SCS CONSULTATION REPORT

BEHAVIOR SUPPORT GUIDELINES

Name: Minnie Mouse
Date: 7.15.2021

DOB: 12/13/1987 (35 years)
Revised: 10/13/22

BACKGROUND: Minnie Mouse is a 35-year African American female who was born and raised in Charlotte, North Carolina by her mother. She was placed at the Woodbridge group home operated by Rescare, Inc. in March 2020. Tanesha did well and moved into an AFL home with Angelia Bell in 2021. She is the middle child of three siblings. She had some developmental delays and received services through the Watkins Center. She completed high school despite years of special education, speech therapy and learning difficulties. Previous records indicate intellectual deficits and various diagnoses ranging from Asperger’s and anxiety to Schizophrenia (denies hearing voices), OCD and seizures, although none since 2013. Minnie Mouse was hospitalized for psychiatric care in 2015 after an acute episode of agitation, aggression and poor self-control and threatening others. Minnie Mouse stated that she did not like how others were speaking to her and it upset her and she did not handle it well. Minnie Mouse has a diagnosis of mild intellectual disability and R/O autism spectrum disorder. Minnie Mouse is making pseudo complaints to avoid going to PSR but likes it once she is there. Tanesha does not perceive that she is disabled and does not want to be associated with others who are disabled. She enjoys going to the YMCA. During an initial team meeting on 6.25.21, a functional behavior assessment (FBA) was conducted to obtain details for the purpose of designing a positive behavior support plan. Due to making so much progress, the team agreed to implement Behavior Guidelines to provide staff with historical and current interventions when necessary. The FBA is updated annually or as needed. Treatment team will meet to review progress at least quarterly. Tanesha takes Risperdal for mood disorder.

Annual Update: for the majority of the time, Minnie Mouse is reported to be happy and content. She has adjusted to attending the PSR program and has made friends there. Minnie Mouse is described as being “heavy handed”. Everything she touches, moves, or closes is with a hard slam. She often complains that others are telling her what to do and she does not like this. Overall, staff are using a best practice approach, helping her feel empowered, by treating her like an adult, and assisting her with more gentle, soft touches. They are working with Minnie Mouse on development of coping skills and increased self-awareness. She continues to display noncompliance, increased voice volume, and pseudo-complaints.

BEHAVIOR ANALYSIS

STRENGTHS

: verbal, healthy, family support, talks to mom every day; likes to cook, take brisk walks, clean, dance. She is friendly.

NEEDS

: walk with her head up, stay calm and talk about her problems, empowered to cope with deficits and increase independence, help to more accurately perceive the tone, words, and non-verbal’s of others (she perceives others “giving he attitude” but is not necessarily the case). This typically happens when someone is telling her something she did not want to hear.

TRIGGERS:
things that may set her up for failure include harsh tone of voice, negative attitude of others, being told what to do, being treated as if she is not smart, crowds, noise.

Early Warning Signs
: eyes roll back in head and seems ready to fight; voice volume gets louder, repetitive

TARGET BEHAVIORS: in


the past…these have not been reported since residing at the home

1.
Physical/property Aggression: defined as hitting others or other intended harmful behaviors, including slamming doors and throwing objects.

2.
Verbal Aggression/Agitation: defined as verbal and nonverbal signs that she is upset and agitated by noting changes in voice pattern and volume, and tension in body after two (2) attempts of redirection within 10 minutes

3.
Non-Compliance: defined as refusing to complete necessary tasks that are essential to health and safety. This includes taking medications, participating in formal programs, and personal hygiene tasks.

CURRENT BEHAVIORAL ISSUES:

1.
OCD SYMPTOMS: defined as constant handwashing, wanting her bed sheets washed daily, or any repetitive behavior of concern.

2.
Self-talk: she has been observed to talk to herself when along in her room. Tanesha denies hearing voices. This behavior may be a development of self-reassurance or rehearsal.

3.
Pseudo-complaints: any complaints about her health that are not valid for the purpose of escaping or avoiding certain activities. She is reported to making complaints to avoid going to PSR even though she enjoys it once there.

FUNCTION OF THE BEHAVIOR/HYPOTHESIS:

It is believed that Tanesha displays the above target behavior for the purpose of control. She likes attention and likes to have her way. She wants to be like everyone else.
Individualized psychotherapy is recommended.

BEHAVIORAL STRATEGIES FOR PREVENTING AND RESPONDING TO ALL SITUATIONS:

· At least every 15 minutes, keep Tanesha engaged in tasks through habilitation goals, leisure activities, chores within the home, etc.

· Tanesha’s copping mechanism includes going to her room to calm down, going for a walk and listening to music or calling her guardian

· Structure environment and daily routine; Staff MUST be consistent with following her routine/schedule

· Make daily tasks organized and predictable; allow choices when appropriate

· Watch for subtle signs of /anxiety

· Reward positive behaviors with relevant rewards—
catch her being good and give praise, high 5s, etc.

· Responses to behaviors MUST BE CONSISTENT

· Coping strategies….

· She will call people she trusts, such as her guardian. This allows an outlet for her to express her feelings.

For all target behaviors:

· Give Space and Time; model relaxing stance, deep breathing,

· Maintain Personal Space/Boundaries

· Do not get into a power struggle

· Do not interrupt OCD behaviors but try to prevent them through the routine or via conversation. Once started she may need to finish or may be agitated

· If she is alone and talking to herself and not bothering anyone, allow it to happen. This could be helping her if it is not a hallucination. Listen to her words to make sure it is not a dangerous thought. Talk to her about it as necessary.

· Let her know you are available to talk anytime she needs to. Check in with her frequently to see if she would like to talk.

· Staff must use a calm, even tone of voice

· Do not tell her what to do but ask her. Use the “w” questions to elicit responses and let her feel she is control.

· Encourage appropriate tone, deep breathing; Implement coping skills

· Reinforce with verbal praise and high fives when self-control is displayed

DOCUMENTATION: all inappropriate or maladaptive behaviors will be recorded on the Behavior Log and include the date, time the episode began and ended, description of behavior, interventions used, individual’s response to interventions, and staff initials. All staff working with John are responsible for documentation. This data will be forwarded to this psychologist for analysis each month.

PROGRAM IMPLEMENTATION: Behavior Guidelines will be implemented follow training of all staff involved in working with Tanesha on appropriate implementation of the procedures specified in this plan (by Jan Kay, LPA, psychologist). It is the provider agency’s responsibility to submit the behavior support guidelines to their Human Rights Committee for review per policies and procedures if applicable. The guardian will approve this guideline prior to implementation and upon subsequent updates/revisions.

PROGRAM EVALUATION: Psychologist will review data and indicate progress in monthly progress notes. Trainings

and modifications will continue to be made as needed. Team meetings will convene at least quarterly to review progress. Plan will be reviewed and approved by guardian every 12 months.

_______________________10.30.23 ___________________________

Jan Kay, M.A., HSP-PA Guardian date

Licensed Psychological Associate

Contract Psychologist

___________________________

AFL Provider date

____________________________

AFL/Rescare QP date

TJ Behavior Consultation & Guidelines 2023
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