Positive Approaches Journal, Volume 10, Issue 4

Nonnemacher | 82-90




Positive Approaches Journal - Volume 2 Title

Volume 10 ► Issue 4 ► February 2022



Putting the Positive in Behavioral Support: Considering the Role of Autonomy, Mastery, and Purpose

Stacy L. Nonnemacher, Ph.D.



Introduction

We have made many strides in the understanding of effective behavioral support. Gone are the days of aversive strategies and interventions in the name of behavioral modification. We welcome the marriage of respectful, person-centered supports and science leading to long-lasting, meaningful changes in a person’s life.


Let’s Get on the Same Page

Everything we do is behavior. You are reading this article right now, that is a behavior. You may have used your mouse to scroll or picked up your coffee to take a sip while reading this article. These are all behaviors. At some point, we humans gave the word “behavior” a bad name. We all have behavioral repertoires, some work and some don’t support how we define living a meaningful life. And when someone we support is engaging in behaviors that may be interfering with their ideal functioning, we often say that the behavior is problematic and challenging. These descriptors are accurate but what we need to reconceptualize is who finds these behaviors problematic or challenging. Oftentimes, what the person is doing may be working for that person, while also being dangerous or disruptive. It may be their best attempt at getting what they want because they have no other functional way to communicate or may have historically been getting what they need as a result of engaging in this behavior. In a sense, this is working for them. However, the supporters of the person may find the behavior is not working; they are doing their best to provide support so that the person does not have to self-harm, hurt others, engage in property destruction, etc. to get what they need. In the end, the behavior is problematic or challenging to the people who support the person rather than to the person engaging in it to get their desires met.

Evolution

While much can be said about the evolution of behavioral support, for the purpose of this article, it is important to note that as the disability field has shifted from institutional to home and community support, we have worked to find better ways to support people across the lifespan. Behavioral science has moved from its early roots in theory to a focus on actionable consequences or finding ways to minimize behaviors, towards embracing a more person-centered, proactive approach that emphasizes the importance of quality of life and skill-building. Like any science, we continue to change and adapt based on what we learn as we practice and use technology to increase the precision of our implementation and research. Therefore, we land in a place where Positive Behavioral Support (PBS) marries the science from years of applied research and the art of individualized, person-centered supports.

Positive Behavioral Support

Positive Behavior Support is an approach to supporting people in home, school, work, and community environments that combines the principles of applied behavior analysis, implementation science, and best practices from other human service fields. It is characterized by a commitment to collaboration; basing interventions on a thorough understanding of the person and environmental influences affecting behavior; proactive, educative, and functional strategies; making decisions on the basis of objective information; and focusing not just on behavior change, but also on improvements in quality of life.1

PBS is predicated on several core features including1:

1.     Data-Based Decision Making: PBS relies on objective data for decision-making. During assessment and through ongoing behavioral support, data is critical to guiding the direction of support.

2.     Collaborative Team Process: PBS requires the engagement of individuals who are the focus of intervention and all relevant stakeholders. A multidisciplinary team is important to ensuring a holistic approach to assessment and intervention.

3.     Assessment of Contexts and Functions: PBS requires objective and thorough assessments to develop effective, individualized support plans. Collecting both indirect and direct data to highlight patterns in function and contexts while also capturing broader physical and social ecology that might be contributing to the behavior is at the heart of PBS.

4.     Multicomponent Plans: PBS plans include multiple components that are linked directly to the patterns identified in the assessment. Plans should include:

a.      Preventative strategies.

b.     Methods to teach replacement behaviors and other skills.

c.      Interventions that focus on reinforcing positive behavior rather than problem behavior.

5.     Lifestyle & Quality of Life Change: PBS is driven by the goal of improving people's quality of life. Finding purpose and meaning while focusing on improving advocacy, relationships, community engagement, productivity, and health and safety sets the stage for behavioral supports to work.

A Focus on Lifestyle and Quality of Life

“It is motivating when meaning and purpose are given to treatment beyond just avoiding offending behavior.” James Haaven2

While James Haaven speaks of treatment for persons who have sexually offended in this quote, it is a poignant consideration for all supporters. Avoiding the behavior of concern and focusing only on fundamental, physiological needs like food, shelter, and water ignores the importance of meaning and purpose as motivating qualities for someone to show up and have the drive to change – whether that is intrinsically or extrinsically motivated.

In fact, some assert that people who have their psychological needs to be competent, autonomous, and related to others met are also more motivated to grow and change – known as Self-Determination Theory3. This theory posits that physical and social environments that focus on meeting these psychological needs strengthen intrinsic motivation. Of course, there are times when extrinsic factors like rewards and praise are needed, but in a behavioral approach to treatment, we can do better in creating environments that focus more on getting these psychological needs met as a critical function in behavior change.

Dan Pink4 translated the Self-Determination Theory and other similar theories and research into a recipe of three easily understood ingredients that focus less on extrinsic desires and more on creating opportunities to foster autonomy, mastery, and purpose. We need to get better at embracing these three notions as central components of behavioral support.

Including Autonomy, Mastery, & Purpose in Behavioral Support

“Control leads to compliance; autonomy leads to engagement.” Daniel Pink4

- First, ask yourself how much autonomy someone has in their day. Taking inventory and seeing where someone is “decision deficient” could be very telling to how they are showing up and perhaps asserting themselves to seek control in a life over which they may feel they have no control.

- Second, mastery or being good at something or just having the skills to accomplish a task motivates one to show up time and time again even on the days you don’t feel like doing that task. If you focus on ensuring that people have the skills they need to be successful, they will engage and make progress.

Third, having a purpose, contributing to a larger goal, connecting with others, or sharing a common goal that is outside of ourselves bolsters the motivation of those who are autonomous and who have the skills to be successful. Finding meaning and purpose or something that a person is passionate about can make those other things bearable and more tolerable.

Conclusion

So, let us eliminate goals that focus on avoidance, and support plans that seek only to decrease challenging behavior. Instead, let us work on creating a system of support that seeks to provide opportunities for autonomous living where the person has the skills to be successful and finds or has purpose and connection outside of themselves. If we ground our behavioral support plans in the understanding that there is more than just minimizing, decreasing, or disruptive behavior; we can increase the chances that overall well-being and psychological health will be impacted. Consider James who was supported in the community with many restrictions to minimize his use of technology and social media due to a court order. James was described by his team as “unmotivated” and “resistant” to treatment. In fact, most of James’s day was spent playing video games and arguing with his staff about what he should be doing instead. James had a well-written Behavioral Support Plan (BSP) and while the team was able to put good antecedent and consequence strategies in place, they struggled to engage James in building skills like Activities of Daily Living (ADLs) and to follow through with things like scheduling his day. It wasn’t until a new, weekend staff person was hired that this began to change. The new staff person was the same age as James and talked with him as a peer. They talked about new things they could do together on weekends like go to clubs and bars. Long story short, the new staff person didn’t focus solely on correcting, controlling, and redirecting James. He gave James options to try new, age-appropriate things to occupy his free time (and he had a lot of it!) In turn, James paid more attention to his hygiene which prior to this, was one of the points of contention between James and his staff. We know that never ends well because, as in this case, the behaviors that were being addressed are looked at as “quality control.5” Unfortunately, this new staff person left his position as so many direct supporters do, and the focus on meaning and purpose was never written into James’s BSP, skills were not generalized, and the team returned to focusing on avoidance and decreasing challenging behavior. Thus, the team did not capitalize on the momentum of real behavioral change driven by a focus on autonomy, mastery, and purpose. We all know where that left James. Let this be a lesson to us all. Taking a behavioral approach in the treatment of challenging or interfering behaviors should consider both the art and science of support and an understanding and utilization of the PBS model to meet the needs of people like James and of those around him. Considering factors like autonomy, mastery, and purpose like James’s staff unknowingly did will provide the basis for engaging someone when teams feel all hope is lost. Acknowledging these positive changes and what is most influential in that change is important – even more important is to take what you learn and continue incorporating that in the supports for that person.




References

1.     What is Positive Behavior Support? Home and Community Positive Behavior Support Network (HCPBS). https://hcpbs.org/what-is-positive-behavior-support/

2.     Blasingame GD, Haaven J. Practical Treatment Strategies for Persons with Intellectual Disabilities: Working with Forensic Clients with Severe and Sexual Behavior Problems. Wood “N” Barnes Pub; 2006.

3.     Deci E, Ryan R. Motivation, personality, and development within embedded social contexts: An overview of self-determination theory. The Oxford Handbook of Human Motivation. 2012.

4.     Pink DH. DRIVE: The Surprising Truth about What Motivates Us. Canongate Books Ltd; 2018.

5.     Hingsburger D. Power Tools: Thoughts about Power & Control in Service to People with Developmental Disabilities. Langara College; 2007.



Biography

Stacy L. Nonnemacher received her Ph.D. from Lehigh University. She is currently the Clinical Director for the Bureau of Supports for Autism and Special Populations in the Office of Developmental Programs in Pennsylvania's Department of Human Services.  Stacy is the Editor in Chief of the Positive Approaches Journal. She has been involved in the field of disabilities for over twenty-five years supporting children, adolescents, and adults in home, community, and school settings. Dr. Nonnemacher has conducted applied research and training on Positive Behavioral Support, fostering self-determination, Functional Behavioral Assessment, and the needs of and support for individuals with autism.

Contact Information

c-snonnema@pa.gov