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Over the past few years, a number of studies have demonstrated the efficacy of combining positive behavior support and family-centered intervention in home settings. Family-centered positive behavior support is often conducted within the context of natural routines that occur regularly in home or community settings. The purpose of this article is to describe many of the unique challenges and benefits related to assessment, intervention design, and implementation that are inherent in parent-professional collaboration for positive behavior support. This is accomplished through an example of a partnership that resulted in the provision of a variety of visual supports to a young child with autism who exhibited severe problem behaviors during daily routines.
If professionals and parents can accept the challenge of taking on new roles and expectations by working creatively and cooperatively with each other and by establishing an atmosphere of mutual trust and respect, children with diverse needs and capabilities can benefit enormously. (Wood, 1996, p. 173)
Over the past decade, the field of positive behavior support has grown rapidly as a set of practices that focus on the function(s) of problem behaviors in order to develop and teach functional alternatives (Horner, 2000). Based solidly on both a values base about the fights of people with disabilities and the principles of applied behavior analysis, positive behavior support interventions (a) consider the contexts within which the behavior occurs; (b) address the functionality of the behavior; and (c) result in outcomes that are acceptable to the individual, the family, and the supportive community (Koegel, Koegel, & Dunlap, 1996).
When problem behavior occurs in the family home, parent-professional collaboration is needed in order to design interventions that fit the context for intervention. Moving toward a truly collaborative approach with regard to intervention planning should reduce the occurrence of "systems that fail," whereby "a fix [that is] effective in the short term [may have] unforeseen long term consequences which ... require even more use of the same fix" (Senge, 1990, p. 388). Often, traditional behavioral interventions fail due to a lack of "buy in" from the family, or because there is "poor fit" between the problem behavior and the behavioral intervention. When either of these consequences occurs, more time and effort are required by the behavior support interventionist and the family to arrive at an effective solution.
A small number of studies have demonstrated the efficacy of parent-professional collaborative partnerships related to the design and implementation of positive behavior support interventions in the context of natural family routines. For example, Lucyshyn, Albin, and Nixon (1997) described a 26-month intervention conducted by the parents of an adolescent girl with multiple disabilities in the context of dinner time, home leisure, restaurant, and grocery store routines. Vaughn, Dunlap, Fox, Clarke, and Bucy (1997) provided support to a boy with Cornelia DeLange syndrome, severe intellectual disabilities, and chronic medical problems. In this case, a positive behavior support intervention was implemented during family-centered community routines that included shopping in a grocery store, eating at a fast-food restaurant, and banking at a drive-through window. Vaughn, Clarke, and Dunlap (1997) worked with the family of a boy with multiple disabilities and agenesis of the corpus callosum to decrease problem behaviors during fast-food restaurant and home toileting routines. Finally, Clarke, Dunlap, and Vaughn (1999) described an intervention with a boy with Asperger syndrome who exhibited severe problem behaviors during his morning "getting ready for school" routine. In each case, the intervention resulted in a marked decrease in the frequency and intensity of problem behavior as well as an improved quality of life for both the child and his or her family.
Typically, collaborative behavior support planning requires professionals and family members to participate together in five successive phases that involve "reciprocal information sharing, creative problem solving, and shared decision making" (Snell, 1997, p. 219). The five phases include
1. building relationships between the family and the professionals,
2. conducting a functional assessment of the behaviors of concern,
3. identifying natural routines as contexts for intervention,
4. developing behavior support plans related to each of the routines, and
5. implementing and revising the support plans as needed.
Such collaborative efforts have the potential of resulting in substantial and enduring behavior change and improved quality of life for the children involved and their families through the use of multicomponent intervention packages (Carr & Carlson, 1993).
The purpose of this article is to describe the process of parent-professional collaboration for positive behavior support and illustrate it with an example of Wyatt, a preschooler with autism, and his family. In order to accomplish this, the article will operate simultaneously on two levels: (a) the general level, with regard to principles and practical strategies that apply to family-centered positive behavior support interventions, and (b) the specific level, with regard to how these principles and strategies were actualized on behalf of Wyatt by his family and the consultant who provided them with support. The article will address many of the unique challenges that must be faced when implementing such interventions in homes, including those related to assessment, intervention design, and implementation within the family context.
Introducing Wyatt and His Family
At the time of intervention, Wyatt Mallard was a high-spirited and active 4-yearold with an engaging smile who had been diagnosed with mild/high-functioning autism at the age of 3 years by a multidisciplinary hospital team in the Canadian province where he lives (see Note). He enjoyed playing with trains, using a computer, watching videos, riding his bicycle outside, and swimming at a local community pool. Although he was verbal, his language comprehension and production were delayed for his chronological age. Wyatt used both immediate and delayed echolalia as well as generative language and problem behaviors to make his wants and needs known and to comment. His social skills were markedly impaired; he usually played by himself and had difficulty interacting with other children, joining them in play, knowing the rules of play activities, taking turns, and sharing materials.
Wyatt lived at home with his mother and father, Laura and Martin, and with his younger brother, Elliott. Laura was a full-time homemaker at the start of the intervention, and Martin was employed as a medical instrument repair technician. A respite worker provided childcare in the family's home two mornings a week and some evenings. Wyatt attended an inclusive preschool program for children with autism and their typical peers every weekday afternoon for 3 hours.
The intervention was carried out collaboratively by Wyatt's parents with the support of a consultant (the first author), who was then the coordinator of his pre-school. Wyatt's parents were highly motivated to address his problem behavior using a collaborative approach because Wyatt was eligible for behavioral support services through his preschool for only 1 year due to his upcoming transition to kindergarten, and his family had no access to alternative behavior support services. They were aware of the time commitment that would be required and they agreed to record and share their perceptions of the experience. Table 1 summarizes the major phases and subphases of the assessment and intervention process.
Phase 1: Building Relationships
The positive behavior support paradigm exemplifies a systems model of support in which each participant affects the others as learning and change occur among all. A family-centered orientation to positive behavior support requires consultants and family members to work together by first establishing trust, openness, and reciprocity (Dunst, Trivette, & Deal, 1988). This means that the first step in any intervention involves developing a relationship between the consultant and family that enables the former to better understand the family's structure, strengths, routines, capacities, and needs. In so doing, positive behavior support offers an opportunity for both the consultant and the family to engage in a mutual problem-solving process. This process can lead to more relevant questions, more acceptable and feasible interventions, and more meaningful outcomes in relevant contexts (Dunlap, Fox, Vaughn, Bucy, & Clarke, 1997; Graves, 1991; Turnbull & Reuf, 1996; Turnbull & Turnbull, 1993; Vaughn, Dunlap, et al., 1997).
The Mallard Family
Initially, the consultant spent time getting to know Wyatt and his family outside of the preschool environment. She visited the family home several times during the day when Wyatt, Elliott, and Laura were present. She also accompanied the three of them to a community pool on several occasions and …