Report 3

NOTE: This report was written by a participant in Institute for
Applied Behavior Analysis’ Summer Institute

(http://www.iaba.com) on “Assessment and Analysis of Severe
and Challenging Behavior.” All identifying information has been
changed. This report is presented as an example of the type of
report that participants will be able to write after completing
the course.
COMPREHENSIVE FUNCTIONAL ASSESSMENT REPORT

AND RECOMMENDED SUPPORT PLAN
Client Confidential
Date of Report: July 27, this year (draft)

Referral Date: July 1, this year
Period of Report: July 26 – August 4, this year
IDENTIFYING INFORMATION
Name: Jane Doe

Date of Birth: July 2, 1976
Address: Any Lane, Apartment 2
Any Town
Referral Source: Tina Timmons, Manager, Supported
Employment Service
REASONS FOR REFERRAL
Jane was referred for an evaluation by Tina Timmons,

manager of the Supported Employment Service, Inc (SESI)
program, a behavior management day service that is a division
of the Alphabet Program (ABCD). The purposes of the
evaluation were to assist Jane in securing the services and
programming which would enable her to develop and to use her
capabilities, to get the most out of the educational
Comprehensive Functional Behavior Assessment Report and Support Plan
Page 2
© 2002 Institute for Applied Behavior Analysis, All Rights Reserved.
opportunities that can be made available to her and to enable

her to develop and to use her capabilities for more independent,
normal living and more productive activity than her behavior
problems presently permit. Accordingly, it was requested that
the evaluation focus on these behavior problems, which were
characterized as physical aggression, verbal aggression, anger
management and problem solving, and the type(s) of behavioral
services, support strategies, programming, professional
competencies and skills, and environments required to
eliminate, minimize, or manage them.
Specifically, Jane has engaged in aggressive behavior on

an average of approximately once per month over the past year.
In March and April this year she verbally and physically
assaulted a member of her SESI-ABCD group on three separate
occasions, resulting in the other client’s withdrawal from SESI
as he feared future attacks. This was also followed by a period
of sporadic attendance at work her subsequent resignation to
avoid losing her job. She also moved from a group home setting
to supported independent living in March this year and started
a new job July 5, this year with a new job coach. Concern from
SESI-ABCD staff seems to be that future episodes of similar
behavior could jeopardize her placement in the program and her
current job. Staff members supervising her supported living
arrangement have not noted any instances of aggression and
are not concerned with this behavior at the present time.
DESCRIPTION OF ASSESSMENT ACTIVITIES
The assessment is based on information obtained from

the following sources on July 26, this year:
A. Interviews with Jane at her workplace (60 min.) and

over the phone (15 min.); with Mary Whitten, Jane’s
current Employment Specialist with SESI (20 min.);
Charlie Quinton, Jane’s former Employment
Page 3
Specialist with SESI (75 min.);and Kim Chow, SESI

Supervisor (90 min.);
B. Direct Observations of Jane in her place of work

(Wiener's are Us) with job coach present (60 min.);
C. Review of the SESI-ABCD case file and field

notebook (180 min.);
D. A Reinforcement Survey completed by Jane

(obtained from SESI file);
E. Telephone Conference with Ginger Bertrulano,

Manager for Help Me (15 min.);
BACKGROUND INFORMATION
I. Brief Client Description.
A. General. Jane is a 24 year-old Caucasian female

with light brown hair and blue eyes. She is short
(approximately 62 inches tall) and heavyset. She
indicates that she wears size 20 clothing and she
appears to be about 200 pounds. She was wearing
her Wiener's are Us uniform at the time of the
interview. It was clean and properly fastened. Her
face and hair were also clean. No identifying marks
or physical disabilities were visible or indicated in
the files. Jane was friendly and pleasant when
interviewed.
Jane was diagnosed with Post-Traumatic Stress

Disorder and Mild Mental Retardation in May 1993 by
Dr. William Webster, psychologist at Saturn Hall.
Documents in her SESI-ABCD file indicate that she is
also currently diagnosed with either Schizoaffective
disorder or Schizophrenia, although no
Page 4
documentation was present supporting the either

diagnosis. Indeed, previous reports indicate that her
reality testing was not impaired and that her
thinking was not disordered. A Counselor’s Report
from County Regional Center for Developmentally
Disabled Persons (August 20, 1984, when Jane was
8 years old) indicates that Jane also carries a
diagnosis of aphasia.
B. Language and Communication Skills. Jane’s primary

method of communication is the spoken English
language. Her speech is clear and easily
understandable. It is reported that she has a
repertoire of approximately 20 signs using
conventional sign language, which she learned while
residing with her foster mother, Snow White. All
verbal and written reports indicate that Jane’s
communication skills are well developed, including
the ability to emit complex sentences. The writer
observed that she is able to articulate her likes and
dislikes. She is also able to clearly describe her job
duties. Charlie Quinton, Jane’s former Employment
Specialist, told the writer that he sometimes
observes Jane using complex words out of context.
He was unable to give a specific example but stated
a general belief that her vocabulary exceeds her
level of comprehension. The writer also observed in
the interview that sometimes when asked a
question, Jane would fail to respond. When the
question was broken down into shorter sentences
and repeated, Jane would respond to the question,
suggesting that she did not understand the question
when it was first asked. It was also noted that Jane
thought that she had responded to the question
when she had not. For example, when the writer
asked her why she had discontinued counseling with
Dr. Anything, Jane responded “I quit”. With further
verbal prompting she was able to tell the writer that
Page 5
she left the counseling because she did not think

she needed any more help.
Jane agreed to discuss her aggressive episodes with

the writer but told the story from a different point of
view than staff reports. In general, staff indicate that
her descriptions of emotionally charged situations
are quite different from that of her peers or staff. For
example, there was a situation where she assaulted
another member of her SESI group. She
acknowledged that she slapped him with an open
hand. When asked about the sequence of events,
Jane indicated that she observed this man touching
her friend in “the chest area”, she told him to stop,
he tried to retaliate and she hit him. She then says
she left the area but heard him talking about her and
returned to slap him in the shoulder. In the opinion of
staff, however, no inappropriate touching had
occurred.
With respect to the aggression, it should be noted

that numerous messages are attributed to the
cluster of aggression, tantrums, and/or verbal or
physical threats. Some staff believe that the
behavior is triggered by memories of childhood
abuse and communicates desire for person to stop
activity that is bothering her. Others hypothesize
that the aggression is an expression of frustration at
the inability to have her needs met: “When she has
no other way out”. It should also be noted that an
episode of minor self-injury (picking at scabs on
back of hand) seemed to be an expression of anger
towards a staff member who had refused to comply
with a request made by Jane.
C. Cognitive and Academic Abilities. Formal testing

conducted by Dr. William Webster in 1993 placed
Jane in the mildly mentally retarded level of
Page 6
functioning. At the time, Jane’s Verbal IQ was 67, and

her Performance and Full Scale I.Q.’s were both 66.
Her impairment was most severe on subtests
measuring distractibility from stimuli presented
auditorily and anticipation of consequences of social
behavior. A psychological summary completed by Dr.
Hightower in August 1993 mentions earlier
psychological testing completed by Dr. Bully (no date
or affiliation noted). According to Dr. Bully, a large
discrepancy was noted between Jane’s verbal IQ
(50) and performance IQ (80), resulting in a full scale
IQ of 63. This discrepancy was attributed to
“receptive and expressive developmental language
deficits”. A report written by Jennifer Tilley
(Counselor) in August 1984 reports that Jane had
been diagnosed with aphasia, defined as “diminished
ability to correctly use and comprehend language” in
the Dictionary of Developmental Disabilities
Terminology (p. 20; Accardo, P.J. & Whitman, B.Y.,
1996). The documentation supporting that diagnosis
was not available.
Jane graduated from Pumpkin High School with her

high school diploma. All available records indicate
that she was in special education classes for the
majority of her tenure at school. She was registered
in classes at local Community College last year but
attended for just a few days before dropping out. She
is not currently expressing interest in further
academic pursuits.
Jane can sign her name independently, address an

envelope and mail a letter. She can usually complete
a job application independently, but may require
some verbal prompting. She can read simple recipes
and instructions and has used the want ads to do a
job search. Reading is not a pastime for Jane.
Charlie Quinton estimated that she can read at a
Page 7
grade four or five level. No formal testing was

available in this regard.
Verbal reports indicate that Jane can add, subtract

and multiply but cannot perform division. According
to Charlie Quinton, Jane has difficulty making
change and relies on a calculator to assist her with
most math functions. Regarding measurement skills,
Jane did indicate that she has recently lost weight,
suggesting that she weighs herself. The writer,
however, was not able to determine how accurate
she is in weighing herself. Recipes that she prepares
independently would probably not involve
measurement (e.g. ground beef with peppers and
onions). Jane knows what time she needs to catch
her bus, what time she needs to transfer, and what
times she starts & finishes work. When asked to
describe what she does on the weekend, however,
Jane began to describe her weekly activities. She is
able to differentiate between the days that she is
and is not required to be at work.
D. Self Care Skills. Verbal and written reports from

staff indicate that Jane is completely independent in
her self-care abilities. It is worth noting that at the
last reported dental examination Jane had 23
cavities, suggesting that she has or had some
difficulty brushing her teeth. The residential support
services manager indicated that in-home staff check
to ensure that her grooming is completed but
previous reports indicate that she is completely
independent in this area.
E. Domestic Skills. Verbal and written reports from

staff indicate that Jane can complete all indoor
maintenance tasks independently. The writer was
not able to verify her skill level as her home was not
directly observed. Jane completes her laundry
Page 8
independently. There are laundry facilities at her

apartment. She spontaneously informed the writer
how much it costs for her to wash and dry her
laundry. Jane is able to prepare her own meals. She
described the SESIs to prepare a fried egg sandwich,
one of her favorite quick meals to prepare. Written
reports describe that she is able to prepare complex
meals independently but residential support staff
indicate that she requires verbal prompting to
prepare a novel or complex recipe.
F. Community Skills. Jane takes the bus to work

independently from her apartment. She was able to
describe the routes and schedules of the two buses
she takes to get to work. The bus ride takes
approximately one hour each way. A progress report
from Map, the agency that operated Jane’s former
group home, dated February 1, this year indicated
that she was using public transportation
independently. However, one of the learning
objectives established by Help Me was to teach her
the route to work, which she successfully learned.
The type of instruction used was not specified. The
writer hypothesizes from this information that Jane
requires some assistance to learn novel bus routes.
She has walked from her job to her SESI group when
her bus pass was not available.
Residential support staff accompany Jane to

complete her grocery shopping. The purpose of the
assistance is primarily to provide verbal prompts to
ensure that Jane remains within her budget for
groceries.
Jane currently completes an emergency skills

checklist on a monthly basis as part of her SESI-
ABCD behavior support plan, which includes
ensuring that she is carrying her identification. Jane
Page 9
has consistently been meeting the criteria in the

checklist for the last 6 months.
Money management is consistently identified as an

area of difficulty for Jane. Budgeting skills were
targeted by Map as an opportunity for learning for
Jane and are currently targeted by the SESI-ABCD
program as well. Jane consistently states that she
does not require assistance in this area and no
formal protocol is currently in place. Previous
reports from residential care services indicate that
she gives money away freely and has incurred debts
of over $1000.00. Since resuming employment, she
reports that she has opened a bank account. She
was able to report to the writer the amount of money
that is set aside from her social assistance check
each month for rent ($420.00 paid by direct deposit),
for groceries ($150.00) and for laundry ($20.00). She
was able to report how much she had earned on her
first paycheck from Wiener's are Us ($214.00) and
how much she had spent from her paycheck (e.g.
$25.00 to purchase a kitten). When asked by the
writer how much money she had left over from her
paycheck, she did not respond. When prompted she
indicated that she did not know but was sure that
she would have enough money. She also stated
“When I go shopping, if I see something I like, I buy
it”. She did not show recognition, even when
prompted, that she might have to consider how much
money she had left in her budget before purchasing
a particular item. According to Charlie Quinton,
former Employment Specialist, Jane would also ask
other members of her SESI group for money,
sometimes even threatening them to obtain it.
G. Recreation and Leisure Skills. Jane indicates that

she enjoys shopping, going to movies, watching
Page 10
television, and going to church. She attends church

at Rolling Hills Covenant Church every Sunday and
describes this as a good opportunity to socialize
with non-consumers. She also goes to swap meets to
shop on the weekends. Jane also indicated that her
friends Bruce Lee and Brandon Lee occasionally
come to visit her on the weekends. However, none of
the staff interviewed have met these friends. By her
description, she spends most of her evenings and
several hours on the weekend watching television.
Some of her favorite television shows are “Touched
by an Angel”, “The Drew Carey Show” and “Twice in a
Lifetime”.
H. Social Skills. Reports about Jane’s social skills are

conflicting. Her current job coach, who has worked
with her for approximately three weeks, has not
observed any difficulty getting along with co-
workers. She described an instance when Jane
talked with a co-worker spontaneously about what
to do with her pet fish when she buys a kitten. The
co-worker responded positively by asking her if she
could help by taking the fish for Jane. The writer
observed Jane saying hello to her co-workers. She
smiled, made eye contact and shook hands with the
writer when approached for introductions.
Topics of conversation that were not in response to

direct questions were expressions of physical
concerns (i.e. describing knee problems, describing
surgery in February), pets, boyfriend, and favorite
television programs.
Reports from her former job coach, Charlie Quinton,

are quite different. He describes her as having
difficulty initiating and maintaining friendships.
Apparently she developed a close relationship with a
same-age female co-consumer who was in the same
Page 11
SESI group with her. They worked together at Come-

view Video and spent time socializing outside of
group time, attending swap meets and movies
together. When her friend moved to a different job
site the frequency of contact was reduced. No one
interviewed could indicate how often Jane currently
has contact with this individual, if at all. Some staff
interviewed had the impression that Jane emulated
this individual. One example cited was that when
Jane’s friend left Come-view Video, Jane wanted to
leave Come-view Video within one week. Another
example given was that when this individual recently
became engaged, Jane started to talk about
becoming engaged to her boyfriend. It should also be
mentioned that the aggressive episode that Jane
described to the writer involved this young woman.
Jane indicated that she thought that another
member of the group was touching her friend “in the
chest area”. She claims that she hit this individual in
an effort to protect her friend. Some staff interpreted
the episode as Jane expressing jealousy at her
friend spending time with someone else. Charlie
Quinton described Jane as liking “to be the center of
attention”.
Jane is very interested in having a boyfriend. She

indicates that she currently has a boyfriend whom
she sees a couple of times per week. She announced
in the interview with the writer that she will be
getting engaged to this individual. However, none of
the staff contacted have ever met this individual.
When asked for details about this individual, she
indicates that they have been dating for
approximately four months. She reports that she
used to work with him and “just happened” to meet
him again and start dating him.
Page 12
Jane is not currently sexually active and reports that

she has never had consensual sexual relations.
Verbal and written reports indicate that Jane has
recently expressed interest in becoming pregnant.
Past reports show that Jane was introduced to sex

at a very early age (prior to age 8) in the form of
sexual abuse, possibly ritualistic in nature. She
reported that she received formal sex education in
the form of a class at Pumpkin High School. A report
from Map noted that she has had several appropriate
relationships with men but further information about
the nature of the relationships was not provided.
Jane may benefit from further counseling to
overcome the effects of the events of her childhood
and improve her ability to relate to men.
II. Living Arrangement and Family History. Jane currently

resides alone in a studio apartment in Hawthorne, CA. She
has a short walk to the closest bus stop and is walking
distance to a dollar store, She owns a fish and is looking
forward to acquiring a kitten on the weekend. She is
supported by female staff members from Help Me at a 1:1
ratio. From Monday to Friday staff are present for one
hour in the morning (8:00-9:00 am) and for six hours in the
evening (4:00-10:00 p.m.). On the weekends staff are
present from 8:00 am until 10:00 p.m.. Sugar reported that
staff prompt Jane to get out of bed, accompany her to
doctor’s appointments, give her medication, provide
transportation to recreational activities and provide
assistance with preparation of complicated meals. Jane is
able to prepare simple meals herself. Staff are expected
to complete twelve hours of continuing education each
year, which is primarily consists of inservice training on
medical topics (Help Me’s typical population). Dr. Stuart
Little, a clinical psychologist employed by Help Me trains
the staff members who work with Jane in the
Page 13
implementation a behavior support plan that he has

written. The writer was not able to review this plan or the
method of training employed.
When Jane originally moved into the apartment, the case

manager required that she receive overnight supervision
as she had always resided in group homes and had never
spent a night unsupervised. However, Help Me staff felt
that this was not an efficient use of resources as she did
not require this level of supervision. Overnight supervision
was discontinued a couple of months ago. Sugar Cane,
Help Me manager, reported that when Jane left her job at
Come-view Video there was period where she was paging
Sugar “constantly”. Due to the brief nature of the
interaction with Sugar, the writer was unable to determine
the exact frequency per night. However, Sugar noted that
this behavior ceased completely when Jane started her
new job at Wiener's are Us on July 5, this year. Jane
reports that she is very happy with the present
arrangement and gets along well with her support staff.
Prior to the move to her own apartment, Jane was residing

in a group home in Lawndale, CA under the supervision of
Map Residential Care. She was taken into the care of this
agency in May 1994 and discharged from their care when
she moved into her own apartment in March this year.
Jane was not able to say why she had to move into this
group home and the reason was not available in written
files. Given that she was placed at age 18 after residing in
a residential children’s facility, the writer hypothesizes
that she could no longer be served by children’s services
and the move to Map coincided with a move to adult
services. Jane lived in the same house within the Map
system from July 15, 1996 until March this year. Jane
indicates that she moved out of that home because of a
conflict with a male co-resident but no one was able to
corroborate this report. It was verbally reported to the
Page 14
writer that Jane was well liked by staff at this group

home.
Jane resided at Saturn Hall from May 3, 1993 until early

1994. It is not know whether she moved directly from
Saturn to Map. Jane believes that she moved to Saturn
because she “could not find a group home”. Written
reports indicate that Jane was moved to Saturn when her
foster mother could no longer control her violent
outbursts. One incident was described wherein Jane was
upset because one of her foster siblings received a
present and she did not so she bit her foster mother in the
eye area, resulting in a black eye.
Jane was sent to live with Snow White, foster parent,

when she was removed from her family of origin in
November 1983. She was seven years old at the time. It is
reported that she and her siblings were the victims of
severe physical and sexual abuse. It is suspected that
there may have been ritualistic overtones to the abuse
and that Jane may have witnessed the homicides of
transient individuals in the context of this abuse. Her
natural father apparently served at Concrete State Prison
for the abuse perpetrated against Jane and her siblings.
Her mother was implicated in the abuse but never
formally charged. Jane has had absolutely no contact with
her natural parents since she was removed. She did
receive notification within the last couple of years that
her father had passed away.
Jane indicates that she has three siblings: Mercury (age

23), Cinderella (age 22) and Grettle (age unknown).
Reports completed at the time of the apprehension
indicate that all children were removed from the home and
that all experienced severe emotional disturbance. None
of the siblings were placed in the same home. When asked
about her siblings, Jane indicates that she speaks to
Mercury every day by telephone and sometimes visits with
Page 15
him in person. She describes him as “very funny”. When

asked about a previous plan to move into an apartment
with Mercury, Jane indicated that Mercury had decided
that he wanted to move in with her sister Cinderella. She
has sporadic contact by telephone with Cinderella. Jane
verbalized excitement at the possibility of going to
Disneyland with Cinderella when Cinderella regains
custody of her children. Jane currently has no contact
with her sister Grettle but receives reports about Grettle
from Cinderella.
III. Daytime Services Received and Day Service History. Jane

has been served by the Service to Employ People (A
division of the Alphabet Program), a behavior management
day program, since March 3, 1999. She indicates that she
referred herself to the program on the recommendation of
a friend, a fact that is corroborated by the SESI reports.
Target behaviors or goals identified in the most recent
individual service plan are job tenure, aggressive
behavior, verbal aggression, emergency skills, skills
maintenance, budget and social skills. No current protocol
is in place for budgeting as Jane has indicated that she
does not require assistance in this area. Verbal reports
indicate that staff plan to wait until a discrete budgeting
problem arises for Jane (e.g. incurred debt) before trying
to initiate another intervention. As reported earlier Jane
has consistently achieved the emergency skills criteria
implemented through the monthly emergency skills
checklist over the last 6 months. This is maintained
through verbal praise, as is the completion of the skills
maintenance checklist. The writer did not have an
opportunity to review the skills maintenance checklist or
protocol. Social skills objective is implemented through
discussion allotted with the job coach, with no
reinforcement protocol.
Page 16
With regard to job tenure, Jane gained employment with a

local Wiener's are Us on July 5, this year. Her hours of
work are Monday through Friday, 11:00 am to 3:00 p.m..
She is considered to be naturally supported in this
environment at this time. Jane was able to describe all of
the tasks that she is expected to complete as part of her
job. Her manager verbally indicated that she thinks that
Jane is very independent in her position. Observational
data are consistent with this opinion. Jane was able to
clock in with minor assistance from a fellow staff member,
which she sought independently. She was observed to get
a wet rag and wipe down all of the tables, collect and
clean trays and wipe down the pop machine. She also
repeated these tasks as necessary. Employment
Specialist Mary Whitten, assigned to the case when Jane
obtained this job, attends the job site for one hour each
day, from 12:00-1:00 p.m., in order to assist Jane with the
lunch rush if necessary. When Jane started in this
position, she found the pace much quicker than her
previous job at Come-view Video, thereby necessitating
the additional assistance. There are plans to extend Ms.
Jones’s contact with Jane outside of scheduled work time
but time constraints do not allow for more hours at this
time.
Prior to obtaining employment Jane was involved in job

development activities (e.g. resume development). Jane’s
daily activities included meeting in the morning at the
local Community College or other appointed place (e.g.
McDonald’s) to plan the day’s activities and work on job
development if appropriate. Jane worked at Come-view
Video with 1:3 supervision from August 16, 1999 until June
23, this year where her starting wage was $5.75 per hour.
She was required to stock shelves. One of the other
clients at the job site was a paid staff member (and Jane’s
friend) and the other client was present simply because
he required constant supervision by the Employment
Specialist (Charlie Quinton). The consumer who required
Page 17
constant supervision was the individual with whom Jane

was having repeated conflicts. He reported that Jane had
been physically assaulting him outside of staff presence
at the job site after he was noted to have bruising.
Consequently, he no longer attended the job site with
Jane. Jane’s friend, who was working with her, left that
job site to go to another site. The date of these events is
not exactly known but staff report that it was very difficult
for Jane to suddenly be alone at the job site. In April this
year Jane’s attendance at group and her job were
sufficiently sporadic that her employer planned to take
her off of the schedule. Jane tendered her resignation on
June 23, this year, shortly before she was to be taken off
the schedule. Regrettably, the writer did not obtain more
detail regarding the pattern of missed days.
Verbal reports indicate that Jane had difficulty with

another individual in her SESI group before the gentleman
who eventually left the group joined. This woman was
verbally high functioning but diagnosed with cerebral
palsy. It was described to the writer that Jane and this
woman were in frequent conflict. Shortly after this woman
left the group, this other male consumer joined the group
and seemed to become the new target of the aggressive
behavior.
Jane accessed the Neptune County Social and Vocational

Services for assistance with job development from August
1994 until November 1998. The writer is not familiar with
the mandate of this agency but based on verbal reports
from SESI staff and Jane’s description, the writer
hypothesizes that the agency obtains contracts from
employers and several clients go to a single job site to
fulfill the contract. Jane reports that she worked at Here
on Mars University and at the Airport picking up trash. She
also washed dishes at Saturn Mountain University. The
duration of each placement is not known. Jane’s favorite
job was at HOMU where she says she made many friends.
Page 18
Jane indicated that she left the agency because “they

weren’t respectful”. No written or verbal reports were
available to confirm or deny Jane’s reason for leaving.
IV. Health, Medical and Psychiatric Status. The last full

physical examination of which the writer is aware was
completed July 13, 1999. Jane was considered to be in
good health overall at that time. Ongoing health-related
difficulties are an allergy to penicillin and obesity. Jane
verbalizes interest in losing weight but indicates that she
is not currently on any special diet nor does she engage in
regular physical exercise.
1999 - Summary of medical contacts
Date Reason
February 25, March 9, 11, 25, Lab tests due to discharge from
1999 breast
April 26, May 25, July 13, 1999 Routine physical examinations
March 1999 Antibiotics for flu
April 1999 Laryngitis
July 28, 1999 Skin rash
September 28, 1999 Unresolved skin rash
October 13, 1999 Virus/flu
November 4, 1999 Fall and subsequent bruising
December 6, 1999 Pap smear due to vaginal
bleeding
To summarize, Jane visited the general practitioner (Dr.

Rings) 14 times during a 12-month period, outside of the
annual physical examination. She also visited her dentist,
Dr. Circle, on January 28, this year at which time it was
determined that she has 23 cavities. It is not known
whether or not these cavities have been filled. Although a
summary of the year to date was not available, qualitative
data indicate that Jane was hospitalized for surgery to
remove a benign cyst in late February this year. She is
Page 19
currently complaining of pain and swelling in one knee.

There were no verbal or written reports of a history of
seizure activity. Historical reports queried the presence of
a dissociative state but there is no further documentation
available that proves or refutes this assertion. The
manager of her residential support service described Jane
as having a “fixation” on her physical problems. However,
based on the available information, Jane’s reasons for
attending the doctor were reasonable and justified. It may
be that Jane is simply prone to minor health problems.
The following table lists the medications, dosages, and

reason for prescription as indicated in the SESI
Facesheet.
Name Prescribe Schedule of Reason prescribed

d dosage delivery
Maxzide 50 mg 1 tab am Anti-hypertensive
Pepcid 20 mg 1 tab am Gastric upset
Triavil 25 mg 4 at am & 2 tabs Antidepressant
p.m.
Mellaril 50 mg 2 at p.m. & prn Agitation
Depakote 250 mg am/p.m./noon Behavior management
Lomotril 50 mg 2 prn Birth control
When shown a list of current medications as above, Jane

noted that the Mellaril was discontinued sometime after
she moved into her current living arrangement because “I
was doing so well”. Although her account differs from the
documentation, Jane seems to have a good understanding
of her medication.
No more recent history of medication was available. It

should be noted, however, that no mention of medication
was made in the psychological reports completed in 1993,
when Jane came to Saturn Hall.
Page 20
V. Previous and Current Treatments. SESI – ABCD

In the protocol for physical, verbal aggression, and
property damage (response class under the heading
“aggressive behavior”), written May 11, 1999, verbal
praise is being used to reinforce the absence of the target
behaviors in conjunction with a Differential Reinforcement
of Other Behavior (Progressive) schedule of
reinforcement. She can earn a $4.00 lunch or other
reinforcer up to $4.00 in value when she has gone a
minimum of 8 days without the target behaviors. The
longer she goes without engaging in aggressive behavior
the more quickly she can earn the reinforcer. The protocol
also describes positive programming procedures
(teaching anger response, encouraging attendance at PET
classes); ecological strategies (non-directive interactive
style, increasing self-control over schedule, respecting
personal space); and reactive strategies (active listening,
natural barriers). This protocol has been successful in
decreasing the frequency of Jane’s behavior to an average
of 1.3 times per month. The goal set in the individual
service plan dated January 3, this year was for Jane to
maintain the frequency of this behavior on average at less
than once per month. Verbal reports indicate that this
behavior continues to be a concern because of the
severity of the behavior when it occurs and the impact of
the behavior on co-consumers. A summary of supports
currently being offered by SESI is provided below:
Help Me. According to Sugar Cane, the clinical

psychologist employed by Help Me (Dr. Stuart Little)
completed a behavioral assessment and developed a
behavior support plan. The content of the assessment
and/or the plan is not known. Sugar was able to confirm
that the plan did not include treatment for aggression of
Page 21
any kind. She also informed the writer that Jane looks
forward to visits from Dr. Stuart Little.
Map. No records of a specific intervention plan carried

out at Map were available.
Counseling services. Jane received counseling for her

emotional and behavioral problems associated with
childhood abuse starting when she was removed from her
home (age 7) and ending when was approximately 18
years old. Jane states that the purpose of this counseling
was to help her express her emotions. Historical records
suggest that Jane became more physically violent during
these years but does not indicate on what dimensions the
severity of the behavior increased (i.e. frequency,
duration, strength). She also saw Dr. Square Allen
(Neptune-Help Me Clinic) for a couple of counseling
sessions in June-July 1997 but chose to discontinue
service.
FUNCTIONAL ANALYSIS OF PRESENTING PROBLEMS
A functional analysis was conducted for aggressive

behavior. Accordingly, the analysis endeavored to identify the
events that control the emission and non-emission of these
clinically important problems. It is therefore organized around
six specific subcategories of analysis: (1) Description of the
Problem. The analysis attempts to describe the presenting
problems in such detail that they can be objectively measured.
It presents the topography of the behavior, the cycle (beginning
and ending) of the behavior (if applicable), and the strength of
the behavior (e.g., frequency, rate, duration, intensity). (2)
History of the Problem. Three analysis presents the recent and
long-term history of the problem. The purpose here is to better
understand Jane's learning history, and the historical events
that might have contributed to the problem(s). (3) Antecedent
Analysis. The antecedent analysis attempts to identify the
conditions that control the problem behaviors. Some of the
Page 22
specific antecedents explored include the setting, specific

persons, times of the day/week/month, and specific events that
may occur regularly in Jane's everyday life. (4) Consequence
Analysis. The consequence analysis attempts to identify the
reactions and management styles that might contribute to
and/or ameliorate the presenting problems. It also focuses on
the effects that the behaviors might have on the immediate
social and physical environment, on the possible function(s)
served by the problem behaviors and on the possible events
that might serve to maintain or inhibit their occurrence. (5)
Ecological Analysis . The ecological analysis attempts to
identify the critical mismatches that may exist between the
physical, interpersonal and programmatic environments and
Jane's needs and characteristics. (6) Analysis of Meaning. The
analysis of meaning is the culmination and synthesis of the
above analyses and attempts to identify the functions served by
the problem behaviors. The functional analysis of Jane,
organized around these headings, follows:
A. Description of Behavior and Operational Definition.
1. Topography. The following definition was developed

from the definition provided in the Behavior
Intervention Protocol for Aggressive Behavior.
Aggressive behavior is defined as the occurrence of

any or all of the following behaviors:
Verbal aggression:
This includes any of the following behaviors:
 calling other people rude or offensive

names (e.g. “You handicapped bitch”,
racial slurs such as “nigger”);
 threatening to harm others or their
families (e.g. “I’m going to kick your ass”,
“I’m going to get your sister”);
Page 23
 threatening to reveal embarrassing

information about others (e.g. “I’m going
to tell everyone you have to wear a
diaper”);
 threatening to falsify information about
others (e.g. “I’m going to tell Tina you hit
me”);
 directing profane language towards
others or using it to describe others (e.g.
“F*** you” or “She’s a bitch”).
Physical aggression:
This includes using her body or an object to
make forceful contact with the body of another
person, causing the person to report pain or
leaving a mark on the person’s body. Any
attempts that fail due to poor aim or evasion
strategies are also included. Accidental
contact (e.g. during the course of a game such
as soccer) should not be included. Specific
examples of physical aggression include:
Hitting: Making contact with any part of the

body of another person with an open
hand or a closed fist such that the
other person reports pain or a mark
is left on the person’s body.
Biting: Making contact with the flesh or

clothing of another person with the
teeth such that a mark is left or pain
is reported.
Kicking: Making contact with any part of the

body of another person with the feet
such that the other person reports
Page 24
pain or a mark is left on the person’s

body.
Pushing: Making contact with any part of the

body of another person with
outstretched arms and hands with
sufficient force to move that person,
to cause pain or to leave a mark on
the person’s body.
Property destruction:
This includes any actions that render objects
or property in need of repair (e.g. breaking a
table leg) or unusable (e.g. tearing up a piece
of paper).
2. Cycle. Onset of the behavior occurs with the onset of

any one of the behaviors described above. Feedback
from the former Employment Specialist, who
implemented the program until approximately three
weeks ago suggested that the current offset criteria
(i.e. absence of any of the above behaviors for at
least 15 minutes) does not capture all instances of
the behavior. For instance, one instance of physical
aggression consisted of three discrete attacks that
occurred within a 15-minute period. Based on the
description of the incident, which involved an initial
physical attack and two subsequent attacks on the
same individual, in conjunction with the other
limited descriptions of the behavior, it is
recommended that behaviors continue to be coded
as episodes, consistent with the original definition.
3. Course. Starts by calling individual she is angry with

a couple of names, then might kick towards
individual. She may say something like “I hate you. I
don’t want to be in the group” or threaten to contact
Page 25
higher authorities (e.g. “I’m calling Tina on you). She

may engage in minor self-injury at this point (e.g.
scratching the back of hands with fingernails but not
with sufficient force to draw blood).The volume of
her voice increases, her face becomes flushed, her
pupils dilate, progresses to yelling full sentences (for
example threats or accusations such as “You were
talking about me”.). She then moves towards the
individual and strikes with an open hand or closed
fist once or twice then backs away. If target of
aggressive behavior attempts to fight back
physically or verbally, Jane may approach the
individual again to fight or leave the area . Typically
by the time she approaches the target person a
second time, a staff member has intervened.
4. Strength.
a. Rate. Writer could only find evidence of four

Incident Reports for the year this year on the
SESI casefile to indicate the presence of
aggressive events (March 24, March 31, April 12
and April 24). No recording sheets were
observed. Discussion with the Employment
Specialist indicates that rates of verbal
conflict were higher than indicated by tracking
data. Furthermore, the E.S. indicated that he
found out at a later date that one individual,
who had been the target of some of Jane’s
documented attacks, had sustained bruising.
This individual indicated that Jane had been
physically aggressive toward him, resulting in
the bruising.
b. Duration. Exact duration is unknown. Previous

documentation indicates that the average
duration of a tantrum is 10 minutes but report
of the most recent incident indicates that 3
Page 26
separate attacks occurred within a 15-minute

period, comprising a single episode. There was
not enough data available to establish an
average duration.
c. Severity. The most severe physical injuries

that have resulted from this class of behavior
within the last year are bruises and a bloody
lip. One client has left the SESI program
because of Jane’s behavior towards him.
B. History of the Problem. There are reports of Jane

engaging in physical aggression, verbal aggression and
property damage from the time that she was taken into
foster care in 1983.
Counselor’s report, completed by Jennifer Tilley, 1983 :

Severe attacks of self-abuse are described that were
believed to be in response to attempts to impose
diHOPPline. Examples of such behavior were completely
removing her own toenails, attempting to remove her own
eyeball. She also physically attacked her foster mother, at
one time biting her with enough force around her eye to
cause a black eye. She also destroyed bedsheets,
bedspreads and clothes for no discernible reason.
Episodes were up to 2 hours in duration.
Psychological report, completed by Dr. K. Lite Color, 1993 :

Refers to an escalating pattern of violence towards the
foster mother including biting. The episode named as the
reason that Jane left the foster home is that she bit the
foster mother in the face when she was angry that one of
the other children received a present when she did not. No
mention of self-abusive behavior.
History of the behavior between 1993 and 1998 was not

available.
Page 27
1998 - Review of frequency of behaviors as recorded in SESI

casefile
Tantrums Verbal Abuse Property

Destruction
January 2 3 N/A
February 2 3 N/A
March 2 3 N/A
April 1 3 N/A
May 0 1 2
June 0 0 2
July 1 5 0
August 0 0 0
September 2 5 0
October 4 5 1
November 0 1 1
December 2 5 0
Average 1.3 2.8 0.75
There is no discernible pattern to this constellation of

data.
The most recent incident reports that the writer was able
to observe are summarized below:
Date Description
March 24/00 Was playfighting in backseat with another
consumer. Consumer with whom she had
previously had conflict said “Watch out for the
police”. Jane became verbally aggressive (racial
slurs and swearing) towards this individual,
escalating to attempting to strangle him with a
seat belt.
March 30/00 Became upset with employment specialist and
verbally abused him. Swore, used racial slurs and
physically attacked consumer who had previously
Page 28
been victim of her attack.

April 12/00 Verbally aggressive towards others in the group
then directed towards other patrons in the area
where they were meeting
April 24/00 Verbally threatened “I’m going to hit you” (unsure
who this was directed towards)
It was also indicated in the written notes that there had

been an incident in April this year involving a physical
altercation between Jane and the consumer with whom
she was having ongoing conflict. It is not known if this
occurred as part of the incidents described above.
C. Antecedent Analysis. In an antecedent analysis, one tries

to identify the events, situations and circumstances that
set the occasion for a higher likelihood of the behavior
and those that set the occasion for a lower likelihood.
Further, in both categories, one tries to identify both the
more distant setting events and the more immediate
triggers that influence the likelihood of the behavior.
Below is firstly an analysis of those setting events and
triggers, i.e., those antecedents, that increase the
likelihood of aggressive behavior and their escalation and
secondly an analysis of those that decrease the
likelihood. Detailed examples substantiating each of
these, based on actual incidents, are also included.
Setting Events. A major stressor such as suddenly

being alone at job site or moving to a new home may
increase the likelihood that Jane will engage in
aggressive behavior. The incident reports mentioned
above occurred within a couple of weeks of Jane
moving into her new home.
Triggers
Location
Aggressive behavior is unlikely to occur when Jane
is either alone or with her support staff from Help Me
Page 29
in the apartment. When asked whether aggression

was included as part of the support plan for Jane
written by Dr. Stuart Little, Sugar Cane indicated
that this had never been a problem there nor did they
anticipate the problem developing in that setting.
People. The aggressive behavior is more likely to

occur if Jane is in the presence of obviously
disabled clients. For example, the one individual that
she repeatedly targeted was in a wheelchair and the
other was challenged with cerebral palsy. She was
witnessed on one occasion to back the wheelchair-
bound individual into a corner and punch him.
Aggressive behavior is not likely to occur when Jane

is in the presence of non-consumers only. She has
not exhibited any aggressive behavior since starting
her job at Wiener's are Us, where she is the only
consumer, even though she had to work more quickly
than at her previous job.
Physically aggressive behavior is less likely to occur

in the presence of physically larger non-consumers.
For example, Jane would be verbally aggressive
towards her Employment Specialist (a non-consumer
who is larger than her) but never directed physical
aggression towards this person.
Time. There was no suggestion that time of day was

related to aggressive behavior. The fact that the
incident reports indicated that the behavior
occurred before noon is likely significant in that the
SESI group was in the morning.
Event. The following types of responses to a request

for help or request to meet a need are highly likely to
trigger an aggressive response:
Page 30
Repeated refusal of a request to help her meet a

need (e.g. getting a ride to the 99-Cent Store)
Statements such as “You’re not the only person in

the group”
Challenging her beliefs or authority
Ignoring her requests
When Jane perceives that a friend is being touched

sexually she is highly likely to behave in an
aggressive fashion. For example, she states that she
was physically aggressive towards another member
of her group because she thought that that
individual was touching the “chest area” of her
friend.
Being offered an alternative solution to presenting

problem decreases the likelihood of an occurrence
of aggressive behavior. For example, when she asked
her Employment Specialist to go to the dollar store
she is never became aggressive if she is told “I’m
sorry we can’t go today but we can go on Friday”.
D. Consequence Analysis.
Planned consequences. Jane’s current behavior support

plan for aggressive behavior rewards her for the absence
of aggressive behavior on a 28-box DROP (Differential
Reinforcement of Other Behavior, Progressive) schedule.
For consecutive days without engaging in aggressive
behavior, Jane fills in progressive numbers of boxes (up to
a maximum of five per day). When she has filled in 28
boxes (minimum of 8 days), she earns a $4.00 lunch (or
reinforcer of equivalent value). The reactive strategies
currently recommended in the support plan include active
listening and natural barriers.
Page 31
Unplanned consequences. Verbal reports indicate that

subsequent to physically or verbally aggressive acts, Jane
either leaves the situation or apologizes to the target of
the behavior and the group (e.g. “I’m so sorry. I don’t know
why I do these things”). The Employment Specialist
utilizes active listening but describes this as a “stopgap
measure” which slows the course of the behavior but has
been ineffective in de-escalating the behavior. He
indicates that he has not found any techniques that are
effective in de-escalating the behavior once it starts
except to agree with her request.
Clients that she has attacked typically fight back and

others freeze. It has been necessary for the Employment
Specialist has had to place a barrier between Jane and
other client. In one case he described having Jane and the
other client each trying to go around him to get to each
other.
Jane stated that she chooses to throw objects that will
break when they connect with the wall, suggesting that
she enjoys the noise made by these objects.
In the long term, these outbursts seem to be related to

Jane’s poor attendance at the SESI group and at work.
Subsequent to the series of incidents noted in the
incident reports, Jane began to miss shifts at work and
time at SESI group. This eventually resulted in Jane
having to submit her resignation to Come-view Video to
avoid being fired from this position.
E. Ecological Analysis. There are a number of ways in which

understanding the ecology surrounding and how it may
conflict with Jane's needs and characteristics, may be
helpful in understanding the meaning of her behavior and
in understanding the ecological changes that may be
necessary to provide the necessary support for her. The
brief discussion addressing the ecological analysis is
organized below around the physical environment, the
Page 32
interpersonal environment and the programmatic

environment.
Physical environment. There are currently no

obvious conflicts or mismatches in the physical
environment.
Interpersonal environment. As identified in the

Behavior Intervention Protocol for Aggressive
Behavior designed by SESI, Jane is more likely to
engage in aggressive behavior when she feels that
she is being told what to do. Furthermore, she seems
more likely to challenge people in her environment
that confront her about her behavior and/or her
disability. Her previous Employment Specialist
stated that he felt he had to adopt a more
authoritarian approach (e.g. confronting her about
her behavior) with his clients in the interest of self-
preservation. He stated that when he adopted this
approach he began to see a “dark side” of Jane, that
she was “manipulative”: “She probably fooled me the
longest of any of them [consumers]”. He also
described needing to be more directive in his
approach at her previous job at Come-view Video,
whereas she is naturally supported in her present
work environment. It is the opinion of the writer that
the change of Employment Specialist has occurred
at a good time as her former E.S. was feeling that he
no longer had the personal resources to help Jane
with her behavior. Her present E.S. describes a less
confrontational style, although she has not yet had
to deal with one of Jane’s major outbursts. She also
sees her role as facilitating Jane’s ability to
complete the tasks of the job, rather than directing
her activity on the job.
SESI co-consumers who Jane assaulted were both

African-American, physically disabled and assertive
Page 33
to aggressive in approach to conflict. Based on

verbal reports and observations of Jane in her work
setting, it seems that more conflict arises with
groups of other consumers than individually or with
others who are not consumers.
Programmatic environment. The ecological

strategy of “Interactive Style” as described in the
Behavior Intervention Protocol was has not been
consistently implemented by all staff. There is also
some concern about the social validity of the
approach. Former E.S. indicated that he did not
perceive sufficient response to occurrences of this
serious behavior by the administration. He feels that
the other client who was usually the target of Jane’s
aggressive behavior was not sufficiently protected
by ABCD.
SESI and Help Me may be duplicating services or be

able to obtain crucial information from each other if
copies of behavioral assessment and support plan
completed by Dr. Stuart Little may be shared with
SESI and vice versa.
F. Impressions and Analysis of Meaning. In considering the

functional analysis and the background information
summarized above, there are a number of factors that are
helpful in trying to understand the meaning of Jane's
behavior.
Jane is a complex and talented individual who has done a

remarkable job of overcoming many barriers in her life.
When one considers the longitudinal nature of the data it
is obvious that the severity and duration of aggressive
behavior has decreased over the years. Given the severity
Page 34
of the aggressive that was modeled for her and

perpetrated against her, it is a testament to the training
that she has already had that she does not respond to
every situation with aggressive behavior. It seems that
Jane, like everyone else, wants to feel normal – be around
“normal” people, do the things that “normal” people do,
have the experiences that “normal” people have. There are
barriers to her ability to achieve these experiences. She
does not always understand what other people are saying
or the complexities of their social interactions. She is
confused about sex and intimacy and love. Consequently
she may perceive innocuous social cues as threats to
which she needs to be respond. Also she does not possess
a large repertoire of coping responses to which she can
control a threatening or confusing situation. She seems to
be using the strongest behaviors she has in her arsenal to
order the situation in the way that she wants it.
Alternately (or additionally) she may seek to control those
individuals over which she at least has physical control in
an effort to improve her own limited sense of self-worth.
Also, one cannot discount the modeling effect of the
abuse she suffered as a child. It is our job then to help her
make sense of this confusing world through the
acquisition of skills such as discrimination of social cues
and anger management training.
MOTIVATIONAL ANALYSIS
A motivational analysis was carried out to identify those

events, opportunities and activities that Jane enjoys and that
may be used to enhance her quality of life and provide her with
incentives to improve her behavior and to enhance her
academic progress. The results of the analysis showed a
number of events that could be used effectively as positive
reinforcement in a well designed support plan to reduce the
identified behavior problems. These events include, but are not
Page 35
limited to money, shopping trips (especially swap meets and

the 99 Cent Store), receiving beauty treatments like manicures,
and watching favorite television programs (e.g. “Touched By An
Angel”, “The Drew Carey Show”). Although she identified
several edible reinforcers, it is recommended that these be
avoided due to Jane’s desire to lose weight. She expressed a
great deal of excitement for a future trip to Disneyland. These
reinforcers, and others, should be used in a variety of ways, the
least of which would be through the contingencies of formal
reinforcement schedules.
MEDIATOR ANALYSIS
A "Mediator Analysis" was conducted for the purposes of

identifying those persons who might be responsible for
providing behavioral support for Jane, their abilities to carry out
the recommended support plan, given the demands on time,
energy, and the constraints imposed by the specific settings,
and motivation and interest in implementing behavioral
services as recommended. The analysis showed the following:
The primary responsibility for implementing the behavior

support plan will be with Mary Whitten, Jane’s currently
assigned Employment Specialist. Upon brief meeting she
appears to naturally possess the interactional style
recommended in the Behavior Support Plan. However, it will be
necessary to prepare her for the occurrence of the target
behavior. She may also require more specific training in the
implementation of the plan as she has only occasionally worked
with Jane in the past. She is physically smaller or the same size
as Jane so she may require assistance to develop strategies
other than the interpositioning strategy used by the previous
Employment Specialist. Currently she is only assigned to spend
one hour per day with Jane at the job site, constraining the
amount of time that will be available to carry out other
interventions (e.g. focused intervention strategies). Supervisor
Kim Chow indicated that a new schedule is currently being
Page 36
developed to allow Annie to spend more time with Jane. Annie

will likely require specific training in the interactive style that
works best with Jane, as well as specific education about the
function of the behavior.
It should also be noted that if the plan is to be very

successful, training and involvement of Help Me staff in the
implementation of this plan is also recommended.
RECOMMENDED SUPPORT PLAN
A. Long-Range Goal. The long-range goal for Jane is to

establish enough self control over her behavior that she
will be able to live and work in the least restrictive setting
possible that is capable of meeting her developmental and
behavioral needs. The goal of her educational plan is to
provide her with the academic and other skills necessary
to meet her needs, while eliminating those behaviors that
tend to stigmatize and isolate her from full community and
social presence and participation. Additionally, the goal is
to transfer the control of Jane's behavior from external
mediators (parents and staff) to internally generated
controls. The plans and objectives presented in the
following paragraphs are intended to increase the
likelihood that the following specific outcomes will occur:
1. Jane will live in and contribute to her community at

a level commensurate with her non-disabled peers.
This will include living in her own apartment and
being naturally supported in her work environment
with the minimum support necessary to meet her
developmental needs.
2. Jane will develop the full range of relationships with

friends and family thereby increasing her natural
supports in the community, reducing her overall
Page 37
reliance on staff, and enhancing her overall quality

of life.
3. Jane will master a wide range of coping strategies

that will help her deal with the everyday challenges
faced by all of us, thereby increasing her control
over her environment.
B. Operational Definition(s).
1. Aggressive behavior
a. Topography. Aggressive behavior is defined as

the occurrence of any or all of the following
behaviors:
Verbal aggression:
This includes any of the following behaviors:
 calling other people rude or offensive

names (e.g. “You handicapped bitch”,
racial slurs such as “nigger”);
 threatening to harm others or their
families (e.g. “I’m going to kick your ass”,
“I’m going to get your sister”);
 threatening to reveal embarrassing
information about others (e.g. “I’m going
to tell everyone you have to wear a
diaper”);
 threatening to falsify information about
others (e.g. “I’m going to tell Tina you hit
me”);
 directing profane language towards
others or using it to describe others (e.g.
“F*** you” or “She’s a bitch”).
Physical aggression:
Page 38
This includes using her body or an object to

make forceful contact with the body of another
person, causing the person to report pain or
leaving a mark on the person’s body. Any
attempts that fail due to poor aim or evasion
strategies are also included. Accidental
contact (e.g. during the course of a game such
as soccer) should not be included. Specific
examples of physical aggression include:
Hitting: Making contact with any part of the

body of another person with an open
hand or a closed fist such that the
other person reports pain or a mark
is left on the person’s body.
Biting :Making contact with the flesh or

clothing of another person with the
teeth such that a mark is left or pain
is reported.
Kicking: Making contact with any part of the

body of another person with the feet
such that the other person reports
pain or a mark is left on the person’s
body.
Pushing: Making contact with any part of the

body of another person with
outstretched arms and hands with
sufficient force to move that person,
to cause pain or to leave a mark on
the person’s body.
Property destruction:
This includes any actions that render objects
or property in need of repair (e.g. breaking a
Page 39
table leg) or unusable (e.g. tearing up a piece

of paper).
b. Cycle. The recording cycle for the response

class Aggressive Behavior begins with the
onset of any of the above topographies and
ends when all of the behaviors have been
absent for 15 minutes.
C. Short Term Measurable Objectives. The following

objectives and plans are suggested on the assumption
that Jane has the opportunity to continue to live in her
own apartment and work in a naturally supported setting.
It is unlikely that they would be realistic if she did not
have these opportunities. These objectives were also
selected as being most reflective of Jane's priority needs
and as being the most realistic given her level of
functioning at the time. Given that the recording definition of
Aggressive Behavior has been altered, it is recommended that
three new baselines be collected: physical aggression, verbal
aggression and property damage. Objectives should then be
set for each type of aggressive behavior. It is recommended
that a 50% reduction in the baseline occurrence of each type of
aggressive behavior by the end of a 6-month period be
established as the short-term objectives. Further objectives
may be established as a function of the success or failure
of the recommended strategies.
D. Observation and Data Collection Procedures.
1. Methods.
a. Aggressive behavior. The writer observed four

incident reports describing episodes of
aggressive behavior. It is recommended that a
revised version of incident-based data
collection continue, in addition to a daily
Page 40
recording of the occurrence/non-occurrence of

physical aggression, verbal aggression and
property damage.
i. Daily recording
The purpose of adding formal daily
recording to the data collection methods
is to serve as a reminder to staff as to
when they need to complete an incident
recording form. Each day, staff should be
assigned to record the occurrence/non-
occurrence of the behavior. A sample
format is shown below:
Date Aggressive
behavior?
V P PD
e.g. September 20, +/- +/- +/-
this year
ii. Incident recording

In addition to the daily recording
described above, it is recommended that
each incident of aggressive behavior be
recorded, including the following
information:
 Date and time of aggressive episode

 Duration of aggressive episode
 Location of aggressive episode
 Each topography that occurred (i.e.
physical aggression, verbal
aggression and/or property damage)
 People present at the time of the
episode
 Activity at the time of the episode
 Events leading up to the episode of
aggressive behavior. This should
Page 41
include the closest verbatim

account of any interactions with
Jane that occurred immediately
prior to the event.
 How people reacted.
 Description of any property damage
or injury that occurred as a result.
 Observer’s impressions regarding
the occurrence of the aggressive
episode.
 Jane’s impressions regarding the
aggressive behavior (if possible to
obtain)
I think that it would be helpful to develop a

form that specifies each of the above as a
separate field to help staff completing the form
to consistently complete the same information.
Having fields defined in this way will also help
in the calculation of a reliability index (see
below for description of same).
The frequency of the occurrence of each

topography (i.e. physical aggression, verbal
aggression and property damage) should be
graphed in addition to the total frequency of
aggressive behavior. These graphs should be
available on a quarterly basis.
2. Observational Reliability.
a. Aggressive Behavior. Observational reliability

will be determined using an incident-based
strategy. As this behavior occurs at relatively
low rates, it is unlikely for an aggressive
episode to occur during a supervisory visit.
Therefore, after an incident has been recorded,
the supervisor should interview the client and
Page 42
the staff member who completed the incident

report and score the presence or absence of
each required piece of information. In other
words, if both the supervisor and the front-line
staff have recorded the same time & date, that
would be recorded as an agreement (“+”). If
one person indicates that the episode included
physical and verbal aggression and incident
report indicates that it only included verbal
aggression, that would be scored as a
disagreement (“-“). The following formula
should be used to calculate a reliability index
for the recording of aggressive episodes:
# of agreements X 100 = reliability

index
-------------------------------------------
# of agreements + # of disagreements
The observational reliability index should be

presented in the quarterly report.
In the case of physical aggression and property

damage, permanent product reliability could be
established by viewing the damage to persons
or property caused by the aggressive behavior.
E. Intervention Procedures. In the following paragraphs, a

summary of possible strategies to support Jane is
presented. These are by no means meant to be
comprehensive or exclusive of other procedures. They
simply represent a set of starting points that would be
elaborated and modified as services are provided.
Support is organized around four primary themes:
Ecological Strategies, Positive Programming Strategies,
Focused Support Strategies, and Reactive Strategies.
Page 43
1. Ecological Strategies. Many behavior problems are

a reflection of conflicts between the individual
needs of a person and the environmental or
interpersonal context in which the person must live,
go to work or otherwise behave. As part of the
above evaluation, several possible contextual
(ecological) conflicts were identified. It is possible,
that by altering these contextual conflicts, that
Jane's behavior may change and her progress may
improve, thus eliminating the need for consequential
strategies. In the following paragraphs, a number of
"Ecological Manipulations" are presented with the
intention of providing a better mesh between Jane's
needs and the environments in which she must
behave:
a. Interactive style. It was recommended in

Jane’s protocol for aggressive behavior that a
“non-directive” approach be used when
communicating with Jane. However, it is not
clear that this approach was consistently
implemented. The writer noted that when Jane
is challenged, refused or told what to do, she is
more likely to engage in aggressive behavior.
Some specific guidelines about characteristics
of individuals who work with Jane follow:
 People who work Jane should be low-

keyed. They should be willing to rephrase
requests, find different ways of
communicating a message to Jane, or
even to leave and come back later.
 People who work with Jane should avoid

making demands. Instead, they should
attempt to elicit cooperation by asking
Jane to choose from a list of choices.
Page 44
 People who work with Jane should

respect her as an adult. Operationally,
this means dropping the “staff-client”
power struggle and adopting the role of a
mentor or helper. It is likely that staff who
are working with or are expected to work
with Jane will require role-play training in
this approach.
b. Using simple clear speech. As Jane seems to

have some difficulty understanding complex
speech, it is recommended that communication
be simple and concrete. Confusion in social
situations seems to be related to the
occurrence of aggressive behavior for Jane as
it seems that she sometimes reacts based on
her misperception of social cues. Staff should
use short sentences when talking to Jane and
be alert to signs that she has not understood
what was said (e.g. failure to respond).
c. Group placement. When placing Jane in group

settings, great care should be taken to avoid
placing her in groups with consumers who have
obvious physical or developmental disabilities
as it seems that Jane is more likely to assault
individuals with such challenges. Groups of
consumers who are of similar or slightly higher
level of functioning than Jane would be
preferred.
d. Increased access to family and friends.

Individuals with a large circle of support (i.e.
important people in their life) have a better
quality of life and are therefore less likely to
engage in challenging behavior. Jane’s circle of
support currently consists almost entirely of
Page 45
paid staff. Jane currently interacts with her

brother frequently by telephone and has limited
to zero contact with her sisters. It is
recommended that staff responsible for the
management of Jane’s case make every effort
to contact the family members, assess the
level of contact they wish to have with Jane,
and provide that level of contact.
In addition, it was mentioned that Jane had a

very close friend in her SESI group who moved
to another job site. Jane was close to this
young woman and they spent a lot of time
together. It is strongly recommended that staff
responsible for managing Jane’s case assist
her in re-establishing contact with this woman,
given that both parties are interested in
maintaining the friendship. Every effort
possible should be made to help Jane and her
former friend stay in contact with one another,
as a means of expanding Jane’s circle of
support.
e. Sharing of information with residential services

provider. Currently SESI has no record of the
behavior support plan that has been
implemented in Jane’s residential setting. It is
recommended that Help Me and SESI share
information about the services being offered in
the interest of improving consistency between
staff and increasing the predictability of Jane’s
environment across settings.
f. Ecological inventory:. Currently Jane has few

interests outside of her residence. She
identifies watching television, shopping and
attending church as her main leisure activities.
Research has clearly demonstrated that low
Page 46
levels of activity are the context for

challenging behaviors. As part of this
intervention, every effort should be taken to
determine Jane’s interests and activity
preferences. Staff may want to use activities
identified on the reinforcement inventory as
very interesting to Jane as a starting point to
suggest some activities. She should be given
the opportunity (within reason) to participate in
the activities she specified. Outings to try new
activities could be scheduled into her day
timer. During these activities, the following
information should be formally recorded.:
 Jane’s emotional response to the activity

 Jane’s proficiency in the activity
 Related and unrelated activities that
occur during and immediately after the
selected activity.
Over time a list of preferred activities will be

developed that can be used either contingently
or noncontingently as part of a behavior
support plan.
g. Re-distribution of available staffing. Currently

the Employment Specialist assigned to Jane’s
case, Mary Whitten, observes Jane in her work
environment for one hour per day, between the
hours of 12:00 and 1:00 p.m.. Initially this was
necessary to ensure that Jane could keep up
with the pace of the job requirements. Given
Jane’s current level of job performance, it is
the opinion of the writer that 1:1 staff time be
maintained. Instead of helping Jane work, time
would be better spent helping Jane develop
some of the skills described in the section on
Positive Programming.
Page 47
h. Informal instruction. The strategy of “training

loosely” should be used with Jane, whereby
opportunities to instruct her on skills are not
restricted to structured, focused training trials
only. Instead, instruction should be provided
whenever and wherever the opportunity
presents itself. The purpose of using this
strategy is to expand the learning process to
the natural times and locations that the skills
are required.
i. Maintenance of naturally supported working

environment. It is recommended that Jane not
be placed back into a SESI group. She is
currently naturally supported in her work
environment so there is currently no reason to
place her back in that setting. Her recent
problems with aggressive behavior have been
in the context of the SESI group.
j. Daytimer with daily planning. In order to

encourage Jane to exercise control over her
daily schedule, it is recommended that she
purchase a daytimer (i.e. a portable daily
calendar) wherein she can keep track of
scheduled appointments, work schedule and
scheduled leisure activities. As Jane’s
aggressive behavior sometimes seems to be
her way of exercising control over her
environment, the daytimer is recommended
help her find other ways of exercising that
control.
k. Counseling. Counseling is recommended for

Jane to address lingering abuse issues. Based
on her difficulty talking about sex and intimacy
in addition to her reliance on romantic
Page 48
fantasies it is clear that Jane continues to be

confused about her own sexuality. Her
knowledge of sex from a sex education
standpoint is also questionable. In addition,
Jane’s need to assert herself over those less
powerful than her with aggressive behavior,
would suggest that her opinion of herself is
quite low. Any counselor to whom Jane is
referred should have the following
characteristics: experienced in treating victims
of physical/sexual abuse and/or Post-Traumatic
Stress Disorder; would be willing to meet with
her in a natural setting rather than in an office;
and would be willing to talk to her in the style
of a mentor providing guidance rather than as
an authority figure giving her directions. Issues
that should be addressed in this setting include
past abuse, sex education, social mores
surrounding sex and intimacy, and self-esteem.
2. Positive Programming. Challenging behavior

frequently occurs in settings that lack the
opportunities for and instruction in adaptive, age-
appropriate behavior. It is our assertion that
environments that provide instruction to promote the
development of functional academic, domestic,
vocational, recreational, and general community
skills is procedurally important in our efforts to
support people who have challenging behavior. To
the extent that Jane exhibits a rich repertoire of
appropriate behaviors that are incompatible with
undesired behavior, the latter should be less likely to
occur. Positive programming, therefore, should not
only result in developing Jane's functional skills, but
also contribute to reducing the occurrence of
problematic behavior. At the very least, a context of
positive programming should make it feasible to
Page 49
effectively and directly address Jane’s aggressive

behavior. In the following paragraphs, several initial
thrusts for positive programming are presented:
a. General Skills.
1) Self-Care domain
a) Rationale / Logic. The writer

recognizes that skills like budgeting
and toothbrushing are important
functional skills that Jane could
learn. However, pursuant to the goal
of reducing frequency and severity
of the target behavior by increasing
the availability of noncontingent
reinforcement, the writer suggests
choosing a skill that Jane will find
intrinsically enjoyable. This will also
serve the purpose of developing
rapport with staff as, hopefully, Jane
will not so strongly associate “staff”
with “telling me what to do”.
According to staff reports and the

reinforcement inventory that Jane
completed, she enjoys getting her
nails done. Therefore, the writer
recommends that Jane be taught to
give herself a manicure.
b) Objective. By November 1, this year,

Jane will be able follow all of the
SESIs of giving herself a manicure
without staff assistance and with
100% accuracy.
Page 50
c) Method. Jane should be taken

shopping to buy the following
materials necessary to complete
the task:
Clear nail polish, colored nail polish,
nail clippers, emery board or nail
file, nail buffer, hand cream.
Using a whole task forward chaining

procedure, Jane will be taught the
following SESIs of giving herself a
manicure:
 Squeeze hand cream into

hand.
 Rub hands together until hand
cream is no longer visible
 Using nail clippers, cut nails
such that they are all the same
length.
 Using the nail file or emery
board, file nails until they are
all the same length.
 Put one coat of clear nail
polish on each fingernail.
 Put two coats of colored nail
polish on each fingernail.
 Let nails dry for at least fifteen
minutes before starting any
activity where you have to use
your hands.
The reinforcer that should be used for

this chaining procedure is giving verbal
praise. The whole-task forward chaining
procedure involves presenting the entire
task then prompting Jane through each
SESI except the one she is performing for
Page 51
reinforcement. Training sessions could be

conducted on a weekly or bi-weekly
basis, according to Jane’s wishes and
desires. Sessions should be approached
as a fun activity, not as a required part of
a training program.
2) Vocational Domain
a) Rationale/Logic. Jane has repeatedly

verbalized an interest in working with
children. She mentioned it in the
interview with the writer and has enrolled
in child-care classes at the local
Community College but never
substantially participated. Given her
comprehension difficulties, it is not
unexpected for her to have difficulty in a
classroom setting. She may learn better
in a setting wherein she is actually
required to interact with children.
However, given her history of aggressive
behavior, options in this area should be
explored very carefully.
b) Objective. By August 1, next year, Jane

will have acquired a volunteer position
working with children, supervised by a
responsible adult, that she will attend at
least one hour per week.
c) Method. Assigned staff should complete

a background check to ascertain whether
Jane has physically assaulted children in
the past. IF SUCH A HISTORY EXISTS,
STAFF WILL HAVE TO CAREFULLY
EVALUATE THE WISDOM OF PROCEEDING
WITH THIS OBJECTIVE ACCORDING TO
Page 52
THE RECENCY AND SEVERITY OF THE

INCIDENT.
Jane and assigned staff should work

together to procure a list of agencies that
could be contacted regarding possible
volunteer positions related to childcare.
Jane should be assisted as necessary to

contact these agencies, complete the
necessary applications and attend
interviews.
In this setting, at least initially, a 1:1 staff

should supervise Jane to establish safety
of the children and the skills necessary to
maintain the position.
The presence of the 1:1 staff should

gradually be faded such that Jane
becomes naturally supported in that
environment. However, Jane should
remain under the supervision of a
responsible adult.
If Jane wishes to pursue this goal, some

difficult situations typically experienced during
the course of caring for children could be
incorporated into the incident-based social
skills training described under the section
below describing “Functionally Equivalent
Skills”. This might help prepare her for the
difficult and potentially frustrating scenarios
she could face when dealing with children.
3) Recreational Domain
Page 53
a) Rationale/Logic. Jane reports that she

spends most of her time watching
television, shopping, and going to church.
An ecological inventory has been
recommended under the heading
“Ecological Strategies” to expose Jane to
more leisure activities and assess her
interest in and proficiency at those
activities. It is important, however, not to
stop at the assessment phase of this
procedure. A plan needs to be
implemented to ensure that not only is
Jane exposed to a variety of
opportunities, she should also have an
opportunity to participate in those
activities on a regular basis. This will
serve the dual purpose of improving her
quality of life and, consequently, reducing
the likelihood that she will engage in
aggressive behavior.
b) Objective. By January 1, next year, Jane

will have incorporated at least one new
activity into her weekly schedule. This
excludes work, shopping, watching
television and therapeutic activities (like
counseling).
c) Method.
i. An ecological inventory will be
completed. Jane should be given the
opportunity (within reason) to
participate in the activities she
specified. Outings to try new
activities could be scheduled into
her day timer. During these
activities, the following information
should be formally recorded.:
Page 54
 Jane’s emotional response to

the activity
 Jane’s proficiency in the
activity
 Related and unrelated
activities that occur during
and immediately after the
selected activity.
ii. From a list of identified preferred

activities, Jane should choose an
activity that she would like to
incorporate into her weekly
schedule.
iii. Assigned staff should help Jane
choose a location to participate in
the scheduled activity.
iv. Staff should support Jane in
learning how to transport herself
independently to the activity (i.e.
learn a novel bus route) through
modeling and shaping procedures.
v. Staff should also brainstorm with
Jane how she can access the
resources necessary to participate
in the chosen activity (e.g. money
for admission, a bathing suit for
swimming, etc.).
vi. On a weekly basis, Jane should be
prompted to schedule a day for the
activity in her daily planner. The
prompts should gradually be faded
over time.
At each stage of this process, gentle

shaping should be used to help Jane
choose the most appropriate solution.
Page 55
b. Teaching Functionally Equivalent Skills. People

engage in seriously challenging behaviors for
perfectly legitimate reasons. They use these
behaviors to communicate important
messages, to assert themselves, to manage
unpleasant emotions, to escape unpleasant
events, and to gain access to events and
activities. One important strategy for helping
people overcome their challenging behaviors is
to provide them with alternative ways of
achieving the same objectives, alternative
ways of satisfying their needs. These
alternatives are defined as functionally
equivalent skills because they achieve the
same goal as the challenging behavior or
communicate the same message. The above
analysis of Jane's behavior concluded, among
other things, that these aggressive episodes
are related to difficulties with social problem
solving.
1) Rationale / Logic. Jane seems to have

a limited repertoire of behaviors that she
uses to control her environment. When
she cannot get her needs met or is
challenged in her way of meeting those
needs, she may become frustrated and
lash out at those around her. Therefore it
is recommended that Jane receive
specific social skills training based on
identifying alternative solutions to
incidents that have occurred in the past
or similar incidents, thereby reducing her
need to rely on aggressive behavior as a
way of controlling her environment.
Page 56
2) Objective. By January 1, next year,

Jane will be able to respond to
generalization probes based on pre-
scripted social situations without
prompting in five out of five daily trials.
3) Method.
a. SESI incident reports should be

gathered together from the time
that Jane started receiving services
in that setting. Any other
descriptions of incidents that SESI
has access to could be reviewed as
well. Incidents that include any of
the topographies described under
the response class of “Aggressive
Behavior” should be extracted.
b. Scripts should be written based on

each incident that include the cues
for the aggressive behavior and
possible solutions. For example:
Script #1
Antecedent: You’re trying to
get your Employment
Specialist’s attention. Another
consumer turns to you and
says “Shut up! I was here
first”.
Solution: “Sorry, I thought you

were done”
Solution: “I feel hurt when

you talk to me like that. I just
Page 57
wanted to get Annie’s

attention.”
Script # 2
Antecedent: You see a man
touching your friend in her
private places.
Solution #1: Ask your friend

“Are you OK?”
Solution #2: Go and tell a

person in authority (your job
coach, for example)
c. For each script, it should be

demonstrated that Jane can
describe what she would do in the
described situation.
e.g., “What would you do if

someone told you ‘You know,
you’re not the only person in
the group’?”
d. When Jane has demonstrated verbal

competence (i.e. requires no
prompting to come up with solution)
in a situation, the script should be
role-played with Jane switching
parts. Her performance should be
recorded as correct, prompted, or
incorrect.
e. When Jane has demonstrated both

verbal and analog competence with
a particular script, she should be
told that a staff person will
Page 58
approach her when she is not

expecting it to practice the script.
Initially the day should be
announced, but the announcement
should be faded over time.
These training sessions should be conducted

with Jane three times per week, for
approximately 15 minutes at a time. Jane’s
mastery at each level of skills should be
documented and presented in a quarterly
report.
c. Teaching Functionally Related Skills. There are

many skills that if learned by the person, may
have a direct impact on the person's behavior.
For example, a person who is taught the
difference between demeaning criticism and
well-intended feedback may start acting
differently to the feedback she receives from
others. The purpose of this category of
strategies, again, is to empower the person; to
give the person greater skills. In the following
paragraphs, discriminatory skills are identified
which are thought to be related to Jane's
aggressive behavior.
1) Rationale / Logic. Jane’s aggressive

behavior seems to be related to the
misperception of innocuous social cues.
In other words, due to a limited level of
comprehension of social events, Jane
may perceive certain events as being
threatening and requiring strong action. It
would not be helpful to teach Jane not to
respond to any events, as certain events
certainly are threatening. Therefore the
Page 59
intervention described here is designed

to help Jane discriminate between
threatening and non-threatening events. It
should be noted that Jane would be
learning how to respond to both types of
events as described above (i.e.
Functionally Equivalent Skill).
2) Objective. By January 1, next year Jane

will be able to accurately classify
scenarios presented to her as either
threatening (i.e. requiring action) or non-
threatening within 10 seconds without
prompting, without error, and without
exhibiting aggressive behavior ten times
consecutively.
3) Method
i. In order to develop possible

scenarios, generic pictures clipped
from magazines or staged for this
purpose should be compiled. One
might picture a man standing next
to a woman with hand on her arm,
while another might show a picture
of a woman recoiling from a man
who is approaching her.
ii. Staff should brainstorm with Jane

possible descriptions of these
scenes. For example, staff might
say,
“Jane, what do you think could be
happening in this picture?”
Using this approach, a list of
scenarios would be compiled.
Efforts should be made to ensure
Page 60
that the list includes both innocuous

and threatening social situations.
iii. All of the scenario descriptions

should be transferred to 3x5 index
cards and assembled with the
pictures used to generate the
scenarios.
iv. Using a discrete trial training

format, each card and
accompanying picture should be
presented to Jane. She should be
encouraged to classify the scenario
as either threatening or non-
threatening.
v. When Jane chooses the correct

classification, she should be
verbally praised and asked “So what
should you do in this situation?”
Through gentle shaping, staff should
help Jane come up with a viable
solution. Typically, a non-threatening
situation would require no action on
her part.
vi. On any trial that Jane does not

choose the correct classification,
staff should end the session, to be
repeated later in the day.
vii. The next time that Jane is asked to

classify the same social interaction
that she classified incorrectly the
first time, she should be verbally
prompted immediately after staff
Page 61
make the request for her to classify

the scenario.
viii. The correct response should then

be reinforced with social praise and
Jane should be asked “So what
would you do in that situation?”
Again, Jane should be guided to
some viable solutions using gentle
shaping.
It is recommended that once Jane can meet

the objective described above, discrimination
training be conducted using video presentation
of threatening/non-threatening situations.
CAUTION
It is possible that viewing and describing
threatening situations may be too difficult for
Jane. If there is any indication that this
procedure is increasing levels of agitation or
otherwise causing Jane distress, the procedure
should be discontinued and other options for
teaching discrimination should be explored. A
game like “Stacking the Deck”, developed by
Richard Foxx and others and available from
Research Press may be another option.
d. Teaching Coping and Tolerance Skills. Many of

Jane's seriously challenging behaviors are a
reflection of her inability to cope with aversive
events such as delay in gratification, denial,
the need to perform a non preferred activity,
etc. While Jane can avoid some of these
behaviors, aversive events are also naturally
occurring. Especially if she is to lead a full life,
from time to time, she will face the
disappointments we all have to face, for
Page 62
example, not getting something that she wants,

when she wants it and having to wait for it, i.e.,
delay; not getting something she wants, at all,
i.e., denial; being told by somebody that a
relationship is not possible; being criticized or
reprimanded; etc. In the face of these events
and the emotions they understandably arouse,
Jane’s coping responses have not had the
opportunity to develop much beyond the
primitive responses of a young child; nor is she
likely to develop much beyond this level
through "natural consequences." Rather, it will
be necessary to be systematic in applying
sophisticated instructional technology, with
the objective of teaching her these very
important coping and tolerance skills. The
following is a recommendation for how to
proceed in the important area of skill
development, with the initial focus being on
Jane's ability to relax.
STAGE 1
1) Rationale / Logic. In order for any

coping/tolerance strategy (e.g.
desensitization) to work, it must first be
ensured that Jane can adequately cue
herself to relax. Although relaxation
training was mentioned in written reports
about Jane, no qualitative or quantitative
data was available to indicate that Jane
has mastered the relaxation response.
The intervention described below is
designed to ensure that Jane has
mastered relaxation so that she may then
use it in situations she finds difficult and
so that staff may proceed with
desensitizing her to threatening or
Page 63
upsetting situations. The deep breathing

method was chosen as it is portable and
easily modeled by staff, making it
unnecessary to touch Jane to teach the
correct response. A progressive muscle
relaxation procedure could be introduced
when Jane is familiar and comfortable
with the deep breathing method.
2) Objective. By January 1, next year, Jane

will be able to respond without error to
the verbal cue “Relax” with the deep
breathing relaxation response (described
below) without further verbal or nonverbal
prompting by staff in five out of five in-
vivo practice sessions.
3) Method. Jane will be verbally presented

with the following instructions by staff,
who will also model the behavior:
a. Choose a quiet place.

b. Sit, stand or lie down in a comfortable
position.
c. Take 10-15 deep breaths, breathing in
through the nose and out through
the mouth. (Staff should model
breathing into the diaphragm as
opposed to breathing into the chest)
d. Shake your arms as you are breathing
in and out.
e. When you have taken all of your deep
breaths, sit or stand quietly for a
couple of minutes before returning
to what you were doing.
Staff should start each brief session (10

minutes maximum) by saying, “When I say
Page 64
‘Relax’ we are going to start the

relaxation session”. After initial
presentation, the SESIs of deep breathing
should be taught by modeling and shaping
successive approximations toward the
correct response. When Jane has
mastered each SESI of deep breathing as
described above, the verbal cue should be
faded until she can respond to the single
word “Relax”. When she is able to
respond to the single cue in focused
practice sessions, generalization probes
should be conducted using the single-
word cue until the objective is met.
STAGE 2
1) Rationale/Logic. As noted in the

functional analysis, there are several
events that seem to cause Jane
discomfort, which is then manifested in
the form of frustration, anger, and/or
aggression. For example, Jane describes
physically attacking an individual who
was, she believed, touching her friend
inappropriately. One strategy for helping
Jane overcome her powerful reactions to
these events is pairing these events with
the relaxation response, otherwise known
as desensitization.
2) Objective. By December 1, next year,

Jane will be able to listen to a description
of the highest item on a pre-established
hierarchy while simultaneously engaging
in the relaxation response during five
consecutive sessions.
Page 65
3) Method
a. Based on the incident review

(described under the heading
“Functionally Equivalent Skills),
development of threatening/non-
threatening discrimination task
(described under the heading
“Functionally Related Skills”), and
discussions with Jane, a hierarchy
of stimuli that cause frustration and
anger should be developed. The
events at the bottom of the
hierarchy would be those that only
cause minor frustration, while the
events at the other end of the
hierarchy would cause significant
discomfort. Events between would
gradually produce more and more
frustration.
b. Sessions should be scheduled with

Jane to occur once per day, for a
maximum of 10 minutes.
c. During each session, the relaxation

should be cued, as described in
Stage 1 of this procedure. While
Jane is relaxing, the first item on
the hierarchy should be described to
her and she should again be cued to
relax. The rationale for this
procedure is that the relaxation
response would compete with the
frustration producing stimuli.
d. When Jane has successfully relaxed

with the presentation of the first
Page 66
item on the hierarchy for five

consecutive sessions, the next item
on the hierarchy should be
presented using the same
procedure. The hierarchy should
gradually be ascended in this way.
e. If Jane is unable to relax upon

presentation of any of the items in
the hierarchy for four consecutive
sessions, the procedure should be
reviewed and revised.
3. Focused Support Strategies. Some of the ecological

strategies that were recommended above, depending
on their complexity and/or difficulty, may take time
to arrange, and positive programming will require
some time before new skills and competencies are
mastered. Although these ecological and positive
programming strategies are necessary to produce
good long-term quality of life outcomes for Jane, it is
also necessary to include focused strategies for
more rapid effects; hence the inclusion of these
strategies in our support plans. Specific
recommendations for the limited but important need
for rapid effects are made below.
The focused support strategy currently employed to

deal with Jane’s target behavior is a Differential
Reinforcement of Other Behavior, Progressive
(DROP) schedule of reinforcement. According to the
schedule that she is currently on, she may earn her
reinforcer of a $4.00 lunch after a minimum of 8
days. She makes X marks on a 28 box DROP chart
(one on the first day, two on the second day, and so
on up to a maximum of five boxes for the fifth and
each consecutive day that she goes without
engaging in aggressive behavior). It is hypothesized
Page 67
that the reinforcer is not of sufficient magnitude to

preclude the occurrence of aggressive behavior
when Jane is very upset. With the average
occurrence of the behavior being once per month, it
is recommended that the amount of time between
available reinforcers also be increased. The
mediating system used for the DROP schedule
should also be made more meaningful. Finally, in
order to provide a greater target for Jane to aim for,
it is recommended that she be provided with a large
reinforcer once she has repeatedly met the criteria
for reinforcement according to the DROP schedule.
The details of these recommendations are provided
below.
Revised mediating system. Jane is currently

required to make X’s in boxes on a standard
DROP sheet. It is recommended that a revised
DROP sheet be developed with Jane that is
more colorful and interesting. In the
reinforcement inventory that Jane completed,
she indicated that she collects “hearts”,
suggesting that hearts have some intrinsically
reinforcing value to her. Also she has indicated
that one of her favorite television programs is
“Touched By an Angel”. Rather than using X’s,
perhaps small heart and angel stickers could
be used to indicate the progressive levels of
reinforcement. Not only do these have some
intrinsically appealing value to Jane but they
also convey positive regard for Jane, perhaps
facilitating her involvement in the program,
thereby reducing the likelihood of the
occurrence of aggressive behavior. Although
revising the mediating system in this way may
not be considered age-appropriate by some, it
is the writer’s opinion that the endemic
Page 68
interest in such a revised system mitigates the

concern for age-appropriateness.
Revised inter-reinforcement interval. Jane

currently has to complete a 28-box DROP sheet
to earn a $4.00 lunch (or equivalent). It is
recommended that Jane work of a 60 box DROP
sheet to delay the frequency with which she
can earn the reinforcer, commensurate with
the reported rate of occurrence of the behavior.
Revised reinforcers. As the amount of time

Jane is required to go without earning a
reinforcer has increased, the magnitude of the
reinforcer should be increased accordingly.
Therefore she should be reinforced as follows:
60 hearts or angels = Going to a movie with

popcorn and pop (or other
reinforcer of similar
magnitude)
To increase interest, Jane may be able to choose

from a variety of unknown pre-determined
reinforcers of similar value when she completes
each DROP sheet, analogous to a grab bag system.
In other words, when Jane completes her DROP
sheet, she would have the opportunity to reach into
a box and draw out a pictorial representation of a
reinforcer (e.g. movie ticket).
The number of sheets that Jane has earned should

be recorded on a form that includes a table similar
to the one below:
DROP Sheet # Date completed

1 September 15,
this year
Page 69
2 October 3, this
year
3 October 17, this
year
4 October 31, this
year
Each time a DROP sheet is completed, it is also

recommended that Jane receive a Disney sticker to
place in her daytimer as an ongoing reminder of her
success.
When the fourth DROP sheet has been completed,

Jane will have earned a trip to Disneyland. Once the
trip to Disneyland has been earned, she will start to
work towards the trip again.
The trip to Disneyland is suggested as a reinforcer

because of Jane seemed to be excited about the
possibility of going there with her sister. However,
other reinforcing events of similar magnitude may be
identified during the course of the ecological
inventory. These may be used instead of the trip to
Disneyland, in accordance with Jane’s wishes, if
there are concerns about her becoming satiated on
that reinforcer. One example may be a trip to the
Rose Bowl Flea Market, a large version of a swap
meet.
Antecedent Control Strategies

The most powerful way to prevent episodes of
aggressive behavior is to use a respectful interactive
style with Jane. This was described under the
heading of “Ecological Strategies” but should also be
considered an antecedent control strategy.
The writer noted that when Jane is challenged,

refused or told what to do, she is more likely to
Page 70
engage in aggressive behavior. Therefore, the way

you ask Jane to do things or even the way you offer
assistance can affect whether or not she becomes
aggressive. Examples of how to interact with Jane
are offered below:
Instead of
“You know, you aren’t the only person I have to help.”
Say
“I can see that you want my help right now Jane. I’m
sorry, but I don’t have time to take you to the store
right now. Can we go tomorrow?”
Instead of
“Jane, we have to go to your appointment right now!”
Say
“Jane, it’s going to take a little while for us to get to
your appointment. You know how traffic can be! How
long will it be until you are ready?”
Another antecedent control strategy for Jane is to

avoid having her placed in groups with obviously
disabled consumers as she is more likely to be
assaultive towards individuals with obvious
disabilities.
4. Reactive Strategies. Efforts to manage the

antecedents to Jane's aggressive behavior are likely
to have a considerable impact on the rate of their
occurrence, as will the focused support and positive
programming strategies recommended above.
However, these behaviors are still likely to occur, at
least to some degree, especially during the initial
stages of the implementation of the support plan, as
the necessary adjustments to the plan are identified
and made. Therefore, staff may need measures for
dealing with these behaviors when they occur. Such
reactive strategies have an even more limited role
Page 71
than the focused strategies recommended above.

Specifically, reactive strategies are designed to
produce the most rapid control over the situation, in
a manner that keeps both Jane and staff as free
from risks to injury as possible and that keep Jane
free from risks of exclusion and devaluation as much
as possible. Accordingly, reactive strategies are not
intended to produce any change in the future
occurrence of Jane's challenging behavior. Both
rapid and durable changes, instead, are being sought
by the Ecological Strategies, Positive Programming
Strategies, and Focused Support Strategies
described in the preceding sections. These
proactive strategies are also expected to prevent
any counter therapeutic effects that might accrue
from the nonaversive reactive strategies being
recommended here. The following procedures are
suggested as initial strategies that fit within ABCD's
"Emergency Management Guidelines." They, along
with other strategies that fall within the guidelines
which may be considered in the future, are expected
to preclude the need for the physical management of
Jane's behavior, including the need for physical
restraint.
Active listening. When Jane is becoming angry,

every effort should be made to attempt to see
the situation from her point of view. She needs
to hear that you understand how she is feeling
and where she might be coming from. For
example:
“Jane, I can see that you are feeling really frustrated

with me right now.”
This should be reflected at approximately the same

level of emotion that Jane is expressing at the time.
Page 72
In conjunction with this active listening strategy,

every effort should be made to elicit communication
from Jane when she is starting to become angry. For
example,
“Jane, tell me about what’s bothering you”.
Positive program reminders. Before Jane has

escalated to the point of physical aggression,
she may also be reminded of the skills that she
is working on as part of her positive program
training (e.g. relaxation response).
Stimulus change. It may be possible to

interrupt the chain of Jane’s behavior once she
has started an aggressive episode with a novel
event. For example, staff could put on Mickey
Mouse ears and start singing the Mickey Mouse
Club song, also serving the purpose of
reminding Jane of the large reinforcer she is
trying to earn. It will be important to come up
with a list of possible stimulus change
procedures, depending on the level of
comfort/discomfort staff working with Jane
would have implementing such a procedure.
Geographical containment. Geographical

containment should be used particularly if staff
are afraid of imminent physical harm to
themselves or another person. Essentially this
strategy involves finding a natural barrier in
the environment that can be placed between
Jane and the target of her aggressive behavior.
The goal of geographical containment is to
eliminate the need for physical contact,
thereby reducing the risk of injury. Active
listening and facilitated communication as
described above should continue to be
Page 73
employed when using this strategy. If

necessary, staff should call for assistance.
5. Staff Development and Management Systems. Key

elements that will determine the degree of success
of this support plan are staff competence and
management systems that assures staff consistency
in providing services to Jane. The following is
recommended:
a. Procedural Protocols. Each strategy and

procedure described above should be broken
down into teachable SESIs.
b. Three tiered Training.
1) Each staff person would be required to

show "verbal competence" for each
procedure. That is, they would need to
describe each and every SESI in the
specific procedure. Each staff would be
scored using a "+/O" system for each SESI
of the procedure. A 90% criterion is
considered passing.
2) Each person would be required to show

"role play competence" for each
procedure. That is, they would need to
demonstrate each SESI of a procedure to
another member of Jane's support team.
The scoring system would be the same as
for "verbal competence," as described
above.
3) Finally, each staff person would need to

demonstrate "in-vivo" procedural
Page 74
reliability; that is, the ability to carry out

each program component of Jane's
support plan for which they are
responsible. This would require the
designated person to observe each staff
person as they provide services and to
see the degree to which what they do
agrees with the written protocols. The
scoring procedure described above would
be used again, and 90% consistency
should be considered as minimally
acceptable. For those procedures that do
not occur frequently, such as the need to
react to Jane’s infrequent aggressive
behavior, role-play competence should be
reconfirmed on a regular schedule.
c. Periodic Service Review. Jane's entire support

plan should be operationalized into a series of
performance standards to be met by the
support team and integrated into a Periodic
Service Review. Monthly (initially, weekly)
monitoring should be carried out by the
designated coordinator and the status of the
support plan's implementation should be
quantified as a percentage score. Three score
should be summarized on a graph and kept
visible to staff as an incentive to achieve and
maintain a score of 85% or better. Three
should be reviewed regularly by management
and feedback should be provided. More
information on how to develop and implement a
Periodic Service Review system can be
provided on request.
COMMENTS AND RECOMMENDATIONS

Page 75
The intervention strategies recommended to help Jane

get control over her aggressive behavior are summarized
below:
Ecological Strategies
Interpersonal: Interactive style; Using simple clear
speech; Group placement; Increased access to
family; Increased access to friends
Programmatic: Sharing of information with
residential services provider; Ecological inventory;
Re-distribution of available staffing; Training loosely;
Maintenance of naturally supported working
environment; Daytimer with daily planning
Other: Counseling
Positive Programming
General Skill: Giving self a manicure, Child care
volunteer options, increased leisure involvement.
Functionally Equivalent Skill: Incident-based social
skills training
Functionally Related Skill: Threat/No threat
discrimination training
Coping/Tolerance Skill: Relaxation and
desensitization
Focused Support Strategy: DRO and DROP schedule

combined
Reactive Strategy: Active listening, Stimulus change,
geographical containment
Staff Development and Training: Procedural protocols,
three-tiered training, periodic service review.
1. Revisions are certain to be necessary during the initial

stages of implementation and as Jane's responsiveness to
the new support plan are observed. Early revisions and
fine-tuning are necessary in the initial implementation of
any support plan, especially one as comprehensive as this
one attempts to be.
Page 76
2. It is recommended that Jane receive a thorough

psychological evaluation specifically to evaluate her
current level of expressive and receptive language skills.
In the opinion of the writer, she may have some difficulty
processing information, based on observations and
reviews of previous reports. Knowledge of the extent of
this deficit would be very useful in designing future
intervention strategies or in modifying the strategies
recommended above.
3. Counseling is recommended for Jane to address lingering

abuse issues. Based on her difficulty talking about sex
and intimacy in addition to her reliance on romantic
fantasies it is clear that Jane continues to be confused
about her own sexuality. Her knowledge of sex from a sex
education standpoint is also questionable. In addition,
Jane’s need to assert herself over those less powerful
than her with aggressive behavior, would suggest that her
opinion of herself is quite low. Any counselor to whom
Jane is referred should have the following characteristics:
experienced in treating victims of physical/sexual abuse
and/or Post-Traumatic Stress Disorder; would be willing to
meet with her in a natural setting rather than in an office;
and would be willing to talk to her in the style of a mentor
providing guidance rather than as an authority figure
giving her directions. Issues that should be addressed in
this setting include past abuse, sex education, social
mores surrounding sex and intimacy, and self-esteem.
Thank you for the opportunity to help Jane gain control

over her challenging behavior. I hope this information has
been helpful. If you have any questions about this report,
do not hesitate to contact Dr. Howard Stern or Dr. John
London.
Page 77
_______________________________________
writer
_______________________________________
Clinical Director
_______________________________________
Associate Director
Page 78
Client Confidential
Positive Programming Protocol
Consumer’s name: Jane Doe

Protocol name: Incident-based social skills training
Date of implementation: TBA
Revision date(s): New protocol
Definition of Skill:
Identification and practice of possible solutions to prepared
scripts of social situations.
Purpose of Protocol:
Teach Jane alternative methods of solving difficult social
situations.
METHOD – PREPARATION
Materials required
3x5 index cards
Responsible person
Assigned specialist
Steps
f. STEP incident reports should be gathered together from

the time that Jane started receiving services from STEP.
Any other descriptions of incidents that STEP has access
to could be reviewed as well. Incidents that include any of
the topographies described under the response class of
“Aggressive Behavior” should be extracted.
g. A set of scripts for staff and corresponding scripts for

Jane should be prepared. Scripts should be written based
on each incident that include the cues for the aggressive
Page 79
behavior and possible solutions. Scripts of similar

situations may also be developed. For example:
EXAMPLE A
Script #1 – Staff
Setup: Jane is trying to get the Employment
Specialist’s attention. Another consumer is already
talking to the Employment Specialist.
Staff (playing the other consumer): “Would you shut up! I

was here first!”
Script #1a – Jane

Look at the person
Say “ I feel hurt when you talk to me like that. I just
wanted to get Annie’s attention”
Don’t say anything else
Script #1b – Jane

Look at the person
Say “I’m sorry. I thought you were done”
Don’t say anything else
EXAMPLE B
Script #2 – Staff
Setup: Jane sees her friend being touched in the chest
area.
Script # 2a – Jane
Look at your friend
Ask your friend “Are you OK?”
She says “Yes”
Script #2b – Jane

Look at your friend
Ask your friend, “Are you OK?”
If she says no,
Page 80
Go and tell a person in authority (your job coach, for

example)
When all of the scenarios have been developed, they should be

transferred to 3x5 index cards. A suggested order of
presentation should be established starting with the easiest
social situations and ascending a hierarchy to more complex
scenarios.
METHOD -- IMPLEMENTATION
Schedule
Two to three times per week, 15 minute sessions
Location
Jane’s home or other non-work/office setting
Materials required for training session

3x5 index cards with scenarios written on them
Can of Coca-Cola or other small edible
Steps
a. At the beginning of each session, approach Jane and say
“Hey Jane. Why don’t we have a Coke [or whatever edible
is available] and do a little play-acting”. Variations:
Variations are permitted as long as the style of approach
is light-hearted, non-confrontational and accompanied by
a tangible reinforcer.
b. Starting with the least difficult scenario in the hierarchy:
Verbal competence: For each scenario, review the setup

and possible solutions with Jane until she can tell the
story without prompting. When she can tell the story
twice without prompting, move on to the development of
role-play competence.
Analog competence: Role-play the scenario with Jane.

Start with staff playing the part of Jane (modeling) and
Page 81
Jane setting up the situation. Then switch roles and have

Jane play herself in the situation, prompting her as
necessary. The prompts should gradually be faded until
Jane is able to role-play the scenario without prompting.
When she is able to role-play the scenario twice without
prompting, move on to generalization trials.
h. Generalization probes: Jane should be told that a staff

person will approach her when she is not expecting it to
practice the script. Initially the day should be announced
and Jane should be prompted through the exercise. Then
the prompts should be gradually faded, then the
announcement of the day of the trials should be gradually
faded.
Each session should be ended with Jane being verbally praised

for her efforts in that session. Data should be recorded
immediately after the session.
Pass:Pass to next scenario when Jane has successfully

responded to 3 consecutive generalization probes without
prompting.
Fail: If Jane does not move up the scoring matrix on a

particular script for 3 consecutive sessions, the protocol
should be reviewed and revised.
Data Collection Methods

The results of each session should be recorded in a log book
created for this purpose. Each entry should include the
following information:
a. A description of the scenario employed.
b. Indication of what instructional step(s) was worked on.
c. Highest level of competence achieved (see scoring matrix
below)
d. Staff comments (optional)
e. Indication of whether Jane is ready to move to the next
level
Page 82
Scoring matrix
Verbal Analog (Role-play) In-vivo
Incor Correct Incor Correct Incor Correct
r rect rect
e
c
t
Prom No Prom No Prom No
pt prom pt prom pt prom
pt pt pt
1 2 3 4 5 6 7 8 9
Data Summary Methods

Information should be transferred to the data summary sheet
on a weekly basis, indicating the date of each session, which
scenario(s) was introduced in that session, and the highest
level of competence achieved according to the scoring matrix.
Script 1 2 3 4 5 6 7 8 9 10
#
Sept. 4
10
Sept.1 6
2
Sept. 9 4
20
Sept. 9 1
23
Sept. 3
25
Sept. 6
27
The percentage of total scenarios mastered (i.e. Level 9) should

be indicated in the quarterly report. Any problems with the
procedure should also be noted at at that time.
Page 83
Procedural Reliability
Supervisor should observe one initial training session then one
session per month to ensure that the procedure is being
followed as outlined above. Procedural reliability checklist for
this procedure should be used for this purpose. Each step
should be scored as “+” (completed) or “-“ (not completed).
Feedback should then be given to assigned staff based on the
results of the checklist.

Report 3

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Report 3

Uploaded by

Copyright:

Available Formats

NOTE: This report was written by a participant in Institute for

Applied Behavior Analysis’ Summer Institute

COMPREHENSIVE FUNCTIONAL ASSESSMENT REPORT

Date of Report: July 27, this year (draft)

Name: Jane Doe

REASONS FOR REFERRAL

Jane was referred for an evaluation by Tina Timmons,

opportunities that can be made available to her and to enable

Specifically, Jane has engaged in aggressive behavior on

DESCRIPTION OF ASSESSMENT ACTIVITIES

The assessment is based on information obtained from

A. Interviews with Jane at her workplace (60 min.) and

Specialist with SESI (75 min.);and Kim Chow, SESI

B. Direct Observations of Jane in her place of work

C. Review of the SESI-ABCD case file and field

D. A Reinforcement Survey completed by Jane

E. Telephone Conference with Ginger Bertrulano,

I. Brief Client Description.

A. General. Jane is a 24 year-old Caucasian female

Jane was diagnosed with Post-Traumatic Stress

documentation was present supporting the either

B. Language and Communication Skills. Jane’s primary

she left the counseling because she did not think

Jane agreed to discuss her aggressive episodes with

With respect to the aggression, it should be noted

C. Cognitive and Academic Abilities. Formal testing

functioning. At the time, Jane’s Verbal IQ was 67, and

Jane graduated from Pumpkin High School with her

Jane can sign her name independently, address an

grade four or five level. No formal testing was

Verbal reports indicate that Jane can add, subtract

D. Self Care Skills. Verbal and written reports from

E. Domestic Skills. Verbal and written reports from

independently. There are laundry facilities at her

F. Community Skills. Jane takes the bus to work

Residential support staff accompany Jane to

Jane currently completes an emergency skills

has consistently been meeting the criteria in the

Money management is consistently identified as an

G. Recreation and Leisure Skills. Jane indicates that

television, and going to church. She attends church

H. Social Skills. Reports about Jane’s social skills are

Topics of conversation that were not in response to

Reports from her former job coach, Charlie Quinton,

SESI group with her. They worked together at Come-

Jane is very interested in having a boyfriend. She

Jane is not currently sexually active and reports that

Past reports show that Jane was introduced to sex

II. Living Arrangement and Family History. Jane currently

implementation a behavior support plan that he has

When Jane originally moved into the apartment, the case

Prior to the move to her own apartment, Jane was residing

writer that Jane was well liked by staff at this group

Jane resided at Saturn Hall from May 3, 1993 until early

Jane was sent to live with Snow White, foster parent,

Jane indicates that she has three siblings: Mercury (age

him in person. She describes him as “very funny”. When

III. Daytime Services Received and Day Service History. Jane

With regard to job tenure, Jane gained employment with a

Prior to obtaining employment Jane was involved in job

constant supervision was the individual with whom Jane

Verbal reports indicate that Jane had difficulty with

Jane accessed the Neptune County Social and Vocational