Peds: Chap 18 Mobility and Chap. 21 Behavioral Approach

Mobility

• Functional Mobility
  ➤ Moving from one position or place to another
  ▪ Examples: Bed mobility, transfers (e.g., wheelchair to toilet), walking inside the home

• Community Mobility
  ➤ Moving around in the community using public or private transportation
  ▪ Includes: Buses, taxis, personal vehicles, walking to destinations

Delay

• Physical Disabilities
  ▪ May limit independent movement or access to environments

• Restricted Experiences
  ▪ Fewer opportunities for play, learning, and social interaction

• Less Self-Initiated or Self-Produced Mobility
  ▪ Relying on others for movement limits autonomy

• Delays in Development
  ▪ Affects cognitive, motor, and social development

• Reduced Exploration and Curiosity
  ▪ Less movement = fewer chances to explore surroundings

• Limited Spatial Knowledge
  ▪ Difficulty understanding space, distance, or navigation

• Motivational Effects (Learned Helplessness)
  ▪ Over time, lack of success in moving can lead to giving up or not trying

Mobility Devices

• Gait Trainers
  ▪ Support upright walking and balance, often used during rehab or early walking development

• Scooters
  ▪ Battery-powered seated mobility device, often for community use
  ▪ Requires good upper body control and cognition

• Power Wheelchairs
  ▪ Electrically powered; controlled by joystick or switches
  ▪ For users with limited strength or endurance

• Manual Wheelchairs
  ▪ Propelled by the user or a caregiver
  ▪ Requires upper body strength or caregiver support

• Power Assist
  ▪ Adds a motor to a manual wheelchair to reduce effort during propulsion
  ▪ Good for users who want independence but need some help

• Emerging Technologies
  ▪ Examples: Smart wheelchairs, exoskeletons, adaptive drive systems
  ▪ Aim to increase independence and efficiency

Augmentative Mobility

Definition:
All types of mobility that supplement or support ambulation (walking), especially for individuals who can’t ambulate independently or consistently.

Purpose of Augmentative Mobility Devices:

• Explore the Environment
  ▪ Encourages curiosity and interaction with surroundings

• Experience Success
  ▪ Builds confidence through independent movement

• Control the Environment
  ▪ Empowers users to make choices and navigate spaces

• Reduce or Avoid Social and Emotional Handicaps
  ▪ Promotes inclusion, peer interaction, and self-esteem

• Transition to Functional Mobility
  ▪ Can be a stepping stone toward walking or independent wheeled mobility

Classification of Mobility Skills

• Never Ambulate
  ▪ Individual has never developed the ability to walk

• Inefficient Mobility
  ▪ Can ambulate but not effectively
  ▪ Issues with rate, speed, or endurance that limit independence

• Lost Independent Mobility
  ▪ Previously mobile but lost the ability due to injury, illness, or progression of a condition

• Temporarily Require Assisted Mobility
  ▪ Need support (e.g., device or caregiver help) for a short period due to recovery, surgery, etc.

AT Professional (ATP)

Definition:
A service provider who:

• Analyzes the needs of individuals with disabilities

• Assists in selecting appropriate mobility or assistive equipment

• Trains the user on how to properly and safely use the device

Goal:
To ensure the chosen technology meets the user’s functional, environmental, and personal needs.

Mobility Devices

Alternative Mobility Devices:

• Tricycles
  ▪ Promote movement, balance, and coordination
  ▪ Often used for play and strengthening

• Prone Scooters
  ▪ User lies on stomach and propels with arms
  ▪ Builds upper body strength and encourages active play

• GoBabyGo
  ▪ Modified ride-on toy cars for kids with mobility challenges
  ▪ Promotes independence, play, and exploration

• Mobile Stander
  ▪ Provides upright support while allowing movement
  ▪ Encourages weight-bearing and mobility

• Walkers
  ▪ Provide support during ambulation
  ▪ Available in various styles (posterior, anterior, with/without wheels)

Alternative Powered Mobility Devices:

• Custom or adapted powered mobility devices
  ▪ Designed for individuals not yet ready for standard power wheelchairs
  ▪ Examples include joystick-controlled ride-ons or powered platforms

Wheeled Mobility Systems

1. Manual Wheelchairs

▪ Propelled by the user or a caregiver
▪ Requires upper body strength and coordination (or assistance)

2. Power Assist Devices

▪ Motorized add-ons to manual chairs
▪ Reduce the effort needed to propel the chair
▪ Ideal for users who want independence but fatigue easily

3. Power Wheelchairs

▪ Fully motorized and controlled by a joystick or adaptive switch
▪ Suitable for users with limited strength, coordination, or endurance

4. Selection of Wheelchair Accessories

▪ Includes items that improve comfort, safety, posture, and function:

• Cushions (pressure relief, posture support)

• Trays (support for arms or activities)

• Headrests, lateral supports

• Seatbelts, harnesses

• Wheel locks, anti-tip bars

Powered Mobility Evaluation and Intervention

1. Define Goals

▪ What do you want the child to achieve with powered mobility?
▪ Goals may include independence, participation, exploration, or social interaction.

2. Determine Access and Driving Method

▪ Identify how the child will control the devi

• Joystick

• Switch

• Head array

• Eye gaze

• Other adaptive input methods

3. Evaluate Switch Placement

▪ Placement should be:

• Accessible (within the child’s range of motion)

• Comfortable

• Consistent with natural movement patterns

4. Input Devices

▪ Devices used to control the wheelchair

• Joysticks

• Switches

• Sip-and-puff systems

• Touchscreens

• Head controls

5. Identify Interfering Factors

▪ Consider challenges such as:

• Visual impairments

• Cognitive delays

• Behavioral issues

• Muscle tone or range of motion limitations

• Safety awareness

6. Guidelines for Teaching Powered Mobility

▪ Start in a safe, open space
▪ Use short, motivating practice sessions
▪ Provide verbal cues, modeling, and hands-on guidance
▪ Reinforce success and celebrate progress
▪ Focus on gradual skill development (e.g., moving forward → turning → stopping)

Wheelchair Features

1. Style of Frame

▪ Rigid Frame: Solid and lightweight, often used for active users
▪ Folding Frame: Easier to transport and store, slightly heavier

2. Tilt-in-Space

▪ The whole seat tilts backward while maintaining hip/knee angles
▪ Helps with pressure relief, positioning, and head/trunk control

3. Recline

▪ The backrest reclines independently of the seat
▪ Good for rest, catheter access, and pressure relief

4. Footrest Style

▪ Swing-away: Easier transfers
▪ Elevating: Useful for edema management or limited knee flexion
▪ Fixed: Lighter and more compact

5. Armrest Style

▪ Desk-length: Fits under tables
▪ Full-length: Better arm support
▪ Removable or flip-back: Assists with side transfers

6. Backrest Height

▪ Higher = more trunk support
▪ Lower = more mobility for active users

7. Backrest Adjustability

▪ Adjustable height and angle to match user needs
▪ Important for posture and pressure management

8. Floor-to-Seat Height

▪ Affects transfers, propulsion, and fit under tables
▪ Must be customized to user’s leg length and mobility goals

9. Style and Location of Wheel Locks or Brakes

▪ Push-to-lock vs. pull-to-lock
▪ Extensions available for limited reach
▪ Placement must be accessible to the user or caregiver

10. Type, Size, and Placement of Wheels and Casters

▪ Rear Wheels: Large for propulsion (manual wheelchairs)
▪ Front Casters: Small and swivel for maneuverability
▪ Power chairs: May have mid-wheel, rear-wheel, or front-wheel drive

11. Additional Features

▪ Anti-tip bars
▪ Trays, oxygen tank holders, backpacks
▪ Lateral supports, headrests, seat cushions
▪ Custom seating systems

Seating and Positioning

1. Biomechanics of Seating

▪ Focuses on how the body is supported in a seated position
▪ Goal: Promote stability, comfort, and function while reducing fatigue and injury

2. Alignment of Pelvis, Spine, and Head

▪ Pelvis: Neutral alignment is key (avoid posterior/anterior tilt)
▪ Spine: Should maintain natural curves
▪ Head: Should be upright and midline to support vision, breathing, and swallowing

Poor alignment can lead to discomfort, pressure sores, and reduced function

3. Neurophysiologic Factors

▪ Includes tone (hypertonia/hypotonia), reflexes, and motor control
▪ These affect posture, movement, and ability to maintain positioning
▪ Supportive seating may be needed to manage these issues

4. Reaction to Tactile Input

▪ Some children are hypersensitive or hyposensitive to touch
▪ The materials and fit of seating may need to be adjusted to reduce discomfort or improve awareness

5. Body Reaction to Orientation in Space and Movement

▪ Vestibular and proprioceptive systems affect balance and movement
▪ Positioning systems should consider how a child reacts to being tilted, upright, reclined, etc.
▪ Support may be needed to reduce fear, encourage engagement, and increase postural control

Seating Guidelines

Goals of Optimal Seating and Positioning

1. Promote Optimal Alignment for Function
   ▪ Align pelvis, spine, head, and limbs to support posture and movement
   ▪ Encourages efficient use of energy and body mechanics

2. Increase Stability to Improve Distal Motor Function
   ▪ A stable core allows for better control of arms and hands
   ▪ Essential for tasks like feeding, writing, and playing

“Proximal stability for distal mobility."

What it means:

To move and control your hands (distal function), your core, shoulders, and pelvis (proximal areas) need to be stable first. Without that stability, fine motor skills like writing, feeding, or buttoning become way harder.

3. Minimize Undesirable Tone and Reflexes
   ▪ Proper positioning can reduce spasticity and abnormal reflexes
   ▪ Supports smoother, more controlled movement

4. Distribute Seat Pressures to Maintain Skin Integrity
   ▪ Prevents pressure injuries (bedsores) by spreading weight evenly
   ▪ Use of cushions and custom seating is key

5. Improve Physiologic Function
   ▪ Better breathing, swallowing, and digestion with upright, aligned posture
   ▪ Reduces aspiration risk and supports overall health

6. Increase Ability to Perform ADLs (Activities of Daily Living)
   ▪ Supports independence with tasks like eating, dressing, and toileting

7. Provide Comfort
   ▪ Reduces fatigue, pain, and behavioral issues
   ▪ Encourages participation and attention

Client Education: Safe Transport Tip

ANSI/RESNA WC-20: Wheelchairs Used as Seats in Motor Vehicles

Definition:
A safety standard developed by ANSI (American National Standards Institute) and RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) for wheelchairs that are used as seating during vehicle transportation.

Key Points of WC-20 Compliance

• WC-20 Compliant Wheelchairs Must Have:
  ▪ 4 accessible and clearly marked securement points
  ▪ These points are used to safely attach the wheelchair to the vehicle with tie-down straps or a docking system

• Purpose:
  ▪ To reduce risk of injury during transport
  ▪ Ensures that the wheelchair can be used as a safe seating option in moving vehicles

Client Education: Safe Transport Tips

• Always secure the wheelchair using WC-20-approved tie-downs

• Educate on proper positioning and use of seatbelts

• Remove loose parts or accessories that may shift during travel

• Reinforce the importance of locking wheels and using headrests or trunk supports if needed

Key Factors in Selecting and Using Mobility Devices

1. Fit of the Child to the Device
   ▪ Must match the child’s size, posture, and support needs
   ▪ Poor fit can cause discomfort, poor alignment, or lack of function

2. Features of the Device
   ▪ Does the device support the child’s goals (e.g., tilt, recline, joystick control)?
   ▪ Are the features customizable or adjustable?

3. Physical and Social Environments
   ▪ Will the device fit through doorways, work on uneven terrain, or function in school/home settings?
   ▪ Will it promote inclusion or create barriers socially?

4. Ability of the Professional or Caregiver to Determine Access
   ▪ It's critical to accurately assess how the child will operate the device (e.g., joystick, switch)
   ▪ Trial-and-error and interdisciplinary input are often needed

5. Anticipated Changes the Child May Go Through
   ▪ Growth, developmental progress, or decline should be factored into the equipment choice
   ▪ Device should allow for some adjustability or replacement planning

6. Mounting of Augmentative Equipment
   ▪ Where and how communication devices or switches will be attached
   ▪ Must be secure, accessible, and not interfere with mobility

7. Client & Caregiver Education
   ▪ Essential for safety, proper use, maintenance, and confidence
   ▪ Includes training on transfers, battery care, emergency protocols, etc.

Guiding Behavior Questions

Why Does Challenging Behavior Occur?

Challenging behavior happens because it serves a purpose (function) for the individual. It’s often a way to:

• Get something (attention, item, sensory input)

• Avoid something (tasks, people, discomfort)

• Communicate a need when other communication methods are limited

• Express frustration, anxiety, or confusion

✳ Behavior is usually a form of communication—especially in children or individuals with limited verbal skills.

2. What Are Antecedents and Consequences & How Are They Related to Behavior?

• Antecedent: What happens before the behavior (the trigger)
  ▪ Example: Teacher gives a difficult math worksheet

• Behavior: The observable action
  ▪ Example: Child throws the worksheet

• Consequence: What happens after the behavior (the outcome)
  ▪ Example: Teacher removes the worksheet

➡ The ABC model (Antecedent–Behavior–Consequence) helps identify the function of the behavior so you can plan effective interventions.

3. Principles & Strategies to Reduce Challenging Behaviors 🔹 Principles:

• All behavior is communication

• Behavior is influenced by the environment

• Prevention is better than reaction

• Reinforce positive behaviors, not just stop negative ones

🔹 Strategies:

Antecedent-Based (Prevention) Strategies:

• Use visual schedules or if-then statements

• Give choices to increase control

• Modify tasks to match ability

• Prepare for transitions with cues or timers

• Keep routines consistent

Teaching Replacement Behaviors:

• Teach appropriate communication (e.g., sign, words, AAC)

• Practice calm-down strategies

• Reinforce desired behaviors with praise or rewards

Consequence-Based Strategies:

• Reinforce positive behavior immediately

• Use natural consequences

• Minimize attention for negative behavior if it's attention-seeking

• Avoid reinforcing the problem behavior (don’t remove demands if that’s what the child wants)

Strategies for Managing Difficult Behavior

What is Behavior?

Behavior is any observable and measurable action a person does.
It can be:

• Verbal (e.g., yelling, asking for help)

• Nonverbal (e.g., hitting, walking away, crying, hugging)

Behavior isn’t “good” or “bad”—it’s a form of communication.

What Is the Purpose of Behavior?

All behavior serves a purpose (also called a function). The four main purposes are:

1. To Get Something (Access)
   ▪ Toys, food, attention, sensory input

2. To Avoid Something (Escape)
   ▪ Tasks, people, settings, discomfort

3. To Seek Sensory Input
   ▪ Rocking, spinning, touching—meets internal needs

4. To Communicate or Express Feelings
   ▪ Anger, frustration, excitement, confusion

Why Do Children Behave in Certain Ways?

Children behave the way they do because:

• It works (the behavior gets them what they want or need)

• They may lack other tools or skills (like words, self-regulation)

• They may be responding to the environment (loud noises, unclear directions, transitions)

• It may be habitual or automatic (like stimming or fidgeting)

🔁 Bottom line: Behavior is functional and learned—we can shape it by understanding the “why” behind it.Want a mini case scenario or visuals to go with this?

Understanding Behavior

Behavior theory (especially Applied Behavior Analysis, or ABA) has shaped how we understand and address challenging behavior. Key contributions include:

✅ Behavior Has a Function

• Behavior is not random—it happens for a reason (access, escape, sensory, attention)

✅ Behaviors Are Learned

• Behaviors are shaped over time through reinforcement (rewards) or punishment (consequences)

✅ We Can Teach Replacement Behaviors

• Instead of just eliminating problem behavior, we teach a more appropriate behavior that serves the same function

✅ The ABC Model

• Antecedent → Behavior → Consequence

• Helps us understand what triggers behavior and what reinforces it

Functional Behavior Analysis (FBA)

Definition:
A structured process for observing and analyzing behavior to figure out its function (or purpose).

🔍 Steps in an FBA:

1. Define the Behavior Clearly
   ▪ Describe what it looks like—observable & measurable

2. Gather Data
   ▪ Use observation, interviews, and checklists
   ▪ Identify patterns of when, where, and with whom behavior occurs

3. Identify Antecedents and Consequences
   ▪ What happens before and after the behavior?

4. Determine the Function of the Behavior
   ▪ What does the child gain or avoid by doing it?

5. Develop a Hypothesis
   ▪ Statement about why the behavior occurs
   ▪ Example: "When given a difficult task, Sam hits to escape the demand."

6. Create a Behavior Intervention Plan (BIP)
   ▪ Use the info from the FBA to design a plan that:

   • Modifies triggers

   • Teaches replacement skills

   • Changes consequences to support positive behavior

Interventions

Antecedent

What happens right before the behavior (the trigger)

• It sets the stage for the behavior to occur

• Can include things like:
  ▪ A demand or instruction
  ▪ A transition
  ▪ A sensory experience (e.g., loud noise)
  ▪ Someone taking away a toy

✅ Example:
Teacher says, "Time to clean up!" → child screams
👉 “Time to clean up” is the antecedent

Consequence

What happens right after the behavior (the outcome)

• It affects whether the behavior will happen again

• Can increase (reinforce) or decrease (discourage) the behavior

• Examples:
  ▪ Getting attention
  ▪ Escaping a task
  ▪ Receiving a reward or losing a privilege

✅ Example:
Child screams → teacher lets the child skip cleanup
👉 Skipping cleanup is the consequence (which may reinforce screaming)

🧠 Tip to Remember:
Think of A-B-C like a story:

• Antecedent = what triggered it

• Behavior = what the child did

• Consequence = what happened after

Antecedent Interventions

Strategies used to prevent challenging behavior by changing what happens before it starts.

1. Functional Communication Training (FCT)

▪ Teaches a replacement way to communicate (e.g., asking for a break instead of hitting)
▪ Builds appropriate communication skills to meet the same need as the behavior

2. Pivotal Response Training (PRT)

▪ Naturalistic ABA-based intervention
▪ Targets key developmental skills (like motivation, initiation, self-management) that lead to widespread improvements
▪ Focuses on child choice, turn-taking, and reinforcing attempts

3. Environmental Modifications

▪ Change the physical or social setup to reduce triggers
▪ Examples: reducing noise, changing lighting, rearranging furniture, limiting distractions

4. Visual Schedules

▪ Show what’s happening now and next
▪ Helps with transitions, routines, and reducing anxiety
▪ Can include pictures, icons, or words depending on ability level

5. Timers

▪ Provide a clear beginning and end to tasks or transitions
▪ Help with predictability and managing wait time or preferred activities

6. Representational Objects

▪ Use real items or symbols to represent an activity or choice
▪ Supports children with limited language or abstract understanding
▪ Example: Handing a cup to request a drink

7. Positive Behavioral Interventions and Supports (PBIS)

▪ School-wide framework for promoting positive behavior
▪ Uses proactive strategies, consistent expectations, and data-based decision-making
▪ Reinforces expected behaviors and builds a supportive environment

Consequence Interventions

Strategies used after a behavior to either increase positive behavior or decrease challenging behavior.

1. Reinforcement

Strengthens a behavior by providing a desired outcome right after it happens

• Positive reinforcement: Give something the child likes (e.g., praise, sticker, toy)

• Negative reinforcement: Remove something the child doesn’t like (e.g., cancel a tough task after appropriate request)

✅ Example: Child completes task → gets iPad time

2. Contingency Methods

The child gets a reward or access to something only if a specific behavior happens

• If–then format: "If you clean up your toys, then you can play outside"

• Helps clarify expectations and consequences

✅ Example: "First homework, then TV."

3. Token Economies

Child earns tokens (e.g., stars, stickers, points) for positive behaviors
Tokens can be exchanged for rewards later

• Encourages delayed gratification

• Builds consistent reinforcement patterns

✅ Example: 5 stars = choice time or small prize

Behavior Methods and Occupational Therapy’s Holistic Approach

Occupational therapy supports behavior through a whole-child approach—not just addressing the behavior itself, but the why behind it, and what supports success.

🔑 Core OT Strategies: 1. Therapeutic Use of Self

▪ Build trusting relationships
▪ Use empathy, encouragement, and tone to guide behavior
▪ Be a calm, regulated presence

2. Focus on Interests & Volition

▪ Let the child’s interests drive motivation
▪ Recognize their desire for control and autonomy

3. Use of Meaningful Activities

▪ Choose tasks that are purposeful and engaging
▪ Activities should match the child’s goals, abilities, and needs

4. Allow Child Choice

▪ Empowers the child and reduces power struggles
▪ Examples: “Do you want to use the blue marker or red one?”

5. Set Clear Expectations

▪ Use visual supports or simple language
▪ Review rules or routines beforehand

6. Examine All Factors:

• Sensory: Are they overwhelmed or under-stimulated?

• Cognitive: Do they understand what’s being asked?

• Motor: Can they physically complete the task?

7. Consider Environmental Influences

▪ Is the room too loud, crowded, or unstructured?
▪ Modify space, routines, or transitions if needed

8. Be Consistent

▪ Use consistent language, expectations, and consequences
▪ Consistency builds trust and understanding

Collaboration With Other Professionals to Manage Behavior

Effective behavior management often requires a team approach—including OTs, teachers, parents, speech therapists, behavior analysts, and more. Here’s how to collaborate successfully:

🔑 Key Principles for Collaboration: 1. Clear Expectations

▪ Everyone on the team should know the goals, strategies, and roles
▪ Avoid mixed messages by being specific and aligned

2. Holistic View

▪ Look beyond just behavior—consider sensory, emotional, social, cognitive, and physical factors
▪ Value input from all disciplines to get the full picture

3. Listen to Others

▪ Respect and consider input from parents, caregivers, and team members
▪ Everyone brings unique insights and observations

4. Follow Through

▪ Stick to agreed-upon strategies and plans
▪ Inconsistency can cause setbacks or confusion for the child

5. Communicate Often and Clearly

▪ Use simple, direct language
▪ Share updates, successes, and concerns regularly

6. Follow the Plan

▪ Stick to behavior plans, sensory diets, or intervention strategies as written
▪ Modify the plan as a team when needed

7. Be Consistent

▪ Across settings, staff, and routines
▪ Children thrive when everyone responds the same way to behaviors

Support Positive Behavior

✅ 1. Meeting Sensory Needs

Many challenging behaviors are a response to unmet sensory needs—so addressing those needs proactively helps prevent behavior issues.

Examples:

• Provide sensory breaks (e.g., jumping, swinging, fidget toys)

• Use calm-down spaces with weighted blankets, soft lighting

• Offer movement opportunities throughout the day

• Address sensory sensitivities (e.g., noise-canceling headphones, dim lights)

Goal:
Help the child stay regulated, alert, and able to participate

✅ 2. Building New Skills

Behavior improves when kids know what to do instead of the challenging behavior.

Examples:

• Teach communication skills (e.g., asking for help, saying “all done”)

• Practice self-regulation strategies (e.g., deep breathing, using a visual calm-down card)

• Break tasks into manageable steps

• Use modeling, visual supports, and hands-on practice

Goal:
Replace challenging behavior with functional, socially acceptable skills

✅ 3. General Strategies That Support All Kids

• Build strong relationships and use positive reinforcement

• Use clear, consistent routines and expectations

• Praise efforts and reinforce small successes

• Provide choices to increase control and motivation

• Use visuals, timers, and first-then boards

• Keep the environment predictable and structured

Support Positive Behavior

✅ 1. Increasing Compliance Through Contingency Methods

Use "if-then" or "first-then" language to help the child understand expectations.

• Examples:
  ▪ “If you finish your puzzle, then you can play with the cars.”
  ▪ “First math, then snack.”

• Why it works:
  ▪ It sets clear conditions and offers motivating outcomes.

✅ 2. Token Economies

Children earn tokens (stars, stickers, points) for positive behaviors and trade them for a reward.

• How it works:
  ▪ Choose target behaviors (e.g., staying seated, following directions)
  ▪ Give tokens immediately after behavior
  ▪ Let the child “buy” rewards after collecting a set number

• Why it works:
  ▪ Encourages consistent effort and teaches delayed gratification

✅ 3. Positive Reinforcement

Reward behaviors you want to see more often.

• Examples of reinforcers:
  ▪ Verbal praise
  ▪ High-fives
  ▪ Access to favorite activity
  ▪ Small prizes or privileges

• Tip: Reinforcement should be immediate, meaningful, and consistent.

✅ 4. Alternate Preferred and Nonpreferred Activities

Mix in motivating tasks with harder or less preferred ones.

• Example:
  ▪ “First clean-up time, then painting.”
  ▪ “After handwriting, we’ll go outside.”

• Why it works:
  ▪ Keeps kids engaged and builds tolerance for challenging tasks

✅ 5. Addressing Transitions

Help kids shift between activities or settings more smoothly.

• Strategies:
  ▪ Use timers or countdowns
  ▪ Offer transition objects (e.g., bring a toy with them)
  ▪ Give visual or verbal warnings
  ▪ Use songs or routines to signal change

• Why it works:
  ▪ Reduces anxiety and behavior outbursts during change

Behavior Support Process: Team Building to Monitoring

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✅ 1. Team Building & Goal Setting

Collaboration is key! Bring together teachers, therapists, family, and other support staff.

• Purpose:
  ▪ Establish trust and shared responsibility
  ▪ Set realistic, meaningful, and measurable goals
  ▪ Center the child’s strengths, needs, and environments

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✅ 2. Functional Assessment of Behavior (FBA)

Collect data to understand why the behavior happens.

• Methods:
  ▪ Direct observation (ABC recording)
  ▪ Interviews with caregivers/teachers
  ▪ Review of academic, behavioral, and environmental records

• Goal:
  Identify the function of the behavior (e.g., escape, attention, sensory)

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✅ 3. Hypothesis Development

Based on assessment data, create a best-guess explanation of the behavior.

• Example Hypothesis:
  “When given a non-preferred task, Marcus hits to escape the demand.”

• Purpose:
  Helps guide intervention planning by defining triggers, behaviors, and outcomes

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✅ 4. Development of a Comprehensive Support Plan

Create a Behavior Intervention Plan (BIP) tailored to the child.

• Includes:
  ▪ Antecedent strategies (prevention)
  ▪ Teaching new/replacement skills
  ▪ Reinforcement systems
  ▪ Crisis or safety plans (if needed)
  ▪ Roles for each team member

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✅ 5. Implementation & Outcome Monitoring

Put the plan into action and track progress over time.

• Strategies:
  ▪ Collect data regularly (behavior frequency, intensity, duration)
  ▪ Use check-ins, observations, and team meetings
  ▪ Adjust the plan based on what’s working or not