A Family-Centered Prevention
Approach to PBS in a Time of Crisis


Journal of Positive Behavior Interventions
Volume 5, Number 1, Winter 2003, pages 55–59
Abstract: This article describes a family-wide prevention approach to positive behavior sup-
port (PBS) interventions during a period of potential crisis for a family with a child with
autism. Specifically, the mother in this family was to have major invasive surgery that would
require extensive time for recovery. Past functional assessment data and anecdotal evidence
indicated that lack of predictability, structure, supervision, and systematic behavior supports
all contributed to problem behaviors in this family. As a result, a multicomponent intervention
plan was implemented to prevent such problems. The procedures included the following ele-
ments: (a) priming intervention, (b) stakeholder meeting, (c) coordination of services and
schedules, (d) family-wide PBS plan, and (e) ongoing support. The outcome of this interven-
tion was that the child with autism and her siblings showed decreases in their disruptive be-
haviors (as opposed to the expected increases), and the family experienced other family-wide
collateral positive effects from this proactive intervention approach.
Mendy Boettcher
Robert L. Koegel
Erin K. McNerney
Lynn Kern Koegel
University of California, Santa Barbara
55
This article describes a proactive intervention plan devel-
oped with a family-wide perspective. The plan’s emphasis
was on prevention, and it also focused on other important
themes of positive behavior support (PBS; Carr et al.,
2002; Horner, 2000; Horner & Carr, 1997; Horner et al.,
1990; Koegel, Koegel, & Dunlap, 1996). The family that
participated in this particular intervention is involved in a
larger study through our center that is evaluating the
effects of comprehensive, long-term PBS intervention for
individuals with severe behavior problems and their fami-
lies. The child participating in our study, Kelly Smith
(pseudonym), was a 7-year-old girl with autism who dis-
played a variety of behavior problems such as tantrums,
aggression toward siblings, noncompliance, and running
away.Ofthe other four children in the family, two showed
evidence of disabilities. Mr. Smith, Kelly’s father, had a par-
ticularly demanding and stressful work schedule, and Mrs.
Smith, Kelly’s mother, had been diagnosed with a long-
term chronic illness with physically debilitating symp-
toms. Overall, the Smith family presented many complex
issues that were important to consider in developing PBS
interventions.
EDITORS’ NOTE: The Forum section of the Journal of Pos-
itive Behavior Interventions provides for an exchange of opinions,
perspectives, ideas, and informative personal accounts. We welcome
brief articles from family members, professionals, friends, advocates,
administrators, researchers, and other individuals who are con-
cerned with behavioral support issues. The purpose of the Forum is
to facilitate a constructive dialog among our many stakeholders
regarding important issues in practice, research, training, program
development, and policy.
In this issue, we present an article that describes the strategies
a behavior support team used to help a family in a time of crisis.
The crisis involved the scheduling of invasive surgery for the mother
(and principal caregiver) of a child with autism. The team devel-
oped a number of procedures for effectively preventing the occur-
rence of problem behaviors that had appeared during previous
stressful situations. The outcomes of the approach were quite favor-
able for family functioning in many interesting ways. Readers may
find the article to be thought provoking and encouraging regarding
future efforts in developing the preventive aspects of positive behav-
ior support.
10. forum-boettcher, pp.55-59 11/27/02 10:38 AM Page 55

56 Journal of Positive Behavior Interventions
The Need for a Proactive Approach
The particular intervention described in this article arose
out of the family’s need for intensified services when we
learned that Mrs. Smith was going to require major inva-
sive surgery due to her chronic illness. She would be in-
capacitated for approximately 20 weeks. She was in the
hospital for slightly more than 1 week, followed by 6 weeks
of incapacitation during recovery and several more months
of less intensive recovery.
The Smith family had been clients at our center for
several years, and our previous experiences with the family
members indicated that this situation had the potential
to be very difficult for them because it presented possible
challenges similar to those with which they had struggled
in the past. Specifically we had observed that when
unstructured or unpredictable situations arose, the poten-
tial for problem behaviors increased and the stress level of
the family intensified. For example, this pattern had
occurred over the summer when the family attempted to
go on a vacation. They had never tried to take a family
vacation before because of Kelly’s severe disruptive behav-
iors, so this was a significant step for them. They came
home early, however, due to severe behavior problems
exhibited by Kelly that caused too much stress for the par-
ents to handle. Kelly was aggressive toward her siblings,
had several extended tantrums in public places, and
repeatedly ran away (which was a definite safety hazard, as
they were vacationing in a national park in the moun-
tains). The Smith family had experienced similar difficul-
ties during other breaks from school, during new activities
or at new places in the community, and in other similarly
unpredictable and unstructured settings. Functional assess-
ment data and anecdotal evidence indicated that lack of
predictability, structure, adequate supervision, and sys-
tematic behavior supports all contributed to increases in
behavior problems during certain times (such as the fami-
ly vacation and school breaks). We therefore believed that
it would be very important to take a more proactive and
preventative approach in providing support during Mrs.
Smith’s surgery and recovery process. In contrast to their
many negative experiences, such as the family vacation,
our goal was for the Smith family members to experience
a positive outcome.
The Proactive PBS Intervention
In keeping with a comprehensive PBS model, we imple-
mented a multicomponent, family-wide intervention prior
to Mrs. Smith’s surgery. The first goal of this intervention
was to prevent behavior problems from arising due to the
unpredictable nature of having Mrs. Smith in the hos-
pital for a week, followed by months of recuperation and
limited mobility. To address this goal, a priming interven-
tion was implemented. The second goal was to implement
a temporary system of support to avoid the lack of pre-
dictability, structure, and supervision that would occur as
a result of Mrs. Smith’s incapacitation. In addition, because
of Mr. Smith’s work schedule, the five children required
some way to handle supervision, transportation, and coor-
dination of their schedules, which was usually done by
their mother. To address these concerns, a stakeholder
meeting was held to coordinate all necessary services and
schedules, including the newly required respite care. Fi-
nally, it was our goal to further prevent disruptive behavior
and motivate appropriate behavior; therefore, a systematic
behavior support system was implemented in the form of
a family-wide PBS plan.
It is important to note that although the family
required intensive support during this time, coordination
of these services was not any more labor intensive or costly
than the regular ongoing intervention. As clinicians, we
were not required to exert additional effort; rather, we
focused our efforts specifically on coordination of this
intervention instead of other ongoing areas of need.
The PBS intervention developed by the clinicians at
our center was based on key features of model PBS pro-
grams that have been described in recent literature (Dun-
lap, Hieneman, Kincaid, & Duchnowski, 2001; Lucyshyn,
Dunlap, & Albin, 2002). Several features identified by
Dunlap et al., which have also been suggested elsewhere in
the literature (Koegel et al., 1996; Lucyshyn et al., 2002),
were important in our intervention planning. These were
prevention, collaboration, effective instruction, a function-
al perspective on problem behaviors, and a focus on in-
clusion.
PRIMING
First, a priming intervention (Wilde, Koegel, & Koegel,
1992) was implemented by the center clinicians to prepare
the three younger children for what to expect during this
time when the structure of their lives would be quite dif-
ferent from the usual. The purpose was to expose them to
what was going to happen in a concrete and systematic
manner such that they would be better able to predict how
different life at home would be for this extended time pe-
riod. The intervention was important in terms of the fea-
tures of model programs in two ways. First, the purpose of
priming relates to prevention, in that the goal is to prepare
the child in advance concerning what to expect and the
purpose is preventing disruptive behaviors. Second, prim-
ing is a systematic method of instruction with a literature
base that has demonstrated its efficacy. These are two
important criteria of effective instruction, another feature
of model programs (Dunlap et al., 2001).
Specifically, our priming intervention involved mak-
ing a calendar with the children and writing on each day of
the calendar where their mother would be, how she would
be feeling, and how they needed to behave around her. For
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