William Doss BASP PDF 2024

BEHAVIOR ANALYSIS SERVICE PLAN Client: William “Billy” Doss DOB: 04/03/1996 Legal Status: Competent Adult Residence: EZ Living Suncity III Behavior Intensive Group Home 15409 Miller Creek Dr. Sun City Florida 33573 Phone:727-999-1809 Email: [email protected] Daytime Activities: Billy does not...

BEHAVIOR ANALYSIS SERVICE PLAN Client: William “Billy” Doss DOB: 04/03/1996 Legal Status: Competent Adult Residence: EZ Living Suncity III Behavior Intensive Group Home 15409 Miller Creek Dr. Sun City Florida 33573 Phone:727-999-1809 Email: [email protected] Daytime Activities: Billy does not have any daytime activities. Primary Diagnosis: Intellectual Disability Secondary Diagnosis: ADHD, Severe Impaired Processing Speed Disorder, and PTSD Crisis Management Recommended in Plan: Yes, only trained support staff are able to implement agency approved crisis management procedures. Support Coordinator: Michelle Salerno Dream Supported Inc. Email: [email protected] Phone: (813) 400-1436 Support Plan Effective Date: 03/01 Author: Rosana O’Neill, MA, BCBA Certification (#1-13-12778) Original Report Date: 08/16/2024 Revisions/Updates: 8/27/2024, 9/3/2024 Implementation Date: 08/16/2024, 8/27/2024, 9/3/2024 THIS REPORT CONTAINS CONFIDENTIAL INFORMATION AND MAY ONLY BE RELEASED WITH WRITTEN CONSENT EXCEPT AS PROVIDED BY LAW.  LRC Submission Checklist Yes No Self-injury requiring medical attention X Actions which “…a life-threatening situation might result…”(e.g., excessive eating, vomiting, ruminating, eating X non-nutritive substances or pica behavior, holding one’s breath, refusing to eat, swallowing excessive amounts of air). Detectable damage, external or internal damage to others requiring medical attention and/or results in marks on X other’s. Major property damage or destruction (Over $500 or $1000 in one incident). X Actions which have resulted in arrest and confinement by law enforcement personnel. X Resulted in need for behavior services in a behavior focused or intensive behavior Residential habilitation X program. Resulted in need for additional staffing or behavior assistant services in one or more settings X Have resulted in the use of reactive strategies without a formal approved behavior plan X Behavioral programs or manuals implemented as group contingencies or behavior change systems, including X behavioral program manuals, level systems, and token economies are implemented. Section 1: Rational for Services Billy has had more than 40 Baker Act psychiatric hospitalizations and has historical diagnoses of ADHD, Bipolar Disorder, Cyclothymic Disorder, Reactive Attachment Disorder, Paraphilia and Oppositional Defiant Disorder. His current administrative diagnoses are Intellectual Disability, ADHD, Severe Impaired Processing Speed Disorder and PTSD from childhood abuse and neglect. Billy was released from jail on March 27, 2024 after being arrested in May 2023 for 24 counts of child pornography. He continues to state that he did not know the child pornography was on his phone and he did not view child pornography or download these alleged videos to his phone. Court records show the dates and times of the videos. The procedures in the plan address minimizing escape and access for maladaptive behaviors and increasing non-contingent attention and access to sensory items as well as attention and access for appropriate behaviors. The procedures included in this behavior plan are based on the most current behavior assessment (see below). The selection of the proposed interventions are consistent with the assessment results and the strategies are warranted. Section 2: Background Information Developmental, Family, Prior Strategies, & Behavioral History: William “Billy” Doss is a 28 year-old Caucasian male. He was born to a 15-year-old mother who was addicted to crystal meth and was an alcoholic. He has a history of both of these exposures in utero. This exposure is associated with neurobehavioral disorders, frontal lobe executive functioning disorder, impaired cognition and a host of developmental disabilities and delays. Billy displays an impaired capacity to recognize and prevent exploitation by William Doss BASP 08/2024 others, impulsive social and personal judgments and an impaired ability to recognize safety rules within his personal life and within his community interactions. Billy currently lives at the EZ Living Suncity IB group home with 5 other males. In 2023, Billy was arrested and charged with possession of 23 counts of child pornography. He was put in jail, and then released to EZ living under conditional release. Some previous placements included a group home in Tampa where he was given a 30 day notice, supported living in 2022, Caring Friends and Companions Group Home where he lived back in 2017, Extended Foster Care transition home called Diane’s Angels in St. Petersburg where he was placed through the Safe Children’s Coalition program and was terminated from the program, and many others. Historically, he has moved from family member to family member and domestic violence, severe neglect, and abuse were reported at each of these homes. He was placed in Foster Care in 2003 and his parents’ rights were terminated during his placement in Foster Care. Prior to the age of 18, he was placed in many foster homes and at the Devereux residential treatment facility. At the age of 18, he aged out of Devereux and went into Extended Foster Care. It was recommended by Devereux that he receive constant supervision and monitoring as he poses a safety risk to others and himself due to his anger outbursts and tendencies to engage in sexualized and grooming behaviors. Billy does not attend an ADT, and he does not work. He used to express that he wanted a job, but quickly changed his mind that he would rather not work. Due to BIlly’s court order, he is very limited to where he can go, and he must always be supervised (because he must stay 500 feet away from minors). While Billy is settling well into his new placement, he still engages in maladaptive behaviors including physical aggression and property destructions. He has also had some sexuallly inappropriate behaviors such as trying to look at neighboring child through the group home fence, and also talking to staff about how he obtained the child pornography, and what sexual acts he would like to engage in with minors. Behavior services are crucial for improving Billy’s quality of life, maintaining his health and safety, ensuring his ability to participate in the community, and meaningful daily activities. Previously, behavioral interventions have included various strategies, but their success has been limited, leading to the necessity of ongoing and more intensive support. Billy received behavioral services through Adaptive LLC. prior to SPABA, and his current needs highlight the critical importance of these interventions to prevent further legal consequences, maintain his residential placement, and support his overall well-being. Communication Skills: Billy is verbal and uses vocal language. His primary language is English, and he can express his wants and needs adequately. He has a 9th grade education, can write his name, and can read on a slightly lower level. He gets frustrated when he thinks people are bothering him, and one of the things that bothers him is when he thinks his supports are not listening to him. Billy has a habit of interrupting others when they are talking, and needs to be redirected. Billy has very nice manners overall and needs to be reminded to use them. Self- Care Skills: Billy needs minimal physical assistance with his hygiene routine, but requires substantial prompts and reminders to see that his hygiene and other self-care daily activities are completed. He has a history of generally being non-compliant with staff and regularly refusing to take a shower. He can eat and drink independently, and can heat items up in the microwave. He does not need any assistance with toileting. Billy requires assistance with taking medications properly, scheduling doctor’s appointments, obtaining transportation to medical appointments, accessing the community safely, and accessing community supports such as Voc. Rehab and a Life Skills program. Billy is not able to manage his finances and has a rep payee to manage third party benefits from SSI. He used to receive Food Stamps and maintained his own card but often sold these upon receipt to trade for drugs and other preferred items. He does not have many personal items, and isn’t allowed access to the internet, phone, or any electronic device that has internet access due to his court order. He is easily distracted and has difficulty following directions without frequent reminders, prompts and mediations. He has a short attention span and needs reminders to stay focused on tasks. William Doss BASP 08/2024 Consumer Strengths, Social, and Interests: Billy is very social and enjoys being around others. He enjoys playing video games, running errands, taking walks, and going shopping. His favorite video game is Call of Duty. He also loves listening to music, and socializing with friends and peers. Billy loves animals and used to have a dog named Diamond before he was arrested. Billy enjoys food as well, and likes Ramen noodles which he can often make by himself. Section 3: Medications & Medical Issues Diagnoses: Intellectual Disability, ADHD, Severe Impaired Processing Speed Disorder, and PTSD Height: 6’5 Weight: 181 lbs Treating Physicians: PCP: Joanna Mulder, Phone: 813-376-0712 Psychiatry: Olive Health, Phone: (813) 417-4767 Medical Concerns: Billy has a history of his iron and his blood platelet count being down. He needs to have blood work done every 6-12 months.. He takes medications for behavior prescribed by a psychiatrist. Billy has a history of seizures when he was younger with no witnessed recent seizures, only self-reported presumably to seek shelter/food in a hospital environment. Billy is allergic to Haldol, and has some allergies to fire ants, bees, and wasps. Current Medications: Medication Dosage Purpose Possible Side Effects Reported Side Effects Lamotrigine| 25/mg (Milligram), Mood dizziness, headaches, None Reported Lamotrigine|TABLET, BID (2 times daily) and blurred vision, FILM|ORAL|25|mg/1 gastrointestinal issues like nausea, vomiting, or diarrhea Quetiapine fumarate| 50/mg (Milligram), Mood drowsiness, dizziness, None Reported Quetiapine fumarate| BED (At bedtime) and dry mouth. TABLET, EXTE|ORAL| Patients might also 50|mg/1 experience weight gain, changes in appetite, and metabolic effects like increased blood sugar and cholesterol levels. Quetiapine Fumarate| 100/mg (Milligram), Mood drowsiness, dizziness, None Reported Quetiapine Fumarate| Daily and dry mouth. TABLET, FILM|ORAL| Patients might also 100|mg/1 experience weight gain, changes in appetite, and metabolic effects like increased blood sugar and cholesterol levels. William Doss BASP 08/2024 Medical Rule Out: No procedures in this plan are contra-indicated and behaviors in this plan have no medical etiology. Agency approved reactive strategies sign off has been obtained and is updated annually and there are no restrictions. Section 4: Functional Assessment Evaluation Procedures Evaluation procedures utilized to determine maintaining functions of behaviors of concern include ABC data, frequency data, direct observations, record reviews, client interviews, and caregiver interviews. Summary of Functional Behavior Assessment (FBA): Updated Assessment completed by Rosana O’Neill on 7/4/2024 Assessment procedures used: Interviews with supports: 07/04/2024 Interview with staff: 07/011/2024 Direct Observations: 07/04/2024, 07/11/2024 Records Review: 06/26/2024, 07/08/2024, 07/09/2024, 07/28/2024, 8/3/2024 Reinforcer Assessment People Tangibles Activities Other peers, preferred staff, BCBA video games, ramen going shopping, listening to noodles, dogs music, playing video games, walks Reinforcer assessment conducted via interviews, All About Me questionnaire, and records review. Maladaptive Behaviors Targeted for Reduction Definition Definition Any actual or attempted instances of Billy Hitting, pinching, pushing, spitting, punching, pulling hair, scratching, kicking, Physical Aggression biting or any other attempts to do physical harm to another person; forcefully grabbing someone’s arm. Any instance in which Billy engages with an item in any manner that results in damage (use of the item is altered but it can still Property Destruction be used); or total destruction (the item is not able to be used). This also includes throwing items such as chairs, tables, etc. Any instance in which BIlly engages with electronics to access the internet, can take photos/videos or can send and receive Inappropriate Access to Electronics images. He may engage with devices that can’t do any of these functions. Any instance of Billy being in possession of or viewing images/videos of children/teenagers under the age of 18 (with Inappropriate Content (Minors) knowledge) for 3 seconds or longer. This includes sexual and non sexual images. Any instance of Billy making sexual noises/sounds to others, making sexual comments including about minors or making Inappropriate Sexual Statements gestural or verbal sexual advances at another person including minors. May or may not be directed at a stranger. William Doss BASP 08/2024  Any actual or attempted instance of Billy kissing, touching, or engaging in sexual activities with another person/stranger or minor without consent (with minors, consent is irrelevant. It’s considered inappropriate). This includes Billy reaching/crawling Inappropriate Sexual Touch under bathroom stalls, looking at others private areas or touching himself while looking at others private areas in bathrooms, locker rooms, and other places where others may be disrobed. Any instance of Billy yelling at others above conversational Verbal Aggression tone, using profanity, making threats, or engaging in any verbal statements that are meant to demean or hurt others. Functionally Equivalent Replacement Behaviors Definition Definition Anytime Billy verbally or gesturally requests items or activities Appropriately Requesting Items appropriately without engaging in the target behaviors. Any instance in which Billy engages in functional Appropriate Escape communication to escape, avoid or delay aversive stimuli. Any instance of Billy engaging in appropriate sensory activities Appropriate Sensory in the absence of problem behaviors. Anytime Billy accepts an alternative item or activity or waits for Tolerating Delay/Denial a preferred item or activity when the one he wants is not available without engaging in the behaviors of concern. ABC Data Behaviors of Concern Hypothesized Antecedents for Consequences for Replacement Behavior (Maintaining) Behavior behavior Behavior Function(s) Physical Aggression: Appropriately Billy wanted to walk to Requesting Billy was blocked Billy lunged at staff and the store without staff Access Items, and redirected. attempted to hit them. supervision Tolerating Delay/Denial Property Destruction: Appropriate Billy was left to Billy threw something at Billy wanted staff to Escape, calm down in his Escape the TV. leave him alone Tolerating room. Delay/Denial Inappropriate Access to Billy was Appropriately Electronics: redirected to give Requesting Billy wanted to access it back, and Access Items, Billy’s peer let him the internet. reminded of this Tolerating borrow an electronic court order. Delay/Denial William Doss BASP 08/2024  Inappropriate Content Appropriately Requesting Billy had child Billy was charged Items, The police searched pornography on his with child Access/Sensory Appropriate Billy’s phone. phone. pornography Sensory, Tolerating Delay/Denial Inappropriate Sexual Statements: Billy was sitting and Conversation was Appropriate Billy made sexual Sensory talking to his peer redirected Sensory comments about a minor. Inappropriate Sexual Billy was looking into a Billy was Touch: Billy was window where it is Appropriate redirected back Sensory touching himself believed a child Sensory into the house resides there Verbal aggression: Yelling, calling people names Wanted to go out and Redirected back Appropriate Access get a game inside access Property destruction: Banging on the garage door Section 5: Procedures Supervision Requirements Level of Supervision General Community Backyard Front Yard Bedroom Bathroom Mealtime Living Area 3 5 4 4 1 1 3 3 Definitions: 5 - Within Arms Reach - Staff is within arms reach of a client at all times specified. That is, if staff were to extend their arms they would be close enough to touch the client’s shoulder. 4 - Within Line of Sight - Client is within visual sight of the staff. The client may or may not be within arms reach. If the client is behind the staff and therefore out of sight, the level of supervision is not correct. 3 - Within Same Room/Area - Client is in the same room or area as the staff. The client may or may not be within line of sight. If the client is in a different room/area than the assigned staff, the level of supervision is not correct. 2 - 30’ room checks - Staff perform room checks every 30-minutes by opening the bedroom door and visually monitoring client. 1 – 15’ room checks - Staff perform room checks every 15-minutes by opening the bedroom door and visually monitoring client. Fading Plan for Level of Supervision: Due to Bill’s history of child porn possession and official court charges of this, along with his inappropriate behaviors with minots, supervision in the community is not subject to fading at this time. In other areas, following zero instances of target behaviors for 6 consecutive months, supervision within line of sight will fade to within the same room/area. Following zero instances of target behaviors for twelve consecutive months, supervision within the same room/area supervision will be faded to 15-minute checks. Following zero instances of target behaviors for twelve consecutive months, 15 -minute checks will be faded to 30-minute checks. Following zero instances of target behaviors for 18 consecutive months, 30 -minute checks will be faded, and Billy will no longer require supervision. If at any time Billy engages in problem behaviors, then the level of supervision will return to the previous level. William Doss BASP 08/2024 Room Checks: Billy has a history of being in possession of child pornography and inappropriate materials regarding minors. Because of this, he poses a risk to minors and other vulnerable individuals. Every day, staff should ensure that Billy’s room is checked once in the morning, and one at night to ensure that he has not hid anything that can be deemed inappropriate regarding minors both sexually and/or non sexual. If anything is found. It should be confiscated and the chain of command should be followed (GH manager, BCBA, WSC, etc). Fading Criteria: Fading for this restriction will be considered following zero occurrences of inappropriate content for 12 consecutive months. Community Supervision: Billy has a history of sexual interactions with minors and possession of child pornography. Adequate supervision must be provided to prevent Billy from engaging in all of his sexually motivated behaviors. This is especially important in the community. Staff should ALWAYS accompany Billy when he is using any restroom that is not a family or single room restroom. This is to prevent him being alone with children or people of vulnerable populations. Fading Criteria: Due to the nature of his charges, and the ongoing risk that he presents as a sexual offender of minors, this procedure is currently not subject to fading. Reconsideration will take place after 12 consecutive months of zero behaviors in sexual nature towards minors or other vulnerable people. Internet, and Electronic Restriction: Billy was charged with 23 counts of possession of child pornography. He also has a history of inappropriate behaviors with minors, and attempts. Because of this, and along with a court order, Billy is prohibited from using electronic devices that can take and receive pictures along with devices that can access the internet. Additionally he is prohibited from owning a cell phone, and may only make calls using the house phone. Fading Criteria: Due to the nature of his charges, and the ongoing risk that he presents as a sexual offender of minors, this procedure is currently not subject to fading. Reconsideration will take place after 12 consecutive months of zero behaviors in sexual nature towards minors or other vulnerable people. Antecedent Manipulations 1. Recognize Billy ’s precursors and follow protocols listed above. Doing this can avoid a crisis from occurring and keeps Billy and others safe around him. 2. Utilize Premack Principle (first…then statements) when presenting non-prefered demands. This shows him what is expected of him and what he can earn contingent upon compliance. Us language that Billy understands. 3. Be consistent with consequences and do not make promises that you can’t follow through with. 4. Practice staying close with Billy. This shows him that you are establishing yourself as a safe person to be around. Be attentive, listen to him when he speaks, spark conversation, match his emotions, ask open ended questions, use empathetic statements, ignore junk behavior, and stay cool. Billy is a social person, and likes being around staff that he likes. He interacts through stereotypy, and likes hugs. 5. Refrain from coercive behaviors. It is important that you ensure that you identify your own behaviors, and how they can be triggering to Billy. He should be able to establish you as a safe person to be around, especially with male staff, and coercive behaviors only provide attention to target behaviors, and create a negative relationship between you and him. William Doss BASP 08/2024  6. Model appropriate behavior. If you want Billy to engage in appropriate behavior, he will be more willing to do so if you display that same appropriate behavior. Engaging in positive conversations with other peers and initiating positive conversations and positive touch with staff will show Billy what is expected of him. ACQUISITION SKILLS/REPLACEMENT BEHAVIOR STRATEGIES Adaptive Target Behavior How this behavior will be reinforced PRAISE/PROMPTING Staff should… 1. Display enthusiastic body posture, tone of voice and facial expression. 2. Provide Billy with lots of positive praise and attention for asking to access something appropriately. Appropriately Requesting Items - Anytime Billy 3. If the item is available, give it to him. If it is verbally or gesturally requests items or activities not available at the time, let him know when appropriately without engaging in the target it might be available and offer an alternative. behaviors. 4. If what Billy wants is restricted, explain to him why he can’t have it and offer him an alternative. 5. If he is being appropriate, be sure to give a lot of attention to him to maintain positive interactions. 6. Document on the data sheet. Staff should… 1. Display an enthusiastic body posture, tone of voice and facial expression. 2. Provide Billy with praise for asking to escape appropriately. 3. If possible, allow Billy to take a break or escape the person/place/thing. Also, allow Appropriate Escape - Any instance in which Billy him to move away from the peer if a person is engages in functional communication to escape, avoid who he is trying to escape from. or delay aversive stimuli. 4. If it is related to a task, praise him for asking, and set expectations with him to return to the task. 5. If he is unable to escape, set expectations with him and let him know when he will be able to. Document on the data sheet. PRAISE/PROMPTING Staff should… 1. Display an enthusiastic body posture, tone of Appropriate Sensory - Any instance of Billy engaging voice and facial expression. in appropriate sensory activities in the absence of 2. Ensure that you are offering Billy different problem behaviors. activities to do during the day and while at home. 3. Engage in those activities with him if he wants you too (card games, basketball, etc.) William Doss BASP 08/2024  4. Provide him with praise for engaging in appropriate activities. 5. Document on the data sheet. Staff should… 1. Display an enthusiastic body posture, tone of voice and facial expression. 2. Provide Billy with positive praise for Tolerating Delay/Denial - Anytime Billy accepts an requesting a person/item/activity and let him alternative item or activity or waits for a preferred know when it will be available. item or activity when the one he wants is not 3. Offer Billy an alternative. available without engaging in the behaviors of 4. Provide specific praise for redirecting to the concern. alternative. 5. Ignore any further requests for the person/item/activity. Document on the data sheet REDUCTION BEHAVIOR STRATEGIES: Challenging Behavior Procedure If PA is for access, staff should… Physical Aggression - Any 1. Display neutral body posture, tone of voice and facial expression. actual or attempted 2. Remove all vulnerable peers if possible, and physically block Billy from any further instances of Billy Hitting, physical aggression. pinching, pushing, spitting, 3. Minimize attention, giving only what is needed to keep him and others safe. punching, pulling hair, 4. Do not reprimand him or talk about the behavior with anyone else and avoid coercives. scratching, kicking, biting or 5. Redirect Billyto a neutral task for 5 minutes. Do not allow him to access a preferred any other attempts to do task/person within those 5 minutes. physical harm to another 6. Once he is calm, explain to him that if he wants to access something, he can let staff person; forcefully grabbing know. Do not lecture him or use language that he may not understand. someone’s arm. 7. If he lets you know appropriately, give him that item. 8. If the item he wants is unavailable, let him know why and when he it will be available. Operant(s) Addressed: Offer an alternative. Access 9. If PA or PD continues, continue with least to most restrictive procedures to ensure safety, and follow established emergency protocols including incident reports. 10. Document on the data sheet. Property Destruction - Any If PD is for escape, staff should… instance in which Billy engages with an item in any 1. Display neutral body posture, tone of voice and facial expression. manner that results in 2. Remove all vulnerable peers if possible, and physically block Billy from any further PD. damage (use of the item is 3. Minimize attention only giving what is needed to keep him and others safe. altered but it can still be 4. Do not reprimand him or talk about the behavior with anyone else and avoid coercives. used) ; or total destruction ( 5. Redirect Billy to a neutral task for 5 minutes. Do not allow him to access a preferred the item is not able to be task/person within those 5 minutes. used). This also includes 6. Once he is calm, explain to him that if wants a break from something or to move away throwing items such as from an aversive person or thing, he can let staff know (this can be using signs, and chairs, tables, etc. other functional communication that he knows). Do not lecture him or use language that he may not understand. Operant(s) Addressed: 7. If he lets you know appropriately, let him escape. If it is a task, set expectations with Escape him to come back to it and remind him of his reinforcers. William Doss BASP 08/2024  Access 8. If he is unable to escape at the moment, let him know why and when he can. Thank him for his patience, and offer him an activity or something else that he can engage with instead. 9. If PA continues, continue with least to most restrictive procedures to ensure safety, and follow established emergency protocols including incident reports. If PD is for access, staff should… 1. Display neutral body posture, tone of voice and facial expression. 2. Remove all vulnerable peers if possible, and physically block Billy from any further physical aggression. 3. Minimize attention, giving only what is needed to keep him and others safe. 4. Do not reprimand him or talk about the behavior with anyone else and avoid coercives. 5. Redirect Billy to a neutral task for 5 minutes. Do not allow him to access a preferred task/person within those 5 minutes. 6. Once he is calm, explain to him that if he wants to access something, he can let staff know. Do not lecture him or use language that he may not understand. 7. If he lets you know appropriately, give him that item. 8. If the item he wants is unavailable, let him know why and when he it will be available. Offer an alternative. 9. If PA or PD continues, continue with least to most restrictive procedures to ensure safety, and follow established emergency protocols including incident reports. 10. Document on the data sheet. Document on the data sheet. Inappropriate Access to Electronics - Any instance in which BIlly engages with Staff should… electronics to access the 1. Direct Billy away from the device. internet, can take 2. Review the internet history of the device including pictures photos/videos or can send 3. Contact the BCBA if inappropriate material is found, and keep the evidence with the and receive images. He may electronic that he was using. engage with devices that 4. If not, give the device back to its owner. can’t do any of these 5. Remind Billy of things that he can access appropriately, and remind him of ways that he functions can gain access to those things appropriately. 6. Document on the data sheet. Operant(s) Addressed: Access Inappropriate Content (Minors) - Any instance of Staff should… Billy being in possession of 1. Direct Billy to turn around using a neutral tone of voice, posture, facial expression while or viewing images/videos of avoiding eye contact, while blocking any additional attempt to stare at a minor or children/teenagers under vulnerable individual, visually scan others, or view pornography. the age of 18 (with 2. Direct Billy to another area away from others or the pornographic material, confiscate knowledge) for 3 seconds or it, and redirect to a neutral task. longer. This includes sexual 3. Provide praise when he engages in the neutral task. and non sexual images. 4. Remind him of other activities that he can engage in, and that he can ask for one at any time. Operant(s) Addressed: 5. Report this behavior up the chain of command. Access/Sensory William Doss BASP 08/2024  Staff should… Inappropriate Sexual 1. Display neutral body posture, tone of voice and facial expression. Statements - Any instance of 2. Remember that Billy should never be left alone with female staff, minors, peers, Billy making sexual friends, and must always be within arm's reach in the community. noises/sounds to others, 3. Do not give Billy attention for the comments/noises being made. making sexual comments 4. If in public, move Billy away from the area if in earshot of another person. including about minors or 5. Redirect the conversation talking about something different. making gestural or verbal 6. If Billy successfully redirects, continue the appropriate conversation with him. sexual advances at another 7. Provide praise for engaging in appropriate conversations. person including minors. 8. If Billy continues to make comments or noises, continue to ignore, and praise other May or may not be directed peers in the area for engaging in appropriate conversations. at a stranger. 9. Remind him of ways that he can engage in appropriate sensory. Operant(s) Addressed: Sensory Document on the behavior data sheet. Inappropriate Sexual Touch - Any actual or attempted instance of Billy kissing, touching, or engaging in sexual activities with another person/stranger or minor Staff should.. without consent (with 1. Block any additional attempts to touch another person while avoiding eye contact and minors, consent is irrelevant. having a neutral tone of voice, posture and facial expressions. It’s considered 2. Direct Billy to a direct area away from others. inappropriate). This includes 3. Prompt him to engage in a neutral activity and provide praise when he engages in the Billy reaching/crawling under activity. bathroom stalls, looking at 4. Wait for 10 minutes after the incident to follow appropriate social interaction others private areas or procedures then follow appropriate sensory stimulation procedures touching himself while 5. Remind Billy of appropriate ways to get attention. looking at others private 6. If this occurs with a minor, report it to the necessity parties and follow the chain of areas in bathrooms, locker command. rooms, and other places 7. Document on the data sheet. where others may be disrobed. Operant(s) Addressed: Sensory If access staff should… 1. Display neutral body posture, tone of voice and facial expression. Verbal Aggression- Any 2. Ignore Will ’s cursing or loud vocalizations (yelling, screaming, threats, etc.) instance of Billy yelling at 3. Remind Will that if he wants to access something, he can ask nicely to do so. If he others above conversational asks appropriately, give it to him. If it isn’t available, follow tolerating delay/denial tone, using profanity, making procedures. threats, or engaging in any 4. Praise for compliance verbal statements that are 5. If Will continues with VA use planned ignoring for additional verbal aggression. meant to demean or hurt others. Document all instances of verbal aggression on the behavior data sheet. William Doss BASP 08/2024  Section 6: Documentation Data Collection Data will be collected by group home staff. All individuals who will be collecting data will use the data sheets attached to this plan. Data will be collected, graphed, and analyzed on a monthly basis including weekly data points by Rosana O'Neill Data sheets o Replacement Behaviors: Frequency of occurrence per day utilizing the daily total datasheet o Challenging Behaviors: Frequency of occurrence per day utilizing the daily total datasheet Quarterly summaries Monthly Graphs Use of Emergency Procedures: Prior to the implementation of emergency procedures, Billy must have a physician sign off to ensure that implementation of crisis management strategies are medically approved and there are no contraindications to the implementation of these strategies. Billy currently has obtained a sign off from his physician and has no restrictions. All crisis management strategies should be implemented starting with the least restrictive strategy moving to the most restrictive as required to maintain the safety of Billy peers, and caregivers. Crisis Management Strategies may only be utilized by staff with current certification in an APD approved system of crisis management. In addition, all response blocks that last longer than 15 consecutive seconds of skin-to-skin contact, transportation procedures lasting longer than two consecutive minutes, and hand over hand prompting lasting longer than two consecutive minutes must be reported on the reactive strategy log and submitted to the Agency for Persons with Disabilities. Section 7: Goals & Objectives Short-term Outcomes: 1. Behaviors for Reduction: Reduce the frequency of Physical aggression to 4 occurrences per month for 3 consecutive months. Reduce the frequency of property destruction to 2 occurrence or fewer per month for 3 consecutive months Reduce the frequency of inappropriate access to electronics to 1 occurrences or fewer per month for 3 consecutive months. Reduce the frequency of inappropriate content to 1 occurrences or fewer per month for 3 consecutive months. Reduce the frequency of inappropriate sexual statements to 4 occurrences or fewer or per month for 3 consecutive months Reduce the frequency of inappropriate sexual behavior to 1 occurrence or fewer or per month for 3 consecutive months. Reduce the frequency of verbal aggression to 4 occurrences or fewer or per month for 3 consecutive months. William Doss BASP 08/2024 2. Acquisition Objectives: Appropriate Requesting will increase to 60 or more occurrences per month for 3 consecutive months. APpropriate Escape will increase to 60 or more occurrences per month for 3 consecutive months. Appropriate Sensory will increase to 60 or more occurrences per month for 3 consecutive months. Tolerating Delay/Denial will increase to 60 or more occurrences per month for 3 consecutive months. Long-term Outcomes: 3. Behaviors for Reduction: Reduce the frequency of physical aggression to zero occurrence per month for 6 consecutive months. Reduce the frequency of property destruction s to zero occurrence or fewer per month for 6 consecutive months Reduce the frequency of inappropriate access to electronics to zero occurrences or fewer per month for 6 consecutive months. Reduce the frequency of inappropriate content to zero occurrences per month for 6 consecutive months. Reduce the frequency of inappropriate sexual statements to zero occurrences per month for 6 consecutive months. Reduce the frequency of inappropriate sexual behavior to zero occurrences per month for 6 consecutive months. Reduce the frequency of verbal aggression to 0 occurrences or fewer or per month for 6 consecutive months. 4. Acquisition Objectives: Appropriate Requesting will increase to 120 or more occurrences per month for 6 consecutive months. Appropriate Escape will increase to 120 or more occurrences per month for 6 consecutive months. Tolerating Delay/Denial will increase to 120 or more occurrences per month for 6 consecutive months. Appropriate Sensory will increase to 120 or more occurrences per month for 6 consecutive months. Ultimate Outcomes: 1. Billy will be able to communicate his wants and needs independently. 2. Billy will engage in meaningful activities in the community without engaging in behaviors of concern. 3. Billy will be able to engage safely with others in the community. 4. Billy will engage in appropriate conversations without engaging in dangerous sexual behavior or inappropriate comments. Section 8: Training & Monitoring Training: All caregivers who work with Rosna O’Neill will be trained to implement this BASP by the behavior analyst who developed this program, Rosana O'Neill. Training will consist of: Describing the rationale for the BASP, rehearsing procedures with caregivers, hosting a question/answer session, role-playing common scenarios (when practical, modeling strategies via natural interactions with the consumer are preferred over role-plays), and providing the trainees with a post-training check to establish immediate strengths and weaknesses with regard to program familiarity. Corrective feedback and praise will be provided as appropriate during training. The behavior support plan, data sheets and monitoring sheets will be used to train staff. William Doss BASP 08/2024  Following the training, the caregiver must demonstrate an initial training score of 100%. All caregivers who demonstrate less than 100% on the initial training score will be retrained immediately by the BCBA, Rosana O'Neill. Monitoring: BCBA Rosana O'Neill will monitor the implementation of behavioral services at the group home, adt and in the community minimum of twice a month. Monitoring will take place at a minimum of one time per quarter for every caregiver. Monitoring procedures will consist of direct observation of Billy and caregivers during interactions and implementation of the behavior plan, as well as review of the data sheets. If there are no occurrences of challenging behaviors presented during the direct observations then role-plays, verbal report, and reviews of incident reports will be used to assist with monitoring implementation of reduction strategies. All caregivers who work with Billy must achieve an ongoing monitoring score of at least 80%. Any caregiver scoring lower than 80% will be retrained by the behavior analyst immediately and will demonstrate the skills they were retrained on at the end of the retraining. The behavior analyst will monitor 50% of the staff in the group home environment every month. Local Review Committee Monitoring Schedule: The BASP will be presented EVERY 12 MONTHS for annual approval. Section 9: Integration of Services Family: The behavior analyst will train the BASP with Billy and family members to allow them to be able to use the reduction and acceleration procedures during visits. Group home: The behavior analyst will train the BASP with the caregivers at his group home to allow for the use of the reduction and acceleration procedures in the group home setting. Support Coordinator: This plan will be provided to the Waiver Support Coordinator, along with quarterly/annual summaries and monthly graphs. Training will be provided to the Waiver Support Coordinator to allow use of the reduction and acceleration procedures during visits. Psychiatrist: The behavior analyst will attend appointments or provide updated data graphs for psychiatric visits to ensure integration of behavioral and psychiatric services. Physicians: This plan will be shared with all physicians as needed. A physician’s consultation regarding any medical conditions will be obtained. Medical oversight will be provided based on physicians’ recommendations. Behavior Analyst: BCBA will maintain documentation to record consultations (e.g., visits, observations, meetings, interviews, phone calls, faxes, emails) or other attempts to share information, provide training, or conduct monitoring of the behavior support plan. The Behavior Analyst will also record attempts to assess and measure the behavior in other settings. Section 10: Generalization & Maintenance Generalization and maintenance are actively promoted throughout the specific strategies in Billy ’s behavior support plan. William Doss BASP 08/2024  Behavior training programs will be faded as goals are met, and contrived praise will be faded to naturally occurring contingencies. Once Billy meets the long-term goals listed in this behavior support plan, replacement behavior training programs will be terminated. When Billy gets closer to meeting these outcomes, verbal praise will be slowly faded from a continuous schedule to an intermediate schedule of reinforcement. This will allow for a transfer from the use of contrived reinforcement to naturally occurring reinforcement, which will maintain appropriate replacement behaviors and acquisition skills. Programming with common and natural stimuli and consequences: Generalization will be promoted throughout the implementation of this behavior plan in Billy ’s natural environment, that is, when Billy is in the group home, and in the community. Increased attention and reinforcement will be given for use of replacement behaviors when they occur spontaneously. Programming multiple exemplars: In order to ensure generalization, Billy will be reinforced for utilizing replacement behaviors in different situations within the group home and in the community prior to known setting events and at the onset of precursor behaviors. Section 11: Fading Plans FADING OF BEHAVIOR INTENSIVE LEVEL RESIDENTIAL HABILITATION SERVICES The need for the enhanced residential habilitation (Behavior Intensive Level 5 ) will be faded overtime as Billy replaces his problem behaviors with alternative responses to access preferred items, escape/avoid non-preferred activities, and engage in behaviors that result in appropriate sensory. Billy will also need to increase his tolerance for waiting for preferred items or activities and accepting alternative items or activities if the one requested is not available. The primary emphasis in his behavior plan is to increase Billy ’s use of desirable behaviors and consistently prevent him from gaining access to preferred items or activities, and avoiding/escaping non-preferred activities or interactions by engaging in the behaviors of concern. Once he achieves his objectives in his behavior intervention plan and maintains the objectives, the number of hours provided will begin to decrease. Billy ’s success depends on the consistency of all those who interact with Billy ’s with the implementation of his behavior intervention plan. Indicators that Billy is ready to begin fading of the Behavior Intensive Services 1. Psychotropic medication is reduced to 2 or less. 2. Billy will be able to live among his peers and staff without problem behavior as evidenced by 0 responses per month for 12 consecutive months. 3. Billy will be safe in his home without dangerous behavior as evidenced by 0 responses for 12 consecutive months. 4. Billy will choose an alternative item/activity when given a choice of 2 items or activities 1 or more times per day for 3 consecutive months 5. Billy will wait for a preferred item for 15 minutes a minimum of 1 time per day for 3 consecutive months 6. Billy will engage in appropriate attention without harming himself or others. FADING STEPS 1. Decrease Behavior Intensive Residential Habilitation to Behavior Focus Extensive II Residential Habilitation 2. Decrease Behavior Focus Extensive II Residential Habilitation to Behavior Focus Extensive I Residential Habilitation 3. Decrease Behavior Focus Extensive I Residential Habilitation to Behavior Focus Moderate Residential Habilitation William Doss BASP 08/2024  4. Decrease Behavior Focus Moderate Residential Habilitation to Standard Moderate Residential Habilitation Fading of Behavior Analysis Services: Transition to an environment requiring less intensive behavioral supports contingent upon the following: Behavior excesses are reduced in frequencies and intensities under prevailing environmental conditions. Reduction in the level of supervision within the client’s home does not lead to occurrences of problematic behaviors. New environmental conditions and spontaneous transitions do not lead to occurrences of problematic behavior. Replacement behaviors readily occur without increased levels of prompting. Support staff proficiently and consistently implement behavioral strategies designed to maintain treatment. Previous levels of direct support supervision and monitoring by the behavior analyst are no longer required. At this time, Billy has not met criteria to fade or discontinue behavior services. Client continue to require restrictions or restrictions have not been faded successfully in the past. This current behavior plan is for a new provider in which new behaviors are now being targeted. When Billy achieves the long-term objectives listed in this behavior plan, the fade out schedule of behavior analysis services will begin as follows: Fade Out Phase 1: BCBA on-site visits will decrease from 1x per week to 1-2x per month. This will occur for 3 consecutive months, to ensure maintenance of the behavior change. Fade Out Phase 2: Once criteria are met for Phase 1, BCBA on-site visits will decrease from 1-2x per month to 1x every three weeks in each environment for 3 consecutive months. Fade Out Phase 3: Once criteria are met for Phase 2, BCBA on-site visits will decrease from 1x every three weeks in each environment to 1x every month for 3 consecutive months. Fade Out Phase 4: Once criteria are met for Phase 3, behavior services will be discontinued. Section 13: Behavioral Incidents (BASE) Behavior Focus Ext II, Intensive Behavior, ADT 1:1 6/19/24: William Doss had an outburst around 2:45 PM, during which he punched three holes in the walls of his bedroom. He was complaining about his face and throat feeling strange and was yelling for Benadryl. The psych doctor and manager were notified and advised that William should be taken to the ER due to concerns about serious side effects from his new medication. He was transported to the ER around 3:00 PM without further issues. The property damage was estimated at $1,113.28. 7/13/24: William Doss had another outburst at approximately 2:45 PM, resulting in him punching three holes in the walls of his bedroom. He expressed that his face and throat were feeling funny and demanded Benadryl. The psych doctor and manager were informed and instructed that William should be taken to the ER because of potential serious side effects from his medication. He was transported to the ER by staff around 3:00 PM. There were no further issues reported, and the property damage was estimated at $1,113.28. William Doss BASP 08/2024 7/13/24 William Doss became upset and caused property damage by punching holes in the walls. His complaints about feeling unwell prompted staff to contact medical professionals, who recommended that he be taken to the ER. The incident was managed, and William was safely transported to receive medical care. 7/29/24: At the home, another consumer came out of his room to take his evening medication and, while heading to the refrigerator to get water, engaged in physical aggression towards staff member Sterline, who was seated in the kitchen area. William Doss (WD) immediately rushed towards the other consumer, ignoring prompts from all staff present not to approach another consumer, and proceeded to hit the other consumer. Ms. Hervelyne arrived at the house, checked on the other consumer, and managed to calm him down. Due to the punch to the face delivered by WD, the other consumer was taken to urgent care. Fortunately, no broken bones were found on the client's face, and he was discharged the same day. 8/7/24: William was playing on the TV and became upset when the TV wasn’t working properly. He started by yelling in his room and then proceeded to beat on the TV, eventually breaking the screen. When staff went to check on him, they found the door locked, and William initially refused to open it. Once he did open the door, staff saw the broken TV laid down flat on another client’s bed. The staff removed the TV and placed it in the garage, after which William calmed down outside. 8/13/24: At 5:26 PM, William Doss (WD) asked staff to take him to the store. Due to his earlier aggressive behavior, staff informed him he would have to wait until tomorrow. In response, WD slammed the house phone, cursed at staff, and repeatedly called Mr. Erik. As he walked to his room, WD punched a hole in the wall and threatened more damage if not taken to the store. Staff de-escalated the situation, and the house manager, Mrs. Hervelyne, prompted WD to calm down, but he refused and threatened to harm staff. Staff ignored the threats and ensured no further damage occurred. Sexual Maladaptive Behavior 05/18/2024: Billy was arrested and charged with possession of 23 counts of child pornography. He was released from jail on March 27, 2024 to the EZ Living group home where he has restrictions that include no access to internet, or devices that receive or send text messages/photos/videos, and no access to minors within 500 feet. William Doss BASP 08/2024  INFORMED CONSENT This plan has been explained to me and I have been informed that I can refuse consent or withdraw my consent at any time and these procedures will be terminated immediately without penalty. All my questions have been answered and I know that if I have questions in the future, I can call my behavior analyst, Rosana O'Neill. Procedures in this plan have been explained to me in common language via consultation, the discussion of scenarios of Billy ’s behaviors, and demonstration of the procedures. I understand that the procedures outlined in this plan can only be implemented as written and my behavior analyst, Rosana O'Neill , will monitor them at least monthly. I agree to the implementation of this behavior plan and understand that I can add my input into treatment planning at any time. This plan utilizes the least restrictive intervention necessary and involves positive reinforcement strategies to increase functionally equivalent replacement behaviors and alternative responses. I understand that due to the severity of the behaviors being targeted for reduction, additional restrictions are necessary to ensure the safety of Billy and others in the environment. These restrictions are: - Person and room checks - Internet protocol - Community Supervision I also understand that these restrictions have fading plans outlined in the behavior support plan and that the data analysis will determine when the next stage of fading is reached. My BCBA Rosana O'Neill will monitor these fading plans via data graphing and analysis. This plan utilizes the least restrictive interventions necessary and involves positive reinforcement strategies to increase functionally equivalent replacement behaviors and alternative responses. Behaviors being targeted for reduction addressed in this behavior support plan include, PA, PD, inapp. access to electronics, inapp. minor content, inapp sexual statements, inapp sexual touch and verbal aggression. In addition, the behavior support plan is targeting functionally equivalent replacement behaviors including, appropriate requests for items, appropriate sensory, appropriate escape, and tolerating delay/denial. Procedures in this plan include the following: Blocking, Redirection, Praise and Reinforcement. Crisis intervention procedures have been signed off by a physician and only to be used by trained staff. These have been described to me and may be implemented when Billy ’s behaviors pose a threat of harm to themselves or others. Only individuals who have current training in the APD approved system of crisis management may utilize crisis management strategies. _____________________________________ William Doss - Client ______________________________________ Rosana O’Neill, BCBA ______________________________________ Date William Doss BASP 08/2024  PROFICIENCY OF IMPLEMENTATION Client Name BASP Month and year Person Monitoring: Rosana O’Neill ANTECEDENT MANIPULATIONS: Staff Staff Staff Level of supervision Person and room checks Internet Protocol Community supervision Data Collection BEHAVIOR TARGETED FOR REDUCTION: Staff Staff Staff physical aggression property destruction inapp. access to electronics inapp. minor content inapp sexual statements inapp sexual touch verbal aggression BEHAVIOR TARGETED FOR INCREASE: Staff Staff Staff appropriately requesting items appropriate sensory appropriate escape tolerating delay/denial PROFICIENCY RESULTS Staff: Staff: Staff: Score: Score: Score: Feedback given: Y N Feedback given: Y N Feedback given: Y N Score following feedback: Score following feedback: Score following feedback: Retrained on procedures: Y N Retrained on procedures: Y N Retrained on procedures: Y N If yes, retrain date: If yes, retrain date: If yes, retrain date: Comments: NO= natural observation VR= verbal report Scores: 0= zero correct 1= half correct 2=all correct William Doss BASP 08/2024  Staff Inapp. Inapp. Inapp. Appropriate Physical Property Inapp. Sexual Appropriate Appropriate Tolerating Initials Access to Minor Sexual Requests for Aggression Destruction Statements Sensory Escape Delay/Denial Electronics Content Touch Items 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31