Challenging Behavior: Support Plans for Children with Disabilities

Disabilities Dialogue
Challenging Behavior: Support Plans for Children with Disabilities

Tamarack O'Donnell: Welcome. Welcome, everybody, especially to those who are joining us for the first time. And welcome back to those who joined us last month. We're so excited to be here with you today to talk about developing behavior support plans for children with disabilities who also have challenging behavior. I'm Tamarack O'Donnell.

Dawn Williams: Hi, I'm Dawn Williams, and we're both curriculum specialists here at the National Center for Quality Teaching and Learning. We're very glad you're joining us for Disabilities Dialogue.

Tamarack: So as many of you already know, Disabilities Dialogue is a webinar series that takes place on the third Friday of every month. It's at 10 am Pacific Time, 1 pm Eastern Time. And of course all are welcome. We're glad that any of you can make it to join us, but the content is specifically designed for disabilities coordinators. We want to make sure that we're supporting you in your gallant efforts to support teachers and children with disabilities.

Dawn: And we're going to be doing these every month on the third Friday until June. Next month, for example, we're going to be talking about embedded IEP goals and embedding those goals into daily activities and into lesson plans. We'll also do some on ongoing assessment of the teacher and also do one on dual-language learners with disabilities.

Tamarack: So today we'll be -- we're going to give you a quick agenda for the day. We're going to start with the interview segment where we get to talk with Dr. Mary Louise Hemmeter. We'll be talking about determining when it's time for a support plan, the steps in developing a support plan, how to support teachers through implementation, and lastly a brief question about addressing severe behaviors.

Dawn: Then we'll do a question and answer segment, as we mentioned, and we'll end with some resources. We're going to take a bit of a tour, a live tour, if you will, of some of the resources on the ECLKC and other resources to support children with challenging behaviors. But to begin us all off, we have Amanda Bryans with us from the Office of Head Start, and she has a few words to share with you. So I'm going to go ahead and unmute her so you all can hear her. All right, hi, Amanda.

Amanda Bryans: Hi, everybody. It's really nice to see you. I'm a little bit pleased that I don't have a webcam and you have a picture of me that's like 10 years old, so that's good. I'm really thrilled to be here. I wanted to have a chance to talk to my colleagues working out in Head Start and Early Head Start programs throughout the nation, I think, doing one of the hardest and most important jobs. I think Head Start has this remarkable history of including young children with disabilities in our classrooms. We were doing it in the early '70s, long before IDEA, and many of you, I hope, have heard of or knew my colleague Jim O'Brien. Jim retired a couple years ago, and I feel like we've been too quiet in the Office of Head Start and not doing enough to support the work of disability services, managers, or coordinators. So I'm just wanting to tell you that I'm very excited about these calls. I'm looking at them. I hope that they will become not just a way to deliver you -- deliver information and

like TA material but the source of a network for disability services managers, a way for people to start to get to know each other, to create a really dynamic dialogue talking with each other.

I feel that passion is probably the most important part of this work. The belief in the entitlement that children have to get the services they need, the importance of them accessing the great educational opportunities this country has to offer at the earliest possible age. And the work of the disabilities service manager really is a broker to make sure that young children experience school success when they're starting out and that their families are really empowered, that they learn about their rights under the federal law, that they learn enough of the language of disability services and advocacy so that they can get what their kids are entitled to and need, not just during their time in Head Start but beyond. And again, I think that's our history. I know that's what people are doing. I hope -- I want you to be filled up by these calls. I want you to feel like this is -- that you're recognized, that your mission is supported, and that you can access help when you need it.

We don't -- our national centers are often -- we kind of say, well, they can't deliver T and TA directly to programs because there are so many programs, but I want -- we're going to shake that up a little with these webinars and calls so that you get to know each other and you get to know some of the key staff. I would like you to be able to email me directly, and I will do everything in my power to bring any resources or services or help we can to you. So I will make sure that maybe the organizers can put up my email address at some point and everybody could have that. And I hope eventually we're going to have some kind of listserv so we can get people talking to each other.

So I just mostly I want to say thank you, thank you, thank you for being there, for doing what you do, for doing it sometimes in what probably seems like a silo in silence as far as your federal office, but we know you're there and we know you're doing the work. I have been looking carefully at some data. I think that it is -- and this is one of the things I'd like to hear from you and have you verify: it looks to me like it is getting harder and harder to access services, that you're having a tough time in particularly some areas, some states, referring kids, getting them evaluated, and actually getting them through an IFSP or IEP before they leave Head Start. And I want to work with you and with our -the national Office of Special Education Programs, OSEP, to get that -- to shake that loose a little bit. So thank you for being here, thank you for participating, and please let's make this tight, strong network so that we can support each other and make sure that our Head Start and Early Head Start children and families get everything they need.

Tamarack: Yes, thank you so much, Amanda, for joining us to share that and to encourage disabilities coordinators. They are working so hard, and we are really thankful that we have the opportunity here at NCQTL to be able to reach out to you via these webinars to bring the, you know, community of practice together and learn from one another and share new ideas. On that note, we have Mary Louise Hemmeter joining us today. She was with us last month to talk about prevention strategies, and she's back with us this month to talk about developing behavior support plans for children who also have disabilities. She was the director of the Center on the Social and

Emotional Foundations for Early Learning. She is currently one of the directors of the lab school at Vanderbilt University, which is an inclusive early childhood program. She's considered an expert on challenging behavior, and we're very lucky to have her with us today. Thank you so much for joining us again this month, Mary Louise.

Mary Louise Hemmeter: I'm glad to be here. Thank you.

Dawn: All right, good. I'm glad I can see you and hear you. Everything's working out just great. Mary Louise: Yeah, that is a good thing.

Dawn: It's a really, really good thing. So for those of us who weren't able to join us last month, ML, would you mind giving us a quick recap of what we talked about?

Mary Louise: Sure. First I just want to say that, like the others, I'm really glad that we're having the opportunity to do this and to get to talk to this group specifically. I also kind of want to echo what Amanda was just saying in terms of, I hope this is the beginning of a dialogue. And I feel like I'm going to run through information that I usually present in like three days in 45 minutes, and so I hope that we can think about how to do some follow-up on this in the future. But, yeah, so just recapping what we've talked about -- what we talked about last week, I want to do this real quick. But I think there were two main points that were really important to us to get across during the last webinar. And the first of which is that this webinar is focusing on children who have disabilities and also have challenging behavior. We think it's really important that people are clear that not all children with disabilities have challenging behavior and that not all children who have challenging behavior have disabilities. But we do think that when you're addressing challenging behavior in a child who has a disability, you might have to use more specialized, more individualized kind of strategies. And so we wanted to take it beyond how we usually talk about dealing with problem behavior and think about what are the kind of special needs around children who have both disabilities and challenging behavior? So that was the first point.

The second point was last week we really focused on prevention. And I think that all of our research on addressing the challenging behavior of all kids as well as kids with disabilities is that most problem behavior can be prevented. And it can be prevented through our relationships, how we design our environments, how we teach children social skills, and all of those things. And it's so much easier to do those things than it is to have to develop individual behavior support plans. And so last week we talked about some of the ways that you might do this, and on this slide you see some examples of that. I think it's always with -- I think we often think about promotion and prevention as things we do for all kids, and I think that's right, but I also think that we have to do promotion and prevention in an individualized way for children who have disabilities. And all of that is kind of -- we want to do all of that before we begin to think about developing individualized behavior support plans.

Dawn: Yeah, absolutely.

Tamarack: So, Mary Louise, how do we -- when we're moving beyond prevention and a behavior is still a challenge to us, how do we know when it's time to go beyond the support we're providing for all children and create an individualized behavior support plan?

Mary Louise: Okay, that's a really good question, and one that we certainly hear a lot. I think that one of the tendencies is to want to jump to the top of the pyramid, to jump to how do we develop plans for children who have problem behavior. And like I said, we really don't want to jump to the top. We really want to make sure that promotion and prevention pieces are in place. So how do we know when we need to jump to the top is kind of the question, and so I think that the kind of big pieces to think about here are, is the bottom of the pyramid in place? So are good prevention strategies, good promotion strategies in place? Are we doing them consistently? Have we individualized them for children who we're concerned about? And if we have, and children's behavior is still persisting, then we want to think about doing an individualized plan.

But what we'll find is that the more we focus on those bottom levels of the pyramid, the less that we'll have to focus on individualized plans. Sometimes people say, "So what do behaviors look like that are top-of-the-pyramid kind of behaviors or behaviors that need individualized support plans?" And we often talk about that it's not necessarily what the behavior looks like but it's how much the behavior happens, how intense the behavior is, how long the behavior lasts. So if a child is biting and bites every few days and they're 2 1/2 years old, we're probably not real concerned about it. Well, we're concerned about it, but it doesn't need an individualized plan. But if the child is biting in spite of us doing really good prevention and promotion and they're biting a lot and they're hurting children and it's not responsive to our just good developmentally appropriate guidance procedures, then we want to develop an individualized plan. But as most of you guys know, especially those of you who work with toddlers, if we thought we had to develop a plan for every child who bit, we'd be developing a lot of behavior support plans. So it's really about the intensity and frequency and duration of problem behavior that really pushes us to develop an individual plan.

Dawn: Yeah, I think that's such an important point to make, because, I mean, there are lots of things that are just developmentally appropriate that children are doing, and it really is about that duration, the frequency, and the intensity and how much it's affecting that child in that classroom that means it's time for a plan.

Tamarack: Rather than reacting specifically to a particular kind of behavior that might be a trigger for you as a teacher.

Dawn: Mm-hmm, mm-hmm. That, too.

Mary Louise: Absolutely. And that's something we have to help teachers -- because, you know, if you're a teacher and you get spit on a few times, that's going to feel pretty intense, right? And I think it sometimes takes someone who can come into the classroom and help the teacher really think about when is it happening, how much is it happening, is it really intense, are we doing a good job preventing it? And I think that's where we all come in, is how can we help teachers make those kind of decisions?

Dawn: Yeah, like as a disabilities coordinator, that's a good place to step in to help with that. Okay, so prevention isn't getting the job done. So there are some behaviors that are persisting. So what's the first step in making a plan for addressing persistent challenging behaviors?

Mary Louise: I'm very sorry. My office phone is ringing, and I have no idea how to stop it, but it'll stop. Who knew? So, anyway, good question. So I want to just start off by saying, before I kind of talk about what is the first step, I wanted to just make the point that we really think, when we begin to address problem behavior, that it ought to be a team effort. And so we think it's important that we're collaborating with teachers and classroom staff as well as families. And I want to kind of make that point about the importance of working with families on this issue, and I'll try to talk about that throughout, but I think that's going to be really important. So what's the first step? I think the first step is that we have to figure out why a child is engaging in problem behavior. And so if we go back to my biter that I was talking about a minute ago, we have to understand why the child's biting. And so you can imagine a child, maybe Tam, I'll use you as our little child with problem behavior. You can imagine that Tam really, really, really wants Dawn's attention. And so when she can't get

Dawn's attention, she bites her, right? And so then what we have to think about is she's biting because she doesn't know how else to get people's attention. That could be one reason.

Tamarack: Not just to harm somebody or aggravate the teacher.

Mary Louise: No, not at all. But then Dawn might bite Tam because she wants Tam to leave her alone. She wants Tam to not -- not play with her. We can't treat those two things the same way, because they're biting for really different reasons. And so the first step of the process is to do what we call functional assessment, which is really to understand what is the function of the child's behavior, and then once we understand what the function is, we can figure out what to do about it.

Tamarack: Okay, so then as a disabilities coordinator, what role might they play in understanding the function of the behavior when they're trying to support a teacher?

Mary Louise: Yeah, that's a really good question. So people often ask me this question, like, "We need the teacher to collect some data to help us understand the behavior," and I think that that's problematic. Because I think that what we know about children's behavior, especially in group care settings, is that it's -- the behavior is supported, maintained by what's happening in the classroom. And so if we ask the teacher to step back and collect data, we've changed the context. And I think it's important that we don't change the context when we try to figure out what's going on, and so I think that's a time when we need someone else to step in and do some observations.

The other thing that happens here is that if you're a teacher and you're working with 6 or 8 or 16 children, and all of a sudden a problem behavior happens, you haven't been able to see what happened before it. You haven't been able to really see what triggers it, because you're distracted by all the other children in the classroom. And so we think figuring out the behavior is going to take some help from someone outside the classroom.

Tamarack: Okay.

Dawn: Right, definitely. So, and we're thinking this is an important role that the disabilities coordinator can play. Right now on your screen, you see this. It's an example of an observation form from the Center for Social Emotional Foundations in Early Learning. And it's a form that could be used by disabilities coordinators or a supervisor or someone to try and help with that observation and take some of that off the teacher.

Mary Louise: Yeah, and sometimes we have teachers try to fill these out as a way of helping us understand when should we come to observe. So is the problem really mostly happening in large group time or during transitions or during centers? And sometimes this will help us target when we, whoever the "we" is -- the disabilities coordinator, mental health consultant, and those kind of people -- come into the classroom to actually help people understand it. It's helpful to have some information about when to focus their observation.

Dawn: Mm-hmm, mm-hmm. Tamarack: Yeah.

Dawn: So on the screen now we've got some pictures of, you know, kids in different states of emotion. Could you talk about how, you know, maybe during the observation, there might be a lot of other behaviors that the disabilities coordinator or teachers might be observing in the classroom in addition to -- besides the extreme behavior?

Mary Louise: Yeah, this is a really good question. So I do -- there's a couple of things to say about this. One is that, I was talking a minute ago about figuring out the function of the behavior, and I think one of the things we know is that children engage in problem behaviors for really different reasons. And so, I mean, you can look at this slide and think, oh, that one little girl on the bottom might be sad or she might be lonely, and she might be not engaging because she doesn't know what to do, or she's scared or whatever. The little boy on the top might be mad and trying to get someone's attention. So kids engage in problem behaviors for lots of different reasons, and it's really important to understand what those reasons are. "I'm bored, I don't understand, I'm mad, I want your attention," whatever. I think one of the things that's important about this slide is this little girl on the bottom left, which is that not all challenging behavior is what we think of as hitting, kicking, screaming, yelling, taking toys away, but sometimes problem behavior is about withdrawing. And I think those are important children to pay attention to, because I think those are children that get lost because they don't demand people's attention. They don't kind of scream out, "I'm having problem behavior." And yet, those are children who may need just as much support as children whose behavior is more externally motivated.

Tamarack: Right. Okay, so now we've done our functional assessment. We feel like we're getting a better understanding of the communication that the behavior is trying to accomplish. What's the next step in terms of developing a behavior support plan?

Mary Louise: Yeah, so this is where this conversation is going to get a little technical. And this is the part that I hope we can figure out how to do some follow-up later. But when we develop behavior support plans, what you see on the slide right now is kind of the steps or the components of a behavior support plan. So I'm going to walk you through and just give you a real quick example of each of these, knowing that it's going to just give you a little bit of information for the time being. So the first thing that's really important about developing a behavior support plan is being sure that we have a good understanding of why the behavior's happening and that we all agree. So meaning "we," whoever's supporting the teacher, the teacher, the family. That we can all agree on what our hypothesis is about the behavior.

So let's look at the next slide, and then I'll talk about each of the components in a minute. So I want to say a couple of things about this slide. So across the top of this slide, you have information about what we think the hypothesis of the behavior is about. And so for Tim, what we think the behavior -- the trigger, what we think is triggering the behavior is when he's in a group play situation, whether it's inside or outside, and it's not real structured. Meaning he has to kind of manage his own coming and going and interacting with children. When he does that, when he's in that kind of situation and he wants something that somebody else has, he often yells or kicks or screams or pushes them or takes the toy away from them. That's the behavior that we're seeing. And what we think is happening to maintain that is that children leave him alone. Children drop the toy, teachers intervene and kind of help him get what he wants. And in essence what happens is that in our attempt to keep him from having problem behavior, we reinforce the problem behavior, if you will. And so what we're going to have to do is change each of those pieces so that we help him do whatever it is he wants to do, like get a toy or play with someone, that we help him do that in a way that's not hurtful or harmful or aggressive or doesn't interrupt what's going on.

So once we have the hypothesis, then we can begin to develop the bottom part of the plan. And before you switch the slide, I want to just make one point here, which is that you'll notice on this plan that at the bottom, there's prevention strategies that fall under the trigger, new skills that fall under the behavior, and new responses that fall under maintaining consequences. For this plan to work, we've got to change each of those bottom pieces to accomplish the same thing that the top pieces are accomplishing, but in a more appropriate way. So I'll walk you through what that looks like.

Tamarack: Mary Louise, quick question. So you're determining the function from the functional assessment, correct? And if there are a couple different hypotheses, how do you know which route to take, or how do you decide that?

Mary Louise: Yeah, that's a really good question. So generally speaking, children who have significant problem behavior are probably going to engage in problem behavior for a number of reasons. So Tim might engage in problem behavior when he wants to get a toy or he wants to play with a child. But then he might also engage in problem behavior to get out of activities that he finds boring or difficult. Those are two really different reasons he's engaging in problem behavior, and so if we had those two hypotheses, we would develop one of these forms for each of those hypotheses. Now, there's a little bit of a difference -- a different scenario that I want to be sure that people understand, because this could certainly come up in the role that you guys play with people, which is that you could do a bunch of observation, and you could also -- you could all say, "I think he's engaging in problem behavior for this reason," and someone else for another reason, and those two things are incompatible. Then you have to figure out, is it two different hypotheses, or is it -- or can we just not agree because we don't have enough data, and we might need to go back and collect more data. What we always say is that if you don't get the hypothesis right, the plan's not going to work. So you've kind of got to keep going on the hypothesis until you're all pretty sure that you have the right one.

Dawn: Okay, and if we're really going to get at that problem behavior, imagine getting the data from families or grandparents or other caregivers, or is it aftercare, is it just during that school day? When does all that happen? You might have to get that data from multiple sources to really understand your hypothesis to make sure you're on the right track.

Mary Louise: Yeah, and it's entirely possible that children are engaging in different behaviors in different settings for really different reasons. So, you know, you might say, "Every time he wants to play with something or get a toy at school, he's having problem behavior." And the parents are like, "He never does that at home." Well, maybe he doesn't, because he doesn't have to share his toys or he doesn't have other kids who he has to interact with. Or when he's interacting with other kids, an adult's really helping him. And so sometimes that can be as helpful as knowing that there is problem behavior. In other words, what are you doing at home that's preventing his problem behavior that we might be able to do at school? So it is really important that we're engaging families and if kids go to aftercare programs or whatever, that we're engaging all of those people in this discussion.

Tamarack: Right, yeah. Okay, so we have our hypothesis.

Mary Louise: Can I say one more thing about that? The example that I just gave, I want to just make a really important point here, which is a lot of times when there's a discrepancy between what families see happening and what teachers or other caregivers see happening, people think, "Well, you know, the parent's just not tuned in," or whatever. And I think it's really, really important to realize what I was -- the point I was just making, which is that behavior can look really different in different settings. And it is entirely possible that problem behavior is happening in one and not the other. And so I think it's important that we try to understand, that we not write off the parent because they think it doesn't happen, but to understand why they're not seeing the problem behavior and how that can influence what we do.

Dawn: Can you talk a little bit about how that might be different for children with disabilities?

Mary Louise: Yeah, yeah. So I think the process around this isn't any different. In other words, we're still going to do functional assessment in much the same way, but a lot of times children with disabilities' problem behavior is going to happen because they have a delay in their social skills or a delay in their language skills. So for those of you all who have had toddlers in your life as a parent, you know that toddlers have temper tantrums, right? Well, a lot of times toddlers have temper tantrums because they don't have the language they need to communicate what they want. And often children with disabilities who have delayed language skills, delayed cognitive skills, delayed social skills may be 4 or 5 and having temper tantrums for the same reason, which is they can't communicate what they want. But they're older, and so then we have to start thinking about what are the skills they don't have, but if we taught them those skills, they would be less likely to engage in problem behavior?

Tamarack: Right, and do we have a really accurate picture of where they are developmentally?

Mary Louise: Correct. Yeah. Okay, so let me jump in here and talk a little bit about the behavior support plan. So behavior support plans are going to have three parts. Once you've got the hypothesis, you're going to have prevention strategies, replacement skills, and responses. And I'm going to talk about these real quickly. So what prevention strategies are, are individualized strategies that we might use to try to prevent the problem behavior from happening. So go to the next slide. So for Tim, we know that free play indoor/outdoor triggers his problem behavior, so what can we do that makes his problem behavior less likely to happen during those times? And so some of the things we could do is we could review the rules with him before the activity, we could remind him of the expectations, we could do some buddy activities where we actually structure play opportunities where an adult's helping him play. Because if we're doing that and he's getting help playing, then he's not going to need to engage in problem behavior to get help play -- to get into the play interaction.

So I'm not going to walk through all of these prevention strategies, but you can see how these things would serve to prevent his problem behavior from happening. That's the first step. If we can prevent it, that's what we want to do. But oftentimes we do all these prevention strategies, and we get busy, and we're not doing them -- we don't have time to do them all the time, and so the problem behavior still happens. So what's the next important thing? So the next important thing is to teach the child what to do instead of the problem behavior. So remember -- and we call those replacement skills. So remember we talked about Tim hitting and kicking and taking toys away to get a toy or to get what he wants. So we would say, what is it we could teach Tim to do when he wants to play or when he wants a toy? And we call those replacement skills.

So go to the next slide. Oh, let me talk about this, and then we'll go to the next slide. So this is the point that I was just making. So let's just look at two scenarios. So one is that Tim is told that his peer gets a turn. Well, when Tim has to give his peer a turn, he often kicks and yells and throws and has a temper tantrum. And this is a real kid, so these are real examples here. Well, what happened when Tim would do that is the adult would give him another turn to keep him -- to deescalate the problem. Okay, so that's one scenario. Another scenario is he's told to let someone have a turn, the adult prompts him to ask for one more turn, and then he gets another turn. So the outcome's the same, but if you look at those two skills in the middle, the way he's getting to the outcome is different. And he's learned over time that if he kicks and yells and throws, he gets what he wants. Now he's going to learn if he asks for a turn, he's going to get what he wants. And that's going to take him some time to learn because he's kicked and yelled and hit for a long time, and that's been really effective for him.

Dawn: Yeah, I mean, that really does take some time, right? For as long as that behavior persists, it's not going to just go away once you've got that plan and you teach him new skills. Like, you're going to need to persist in those replacement skills, what you're teaching him to do.

Tamarack: And we'll talk about this a bit later, but that's where it's really helpful to, as a disabilities coordinator, support teachers in working through that struggle and having realistic expectations.

Mary Louise: Yeah, and I think the other really critical point here is that we're talking about children with disabilities. And so if you think about anything you teach a child to do, so you teach a child to make a request or you teach a child to make a choice, when they have a disability, that takes time for them to learn. And I think often around problem behavior, we think they should learn the appropriate behavior overnight. But in fact it takes them just as long to learn appropriate behaviors as it takes them to learn anything else. And so I think that's where, once we identify replacement skills, we have to be really -- we have to help teachers develop really effective plans for teaching those replacement skills.

Dawn: Right, right.

Mary Louise: So you want to go to the next slide here? Yeah, so in Tim's case, the replacement skills that they taught him were to ask to play. Tim was pretty high-functioning cognitively. He just had social skills delays. So they were -- they taught him to ask to play when he wanted to play, so basically to use his words. They taught him to problem solve. "So what if you ask to play and the child won't let you? What do you do next?" And what you would do next is get a teacher. And so they gave him, as they were teaching him skills, they were teaching him kind of, if this doesn't work, try this, and if that doesn't work, try this. Because what we know about children with problem behaviors is if they try one thing and it doesn't work, they're going to resort to the problem behavior.

Tamarack: So -- -

Mary Louise: Oh, go ahead. - Tamarack: Go ahead.

Mary Louise: Yeah, so let me just talk about the last part, because it's real related to what I just said. So the -- well, here's an important thing before I go to the last part. So I think that Tam was probably going to ask me about when you teach replacement skills. And this is a little diagram that we often use to talk about the importance of teaching replacement skills. And so what happens in busy classrooms is that the really good opportunities to teach replacement skills are when you would teach anything else: at group time, at small group time, during centers. So you want to teach replacement skills and anything else children need to learn at times when children are engaged and are paying attention and are ready to learn. And so those are times like groups and that kind of thing. What happens in classrooms is they get busy, and we miss those opportunities to really teach, and the behavior escalates. So in Tim's case, maybe he goes up and asks a friend to play and the friend doesn't let him, and so he takes the friend's toy. And before you know it, the friend's grabbed the toy back, the two kids are screaming, the child's crying who got the toy taken away. And this is often when people want to teach. So they want to go, "Okay, what's going on? Let's talk about this. Next time..." What we say is that that's not a teachable moment. So teaching when the problem behavior's already happened, when children's emotions are really high, is not a good time to teach. We want to either teach back where those green arrows are, so all day long. Every time we have an opportunity to prompt him to use his replacement skills, let's do it so the problem behavior doesn't happen. If the problem behavior happens, we deescalate things, we get people calmed back down, and then we might say to Tim, "Okay, Tim, next time you want to play, what are you going to do?" And we might do some role playing and we might structure his interactions with peers to give him practice, but not at the moment that everybody's upset.

Tamarack: So as a disabilities coordinator, this might be a point that's especially crucial to go over with a teacher so that they understand clearly when are the best times of the day to work on teaching the replacement behaviors and setting the child up to be successful.

Mary Louise: Yeah, so we often -- and I think maybe go to the next slide. I think that we often think about how do you do good in -- we think about when you're teaching replacement skills, you ought to just teach them like you teach anything else. And so there's a whole bunch of materials on CSEFEL and the Head Start Center on Inclusion -- this one's from the Head Start Center on Inclusion -- that can help teachers teach these skills. But I think the important thing is to develop a really good instructional plan with or for teachers that talks about what is the prompting strategy we're going to use to teach him, when are we going to do it, how many times a day do we think we have to do it for him to learn it in the most efficient way? And that's where I think even our best teachers need help thinking through what is the most effective form of instruction, and when should we do it, how much should we do it? And I think that's a really important role for disability coordinators.

Dawn: Well, and, Mary Louise, I love the point you've made before where, you know, when you're at the height of being mad, you don't need anyone to teach you how to be mad, right?

Mary Louise: Yeah, I think I said to someone the other day, "I just want to be mad," right? And so when people are mad and someone's like, "Well, next time you're mad, you could do this," like you're just really not very engaged in learning how to be mad in a more appropriate way. Also that a lot of times we reinforce children's problem behavior by trying to deal with it in the moment. So if their behavior's about getting attention and we start saying to them, "Now, what could you do next time?" we're just giving them that attention. And so one of the things we like to do is let the behavior deescalate and then teach it in a way that is, again, back at those green arrows we showed a minute ago, which is before the -- what we want to do is teach all day so that when the child needs to use the skill, so when Tim's in a situation where he needs to use the skill, we want him to have practiced that all morning so that then he can use it in a more appropriate way, at a more appropriate time.

Dawn: Right, absolutely. All right, so there we see just more friendship cue cards there just to give you some examples. These are available on the Head Start Center for Inclusion.

Mary Louise: Yeah. So then let's go to the last part of -- oh, and this is where -- I think I've touched on this, but we did want to -- I mean, this is probably fundamentally the place where, when you're working with a child with a disability, this process is really going to need to be more individualized, and that's just around instruction. So, you know, I think about a little boy that we worked with who was nonverbal. And so when he wanted attention, he would throw things or he would slam his body on the floor or whatever because he didn't have another way to get attention. And so those are the kinds of things where we have to think about we're not going to teach him to suddenly be able to communicate verbally, so what's something we can give him that will help him get his needs met but will be a more appropriate way to do it? So we could think about things like some kind of communication system. We could think about a switch that pushes a button that makes a noise that alerts someone that he needs something. We could think about a buddy system where he has a peer with him that can help do that. But that's where -- I think with children who don't have disabilities, we're often thinking about what's a skill he can already do that we want him to use more consistently or predictably? But with children with disabilities, we're going to have to be really creative about what's something that's within their repertoire that we can help them do to get their needs met more effectively than, you know, throwing things or slamming their body on the floor.

Tamarack: Right. So as a disabilities coordinator, again, this is an opportunity to help teachers to really be creative and intentional about those replacement strategies and brainstorming.

Mary Louise: Yeah.

Dawn: For sure. All right, so responses.

Mary Louise: Yeah, so the final thing here is changing the way that we respond to children's problem behavior so we respond to it in a way that reinforces the appropriate behavior and doesn't maintain the inappropriate behavior. So the example I always give, and I'm sure most people who are parents have had this issue, which is seeing kids in the grocery store screaming for something on the shelves, you know, or screaming for a piece of candy or whatever. And you see parents go, "No, we're not going

to have that now. We're going home to eat dinner. No, we're not going to do that. No, no, no." And then the kid screams loud enough, and the parent gives it to them because it makes them stop screaming, right? But what that does is it completely reinforces the child's problem behavior. And so what we have to do is -- so in that case, we might say to the parent, "The replacement skill is the child has to use a calm voice to say X." So the child screams, the parent says, "If you use your quiet voice, I'll let you have one thing." The child uses his quiet voice, and he gets something. Now, you might say, well, he's getting it and he engaged in problem behavior, but the truth is, he only gets it after he engages in appropriate behavior.

Tamarack: Right, he'll get it regardless, but...

Mary Louise: Yeah, he's going to get it, so let's have him get it with an appropriate skill. So for Tim -- let's look at Tim. So for Tim, well, and this is kind of generic, but I'll give you kind of the general how we respond. So the first step about responding is we always respond to the appropriate behavior by giving the child what he wants. So if we've said, "If you use your words to ask for a toy," then we're -- and he uses his words to ask for the toy, then we're going to let him have the toy for some period of time. So we're always going to reinforce initially. Now, over time, we'll fade this out, but initially we're going to reinforce his appropriate behavior if he uses it. Initially, we're also going to be really -- we're going to anticipate. We know what triggers, we're going to watch for a situation where the behavior is often triggered, and we're going to cue him to use his appropriate behaviors. Again, we're preventing it. In the event that the problem behavior happens, we're going to do what we were just talking about, which is we're going to support the child that got hurt, who had the toy taken away or whatever. When things calm down, we'll then go back to Tim and say, "Okay, next time you want it, what are you going to do?" And we'll role play, practice, that kind of thing.

Dawn: Okay, so now that we've got the plan, could you tell us a little bit about implementing the plan and how to support teachers doing that?

Mary Louise: Yeah, so this is -- there's -- I want to make about three key points here. So one is that if you guys have listened to the different examples of things that I've said might be on a behavior support plan, a lot of times people will say, "We've tried all of those things, and none of those things worked." And that's right. If you did any one of those things and it worked, we wouldn't be developing an individual support plan. So if there's a simple strategy that will work along, we would just do that and we'd be done with it. For these children, because it's going to take them time to learn a new skill, the new replacement skill, we've got to do the prevention strategies until they learn it and we've got to be responding to behaviors in a way that maintain the appropriate behavior and not the inappropriate behavior. So for these kids, if we don't do all of those things, it's probably not going to work. And so it's not any one strategy, but it's the combination of strategies that are going to work. The other thing about this is that often when we first implement these plans, children's behavior gets a little worse, because they -- it's worked and it's not working, and they're kind of pushing the envelope. This is a time that we really have to support teachers, because it's going to be really frustrating to implement all these new things and then have the behavior get worse.

Tamarack: Especially in a classroom of other children, right?

Mary Louise: Yeah, it's going to be really important to support them through that maybe burst of behavior at the beginning.

Dawn: So then, from the last show we had a number of questions about more severe behaviors and more aggressive behaviors. Could you tell us a little bit about how teachers can address those?

Mary Louise: Yeah. So this is a really hard question to answer fast. And so I would expect that this is mostly behaviors that have to do with hurting other children or harming themsel-- children hurting themselves. And these are hard behaviors. And I'm going to tell you kind of the process you would use, but not exactly, because I think this is going to really differ from agency to agency. But generally we talk about the importance of having safety net procedures, which is what do we do if a child is in the middle of an episode of hurting other kids? That's going to be something that program regs are going to be really strict about. And so I can't tell you exactly what you would do, but what we think is important is that you have a plan in place that everybody who is relevant in your agency has approved and that you're doing that in combination with a behavior support plan. So if all we do is safety net procedures, meaning remove the child from the situation where he's hurting another child or whatever we do, if that's all we do, the problem behavior's going to keep happening. So we need to have a behavior support plan in place, but while the child's learning, while that plan's getting implemented, you may need to have procedures in place for how you deal with those behaviors. That, to me, is a really important role of the disability coordinator.

Dawn: Okay. All right, thanks, Mary Louise. We know that is a lot to try and cover in a short amount of time.

Tamarack: You did an excellent job, though. Thank you so much. Mary Louise: Oh, you're welcome.

Dawn: So, Mary Louise, we've got a couple of questions for you. And so one of them was there's a situation where the first thing that the disabilities coordinator will do when they're dealing with challenging behaviors is to cut the child's time down in the classroom and to send them home earlier, as opposed to trying to keep them in the classroom. Any suggestions or comments about that?

Mary Louise: Woo, I could take about 10 minutes to answer that question, so I do want to say that -- I'll give you some thoughts on it, but this is so child-specific that I want to be careful not to suggest that no response is appropriate. I would never -- I would never advise anyone about this without knowing more about the child. So with that in mind, you know, I generally think having a child leave a classroom isn't a great idea. That if -- it's rare that children's behavior is about them being in school too long. It's generally about them not knowing how to navigate something while they're in school. And if that's the case, then we've got to help them learn how to navigate things while they're in school. And so decreasing the time isn't really going to help them do that. You know, on the other hand, if they're kids who have some sleep or health or something else that might make being in school longer difficult, that would be different, but that's generally not the case of what at least I see.

Dawn: Right. I mean, that's a good point. You won't have the opportunity to teach any replacement skills or to teach appropriate behaviors if they're not actually there.

Mary Louise: Right, exactly.

Dawn: That's a really good point. Okay, it's going to take a second to read one. So then how do you help a teacher who believes nothing at all will work to ease the behavior of a child? In other words, I have been told, "I tried that and it didn't work." And we've had a couple of them just like that, too. And I know you addressed that a little bit, but it seems to be a recurring theme coming up in the questions.

Mary Louise: This might be the single most common issue that we get, or question that I get. First of all, I've never -- I can't think of a kid that I've ever worked with that we haven't been able to get something to work, okay? And so I think that it's about, are we developing a plan that's very closely tied to what we know about the child's challenging behavior? Versus, "I'm going to try this, I'm going to try that, I'm going to try this, I'm going to try that." That's not going to work with these kids whose problem behavior is really severe, and so it's what I talked about earlier about the combination of strategies. And I think if we leave this all on the backs of teachers, that's not going to be okay. That this is really something -- even I, who do this all the time, am constantly saying to people, "Do you have any ideas for how we might do this with, you know, Gregory?" or whatever. And so I think it takes a team approach. The other really important thing I want to say here is that when we develop plans, a really important part of evaluating them is making sure they're being implemented as designed. So not that we're doing one or two strategies, but that we're doing the whole plan. If the whole plan is being implemented and being implemented consistently and it doesn't work, then it might be the plan. But we've got to know that it's being implemented and implemented well before we can say whether it's working or not.

Dawn: Got it, got it. Okay, so we know that you need to go. Thank you so much, Mary Louise. We appreciate you taking the time to do this and sharing everything you could as quickly as you could.

Tamarack: Yeah, I really think that disabilities coordinators are going to benefit from some of the tips that you shared, so thank you for joining us.

Mary Louise: So just one real quick thing, and I do have to run. I'm happy to write some answers to questions if that might be helpful. And I want to reiterate this question about children leaving the classroom not being a good idea. I think both from the perspective of for the kid it's not a good idea, and I don't know if Amanda can weigh in here or not verbally, but this might be somewhere where she might want to weigh in about what the policies and procedures are around that. Is that -- I'm sorry to put you on the spot, Amanda.

Amanda: Sure. This was the question about reducing a child's time? Dawn: Yeah, yeah.

Amanda: Yeah, we would not recommend that. I think absolutely what Mary Louise said is very consistent with the Office of Head Start. But I would just add that the only time we think a child's time

in the program should be reduced is if it is an accommodation identified on an IFSP or an IEP. That children, we want to make sure that children who are having difficulties to such an extent that people are thinking maybe they shouldn't be at Head Start or Early Head Start so much have had a full multidisciplinary evaluation and that there's professional opinion regarding, you know, why it is that they're having a hard time and that they would benefit from the accommodation. I totally agree with Mary Louise that children are in a social learning opportunity as part of Head Start and Early Head Start. They need to kind of learn the behaviors that will get them through the day and how to navigate, and we need to make sure they find success in our programs. Too often when we tell a parent that their child cannot be there for the full time, we are not only failing to meet the parent and family's needs, we are communicating that a child is not able, is not successful, and that, you know, there's something wrong or that we're punishing them. And that just is not something we want to at all start. It's really akin to expulsion to reduce their time. So I guess we have pretty strong feelings that it definitely should not be the sort of default position. It should be a rare exception. And like Mary Louise, I failed to say before that I was a disability service manager for five years and I was a director for five years, and we did not ever reduce -- we had 450 kids, we had lots of kids who had very significant disabilities, including, you know, autism spectrum disabilities, and we never had to either disenroll a child or reduce the time. It's our obligation to find the supports that are needed so that children can be successful throughout the day. How do you like that?

Dawn: I love that. This is so fantastic that, one, we are having these calls so we can have these conversations anyway. I mean, it was such a great idea from the Office of Head Start to do this, and so we can even begin to see what the questions are so we have an opportunity to ask them. And that's why I love your point earlier you made about this being the beginning of a dialogue or another place where you could do that. So, you know, we are keeping track of all of these questions. We make sure that our presenters and Amanda see them. And so we also know what's going on there, but then we have an opportunity to try and get something answered. So, Amanda, thanks for hanging on and being there so you can still do this and answer on stuff like that.

Amanda: Thanks, it's great.

Dawn: Thank you. Okay, so we are at 11:00. We do have some resources to share with you guys, but I think it's important for us to end on time here. So we are doing follow-up documents for this. Because our first two shows were a series, they were both on challenging behaviors, there's going to be one follow-up document that we're going to give you for both these shows. And so for people who attended these webinars, we will send you an email with the follow-up document attached that will summarize the presentation. We're not going to send out the PowerPoint. This follow-up document will be a summary of those things. It'll have links to all the resources, like those friendship cue cards I saw people ask for. Those are on the Head Start Center for Inclusion, which you can also get to through the ECLKC. For example, here are some visuals from the Head Start Center for Inclusion that are on the ECLKC. I think these are the problem-solving cue cards. You can get those and print them out. They're all ready to go for you there. So we will make sure that you all get those things, and we are getting to your questions. Here's another one, was the Turtle Technique and these emotion cue cards as well, that you can get those as well. So we will get you the links to all the resources in the follow-up document.

Tamarack: The follow-up document will also show you where the archived recordings can be found as well as archived follow-up documents. So thank you all so much for coming back and joining us this month, or if it was your first time, for joining us today. We really hope to see you next month. It's going to be on March 20th. We'll have Gail Joseph as our guest speaker, and we'll be talking about embedding IEP goals into daily classroom activities.

Thanks so much, and have a wonderful day. [End video]