Steven R. Covey’s #1 Bestseller presents a framework for personal effectiveness. Here are some important “take home” points that will take you into the start of a great school year. 
Photo by Kraken Images on Unsplash.

By Kerri-Ann O'Halloran

The topic of January's professional development training was school refusal.
Currently, school refusal is a topic on the minds of parents, school personnel,
and related service providers alike. Attendance at school is at the forefront of educational concerns at the national and local level. The presenters relied on research from Kearney (et. al.), as well as case studies from PBS clinicians, to provide a comprehensive presentation.

​This month’s feature article is a “guest spot” by Nathalie Theodore, J.D., MSW, LCSW. The article, The Perspective Shift That’ll Totally Transform Your Self-Care Practice was written in April, 2016 and published online at mindbodygreen.com. “Hats off” to Pat Tomanelli, for sharing her favorite “mindfulness” resources throughout the year. We’re hoping that you, too, will find these tips inspirational in your work!

By John Innis

In 2020, COVID 19 turned our lives upside down and inside out. This was a universally shared, yet individually experienced reality. Universally shared, in that everyone’s daily lives had been impacted. Individually experienced, as we have learned is that two people can have very different ways of responding to and coping with the stressors that come with changes. One friend, a cancer-survivor, had not been out of her house in a year except to walk her dog for 10 minutes a day and is mostly miserable. Another friend, a computer programmer, tells me that his life has changed very little because he was always an isolator anyway. Personally, I experienced alternating periods of relative “ok-ness” and abject grief and all shades in-between. I know a number of individuals I support who prefer having the built-in rationale for isolation that the pandemic has afforded them! Everyone is different in their response.

 Written by Carlene Fallica, MS, BCBA, LBA

There are numerous acute and chronic beneficial effects of exercise related to several cognitive, behavioral, and socio-emotional functions. There is growing evidence and an increase in published articles examining the relationship between physical fitness, physical activity, and academic performance in children. In addition, research provides evidence that physical exercise represents a promising
alternative or additional treatment option for maintaining overall health.

Regular exercise helps prevent and manage health concerns & protects against many chronic diseases including: stroke, metabolic syndrome, high blood pressure, type 2 diabetes, depression & anxiety, many types of cancer, arthritis and falls. Exercise helps to lower blood pressure, improve heart health, boost high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, and decrease unhealthy triglycerides. Physical activity aids in weight management by preventing
excess weight gain and helps maintain weight loss. Exercise improves and helps regulate sleep. Research shows that children with regular bedtime routines get to sleep sooner and awaken less often during the night than those without them. In addition, improved sleep hygiene may have some impact on next day attention. Increased physical activity is associated with better executive functioning, including inhibition, planning, working memory and processing speed, in children with ADHD (Gapin & Etnier, 2010). Increased neurotransmitters in the brain, reduced feelings of stress, anxiety & depression, a decrease in stress hormones, and improved mood are also associated with regular exercise. Muscle strength and balance are maintained with exercise, as well as improved joint pain and stiffness. Improved cognitive function for all age groups including long-term and
short-term memory and neuron health are significant neuropsychological benefits.

The global impact of exercise on the brain involves improved cognitive functioning, neurogenesis, neuroplasticity and neurochemistry. The increase in heart rate and breathing, oxygen in the bloodstream and flow of blood to the brain along with the release of neurotransmitters allows for an increase in oxygen and nutrients, leading to the production and growth of new neurons (neurogenesis). Neurotrophins are proteins that aid neuron survival & function. Both neurotrophins and hormones in the brain keep neurons healthy, promote growth of new neurons, improve neural connections and increase brain volume. Neuroplasticity, synaptic plasticity and/or alterations to the strength of already existing synapses improve how existing neurons work.

BDNF (Brain Derived Neurotrophic Factor) is a protein that promotes the survival of nerve cells by playing a role in the growth, maturation (differentiation), and maintenance of these cells. BDNF is crucial for learning and adaptation. BDNF upregulates (increase in the number of receptors) neurotrophins, which support the survival and differentiation of neurons in the developing brain, dendritic branching, and synaptic machinery in the adult brain. In the brain, the BDNF protein is active at the connections between nerve cells (synapses), where cell-to-cell communication occurs. The synapses can change and adapt over time in response to experience, a characteristic called synaptic plasticity. The BDNF protein helps regulate synaptic plasticity, which is important for learning and memory. Certain types of physical exercise have been shown to significantly increase BDNF synthesis in the human brain, a phenomenon which is partly responsible for exercise-induced neurogenesis and improvements in cognitive function. BDNF may have long term benefits including neural plasticity. These sustained benefits of exercise are best achieved with 30 minutes of moderate/intense or 10-15 minutes of high intensity. Our behavior has an impact on the level of BDNF in the brain. It is important to monitor and maintain healthy and appropriate levels of exercise, stress, sleep and nutrition. The primary drive for changing our brain and maintaining overall health is our behavior.

 by Darlene Magito McLaughlin, Ph.D., BCBA-D/LBA-NY

Through these weeks and months of Covid uncertainty, people may be more likely to encounter many aversive events all at once. On a given day, a person may experience a physical event, such as heat/humidity; a social event, such as a long period of waiting for help/assistance in a store; and a physiological event, such as having a headache. The cumulative impact of these setting events can produce behavior changes that others may label as “negative affect” or “bad mood” (Dunlap & Koegel, 1980). In some instances, bad mood may be associated with more pronounced problem behavior, such as “shutting down,” walking away, or “having a meltdown.”

The mechanism through which bad mood impacts problem behavior can be plausibly related to the concept of establishing operations (Michael, 1982). Establishing operations momentarily change the reinforcing or aversive properties of response consequences. For example, the convergence of several setting events (e.g., heat/humidity, waiting, and having a headache) could make a normal daily activity, such as food shopping, more aversive than would be the case if those setting events were absent. Shutting down and leaving the store is a response that extricates the person from the situation. This response is negatively reinforced because it allows the person to escape (terminate) the task. Over time, the tendency to shut down increases as the person recognizes that this is an effective way to avoid aversive situations.

As we endeavor to support ourselves and others through a myriad of setting events post-Covid, we can revisit the classic study by Carr, Magito McLaughlin, Giacobbe-Grieco, and Smith (2003). In the study, the authors used a simple
6-point Likert-type scale, such as this one, to assess mood.

BAD MOOD                                         NEUTRAL                                  GOOD MOOD
0..........................1........................2........................3........................4........................5

The researchers found that when an individual was rated as being in a bad mood, there was a much higher likelihood of problem behavior in the context of ordinary daily activities. When the individual was rated as being neutral or in a good mood, there was much less likelihood of problem behavior while performing these same activities.

In an effort to remediate the situation, the researchers went on to identify things that were typically associated with good mood. Some examples were jokes, making a phone call, eating a donut, listening to certain music/songs, looking at photos, planning a trip or “big” event, playing a game, getting a massage, or taking a bath. The researchers hypothesized that introducing things associated with good mood might reasonably neutralize the impact of bad mood, making problem behavior less likely to occur. Indeed, that’s exactly what happened! The researchers empirically demonstrated that mood induction can be a useful preventive approach for dealing with problem behavior. Understanding when you’re in a bad mood can prompt you to slow down and take the time to identify potential setting events that may be affecting you. Recognizing that you’re in a bad mood can also prompt you to improve your mood by redesigning the environment or initiating active coping. It only takes a few minutes to do it, and the effects are
lasting. Furthermore, practicing mood induction on yourself or others is likely to increase the likelihood of using mood induction again and again, leading to a healthier, happier, and more productive lifestyle!

References:
Carr, E.G., Magito McLaughlin, D., Giacobbe-Grieco, T., & Smith, C.E. (2003). Using mood ratings and mood induction in assessment and intervention for severe problem behavior. American Journal on Mental Retardation, 108 (1), 32-55.
Dunlap, G. & Koegel, R.L. (1980). Motivating autistic children through stimulus variation. Journal of Applied Behavior Analysis, 13, 619-627.
Michael, J. (1982). Distinguishing between discriminative and motivational functions of stimuli.Journal of the Experimental Analysis of Behavior, 37, 149-155.

 by Nancy Langdon, PhD, BCBA-D

It wasn’t what he said-- it was the way he said it. “He WANTS to go for a walk!!” A seemingly innocuous request, but those of us who worked with him regularly knew what this meant-- we knew it was different from “Go for a walk please.” When the emphasis was on the word “WANTS,” and he referred to himself in the third person, Randy was getting ready for a violent burst of self-injury. And it wasn’t a walk he wanted-- it was a break from his schoolwork. We all knew that what we did next would determine the course of the next hour-- and could result in a ninety minute tantrum where Randy scratched his face until it bled, ripped out clumps of his hair, and bit his arms and hands.

Randy had precursor behavior. Precursor behaviors are innocuous behaviors
that reliably precede the occurrence of problem behavior. They act as “warning
signs” that problem behavior is going to occur. Precursor behaviors fall into different topographies, including verbalizations, movements, and non-compliance. Many clients have precursor behaviors-- as clinicians, we have to recognize them and respond appropriately.
​
As behavior analysts, we are taught to focus on motivating operations,
antecedents, behaviors, and consequences. Precursor behavior is often
overlooked. Yet most clinicians will agree that there are times you “know” to tread carefully. Is there something you can identify that is a valid, reliable indicator that problem behavior is likely? Why should you care?

Research has shown that precursor behavior serves the same function of problem behavior. This means these behaviors are members of the same response class. To return to Randy, “He WANTS to go for a walk” served the same function as his self-injurious behavior.

Different methods can be used to identify potential precursor behaviors. Simply stated, any method you use to select your problem behavior can be used to identify precursor behavior too. For example, you can interview parents or teachers and ask if the student has warning signs they are going to have problem
behavior. Likewise, you can observe in the classroom or home setting-- does the child do something specific before problem behavior? Do adults act in a certain way to prevent problem behavior from occurring? Precursor behavior can be operationalized just as problem behavior and should be as specific as possible. For Randy, it wasn’t just “asking to go for a walk.” It was “demanding a walk referring to himself in the third person.”

Once you have operationally defined a potential precursor behavior, you need to determine that it regularly occurs before problem behavior. You can do this through observations-- either informally or by calculating transitional probabilities. Specifically, there are calculations of interest: how often does precursor behavior
lead to problem behavior? How often does precursor behavior lead to another precursor behavior? How often does precursor behavior lead to “other”? How often does problem behavior lead to another problem behavior? This information can be used to mathematically demonstrate that a precursor behavior is, in fact,
a precursor behavior.

So you’ve identified a precursor behavior. What now? There are implications for prevention, assessment,
and intervention.

● Prevention: Efforts can be applied to precursor behavior to prevent an escalation to problem behavior.
For example, training Randy to ask for a break when “he WANTS to go for a walk” will likely prevent
the occurrence of problem behavior.
●Assessment: A functional analysis or experimental manipulation can use precursor behavior as the dependent variable instead of problem behavior. For example, in a typical FBA demand session, the 30s escape can follow the precursor behavior instead of problem behavior. This addresses the often-cited ethical criticism that functional analysis shapes problem behavior. A manipulation of antecedents and consequences of precursor behavior gathers the same information with less risk.
For a demand session with Randy, a 30s escape would follow “he WANTS to go for a walk.”
● Intervention: Typical functional communication training relies on situational determinants to prompt communication-- teaching “break” in response to a demand. Using precursor behavior focuses the effort on the student-- teaching “break” in response to the student indicating the need for one. For Randy, this would mean prompting a break request when he says “he WANTS to go for a walk”
instead of when issuing a demand.

The individuals we work with will display problem behavior-- a better understanding of precursor behavior can help you to reduce its occurrence-- or prevent it altogether.


References:
Langdon N.A.,Carr E.G., & Owen-Deschryver J.S. (2008). Functional analysis of precursors for serious problem behavior and related intervention. Behavior Modification, 32: 804-27.

Smith, R.G., & Churchill, R.M. (2002). Identification of environmental determinants of behavior disorders rhrough functional analysis of precursor behaviors. Journal of Applied Behavior Analysis, 35, 125-136.

 by Dr. Darlene Magito McLaughlin

As students approach middle school and high school, parent training needs often
shift from the “here and now” to “thinking and planning for the future”. Our February inservice, led by Theresa Giacobbe-Grieco, shed light on the many tools and strategies for supporting families in planning and preparing for a smooth transition from school age services. The first step is to determine the strengths, needs, and priorities of the student and the family. This is accomplished through a student-centered process, listening to parents talk about the vision for their child, and listening to the child talk about their vision for life after school is over. PBS consultants are encouraged to use “person-centered planning” maps and tools, located on the Shared Drive, to facilitate this process. It is also helpful to review the child’s IEP, educational classification, and clinical diagnoses, so you can get a sense of what supports and services will be the most appropriate.

Next, the consultant should plan out a series of parent trainings, outlining the process of transition, and honing in on the particular resource needs of the student and family. PBS’ “Transition E-checklist”, located on our Shared Drive, will be an invaluable tool for planning your discussions. The E-checklist will enable you to explore and choose pathways for transition that are the most likely to lead to the desired outcomes. Transition planning is based on the student’s strengths, preferences, interests, educational program, and career experiences/aspirations. The 12 “Touch points” on the PBS E-checklist will provide you with guidance on navigating the transition process. When using the tool, each area is assessed and evaluated as either “in progress” or “completed” The links that are included will direct users to the most up-to-date information and resources that we have available on a particular topic. Many of these resources are publicly available, and others are PBS proprietary materials .

The 12 Touch Points of the Transition checklist include:
(1) Person-centered planning
(2) Pathways to graduation
(3) OPWDD eligibility resources
(4) Long term care coordination
(5) Pathways to employment
(6) Medical care
(7) Guardianship
(8) Financial resources
(9) Housing
(10) Travel
(11) Social lIfe and independent living skills; and
(12) College resources.

How much or how little time is spent on each area will depend on the needs of the student and family. Our job is to make sure that everyone is working together and doing what needs to be done in order to ensure the best possible outcome for the student. It’s never too soon to start planning!

by Dr. Kaarin Anderson Ryan

With so many communication options available to us, sometimes it can be difficult to decide how to contact someone. For many of us, texting has become the default. Here at PBS, we encourage ongoing support and open communication among our staff. We offer secure communication channels through our HIPAA-compliant Google Workspace (emails and document sharing), and have some ability to share clinical and case information using NPA. We also acknowledge that staff share cell phone numbers with each other for phone calls and texting throughout the week to maintain open lines of communication so we can serve schools and families while effectively collaborating with team members. Texting is a big part of these ongoing communications for many of us.

In our business, we have strict rules about exchanging texts with families and teachers due to HIPAA and FERPA laws. **According to these guidelines, we avoid texting anything personal or private with families or teachers. We reserve the use of texts with families and teachers for logistics and scheduling.** But when it comes to texting supervisors and colleagues, we do not have clear guidelines or expectations. Before we get into deciding when to use texting as a communication with colleagues, let’s take a look of some of the ups and downs of using texts with our colleagues.

Benefits of using texts for work:
● Faster response times.
● Convenience. It is just so easy.
● Higher read and response rate than email.
● Less intrusive/interruptive than a phone call.
● Great for scheduling meetings or larger conversations.
● Can increase productivity due to speed and ease of communication.

Downsides of using texts for work:
● Too many incoming texts can be disruptive to productivity. Americans check their phone, on average, 80 times
per day.
● Distinguishing between conversations that are simple enough to resolve over text vs. conversations that need
more detail and attention.
● Text messages can cause communication difficulties at times because it may be hard to read conversational
tone in text messages.
● Using text messages may blur the lines between work time and home time.

You may often be faced with making a decision about whether you should text a colleague or a supervisor. To help you as you make these decisions, consider the following guidelines.

Guideline #1
Before establishing texts as a way to communicate with colleagues or supervisors, discuss preferences with them. Are they OK with exchanging text messages with you during the day? Are there certain times that are not good for them to have you send text messages?

Guideline #2
Limit text messages about work to work hours, unless you have made an exception with your colleague or supervisor.

Guideline #3
Evaluate the situation before texting. Is this something that needs a rapid response or can it wait? If the question or
discussion is not pressing or in need of a quick reply, email may be a better option.

Guideline #4
Consider the complexity of the subject you want to communicate. Is it a complex discussion or does it only require a simple answer? More complex discussions or questions may be better served through email, phone calls, or meetings.

Guideline #5
Avoid using texting as a first point of contact with a new colleague, supervisor or employee. It is always better to get to know someone in-person, or on a video chat or phone call if in-person is not possible.

Guideline #6
Even amongst employees and colleagues, it is important to protect sensitive information when texting. For topics such as salary, work disputes or conflict, or personal situations it is better to use other formats for communication.

Guideline #7
Keep it brief. Try not to send long, rambling texts to colleagues for work-related topics.

Guideline #8
Be open with your colleagues. If you feel that someone is texting you too frequently, or about topics that would be better suited to other formats, have an open discussion about expectations. Help your colleagues to understand your
own preferences to avoid problems with communication.

Finally, remember that texting is one of our least secure means of communication, and as such, should never be used for private or confidential information. This includes names of people we support, or any information that would identify them, to someone who might accidentally see a text message come through on a phone.