What to Expect: Assessing and Treating Challenging Behaviour

Families who come to Progressive Steps with the goal of treating challenging behaviour are often stressed, overwhelmed, and looking for a solution to decrease challenging behaviour quickly. At Progressive Steps, our goal is to help. We specialize in treating challenging behaviour ethically, collaboratively, and using evidence-based methods and treatments are most likely to be effective. This resource will go into detail about our process for effectively assessing and treating challenging behaviour.

Pre-Assessment

Information gathering	This phase involves gathering information that is relevant to assessing and treating behaviour. Information that will be gathered from interviews includes, but is not limited to: What the challenging behaviours look like When and how often challenging behaviours occur Warning behaviours that precede challenging behaviour Identifying potential environment variables that influence challenging behaviours Ruling out medical or psychiatric variables Identifying client preferences This phase also involves getting consent from caregivers and client (if applicable) to proceed with services. If applicable, we will ask you for your consent to exchange information with relevant professionals involved in your child’s education and care, such as their school board and/or psychologist, in order to gather more information about their challenging behaviour and variables that may be influencing it.
Meeting the client	Either the Senior Behaviour Therapist or the Clinical Supervisor will schedule a time to meet and observe the client. This may help identify variables that could influence behaviour that may not be apparent from interviews. Additionally, the clinical team may ask for any videos you have of challenging incidents (if these exist), particularly if none were observed during the scheduled observation.
Crisis Prevention Planning	Once some information has been gathered, the Senior Behaviour Therapist or Clinical Supervisor will meet with caregivers to develop a crisis plan. The goal of using a crisis plan is to help families respond to challenging behaviors the same way each time, to use strategies that could prevent behaviours from getting worse, and respond in ways that keep everyone safe. Developing a crisis plan can take anywhere from 1-3 meetings depending on the complexity of the case and how involved caregivers are. Once the plan is developed, the Senior BT and caregivers will role-play how to use the strategies correctly. This can take between 2-3 meetings, also depending on the complexity of the case and the involvement of caregivers. The caregiver may be required to collect some data on their use of the crisis plan and meet with the Senior BT to identify what is working well and troubleshoot any barriers.

Assessment: Functional Analysis

Preparing	A functional analysis (FA) is the gold-standard for identifying why someone is engaging in challenging behaviour. It involves changing the environment in specific ways to see what “turns on” and “turns off” a behaviour. Before any analysis is conducted, all aspects of the analysis will need to be planned ahead of time. This includes determining who will be involved in the analysis, what the environmental changes look like, how data will be collected, and in what order the conditions will occur (if applicable).
Managing Risk	Because a functional analysis will require the client to be exposed to situations that may trigger challenging behaviour, plans for how risks will be managed will be put in place. This typically involves safety planning and identifying milder, precursor behaviours that will signal the “end” of a condition (instead of waiting for more severe behaviours that put individuals at greater risk).
Assessment day	Once the FA has been designed and plans for managing risk are in place, a date to conduct the FA will be scheduled. The Clinical Supervisor and/or the Senior BT will be present, along with the behaviour therapist and caregiver (if applicable). The clinical team will make sure all people involved in the analysis know what to expect and what their roles are. How long the entire FA takes to implement can vary between clients, but can be as short as 30 minutes or as long as two hours (with as many breaks as the client needs) and can take more than one session. Data will be collected by someone on the clinical team who isn’t directly involved in the analysis.

Assessment results

The data from the FA will be analyzed to identify under what conditions challenging behaviour occurred in the most.

Information from interviews and the FA will be used to summarize what environmental conditions increase the likelihood of challenging behaviour, what specific events trigger challenging behaviour, and what events maintain challenging behaviour.

Treatment Planning

The competing behaviour pathway is a model that summarizes the factors that are involved in challenging behaviour (based on functional assessment) and summarizes alternative and desired behaviours. These alternative and desired behaviours should replace challenging behaviour, and will be targeted in treatment.

Prevention

Treatment planning involves identifying antecedent strategies, which are preventative strategies that could minimize or make challenging behaviours less likely to occur.

Teaching Skills

Treatment planning may also incorporate identifying skills to be taught or strengthened to further reduce the likelihood of challenging behaviours. This is individualized to the client based on the results of assessment, but may include things like increasing functional communication, increasing tolerance and cooperation, teaching appropriate advocacy skills, teaching flexibility, teaching leisure skills, increasing independence in activities of daily living, etc.

Safe Responding

It also involves identifying consequent strategies, or ways to respond to challenging or appropriate behaviours right after they occur. We'll collaborate to develop planned responses that keep everyone safe and help ensure the needs of everyone can still be met.

Factors that Influence Success

Increase success

Proglong treatment or decrease success

Challenging behaviours occur during therapy sessions (which means the therapist is present to observe and intervene) Consistent, timely caregiver involvement Completing assessment forms and interviews in a timely manner Participating in frequent parent coaching sessions Implementing strategies and openly communicating successes and barriers Collaboration with other service providers, professionals and teachers Consistent sessions Appropriate intensity of treatment Strategies used both inside and outside of session time.

Behaviours that have been occurring for a long time (will likely take longer to see change) Undiagnosed, unmanagemed medical or psychiatric conditions Challenging behaviours do not occur during therapy sessions (therapist cannot observe or intervene on behaviours) Caregiver is not available to complete assessments or takes a long time to schedule assessment Caregiver unresponsive or takes a long time to respond to communications from team Caregiver does not participate in creating and implementing a crisis plan, or takes a long time to do so Other service providers using different approaches for the same challenging behaviour Lack of funding to support the intensity of treatment needed Not having enough sessions High rates of staff turn over Therapist not being a good fit for the client or family

Direct ABA vs. Behaviour Consultation

There are factors that influence which type of intervention will be most appropriate for treating challenging behaviour.

If behaviours occur during session, then direct ABA is appropriate because the therapist will be there to respond to behaviour and teach replacement skills when triggers are presented

If behaviours do not occur during session, but occur with caregivers, then a behaviour consultation may be the most appropriate. We will work with caregivers to assess and develop an intervention that they can use in their daily life. They will collect some data and get support from the clinical team.

Limited budget/funding: It’s often the case that a client needs more intensive therapy than funding allows for. This doesn’t always mean there will not be progress, but progress may be slower because the client isn’t getting as many opportunities to practice skills. In these situations, we strongly recommend parent training so caregivers can work on certain skills outside of sessions, as well.