniques to be used in the Behavior Support Plan / Strategy - the end product of “Plan Development” activities.

b. Assessment will be conducted using standard and accepted tools and methodologies. The assessment will either be incorporated into the behavior support / strategy or a summary of it will be shared with the Support Coordinator for Planning Team review.

c. Both the assessment and the resultant Behavior Support Plan / Strategy will conform to the terminology, required plan components, and approval criteria found in Division Circular #34.

d. Assessment/Plan Development activities will be initiated and completed as expeditiously as practicable, to assure effective supports are in place as needed.

e. The Behavior Support Plan / Strategy will be shared with the Support Coordinator for dissemination, Planning Team review, and inclusion in the service recipient’s record

f. New Life Behavioral Health, as a provider of Behavioral Supports and Services, will work both collaboratively and at the direction of the Planning Team.

i. The need for periodic reassessment of the function of the behavior and/or a revision of the Behavior Support Plan / Strategy will be a Planning Team determination, based upon collaborative input from New Life Behavioral Health. Criteria for reassessment or plan revision should be based upon the behavioral presentation of the service recipient and data-based indicators of progress toward the desired outcome.

g. New behavior plans will require consent from the guardian. The behavior plan should be reviewed with the guardian, and they should be provided with a copy left in the home. Consent/ Approvals for the plans and staff training forms can be found in the appendices.

h. Monitoring – when provided to meet the behavior service needs of service recipient(s) with Behavioral Acuity in an embedded capacity (section 3.4) will adhere to these standards

i. Monitoring will be consistent with the examples provided in 17.2.

ii. Monitoring is to be in accordance with the SDR, if applicable,

iii. Monitoring will result in written documentation compiling or summarizing data-based progress towards the intended behavioral outcomes. Monitoring reports will also noting significant behavioral, training or implementation events.

iv. At a minimum, these reports will be prepared and forwarded to the Support Coordinator every 90 days.

v. The frequency of reports shall be every 30 days when the behavior has significant health / safety implications, or when the Behavior Support Plan uses a Level III technique (per DC#34).

i. For providers of embedded services serving individuals with Behavioral Acuity or a NJCAT Behavior score of 3-4, (Agency) acknowledges their responsibility to implement behavior supports and provide ancillary staffing or training as may be needed.

i. In order to meet the needs of these individuals, New Life Behavioral Health will establish policy and procedures to train staff on Crisis Management. This requires the specific review and approval of the Division in accordance with DC#19.

ii. When providing service to individuals requiring “not highly restrictive” devices (such as helmets, knee pads, splinting, etc.), to protect them from injury that would result from intentional behavioral actions, additional policy and procedure is required in accordance with DC#20.

iii. New Life Behavioral Health will identify whether they will operate their own HRC / BMC, for behavior supports and issues needing such review (see DC#34, DC#5 and DC#18).

j. Currently there are no external parties that are responsible to perform any key behavior support functions within our process.

k. Oversight & Monitoring

i. Consistent with New Life Behavioral Health’s Quality Improvement Plan, New Life Behavioral Health will establish a system of administrative oversight to verify that behavioral supports and services are appropriate, effective & timely. These reviews will focus on behavior support timeframes for creation and dissemination, effectiveness as measured by progress towards behavioral outcomes, and satisfaction survey data of caregivers implementing the interventions

SECTION IV. BEHAVIOR SUPPORT PLAN TECHNIQUES

All of the following examples of techniques must follow Division Circular #34 guidelines to ensure proper delivery and oversight.

I. Examples of Techniques to Increase Behavior.

A. Chaining

B. Graduated Guidance

C. Hierarchical Prompting

D. Modeling

E. Negative Reinforcement

F. Positive Reinforcement

G. Shaping

H. Motivational Systems

a. Token Economy

b. Behavioral Contracts

I. Pointed Praise (Level I) – Emphasized praise is given to individual(s) demonstrating a desired behavior.

J. Differential Reinforcement:

1. Differential Reinforcement of Other Behavior (DRO)

2. Momentary Differential Reinforcement of Other Behavior (Momentary DRO)

3. Differential Reinforcement of Lower rates of Behavior (DRL)

4. Differential Reinforcement of Incompatible Behavior (DRI)

5. Differential Reinforcement of Alternative Behavior (DRA)

K. Behavioral Momentum or High-Probability (Hi-P) Request Sequence

L. Functional Communication Training (FCT)

M. Sensory Stimulation

N. Stimulus Control

O. Stimulus Fading

P. Structured Schedule

Examples of Techniques to Decrease Behavior:

A. Noncontingent Escape

B. Noncontingent Reinforcement

C. Planned Ignoring

D. Relaxation Training

E. Restitution

F. Sensory Stimulation

G. Extinction

H. Correction using verbal/gestural prompts

I. Correction using physical prompts without significant resistance, i.e., restitution

J. Verbal Reprimand

K. Systematic Desensitization

L. Overcorrection

a. Restitutional Overcorrection

b. Positive Practice Overcorrection

M. Response Cost

N. Time-out from Positive Reinforcement.

a. Inclusionary Time-out

b. Exclusionary Time-out

O. Satiation of Secondary Reinforcers

P. Satiation of Primary Reinforcers

SUPPLEMENTAL POLICY AND PROCEDURE SECTION

Safe and Effective Behavior De-escalation and Crisis Management

PURPOSE:

To provide guidelines and parameters for the provision of needed behavior management supports and services by providers of Individual Supports, Day Habilitation, Community Based Supports and Respite. (Embedded Behavior Services)

To ensure that an appropriate system of staff training and oversight is in place to identify and deescalate dangerous behavior, to utilize non-contact defensive techniques when facing physical aggression, and to safely implement personal control techniques when so authorized, consistent with found in Division Circular #19.

POLICY:

New Life Behavioral Health recognizes that staff serving individuals with behavioral acuity or with a NJCAT behavioral Level 3-4 assessment will likely need some specialized training to identify, prevent and directly intervene, on occasion, to maintain health and safety when dangerous, aggressive or destructive behavior is exhibited. Each service provider having need to utilize Crisis Management, or reasonably expecting such need to arise, shall develop a comprehensive set of written procedures governing their use. These Policies and Procedures shall be submitted to the Division of Developmental Disabilities (Behavior Policy Review Committee) for review and approval.

PROCEDURES:

The procedures submitted shall include the following

A. The identification of a comprehensive, commercially available, well-established training curriculum designed for the population served. The curriculum to be utilized will be Nonviolent Crisis Prevention (CPI).

a. Curricula must contain robust content which includes

i. Identifying early signs and triggers of pending crisis behavior

ii. Methods to prevent and de-escalate crisis behavior

iii. Non-contact techniques to defensively avoid injury from aggression

iv. A hierarchy of personal control techniques (PCT) sufficient for the population served

v. Training to recognize signs and symptoms of physical distress or injury

b. A copy of all materials, both a Trainers Manual and the Trainee materials, must be forwarded along with this policy for Division review (unless the Division stipulates that it already has the materials / current versions)

i. Training materials must contain both narrative and graphic depiction of methods and techniques to be trained clearly showing all points of interpersonal contact and body posture.

B. New Life Behavioral Health will institute requirements and training standards which address the following:

a. Identify who will train staff (may be listed by job title), and note their qualifications / authorization to be a trainer of this specific material

b. Identify agency staff to be trained (may be listed by job title / location)

i. Specify the timeframe for the initial staff training (typically before working with individuals with demonstrated need)

ii. Specify the routine staff retraining cycle Minimally, the agency must document having staff demonstrate their proficiency in all PCT techniques at least annually.

iii. Specify any other retaining process:

1. Agency policy / timeframe for full retraining

2. Agency policy for retraining based on concerns or issues

3. Staff must be retrained if a prior utilization resulted in injury or distress. In this situation, staff may not use any personal control technique before being successfully retrained.

C. Requirements prior to use of PCT on any service recipient

a. Medical review prior to use

i. Prior to use, and on an annual basis, the IDT will conduct and document a review of the client record, noting any identified health concerns

ii. A physician will review / identify any contraindicated techniques, if the IDT have noted any questions or concerns

D. Authorization / approval requirements for each utilization of PCT

a. Approval may only be granted by the agency CEO or their qualified designee

i. Designee must be Qualified Intellectual Disability Professional (QIDP)

b. Each application of PCT requires an express approval supported by written documentation

i. Approval is limited to one hour limit; a unique, discreet written reauthorization is needed for continued use

E. Procedures to obtain authorization of CEO or designee

a. Provide comprehensive written procedures for obtaining authorization which includes the process by which each request for authorization is made

F. Whenever PCT is authorized, the family / guardian shall be notified and provided a summary within 24 hours of the event

G. Procedures to document and track each authorized use of PCT, to include:

a. Name / Title and time of request completed by the individual making the request to utilize PCT. The request must describe the nature of emergency.

b. Name / Title and time the request was responded to by the CEO or designee

i. Indication of whether or not approval was granted

ii. Note any conditions, limitations or special instructions made with the approval or denial of the request

c. Note: A written order authorizing the PCT and must be placed in the client record within 24 hours of the occurrence

d. When PCT in in use, the service recipient shall remain under continuous observation by all involved staff

e. The following will be documented contemporaneously by the staff during the implementation of PCT:

i. Date / time: application & release

ii. PCT technique and duration

iii. Documented checks, every 15 minutes, on the condition of the individual relative to any signs of distress whether their behavior necessitates continuation of the PCT

iv. In the case of distress or injury, staff will document medical record: the time and nature of any distress or injury the immediate cessation of the PCT the provision of medical attention, as needed

H. Agency requirement for appropriate action if distress / injury falls under Danielle’s Law

I. Unusual Incident reporting of accident, injury, distress or misuse / unauthorized / unapproved use of PCT - in accordance with DC#14

J. Agency procedure for disciplinary action if PCT is used without authorization, under false pretense, or if an unapproved technique is used

K. Describe the agency system of Quality assurance - Methods to limit overuse and monitor for patterns of utilization

a. The agency will establish a quality assurance methodology for usage review & to identify patterns of use

b. The IDT must meet within 5 work days if ever 3 or more PCT events occur in a rolling 6-month period

L. Agency documentation forms for PCT request / approval, and condition checks shall be submitted for Division review

SUPPLEMENTAL POLICY AND PROCEDURE SECTION

The use of “not highly-restrictive” devices for safety and behavior management

PURPOSE:

To provide guidelines and parameters for the provision of needed behavior management supports and services by providers of Individual Supports, Day Habilitation, Community Based Supports and Respite. (Embedded Behavior Services)

To ensure that an appropriate system of staff training, implementation and oversight is in place to safely manage certain dangerous behaviors, when the utilization of a specific permitted device, characterized as “not highly-restrictive” is authorized per a Level III Behavior Support Plan and used consistent with Division Circular #20.

POLICY:

“Not highly-restrictive” devices are described in Division Circular #20. Each service provider requesting approval to utilize them shall submit to the Division of Developmental Disabilities (Behavior Policy Review Committee) a comprehensive written procedures governing their use.

The procedure submitted shall include the following:

A. A statement specifically identifying the form(s) of device to be used and describes staff titles / positions that will be trained to use the device

B. Criteria for use of the device including instructions for the application of the device; which shall only be consistent with an approved Behavior Support Plan. The Behavior Support Plan will be subject to all review and approval as a Level III plan

C. Certification by a physician that the device is not medically contra-indicated for the individual;

D. Identified recordkeeping and review requirements

E. Inclusion of a curriculum for training staff which shall include, but not be limited to, training in the proper use and application of each device to be employed as well as the recognition of the signs of physical distress

a) “Physical distress” means the individual is exhibiting one or more of the following: difficulty breathing; choking; vomiting; bleeding; fainting; unconsciousness; discoloration; swelling at points of restraint; appearance of pain; cold extremities or similar manifestations.

Additionally, the policy must be consistent and contain with the following affirmations:

A. Primary reliance on punishment, physical or mechanical restraints or aversive techniques to decrease undesirable behavior is contrary to Division policy. Reinforcement strategies will be included in these plans with a constant focus on termination criteria for punishment and/or restraints.

B. Devices used for control purposes are considered to be appropriate only when absolutely necessary for safety reasons, and their use shall be minimized in favor of other, more positive interventions.

C. The device will only be used as part of an approved behavior modification program and for the purpose of protecting the individual from accidental self-injury.

D. These devices shall only be applied by staff trained in their use and application.

E. The need for the particular device to be used for behavioral intervention shall be documented in the Service Plan and re-evaluated no less than annually as a part of the plan review or as specified by the Planning Team / IDT.

F. Only commercially produced devices shall be employed.

Devices shall be inspected prior to each use to ensure that they remain in good repair and free from tears or protrusions which may cause injury

GLOSSARY

Accuracy - the extent to which the response meets standards.

Alternating Treatment Design – an experimental design in which the replications involve presenting the different values of the independent variable in an alternating sequence under the same general conditions or in the same experimental phase. Also multi-element design.

Analysis of Behavior - procedure for determining the development of an individual behavior plan. May include: Identification of antecedents; identification of target behavior (type, frequency, duration); medical evaluation to identify or rule out potential medical causes of the behavior; history of the maladaptive behavior and of past and present intervention efforts; and environmental analysis to determine conditions which are maintaining the behavior.

Antecedent Environmental Manipulation – altering aspects of an Individual’s surrounding that may serve as a discriminative stimulus for a specific behavior, that will in turn may modify the behavior in some way. An example would be a structured daily schedule.

Antecedent Stimulus - a stimulus (an event or condition) that precedes a behavior that may or may not be a discriminative for a specific behavior.

Applied Behavior Analysis – the use of behavior principles and methods to evaluate and systematically increase or decrease behavior in applied settings/real world day to day.

Assisted Compliance (formerly known as forced compliance) – requiring an individual to complete a task/demand using hand over hand prompts and using more than equal and opposite pressure. This shall be distinguished from hierarchical prompting and graduated guidance techniques.

Backup Reinforcer – an object or event received in exchange for a specific number of tokens, points, etc.

Backward Chaining - see chaining.

Baseline – the phase of an experiment or intervention where the behavior is measured in the absence of a function based intervention.

Behavior - any observable act an individual performs; synonymous with the term "response." Included are both operant and respondent.

Behavioral Contract - a written agreement between a staff member and person served specifying the reinforcers the person served will receive for acceptable performance or which reinforcers will be removed if a specified behavior occurs. The contract should be attained through negotiation. Also known as Contingency Contract.

Behavioral Momentum [High-Probability (Hi-P) Request Sequence] – a Hi-p request is one that the Person We Serve has a history of complying with. This procedure consists of the staff person providing a series of Hi-p requests (e.g., 3 to 5) in rapid succession, reinforcing compliance with each request, and then providing an instruction that the Person We Serve typically did not comply with. The basis for this procedure’s effectiveness is that it produces a momentum of compliance (i.e., the Hi-p request sequence) that is maintained when we present the Person We Serve with a low probability request. This treatment is generally used to decrease escape maintained behavior.

Behavioral Objective - a statement containing a specific condition, behavior, and criteria that describe the expected performance of the Person Served following intervention. See also Criteria.

Behavior Chain - see chaining.

Behavior Management - systematic interventions using some combination of skill building and behavior reduction techniques, based on individualized program plans made by the interdisciplinary team.

Chaining – an instructional procedure that reinforces the responses of the person served in a sequence, forming a complex behavior. In a forward chaining procedure, a teacher teaches the first link in the chain of behaviors, then the second, the third, etc. In a backward chaining procedure, the teacher first teaches the last link in the chain, followed by the next to last link until the person served has learned all the components of the chain.

Change Over Delay – the duration of time between the cessation of a target behavior and the termination of a treatment procedure. The duration of time is used as a criterion for the termination of the treatment procedure. Example: a time out procedure would end when the person served showed 30 seconds of calm.

Changing Criterion Design – a research design that progressively changes the rate of target behavior to some new criterion (up or down). For example, the criterion for the number of aggressions could be progressively lowered over several months. The effects of the independent variable are shown if the individual served meets or falls below the criterion for any set number of days.

Classical Conditioning – in this type of learning, a neutral stimulus (CS) is repeatedly paired with an unconditioned stimulus (US), and the subject comes to respond to the neutral stimulus even when it is presented alone.

Classroom Management Plan – a written behavior approach that includes Level I and/or Level II interventions only. They are specifically written for a particular classroom and its unique characteristics. For behaviors that occur that are not addressed by the classroom management plan, the Standard Interaction Protocol will be followed if in place.

Conditioned Reinforcer - an event that owes its reinforcing capacity to an association with other reinforcers. For example, by frequently patting a child on the back and then giving her a favored food, the pat on the back is likely to become a conditioned reinforcer. See also Unconditioned Reinforcer.

Consequence - any environmental stimulus or event that contingently follows a behavior, as a result of that contingency relationship, strengthens or weakens the future rate of the behavior.

Consequence Sharing - a group contingency arrangement in which the behavior of one individual served determines the consequence for all other Persons Served. An example would be reading all Persons Served in a group a story if a peer finished his/her work on time. See also Group Contingency.

Contingency – the relationship between a response or behavior and its consequence.

Contingency Contract - a written agreement between a staff member and person served specifying the reinforcers the person served will receive for acceptable performance or which reinforcers will be removed if a specified behavior occurs. The contract should be attained through negotiation. Also known as Behavioral Contract.

Contingent Observation - a time-out procedure in which a Person Served is moved a short distance from an activity after displaying a target behavior, but is able to observe other persons served engaging in behavior appropriately. See also Inclusive Time Out and Time Out.

Continuous Reinforcement Schedule (CRF) - a reinforcement schedule in which each occurrence or non-occurrence of a certain behavior is reinforced. See also Schedule of Reinforcement.

Controlling variables – the environmental events (antecedents and consequences) that influence the probability of a particular behavior.

Correction - restoring the effects of a target behavior, as a consequence for that pre-specified behavior, in the context of an individual's behavior intervention plan. Correction is distinguished from overcorrection in that the restorative act is limited to the immediate effects of the behavior. For example, if the individual is being trained to eat without spilling food on the table, correction may involve cleaning what the individual has spilled; an overcorrection might call for the individual to clean not only his own spills, but to wash the entire table top as well. If more than equal and opposite pressure is required see forced compliance. See also Overcorrection.

Correct Rate - see Rate.

Correlation - a measure of the degree to which two variables have a tendency to change together.

Covert behavior – behavior that is not directly observable to others.

Criteria - that portion of a behavioral objective, which specifies three aspects of intended individual served performance. Contained in the criteria should be the intended: (a) rate or accuracy of performance; (b) duration of performance at a specified rate, accuracy, or frequency; and (c) the date by which the behavior is to be performed, at the two previously stated criteria. See also Behavioral Objective.

Cumulative Graph - a graph in which cumulative responses are represented on the y-axis.

Data Manager – a Monroe Twp staff member who is assigned the duties of collecting, graphing, and presenting behavior data for a specific individual served.

Dependent Variable – a measure of the person served’s behavior.

Deprivation – a condition in which a person goes without a particular reinforcer for a period of time, the effect of which is to make that reinforcer more potent.

Differential reinforcement – a procedure in which a specific desirable behavior is reinforced but other behaviors are not. The result is an increase in the desirable behavior and a decrease in other less desirable behaviors.

Differential Reinforcement of Alternative Behavior (DRA) – reinforcing a more appropriate form of a behavior than the one the Person Served is currently engaging in.

Differential Reinforcement of Incompatible Behavior (DRI) – reinforcing a response that is topographically incompatible with a behavior targeted for reduction. For example, a staff member may reinforce the Person Served to use his or her hands to manipulate a toy rather than engage in self-injury.

Differential Reinforcement of Lower rates of Behavior (DRL) – delivering reinforcement when the number of responses in a specified period of time is less than or equal to a prescribed limit. This maintains a behavior at a predetermined rate, lower than at its baseline or naturally occurring frequency.

Differential Reinforcement of Other Behavior (DRO) - a reinforcement procedure in which an individual or group receives a reinforcer for completely refraining from a specific behavior for a specified period of time regardless of other behaviors demonstrated.

Direct Measurement - the direct observation and recording of behavior as it occurs.

Discrete Trial Format – a teaching format that has clearly discriminable steps as follows: stimulus ( response ( consequence.

Discrimination - a situation in which a behavior is occurring in some circumstances, but not in others. For example, if a individual served gives an answer when called on, but does not give answers at other times, a discrimination has been formed.

Discriminative Stimulus (SD) – the stimulus that is present when a particular behavior is reinforced. For example, a PECS card on the individual served’s desk signals that food is available contingent on a particular response, however, the absence of the PECS card signals that food is not available.

Duration Recording – records the length of time a behavior occurs i.e., the length of time to complete a project, the length of time of a tantrum. It is most useful for behavior with a distinct beginning and end, usually occurring infrequently but lasting for longer periods of time.

Enriched Environment – a treatment procedure, which employs a redesign of the physical environment, so that an individual will have access to a variety of preferred items, materials, etc.

Equal and Opposite Pressure – a degree in which staff provide a physical prompt to a person served equal to the force of the person served’s compliance and/or resistance.

Essential Demands – includes all personal hygiene. It excludes all other activities of daily living such as household chores and/or educational/vocational tasks.

Exclusionary Time-out - the individual is denied access to reinforcement by being briefly removed from the setting in which the target behavior was exhibited. Examples of being removed from the setting include: moving the individual to another part of the classroom or living room, requiring that the person sit in a chair away or on the floor form other individuals, and/or moving the individual to a different room. During the implementation of this procedure, staff must remain within Line of Sight of the individual.

Extinction - a procedure to reduce the rate of behavior that involves the discontinuation of the reinforcement that follows a behavior. For example, a teacher stops attending to a Person Served’s profanities, resulting in decreased profane use of language.

Extinction Burst - the temporary increase in behavior that frequently occurs with an extinction procedure.

Fading - the gradual removal of prompts that help a person served to perform a behavior. Often, many prompts are necessary in the early stages of learning a behavior, but can be systematically removed as competence increases. See also Graduated Guidance.

Feedback - any kind of information indicating whether a behavior was correct or incorrect. Examples of feedback may include: praise, instructions, grades, error correction, reprimands, etc.

Fixed-Interval Schedule (FI) - a reinforcement schedule in which a reinforcer is delivered following the first response that occurs after a specified period of time. On an FI 10 minute schedule, for example, the first occurrence of a behavior, following the passage of 10 minutes, will be reinforced.

Fixed-Ratio Schedule (FR) - a schedule of reinforcement in which a reinforcer is delivered following an unvarying number of responses, since the previous reinforcement. On an FR 10 schedule, for example, a behavior would be reinforced after exactly ten responses.

Forward Chaining - See Chaining.

Frequency Recording (Event Recording) - counting the number of specific, discrete occurrences of a target behavior. It is most useful for recording behavior that has a distinct beginning and end and is of brief duration and has a low frequency.

Frequency within interval recording – a recording method in which the number of occurrences of a target behavior is recorded within consecutive intervals of time during an observation period.

Functional Analysis – an assessment method in which environmental events (antecedents and consequences) are manipulated to demonstrate a functional relationship between the environmental events and behavior.

Functional Communication Training – teaching a verbal or non-verbal communication skill to gain access to desired items/activities or to avoid non-preferred activities in a pro-social manner, so that it replaces a maladaptive behavior that had been used for the same purpose.

Functional Level - the level at which a person is functioning in a specific skill area, e.g. multiplication, as indicated by the highest level objective which the individual served has mastered. See also Progress Graph.

Generalization - a situation in which a behavior that has been reinforced in one situation also occurs in situations in which it has not been reinforced.

Graduated Guidance – a process of teaching a new skill through the fading from most to least prompting without resistance i.e., hand over hand, light physical assistance, modeling/gestural, and verbal. Prompting without more that equal and opposite pressure distinguishes graduated guidance from assisted compliance.

Group Contingency - an arrangement in which consequences depend, to some degree, on the behavior of one, or more, other persons. See also Consequence Sharing.

Hierarchical Prompting – least to most assistive prompting which is used for skill acquisition (teaching prompts) i.e., verbal, modeling/gestural, light physical assistance, and hand over hand without resistance. This shall be distinguished from assisted compliance.

High-Probability (Hi-p) Request Sequence – see Behavioral Momentum

Inclusionary Time-out – the individual is not removed from the setting, instead, the staff person denies the person served access to reinforcers, to include not participating in the activity at hand, through a temporary manipulation of the environment for a specific period of time. Examples may include staff simply ignoring the individual (e.g., removing attention) or by requiring the individual to remain within that setting (e.g., sitting in a chair).

Independent Variable – the variable (treatment), the staff systematically manipulates to influence the dependent variable (person served’s behavior).

Indirect assessment – an assessment that relies on information of others (e.g., questionnaires, interviews).

Informed Consent - a practice in which persons served (or their parents or guardians) are given all information to include risks and benefits that are relevant to the Planned Intervention before agreeing to become involved in the treatment or study.

Intensity - the force with which a response is exhibited.

Intermittent Reinforcement Schedule - a reinforcement schedule in which some occurrences of a certain behavior are reinforced and other occurrences are not. See also Schedule of Reinforcement.

Interval Time Sampling Recording - measuring behavior during specified time periods. The observer records whether or not the behavior occurred during that time period. It is most useful for measuring behavior that occurs very frequently such as thumb-sucking, calling out.

Latency - the time that elapses between an antecedent (cue, prompt, signal) and a response.

Limited–hold (LH) - termination of reinforcer availability if the response to be reinforced does not occur soon enough. A limited-hold restricts the time the reinforcer is available following the interval.

Maintenance of Behavior - the degree to which a behavior remains at an improved level, once a successful procedure is removed.

Modeling – demonstrating a desired behavior in order to prompt an imitative response.

Momentary DRO – a variation of a DRO procedure in which the reinforcer is delivered if the person served refrains from engaging in a target behavior at the moment that the DRO interval clocks out.

Momentary Time Sampling - measures whether the target behavior is occurring at the moment the interval terminates i.e., inseat behavior, and frequent stereotypic behaviors. It is most useful when behavior is frequent or on-going, and continuous observation is not possible.

Motivational System - a structured reinforcement program based on the learning principle that individuals tend to repeat or increase behaviors which are followed by positive consequences. The type of motivational system (e.g., primary, token, behavior contract) and the reinforcement schedule (e.g., continuous, fixed ratio) selected will be determined by the assessed needs of the individual.

Multiple-Baseline Design - an experimental design that demonstrates the effect of a single intervention in one of three conditions; across behaviors, across subjects, or across settings. For example, after baseline is taken on different behaviors a procedure is then applied to one behavior, later to a second, a third, etc. If the behavior consistently changes when the procedure is applied to it, it is clear that the procedure effected the change in behavior.

Multi-Element Design – a single-subject experimental design that allows comparison of the effectiveness of two or more treatments by presenting treatments randomly rather than sequentially. Also known as alternating treatment design.

Negative Reinforcement - the contingent removal of an undesirable stimulus immediately following a response, which serves to increase the future probability of the response. Negative reinforcement increases the future rate and/or probability of the response. Example: A Person Served will not independently initiate brushing his teeth. Therefore, staff remain in the bathroom with him and physically prompt him to brush his teeth. However, when he does initiate brushing his teeth, staff leave the bathroom and allow him to perform the task without prompting. If the rate in which the person we serve initiates brushing his teeth increases, then the REMOVAL of staff from the area is considered a negative reinforcer.

Noncontingent Escape (NCE) – making escape from a task available on a predetermined schedule (e.g., every 60 sec.) independent of the occurrence of a target behavior. For example, once the individual starts the task, the staff person sets a timer to signal when a break is available.

Noncontingent Reinforcement (NCR) – providing attention (or access to a preferred object/activity) to the Person We Serve on a predetermined schedule (e.g., every 60 sec.) independent of the occurrence of a target behavior.

Observational Recording - any procedure used to obtain a record of persons served behaviors (e.g., calling out, out of seat) that do not leave a product. See also Duration Recording, Frequency Recording, Interval Recording and Momentary Time Sampling.

Operant Behavior – a behavior that is controlled by its consequences rather than the antecedents in the environment. Such behaviors are considered “voluntary” and are “emitted” by the individual. Operant behaviors are distinguished from respondent behaviors, which are “involuntary” and are “elicited” by an antecedent stimulus. Examples include hand-raising, writing down assignments and reading aloud.

Operant Conditioning - the process by which the consequences of a behavior increase or decrease the future rate of the behavior. See also Operant Behavior.

Overcorrection - one of two types of punishment procedures: (a) Restitutional Overcorrection - used when an individual disturbs the environment. The offending individual is first required to restore the environment to its original state and then to improve it beyond this state. (b) Positive Practice Overcorrection used when there is no environmental disturbance but a behavior is performed incorrectly. The individual served is then required to perform the correct behavior repeatedly.

Overt Behavior – behavior that can be observed and recorded by a person other than the one exhibiting the behavior.

Partial Interval Time Sampling – this measurement records the response when a single instance of the response occurs in the interval i.e., swearing, bizarre gestures. This measurement is used to record behaviors that may occur in fleeting moments. This measure tends to overestimate the occurrence of the behavior.

Performance Graph - a graph which permits a daily comparison of the rate and direction in which performance changes in order to determine whether a specific objective is met with the level (e.g. correct rate, or accuracy) at which the person actually performs. See Progress Graph.

Permanent Product Measurement - a type of recording in which the outcome or permanent product of the behavior is recorded as an indication of the occurrence of the behavior.

Physical Distress – the individual is exhibiting one or more of the following: difficulty breathing; choking; vomiting; bleeding; fainting; unconsciousness; discoloration; swelling at points of restraint; appearance of pain; cold extremities or similar manifestations.

Physician's Consent - examination and written certification by a physician prior to approval of certain behavior interventions, stating that proper application of the technique is not medically contraindicated for the individual.

Placebo – any medication used to relieve symptoms, not by reason of specific pharmacological action but solely by reinforcing the patient’s favorable expectancies from treatment.

Planned Ignoring – not responding to a specific behavior through either continuing with the task at hand or not allowing the individual to escape the task at hand. This differs from extinction in that the source of reinforcement maintaining the behavior is unknown or the target behavior is maintained by automatic reinforcement.

Pointed Praise - Emphasized praise is given to individual(s) demonstrating a desired behavior.

Positive Practice Overcorrection - see Overcorrection.

Positive Reinforcement – occurs when a behavior is followed immediately by the presentation of a stimulus, and as a result, the behavior occurs more often in the future. Positive reinforcement increases the behavior it follows. Example: A Person Served does not put his/her dirty laundry in the clothes basket. Staff (take data and) begin to give the Person Served a quarter every day that he/she puts his/her dirty laundry in the clothes basket. The Person Served begins to put his/her dirty laundry in the clothes basket daily. Therefore, the quarter is considered a positive reinforcer.

Positive Reinforcer – a tangible object or activity that is used as a consequence for a behavior that increases the future probability of that behavior occurring again. See also Positive Reinforcement

Precursors – Low level behaviors which may be warning signs that higher- level behaviors (e.g., aggression) may follow.

Premack Principle – a situation in which the opportunity to engage in a high probability behavior is made contingent on the occurrence of a low probability behavior, thereby increasing the low probability behavior.

Primary Reinforcer - see Unconditioned Reinforcer.

Progress Graph - a graph which permits a comparison of a person’s overall progress in a curriculum area (e.g. math) with both her projected learning rate and the minimum rate of learning which is expected of any Person Served.

Prompt - any antecedent event used to initiate a behavior.

Punishment - any change in the environment following a behavior that decreases the future rate of that behavior. Events that can serve as punishers include reprimands, and reducing a child's opportunity to earn reinforcers.

Rate - frequency of behavior per unit of time. The observer records the number of events during a specified time period (ex: number of aggressions/hour).

Redirection - refocusing the individual on another activity or topic.

Reinforcement - a process by which the consequence of a behavior increases the future rate of the behavior. The consequence can involve the presentation of something desirable (e.g., a preferred seating arrangement), which is known as positive reinforcement or the removal of an undesirable event (e.g., a final examination), which is known as Negative Reinforcement.

Reinforcement Menu - a description of the reinforcers available to the Person Served.

Relaxation Training - training an individual to reduce stress through physical action. Examples guided imagery, deep breathing or the voluntary tensing and/or relaxing of muscle groups throughout the body producing a relaxation response. It can also involve getting an individual to quietly sit or lie down, using only verbal/gestural prompts, thus reducing a potentially dangerous situation.

Reliability - a measure of the degree to which independent observers agree on the occurrence of a behavior (also known as inter-observer agreement). One commonly accepted formula for calculating reliability:

Agreements X 100

Agreements + Disagreements

Response Cost - a punishment procedure in which a person served’s positive reinforcers are removed contingent upon the occurrence of a target behavior. An example would be removing predetermined reinforcers (e.g. tokens, privileges) (Level II) or removing predetermined personal property or access to routine community outings (Level III) after a target behavior occurs. May include levels systems.

Response Prevention – blocking or using other tactics to make it less likely for an individual to exhibit a response.

Restitution – monetarily replacing items either through replacing the item or its value.

Restitutional Overcorrection – see Overcorrection.

Reversal Design – demonstrates the effect of an intervention by implementing an intervention then removing the intervention and then replicating or repeating the application of the intervention to determine whether it occasions a change in the behavior (AKA A-B-A-B Design).

Safeguarding Equipment - devices that restrict movement used to provide support for the achievement of functional body position or proper balance; devices used for specific medical, dental or surgical treatment; and devices to protect the individual from symptoms of existing medical conditions, including, but not limited to, seizures, ataxia and involuntary self-abuse.

Satiation - a condition in which a person receives large amounts of a particular reinforcer for a period of time, the effect of which is to make that reinforcer less potent.

Satiation of Primary Reinforcers - providing unlimited access to those reinforcers/stimuli (such as food or liquids) that may have biological importance to an individual.

Satiation of Secondary Reinforcers – providing unlimited access to those reinforcers/stimuli that are initially neutral but acquire reinforcing qualities through pairing with primary reinforcers (also called conditioned reinforcers) that have been maintaining the target behavior.

Schedule of Reinforcement - a specification of the number of behaviors that must occur, or the amount of time that must pass, in order for a response to be reinforced. See also Fixed-Interval Schedule, Fixed-Ratio Schedule, Variable-Interval Schedule, Variable-Ratio Schedule.

Secondary Reinforcers – events that have been repeatedly paired with primary reinforcers or other strong conditioned reinforcers that can come to have reinforcing properties themselves. More frequently used are attention, praise, money and other reinforcers not directly related to biological needs.

S-delta (SΔ) – a stimulus in the presence of which a particular response will not be reinforced or will be punished.

Self-Management, (Self-Monitoring) - any procedure an person served undertakes in order to modify some aspect of her own behavior. See also Contingency Contract and Self-Recording.

Self-Recording - an attempt to change one's own behavior by attaining a record of it. This might involve a Person graphing the number of days he or she completed his homework assignments each week.

Sensory Stimulation - to provide stimulation in alternate ways; designed to reduce the need to engage in self-stimulatory behavior.

Shaping - the process of teaching a new behavior by reinforcing behaviors that progressively resemble the desired behavior. Each of the behaviors that approaches the target behavior is called a "successive approximation."

Side Effects - any indirect changes in behaviors caused by a treatment intervention, but which were not the intended targets for modification.

Significant Resistance – refers to Person Served applying more than equal and opposite physical pressure to inhibit staff to physically prompt or manually guide him/her to complete a task or lead them along to a predetermined location.

Standard Interaction Protocol – an approved written behavior approach that may include Level I, II or Level III treatments used for all persons receiving services within a department who do not have an individualized behavior plan or for behaviors that are not covered in an individual behavior plan.

Stimulus - any observable change in the environment that may affect behavior. A stimulus may come before a behavior (i.e., a discriminative stimulus) or after a behavior (e.g., a reinforcer).

Stimulus Control – a change in operant behavior that occurs when either a discriminative stimulus (SD) or S-delta (S() is presented. When an SD is presented, the probability of response increases; and when an SΔ is given, operant behavior has a low probability of occurrence. For example, the presence of a timer running could be a SD for a individual served to earn a reward for appropriate behavior. Thus, the timer has exerted stimulus control over appropriate behavior.

Stimulus Fading – altering the conditions correlated with problem behavior. For example, the rate of instructions provided to the Person We Serve during a task are initially decreased and then gradually increased to ensure low rates of problem behavior. The basis for this procedure’s effectiveness is that it changes the establishing operation for escape behavior. That is, reducing the rate of instructions, or the time required for a break is available, makes the task less aversive to the Person We Serve. This treatment is generally used to decrease escape maintained behavior.

Structured Schedule - an antecedent environmental manipulation that specifies the sequence of identified daily activities

Systematic Desensitization - a counter-conditioning procedure, to reduce anxiety through carefully monitored, extended incremental exposure to the anxiety-evoking stimulus.

Target Behavior - a behavior specifically designated for intervention.

Task Analysis - the process of breaking down a task into its component steps and listing them in the order of their occurrence. For example, a task analysis might consist of the steps a given individual served would need to perform in order to complete a division problem.

Time-Out From Positive Reinforcement– a punishment procedure in which a Person Served experiences a less reinforcing environment following a behavior. The procedure can involve making the existing environment less reinforcing or placing the Person Served in less reinforcing environment. See also Contingent Observation, Exclusionary Time-out, and Inclusionary Time-out, and Seclusionary Time-out.

Time-out in a designated room - the individual is removed from the environment to a specific room used solely for time-out from positive reinforcement intervention procedure where access to potential reinforcers are denied. This differs from exclusionary time-out in that staff are not present in the room with the individual served. Safeguards and guidelines pertaining to the use of a time-out room can be found in Appendix A of DDD Division Circular #34.

Token Economy – a system of generalized learned reinforcers (tokens, chips, letters) in which the Person Served receives for displaying target behavior can save them and exchange them for a variety of back-up reinforcers at a later time.

Token Reinforcer - a tangible item or symbolic event that can be exchanged for a (back-up) reinforcer. Examples of tokens include poker chips, check marks, and money. See also Back-up Reinforcer.

Topography – the physical form or description of a motor behavior. For example, one topography of aggression could be kicking.

Unconditioned Reinforcer - a reinforcer that can strengthen behavior independently of an association with other reinforcers. Common examples include food, water, and sexual activities. See also Conditioned Reinforcer.

Variable-Interval Schedule (VI) - a reinforcement schedule in which the first response that occurs after a specified period of time is reinforced. The time interval varies around an average value.

Variable-ratio Schedule (VR) – under a ratio schedule, the number of times a target behavior occurs determines the timing of reinforcer delivery. With a variable-ratio schedule, the target response is reinforced on the average of a specified number of correct responses. E.g. a behavior on a VR10 schedule would be reinforced on the average of every 10th correct response. Therefore, in a teaching or observation session, the behavior may be reinforced following the 2nd, 4th, 8th, 9th, 12th, 16th, and 19th correct responses.

Verbal reprimand – brief, immediate, firm statement contingent on the occurrence of a target behavior that specifies which behavior to stop, e.g., “No hitting”.

Visual Screen – the use of a hand to lightly cover a person served’s eyes contingent upon the occurrence of target behavior. See also sensory masking.

Whole Interval Time Sampling – records the response when it is emitted throughout the entire interval i.e., on task behavior. This measurement is useful when it is important to know that the behavior is not interrupted. However, it tends to underestimate the occurrences of the behavior.

APPENDICES/FORMS

APPENDIX C

DESCRIPTIVE ANALYSIS OF BEHAVIOR

Interview Form

DATE:

PERSON SERVED:

DATE OF BIRTH:

DATA MANAGER:

INTERVIEWER:

RESPONDENT(S):

DESCRIBE THE BEHAVIOR(S):

Behavior

Topography

Frequency

Duration

Severity

MEDICAL CONSIDERATIONS:

Medical conditions that may affect behavior (e.g. asthma, allergies, headaches, nausea, menstrual pain, etc.)

Current medications:

Typical sleeping patterns:

Typical eating patterns and diet:

PRECURSOR IDENTIFICATION: (What lower level behaviors are observed which may be warning signs that higher level behaviors (e.g. aggression) may follow.)

Behavior

Precursors

HISTORY OF THE BEHAVIOR

Behavior

How long has it been a problem?

Previously attempted interventions

Results

Any major life/family/unusual experiences that may be contributing to/affecting the behavior?

ENVIRONMENTAL ANALYSIS

Are daily activities/schedule predictable for the person? Does he/she know what takes place, when it occurs, and what consequences will result?

Is there a variety of activities? Are they boring, too difficult, or unpleasant for the person?

Does the person get to make choices regarding the activities? In what areas?

Are there many other people around? Is there opportunity for interaction with others?

What is the staffing pattern? To what extent do the number of staff, staff training and qualifications, social contact, etc. affect the behavior?

What is the distribution of positive vs. negative interactions? Is there ample access to and availability of reinforcers?

ANTECEDENT ANALYSIS:

	Most Likely	Least Likely
In what settings/situations is the behavior most/least likely to occur?
When (what times) is the behavior most/least likely to occur?
Which activities are most/least likely to produce the behavior?
With whom is the behavior most/least likely to occur?

What usually happens right before the behavior occurs? Is it a demand situation? Is the person alone or does it only happen when people are around? Does being ignored produce it? Criticism? Interruptions? Transitions? Delays? Noise?

What would be the one thing you could do to produce the behavior?

CONSEQUENCE ANALYSIS

What usually happens following the behavior? How do others react to the person and/or behavior?

When the behavior occurs:

Do others ignore the behavior and continue the task?

Do others redirect the person?

Do others give attention to the person displaying the behavior?

Does the behavior allow the person to escape a particular situation?

Does the behavior allow the person to avoid a particular situation?

Is the behavior punished?

What actions seem to improve/relieve the behavior when it occurs?

	More Likely	Less Likely	Unaffected
If you present the person with a difficult task, is the behavior:
If you interrupt a preferred event, is the behavior:
If the person is spoken to, is the behavior:
If the person doesn’t get what he/she wants, is the behavior:

How much effort is required on the part of the person to produce/maintain the behavior?

Does engaging in the behavior result in a “payoff” (getting attention/avoiding work) every time? Almost every time? Almost every time? Once in a while?

How much time passes between the occurrence of the behavior and the “payoff”? Is it immediate? A few seconds? Longer?

COMMUNICATION ANALYSIS

Complex speech (sentences)	Multiple words (not sentences)
One word utterances	Other utterances (whine, scream)
Complex signing	Simple signs
Shakes head	Echolalia
Pointing	Leading (pulls hand)
Grabbing/Reaching	Gives objects
Increased movement	Moves close to you
Moves away/leaves situation	Fixed gaze
Facial expression	Aggression
Self-Injury	Other (explain)

Which of the above behaviors does the person display to;

Request attention:

Request help:

Request preferred food/objects/activities:

Request a break:

Show you something or someplace:

Indicate physical pain:

Indicate confusion:

Indicate frustration:

Protest/reject situations:

In general, what events/objects/etc. appear to be reinforcing or enjoyable for the person?

What appropriate alternative behavior(s) does the person already know that may achieve the same function(s) as the problem behavior(s)?

DESCRIPTIVE ANALYSIS INTERVIEW SUMMARY FORM

DATE: PERSON SERVED

DATE OF BIRTH: BANCROFT CASE/DATA MANAGER

INTERVIEWER:

RESPONDENT(S):

BEHAVIOR DESCRIPTION

What were the behaviors that were described?

MEDICAL CONSIDERATIONS

What medical considerations are relevant to the occurrence of the behavior(s)? Medications? Sleeping patterns? Eating patterns and diet? Illnesses, conditions?

Page 1 of 2

DESCRIPTIVE/ FUNCTIONAL ANALYSIS INTERVIEW SUMMARY FORM

CONTINUED

ENVIRONMENTAL/ECOLOGICAL CONSIDERATIONS

What are the environmental/ecological features (persons, places, tasks, etc.)? Which are relevant to the occurrence of the behavior(s)?

POTENTIAL FUNCTIONS/ANTECEDENTS/MAINTAINING REINFORCERS

What are the potential functions (including communicative) that the behavior(s) serve(s)? What are reliable antecedents? What are possible maintaining reinforcers or consequences?

Page 2 of 2

APPENDIX X

CONSENT TO USE PROPOSED INTERVENTION

Name of Person Served:

Plan Date:

Proposed Intervention (Title): (attach plan)

Potential Benefits of Using this Intervention to the Individual Receiving Services:

Potential Risks of Using this Intervention to the Individual Receiving Services:

Other intervention options available in the event that you choose not to consent to the above treatment:

I am aware that I may disapprove the implementation of this technique or withdraw my approval at any time. The information on this completed form has been reviewed with me to my satisfaction and it was explained to me that I did not have to agree to this plan. My signature indicates my approval of the implementation of the proposed intervention.

Signature Date

Printed Name

Job Title

APPENDIX H

CONSENT TO USE PROPOSED INTERVENTION

(Informed Consent Form)

Name of Person Served:

Plan Date:

Proposed Intervention (Title):

Potential Benefits of Using this Intervention to the Individual Receiving Services:

Potential Risks of Using this Intervention to the Individual Receiving Services:

Other intervention options available in the event that you choose not to consent to the above treatment:

I am aware that I may disapprove the implementation of this technique or withdraw my approval at any time. The information on this completed form has been reviewed with me to my satisfaction and it was explained to me that I did not have to agree to this plan. My signature indicates my approval of the implementation of the proposed intervention and that I have received a written copy of this plan.

Signature Date

Printed Name

Relationship to Person Receiving Services

Signature of person informing and obtaining consent:

Date

APPENDIX K

Staff Training Form

(attach additional pages as necessary)

Person Served: Plan Date:

Plan Author’s Name and Signature:

Behavior Intervention Techniques and Category of Approval for Each:

The following staff are identified by the plan author as alternative trainers. The signatures below verify that the plan author has trained these staff on all components of the plan and that they are competent to demonstrate and train others:

Print Staff Name	Initials	Staff Signature	Trainer Initials	Date

My signature below acknowledges that I am able to describe and demonstrate all components of the behavior intervention plan:

Print Staff Name	Staff Signature	Trainer Initials	Date

APPENDIX K (cont’d)

STAFF TRAINING FORM

Person Served: Plan Date:

Plan Author’s Name and Signature: Behavior Intervention Techniques and Category of Approval for Each:

My signature below acknowledges that I am able to describe and demonstrate all components of the behavior intervention plan:

Print Staff Name	Staff Signature	Trainer Initials	Date