Supporting adults with autism spectrum disorders in the ... - IOS Press

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110 C.M. Schall / PBS: Supporting adults with ASD in the workplacesidering the skill with which they complete their joband difficult employees when considering their ‘people’skills and behavior challenges [16, 25, 40, 44].This finding is directly related to the characteristics ofindividuals with ASD. The symptoms most associatedwith ASD include impairments in verbal and non-verbalcommunication, deficits in social interaction, insistenceon maintaining routine, stereotyped motor movementsand vocalizations, and unusual responses to sensorystimuli [37, 40, 41].This variable employment profile may have leadto fewer individuals with ASD achieving independentemployment in adulthood [5, 9, 17]. Lawer andBrusilovskiy et al. found that individuals with autismspectrum disorders (ASD) were more likely to bedenied vocational rehabilitation services due to theirdisability being judged too severe [31]. Additionally,they found that individuals with ASD received a moreexpensive set of vocational rehabilitation services thanthose with other disabilities. Despite these two findings,Lawer et al. found that individuals with ASDachieved competitive employment at the same rateas individuals with intellectual disability and specificlearning disabilities [31]. Schaller and Yang foundthat a higher percentage of individuals with autismreceived supported employment than individuals withother disabilities including severe disabilities, intellectualdisabilities, traumatic brain injury, and mentalillness [42]. Thus, due to their unique characteristics,individuals with ASD frequently require a higherintensity of support at work. The most likely explanationfor the increased intensity of services relatedto work is presence of problem behavior [10, 21, 35].This does not; however, seem to deter individuals withASD from achieving competitive employment when theintensity of supports needed are provided [10, 25, 33,35, 49].These findings indicate that individuals, like DJ,would benefit from functional behavior assessmentsand implementation of positive behavior support plans,yet implementing such supports at work presents uniquechallenges [12]. To date, few articles have describedspecific aspects of behavior support and social skillinstruction provided to persons with ASD at work[cf. 22, 23, 45, 46, 49]. Many of those that do describework supports predate the emergence of positive behaviorsupport (PBS) as an evidence-based practice forpersons with ASD [7, 34]. This article presents a reviewof the evidence based practices related to PBS that couldassist individuals like DJ to become independent atwork. Further, this article will discuss implementationconsiderations for service personnel who are supportingadults with ASD at work using PBS.3. Positive behavior support in the workplace:Challenges and opportunitiesProviding PBS at work presents challenges relatedto many factors. Specifically, the fact that PBS mustbe implemented in the visible public context of workmay make it more difficult to implement. There istypically a smaller number of paid support staff toimplement the intervention [20]. There is also an issuerelated to access to behavioral consultation services.While school age students have access to highly qualifiedteachers and other professional staff who usuallyhave behavioral expertise, adults with ASD typicallyhave limited access to staff with behavioral expertise atwork. Finally, PBS interventions would take place in abusiness where staff and customers interact for the purposeof exchanging goods and services and not for thepurpose of implementing interventions for people whopresent challenges. Thus, businesses typically have alower tolerance for the time and resources it may taketo implement PBS interventions [35].Nevertheless, PBS is a set of assessment proceduresand interventions that are uniquely designed to‘fit’ in such community-based contexts [1]. PSB is ascientific approach to understanding problem behaviorthrough the multiple lenses of person-centeredness,applied behavior analysis, biomedical intervention,and systems change [12]. The fundamental componentsin the application of PBS include functionalbehavior assessment, multicomponent intervention, utilizationof multiple perspectives and methodologicalpractices, lifespan perspective, improved quality of life,collaboration between stakeholders, and an emphasison prevention of the problem behavior [6]. Many ofthese characteristics are also espoused by advocatesfor competitive employment for individuals with severedisabilities [21]. Thus, while the provision of PSB in aworkplace presents some challenges, the opportunitiesto increase the success of individuals like DJ at workout weigh those challenges.3.1. Implementation of functional behaviorassessment at workThe process to complete a functional behavior assessment(FBA) is well documented as best practiceassessment for individuals with ASD [7, 12, 34]. The
C.M. Schall / PBS: Supporting adults with ASD in the workplace 111three critical steps to completing a functional behaviorassessment are: 1) indirect assessment, 2) direct assessment/observation,and 3) hypothesis development [2].The first and the third step involve team meetings andanalysis of data. Both steps can occur with the team at alocation outside of the workplace. This would decreaseimposing upon the workplace and the possibility thatthe person would experience embarrassment. The secondstep, however, involves direct observation in theenvironment where the behavior occurs.While these three steps can be implemented asdesigned [cf. 36], it is important for staff to completedirect assessment and observation discreetly. Staff whoare observing an individual with ASD will appear conspicuousif the observers do not take care to blend intothe workplace.Additionally, professional staff who are guiding theprocess should develop easy-to-implement methods ofcollecting direct observation data from job coaches whosupport the person. Carr et al., described a simple ‘indexcard’ method for data collection that accomplishesthis goal [8]. Other such methods include antecedentbehavior-consequencecharts and scatter plots [2, 18,36].In DJ’s case, Sam consulted with a Positive BehaviorSupport Facilitator to assist him in completing thefunctional behavior assessment [47]. They first met withDJ, his mother, DJ’s rehabilitation counselor and Sam’ssupervisor from his employment service organizationin the rehabilitation counselor’s office to begin the firststep of the FBA. During this step, the PBS facilitatorinterviewed the team to define the behavior, and identifiedpotential antecedents to the problem behavior. Thiswas followed by an observation at the coffee shop wherethe PBS facilitator ordered a coffee, and observed DJfrom a table in the corner of the shop. After observationand data collection, the team met to analyze thedata and proposed the hypothesis that DJ’s noises andpushing others was an attempt to avoid correction. Theyobserved that DJ became most noisy and pushed othersaway when he made a mistake and required verbalcorrection and redirection.3.2. Positive behavior support plansOnce the team identifies the function of the problembehavior, the team should collaborate to developthe PBS plan. There is no single set of specific strategiesthat define PBS plans. Rather, there are sociallyvalid criteria that each PBS plan should meet. EachPSB plan should result in an increased quality of lifefor the person. They should also result in increasedindependence and self determination. Plans should bedeveloped to match the context in which they will beimplemented. Finally, plans should be developed in collaborationwith the direct staff who will implement themto ensure increased ‘buy-in’ and fidelity of implementation[1, 12, 24]. These criteria ensure that the valuesof self-determination, and person-centeredness act as abalance to the application of applied behavior analysisin community based settings. These criteria are particularlyimportant to and congruent with the goals ofsupported and competitive employment for individualswith ASD.In order to develop a multicomponent interventionplan, the PBS plan should include strategies in at leastthree intervention categories. They are: 1) antecedentstrategies and ecological modifications designed to preventthe occurrence of problem behavior, 2) teachingreplacement behaviors and new skills to render theproblem behavior unnecessary, and 3) consequentialstrategies to reinforce the new skills and extinguish theproblem behavior [2, 3, 12, 32]. These three, prevent,teach, and reinforce, are the essential components of aPBS plan [13].3.3. Positive behavior support strategiesfor the workplaceLike the caution provided for completing an FBA,the same caution regarding choosing interventions thatare not obvious or disruptive to the work setting applies.Fortunately, many of the recommended workplace supportstrategies meet this standard. The next sections willdescribe each of the evidence-based practices interventionsdesigned to prevent problem behaviors, teach newbehaviors, and respond differently to problem behaviorswhen they occur. These sections will also describe howto implement these interventions in work settings.Preventing problem behaviors: The purpose of anantecedent strategy is to prevent a problem behavior.In the area of workplace supports, this is frequentlyamong the most adaptable strategies. That is, in theworkplace, it is often easiest to redesign work tasks toavoid the antecedents to problem behavior. This is alsoan area of intervention where there are some sound,evidence-based strategies.The first and most logical antecedent strategy for theworkplace is to assure a good job match. The factorsthat are most critical for an adult with ASD include thetasks of the job, sensory characteristics of the job, the‘social climate’, and the flexibility within the workplace
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