The behavior challenges related to autism can feel daunting for family, caregivers, and community service organization professionals alike. But dwelling on challenging behaviors leads to a focus on questions such as, “What will we do when this individual displays this challenging behavior again?” The answers often lead to a culture focused on intervention and physical restraints.
Caregivers often feel that this approach is not effective, and they’re right—physical intervention to address behavior challenges can result in escalation, humiliation, and injury. But the field of community support services has relied on these traditional, reactive approaches for so long there is little belief and less conviction that positive, proactive philosophies and approaches can work.
But instead of focusing on handling negative behaviors, what if the question caregivers asked was, “What will we do to prevent this individual from behaving in this negative way again?”
It’s possible to break the cycle of negative reinforcement and physical restraint, and shift to a dynamic that focuses instead on encouraging positive behaviors. At The Arc of Delaware County, the team has created a positive, restraints-free environment for people with autism and many other developmental disabilities—and helped other organizations reduce their use of restraints too, with the same step-by-step approach used internally.
This approach is based on a series of proven steps that move toward a culturally reinforced positive approach to reduce and even eliminate challenging behaviors in a way that is actionable for organizations, schools, and home care environments.
By applying these steps, other professionals and family caregivers can do the same:
- Let Go of Preconceptions – There is a common belief that in order to prevent people from hurting themselves or others, one must physically intervene. This idea is outdated, ineffective, and can hold teams back from making the all-in personal investment that is necessary to gain real results from a positive approach.
The most effective way to dramatically reduce challenging behaviors and see positive improvement is to fully commit to bringing about a new kind of environment—the caregivers have to change before the individual with challenging behaviors will.
- Gather Data – It’s important to start by collecting baseline data for several reasons. Having a quantitative measure of the starting point allows accurate and objective progress tracking, encourages new thinking, and demonstrates ultimate success.
The first step is to determine what the caregiver or organization wishes to measure, and how that data will be collected. Examples include: number and types of physical interventions utilized by the organization and its various departments, numbers of injuries, number of tantrums, the amount and extent of damage to property, and others as relevant. Each organization may determine what it will measure, but, measurement is critically important.
- Assess Internal Team – This is primarily geared toward organizations, but would be relevant for any group working together to create a more positive environment for an individual with autism to reduce challenging behaviors, including families, caregiving teams, and others.
Instituting this type of change will go more or less easily depending on the expertise of the team involved, and their willingness to embrace whatever changes affect them individually. An early step in the process should be to objectively assess team expertise as well as their willingness to change or improve.
- Define a Plan and Goal – Depending on their size and current expertise any given organization should be able to dramatically reduce their reliance on physical interventions within one to three years. A proper internal assessment will generate the information and analysis necessary to set a proper goal within a reasonable time frame.
For an organization, that goal might look like “The XYZ Organization will reduce the number of physical interventions by 80 percent within 18 months.” For a family or individual caregiver, it may be “I will work with [name] to reduce challenging behaviors by 10 percent this month.”
Organizations should make sure that measurable goals are announced loud and clear throughout the organization.
- Share the Plan with the Full Team – Dramatically increasing the effective use of praise and reinforcement is an essential element of a positive approach. Most people who work in this field have never worked in or experienced an environment where praise and reinforcement are used lavishly.
This presents a dilemma whereby many staff members feel they use praise and reinforcement effectively when, in fact, significant improvement is needed.
An immediate step can be taken to collect base line data. The types and rates of reinforcement should be counted for a particular time interval. Then goals can be established and an organized effort can be initiated to dramatically increase both the types and rates of praise and reinforcement. Consider challenging staff to praise or reinforce each person they are working with once per minute for one week.
- Increase Praise and Reinforcement – Positivity means focusing on the good in people and on the good times. It nourishes strong, caring and productive relationships. The most powerful tool for positivity is consistent use of praise and reinforcement. This practice frees caregivers to use their creative power to find solutions rather than manage problems.
When consistent in this practice, the benefits will quickly become evident—people respond well to praise and reinforcement when it is properly and lavishly used.
This applies to how staff training is approached in addition to direct interaction with individuals with autism.
- Redefine Key Support Roles – This is especially important in organizations, where the roles of specialists like psychologists and behavioral specialists need to evolve from doing to teaching. Job descriptions may need to be rewritten to reflect this change. They should adopt a view of themselves as behavioral mentors to direct service, supervisory and clinical staff.
The goal of this process is to put the tools of positive practice in the hands of the people who do the work. Rather than the traditional paradigm of having a very small percentage of “behavioral specialists” on staff, the emerging new paradigm will use existing specialists to train and develop the entire workforce so that 100 percent of the team will become specialists in positive behavioral approaches.
Outside of organizational settings, caregivers should consider, who else plays a role in the individual’s life? Be sure everyone is on the same page with this new positive approach.
- Limit the Availability of Physical Intervention – Another way to help reduce the implementation of physical intervention is to make it less available. In some organizations all employees are trained in the use of physical interventions. Simply adopting a policy whereby only the absolute fewest number of staff necessary in a given location are so trained sends a powerful message. As does adopting a policy that only our “best” or most “experienced” employees will be so trained.
In other settings, this can be applied by keeping tools used for physical restraint out of easy reach, and ensuring that all participants in the process understand that physical restraint is a last resort.
- Increase Scrutiny of Physical Interventions – It’s important to not only use positive reinforcement, but also to reduce the use of physical interventions. Taking a careful look at instances when physical intervention is used can help in this effort.
This means pausing after the situation is over and considering some key questions: What triggered the situation? What could prevent or minimize the challenging behavior in the future? Can the situation be avoided altogether? How could caregivers proactively reinforce positive behaviors to replace the challenging behavior?
In an organizational setting, scrutiny of these instances also sends a powerful message throughout the organization that these are serious goals being set. Scrutiny will be even more effective if it emphasizes a search for root causes rather than blame.
It’s important that the entire environment’s culture commit to making this change—one individual can’t effect this change alone. But when these steps are applied consistently over time, this shift should be successful in most environments—The Arc of Delaware County team has seen it time and again within the organization, as well as in other organizations that adopt this method.
George Suess is the CEO of The Arc of Delaware County, NY, and founder of fwdshift, a suite of services designed to help human service organizations transform their cultures, and reduce behavior challenges. Contact him at (607) 865-7126 or georges@delarc.org and learn more at www.delarc.org.
