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HABILITATION
  TRAINING
   DEPARTMENT OF ECONOMIC SECURITY
 DIVISION OF DEVELOPMENTAL DISABILITIES
                DISTRICT 1


                                      ITC
Overview
Building Relationships Through Communication

       Principles of Behavior Building

        Potential Barriers to Teaching

     Why Inappropriate Behaviors Occur

       How Your Values Impact Others

               Reinforcement

         Behavior Building Overview

   Habilitation Progress Note Walkthrough

        Good Example of HAH Note
Building Relationships
                 Through Communication
The individuals we work with not only need to learn new skills (how to brush
their teeth, plan a nutritional meal, wash their clothes, etc.) but also need to
develop more positive attitudes towards themselves and towards the people
around them. They must learn to like themselves, develop a feeling of self-
confidence. They need to know that someone likes and cares about them.
They must feel successful and be able to say, "Hey, look what I did!" If they
do not feel good about themselves, then teaching them new skills will seem to
be nearly impossible.


The responsibility for helping the individuals we work with/for develop good feelings
about themselves lies with the people who support them. "As a person who provides
direct support," you can accomplish this responsibility by developing a positive
relationship with the individual. To do this, you must say to the individual by your words
and actions, “I like you”, “You are a worthwhile person", "I know you can do it".
Building Relationships
              Through Communication

We need to respect AND VALUE the individuals we work with. They
have likes/dislikes, needs, wants, etc. just like anyone else. In order
to identify these and help that person learn to fill them we must
develop a relationship with that individual.


Remember--We are here to help "each person" develop their
potential as an individual (i.e., we don't build products. We build
relationships and relationships build people!!)
Building Relationships
            Through Communication
CONCENTRATE ON THE INDIVIDUAL'S STRENGTHS:

• When you are with the individuals, talk about what they can do, don't dwell on
  what they cannot do.
• What are their positive points?
• What can you and the individual do to further develop these positive points?

PRAISE THE INDIVIDUALS:

• Praise the individuals for the good things they do. Do not assume they know
  what they are doing is correct. Praise builds self-confidence. The more things
  they know they can do, the more they will try. Don't forget to praise attempts
  even if they are not successful--praise the fact that they tried. Use the
  individual's name when praising him/her. Let them know it is they, as individuals,
  you are praising. When you praise someone base it on his/her likes. Likes are
  things a person chooses to do or have, that they are willing to work for, and will
  get obvious pleasure from (places, events, people, food, and objects).
Building Relationships
          Through Communication
BE AWARE OF YOUR VERBAL AND NON-
VERBAL ACTIONS


• Some of the strongest communication we give is through our non-
  verbal actions, (eye
• contact, gestures, body language, looks, expressions and body
  contact). People will
• pick up on these things and act accordingly.
  • Are you warm, friendly, and interested?
  • Do you yell at the individual?
  • Do you look angry?
  • Are you afraid of the individual?
  • Do you look bored?
Building Relationships
         Through Communication
TREAT THE PERSON AS A PERSON:

• How many times do you find yourself giving
  orders, saying, "Do this, Do that." or, maybe more
  frequently, "don't do that." Each time you do this, you are
  really telling someone they cannot do anything for
  him/herself and you are taking that person's control from
  them. No one can learn independence or self-confidence
  or trust if someone continually orders them around. It also
  takes away the opportunity to build relationships with
  people.
• Try saying, "Could you help me with this? "I think this is a
  good idea how about you?"
• Give choices whenever possible. Don't we all like to have
  some control over our own lives?
Building Relationships
                  Through Communication

Never talk about an individual in front of him/her as if he/she isn't there.
If you must discuss a person, involve him/her in the conversation with you.


Never talk about an individual's problems or shortcomings in front of other
individuals present. Reserve any discussion for a time when others are not
around or when the person can be involved in the discussion (problem solving)


Never talk about an individual's problems or shortcomings you work with/for to
any person who is not professionally involved with that person.



    U S E T H E S E T O O L S T O P O S I T I V E LY B U I L D R E L AT I O N S H I P S
         A N D Y O U M AY B E A M A Z E D AT T H E O U T C O M E ! ! ! ! ! !
Principles of Behavior
                       Building
• Behavior occurs all the time.
• You influence a person's behavior, whether you realize it or not.
• Every interaction is either therapeutic or not--you make the
  difference.
• Bonds and friendships develop from interactions with people.
• The environment influences behavior 24 hours a day.
• How you structure the environment determines whether it is
  therapeutic.
• At any given moment, there is a desired behavior to promote.
• A person's needs are identifiable through his/her behavior.
• There are constructive ways to respond to needs.
• The individuals who receive services from the division have
  preferences that may be different than staff preferences.
• People can and do change/learn.
Potential Barriers to
     Teaching
Why Inappropriate
                   Behaviors Occur
If you observe a problem, ask yourself which of these might be the
    cause, then do something to POSITIVELY change the situation.


• ATTENTION

• ANGER

• FRUSTRATION

• BOREDOM
ATTENTION
• Attention is the main cause of most problem behaviors. The
  person may be seeking attention from anyone (parents, staff,
  peers, etc.) Individuals who have lived in an institution have
  learned that the fastest way to get attention is to display an
  inappropriate behavior. If you think attention is the cause of the
  problem, you must:
   – Not attend to the behavior and redirect to another appropriate behavior; and
   – Give attention for anything positive the individual does. Teach him/her they will get
     attention for appropriate things, not inappropriate. Do not allow the behavior to
     occur--i.e. give attention for positive things before he/she has to do something
     wrong to gain your attention.
• Remember
   – For someone who has learned to get attention for-negative, inappropriate, behaviors
     in the past, these will increase while you begin to ignore the inappropriate behavior,
     and continue to ignore and re-teach him/her that they will get attention only for
     appropriate things they do. If attention for appropriate things is not given now, then
     ignoring will not work!! Ignoring will not work alone; it must be used with
     attention!!!! Everyone involved with the person must follow this for it to work.
ANGER

• Many individuals do not know how to appropriately express
  their anger, resulting in inappropriate behaviors. If you decide
  anger is the cause of the behavior:
   – Determine why the person is angry, with whom, with what.
   – Look at the whole situation, can you change it?
   – Teach the person appropriate expressions of anger.
FRUSTRATION

• Frustration results when a person tries to do something he/she
  cannot do. If you think this is the cause of the inappropriate
  behavior:

   – Praise the person for all their attempts.
   – If the task is too hard, go to an easier one or break it down into
     smaller, easier steps.
   – Reassure him/her frequently that they can do it.
   – When frustration appears to be building -- have them do
     something different for a while.
Boredom

• What does boredom look like?
• When you decide boredom is the reason
  – Try to change the activity before boredom sets in.
  – Offer interesting, age appropriate activities -- have him/her tell
    you what they want to do.
  – Don't get into the rut of always doing the same things.




      Dealing with inappropriate behaviors is something that will
            occur over and over again until the individual has
        meaningful choices of alternative behaviors in which to
                              choose from.
How Your Values Impact
                   Others
• We all place our judgments onto others. Therefore, a person’s
  behavior may be getting them what it is they need or want in
  the only way they know how to get it.
• We then judge them as inappropriate or appropriate.
   – Your judgments are based on:
       • You’re personal values.
       • Your limited knowledge of the situation.
       • Your emotional state.
• In order to more effectively work with another person, you need
  to put your values/judgments to the side.
Reinforcement

What is a reinforcer?

• Something a person wants and is willing to work for.

What are the four types of reinforcers?

• Material – Something tangible that the person can hold or touch.
• Privileges and Activities - Above and beyond normal or routine.
• Social - Carried with you all the time i.e.; smile, verbal praise, high five etc.
• Token – Something given that can be exchanged for something else.

What are the six ways you can use to choose reinforcers?

• Ask the person.
• Ask others who know the person best.
• Observe the person.
• Observe another person who is similar.
• Premack Principle (Grandma’s Rule) – borders on bribery.
• Reinforcement Sampling – try all ideas to learn what works
Reinforcement

What are the rules in delivering reinforcers?

• Use the person’s name.
• Give immediately and consistently.
• Give contingent on the behavior you want to increase.
• Be the right size and amount.
• The person must want it.
• Must not be harmful to the person.
• Something we have a right to and can easily control.
• Edibles (food) must be paired with social praise and faded when
  appropriate.
• Be specific in your praise.
• Use a variety of reinforcers.
• Be consistent with the person’s
  diet, medication, medical, conditionals, and disability.
Behavior Building
                          Overview
• ANTECEDENTS
   – Describe what is going on before a behavior occurs.
   – Look at:
       •   Who was interacting with the person and how?
       •   What was said and number of times said?
       •   Where and when the incident occurred?
       •   Did the person have a bad cold, fever, etc.?
       •   Did the person get only three hours sleep last night?
       •   Did the person just return from a trip?
       •   Did the person have his/her medications changed?
       •   Did the person have a favorite possession broken or stolen?
       •   Did the person start a new program?
       •   Is the person receiving supports from someone new?
       •   Did the person have a close friend move to a new home or place?
       •   Etc…
Behavior Building
            Overview
PRECURSOR BEHAVIOR


CONSEQUENCES (After the behavior)


DOCUMENTATION



EVALUATE


FOLLOW UP
Habilitation Progress Note
       Walkthrough
Habilitation Progress Note
                              Walkthrough

PRINT YOUR FIRST AND
     LAST NAME




THIS IS THE AMOUNT
OF HAH HOURS YOU
 CAN PROVIDE IN A
       MONTH




 THIS IS THE KEY TO
HOW WE SCORE OUR
CONSUMER BASED ON
  HOW WELL THEY
PERFORMED THE HAH
        GOAL




 PRINT THE CURRENT
    MONTH/YEAR
Habilitation Progress Note
                              Walkthrough


   THE DAY OF THE
      MONTH IS
 REPRESENTED IN THE
 TOP CELL AND IN THE
BOTTOM CELL YOU WILL
 WRITE IN HOW MANY
                                            ADD UP THE HOURS
  HOUR OF HAH YOU
                                           AND PUT THE TOTAL AT
PROVIDED FOR THE DAY
                                             THE END AND THE
                                           TOTAL HOURS NEED TO
                                           MATCH THE ALLOTTED
                                                  HOURS.
Habilitation Progress Note
                              Walkthrough
  THIS IS WERE THE
 HABILITATION GOAL
WILL BE WRITTEN OUT
AND THE NUMBER OF
GOALS WILL DEPEND
 ON THE CONSUMER
  AND THEIR NEEDS



   THE DAY OF THE
      MONTH IS
 REPRESENTED IN THE
 TOP CELL AND IN THE
BOTTOM CELL YOU WILL
  WRITE IN THE SCORE
   YOU GAVE YOUR
 CONSUMER FOR THAT
      HAH GOAL


    IMPORTANT

 YOU MUST FILL IN
 MEANINGFULL AND
  ACCURATE DATA

*THIS IS WHAT DDD IS
GOING TO REVIEW SO
 DO NOT WRITE THE
 SAME COMMENTS
   EVERY MONTH
Habilitation Progress Note
                           Walkthrough




YOU MUST SIGN AND
     DATE
Example of a Good HAH
        Note

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Habilitation

  • 1. HABILITATION TRAINING DEPARTMENT OF ECONOMIC SECURITY DIVISION OF DEVELOPMENTAL DISABILITIES DISTRICT 1 ITC
  • 2. Overview Building Relationships Through Communication Principles of Behavior Building Potential Barriers to Teaching Why Inappropriate Behaviors Occur How Your Values Impact Others Reinforcement Behavior Building Overview Habilitation Progress Note Walkthrough Good Example of HAH Note
  • 3. Building Relationships Through Communication The individuals we work with not only need to learn new skills (how to brush their teeth, plan a nutritional meal, wash their clothes, etc.) but also need to develop more positive attitudes towards themselves and towards the people around them. They must learn to like themselves, develop a feeling of self- confidence. They need to know that someone likes and cares about them. They must feel successful and be able to say, "Hey, look what I did!" If they do not feel good about themselves, then teaching them new skills will seem to be nearly impossible. The responsibility for helping the individuals we work with/for develop good feelings about themselves lies with the people who support them. "As a person who provides direct support," you can accomplish this responsibility by developing a positive relationship with the individual. To do this, you must say to the individual by your words and actions, “I like you”, “You are a worthwhile person", "I know you can do it".
  • 4. Building Relationships Through Communication We need to respect AND VALUE the individuals we work with. They have likes/dislikes, needs, wants, etc. just like anyone else. In order to identify these and help that person learn to fill them we must develop a relationship with that individual. Remember--We are here to help "each person" develop their potential as an individual (i.e., we don't build products. We build relationships and relationships build people!!)
  • 5. Building Relationships Through Communication CONCENTRATE ON THE INDIVIDUAL'S STRENGTHS: • When you are with the individuals, talk about what they can do, don't dwell on what they cannot do. • What are their positive points? • What can you and the individual do to further develop these positive points? PRAISE THE INDIVIDUALS: • Praise the individuals for the good things they do. Do not assume they know what they are doing is correct. Praise builds self-confidence. The more things they know they can do, the more they will try. Don't forget to praise attempts even if they are not successful--praise the fact that they tried. Use the individual's name when praising him/her. Let them know it is they, as individuals, you are praising. When you praise someone base it on his/her likes. Likes are things a person chooses to do or have, that they are willing to work for, and will get obvious pleasure from (places, events, people, food, and objects).
  • 6. Building Relationships Through Communication BE AWARE OF YOUR VERBAL AND NON- VERBAL ACTIONS • Some of the strongest communication we give is through our non- verbal actions, (eye • contact, gestures, body language, looks, expressions and body contact). People will • pick up on these things and act accordingly. • Are you warm, friendly, and interested? • Do you yell at the individual? • Do you look angry? • Are you afraid of the individual? • Do you look bored?
  • 7. Building Relationships Through Communication TREAT THE PERSON AS A PERSON: • How many times do you find yourself giving orders, saying, "Do this, Do that." or, maybe more frequently, "don't do that." Each time you do this, you are really telling someone they cannot do anything for him/herself and you are taking that person's control from them. No one can learn independence or self-confidence or trust if someone continually orders them around. It also takes away the opportunity to build relationships with people. • Try saying, "Could you help me with this? "I think this is a good idea how about you?" • Give choices whenever possible. Don't we all like to have some control over our own lives?
  • 8. Building Relationships Through Communication Never talk about an individual in front of him/her as if he/she isn't there. If you must discuss a person, involve him/her in the conversation with you. Never talk about an individual's problems or shortcomings in front of other individuals present. Reserve any discussion for a time when others are not around or when the person can be involved in the discussion (problem solving) Never talk about an individual's problems or shortcomings you work with/for to any person who is not professionally involved with that person. U S E T H E S E T O O L S T O P O S I T I V E LY B U I L D R E L AT I O N S H I P S A N D Y O U M AY B E A M A Z E D AT T H E O U T C O M E ! ! ! ! ! !
  • 9. Principles of Behavior Building • Behavior occurs all the time. • You influence a person's behavior, whether you realize it or not. • Every interaction is either therapeutic or not--you make the difference. • Bonds and friendships develop from interactions with people. • The environment influences behavior 24 hours a day. • How you structure the environment determines whether it is therapeutic. • At any given moment, there is a desired behavior to promote. • A person's needs are identifiable through his/her behavior. • There are constructive ways to respond to needs. • The individuals who receive services from the division have preferences that may be different than staff preferences. • People can and do change/learn.
  • 11. Why Inappropriate Behaviors Occur If you observe a problem, ask yourself which of these might be the cause, then do something to POSITIVELY change the situation. • ATTENTION • ANGER • FRUSTRATION • BOREDOM
  • 12. ATTENTION • Attention is the main cause of most problem behaviors. The person may be seeking attention from anyone (parents, staff, peers, etc.) Individuals who have lived in an institution have learned that the fastest way to get attention is to display an inappropriate behavior. If you think attention is the cause of the problem, you must: – Not attend to the behavior and redirect to another appropriate behavior; and – Give attention for anything positive the individual does. Teach him/her they will get attention for appropriate things, not inappropriate. Do not allow the behavior to occur--i.e. give attention for positive things before he/she has to do something wrong to gain your attention. • Remember – For someone who has learned to get attention for-negative, inappropriate, behaviors in the past, these will increase while you begin to ignore the inappropriate behavior, and continue to ignore and re-teach him/her that they will get attention only for appropriate things they do. If attention for appropriate things is not given now, then ignoring will not work!! Ignoring will not work alone; it must be used with attention!!!! Everyone involved with the person must follow this for it to work.
  • 13. ANGER • Many individuals do not know how to appropriately express their anger, resulting in inappropriate behaviors. If you decide anger is the cause of the behavior: – Determine why the person is angry, with whom, with what. – Look at the whole situation, can you change it? – Teach the person appropriate expressions of anger.
  • 14. FRUSTRATION • Frustration results when a person tries to do something he/she cannot do. If you think this is the cause of the inappropriate behavior: – Praise the person for all their attempts. – If the task is too hard, go to an easier one or break it down into smaller, easier steps. – Reassure him/her frequently that they can do it. – When frustration appears to be building -- have them do something different for a while.
  • 15. Boredom • What does boredom look like? • When you decide boredom is the reason – Try to change the activity before boredom sets in. – Offer interesting, age appropriate activities -- have him/her tell you what they want to do. – Don't get into the rut of always doing the same things. Dealing with inappropriate behaviors is something that will occur over and over again until the individual has meaningful choices of alternative behaviors in which to choose from.
  • 16. How Your Values Impact Others • We all place our judgments onto others. Therefore, a person’s behavior may be getting them what it is they need or want in the only way they know how to get it. • We then judge them as inappropriate or appropriate. – Your judgments are based on: • You’re personal values. • Your limited knowledge of the situation. • Your emotional state. • In order to more effectively work with another person, you need to put your values/judgments to the side.
  • 17. Reinforcement What is a reinforcer? • Something a person wants and is willing to work for. What are the four types of reinforcers? • Material – Something tangible that the person can hold or touch. • Privileges and Activities - Above and beyond normal or routine. • Social - Carried with you all the time i.e.; smile, verbal praise, high five etc. • Token – Something given that can be exchanged for something else. What are the six ways you can use to choose reinforcers? • Ask the person. • Ask others who know the person best. • Observe the person. • Observe another person who is similar. • Premack Principle (Grandma’s Rule) – borders on bribery. • Reinforcement Sampling – try all ideas to learn what works
  • 18. Reinforcement What are the rules in delivering reinforcers? • Use the person’s name. • Give immediately and consistently. • Give contingent on the behavior you want to increase. • Be the right size and amount. • The person must want it. • Must not be harmful to the person. • Something we have a right to and can easily control. • Edibles (food) must be paired with social praise and faded when appropriate. • Be specific in your praise. • Use a variety of reinforcers. • Be consistent with the person’s diet, medication, medical, conditionals, and disability.
  • 19. Behavior Building Overview • ANTECEDENTS – Describe what is going on before a behavior occurs. – Look at: • Who was interacting with the person and how? • What was said and number of times said? • Where and when the incident occurred? • Did the person have a bad cold, fever, etc.? • Did the person get only three hours sleep last night? • Did the person just return from a trip? • Did the person have his/her medications changed? • Did the person have a favorite possession broken or stolen? • Did the person start a new program? • Is the person receiving supports from someone new? • Did the person have a close friend move to a new home or place? • Etc…
  • 20. Behavior Building Overview PRECURSOR BEHAVIOR CONSEQUENCES (After the behavior) DOCUMENTATION EVALUATE FOLLOW UP
  • 22. Habilitation Progress Note Walkthrough PRINT YOUR FIRST AND LAST NAME THIS IS THE AMOUNT OF HAH HOURS YOU CAN PROVIDE IN A MONTH THIS IS THE KEY TO HOW WE SCORE OUR CONSUMER BASED ON HOW WELL THEY PERFORMED THE HAH GOAL PRINT THE CURRENT MONTH/YEAR
  • 23. Habilitation Progress Note Walkthrough THE DAY OF THE MONTH IS REPRESENTED IN THE TOP CELL AND IN THE BOTTOM CELL YOU WILL WRITE IN HOW MANY ADD UP THE HOURS HOUR OF HAH YOU AND PUT THE TOTAL AT PROVIDED FOR THE DAY THE END AND THE TOTAL HOURS NEED TO MATCH THE ALLOTTED HOURS.
  • 24. Habilitation Progress Note Walkthrough THIS IS WERE THE HABILITATION GOAL WILL BE WRITTEN OUT AND THE NUMBER OF GOALS WILL DEPEND ON THE CONSUMER AND THEIR NEEDS THE DAY OF THE MONTH IS REPRESENTED IN THE TOP CELL AND IN THE BOTTOM CELL YOU WILL WRITE IN THE SCORE YOU GAVE YOUR CONSUMER FOR THAT HAH GOAL IMPORTANT YOU MUST FILL IN MEANINGFULL AND ACCURATE DATA *THIS IS WHAT DDD IS GOING TO REVIEW SO DO NOT WRITE THE SAME COMMENTS EVERY MONTH
  • 25. Habilitation Progress Note Walkthrough YOU MUST SIGN AND DATE
  • 26. Example of a Good HAH Note