Category Archives: Visual supports

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Using FAB Strategies®

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“Functionally Alert Behavior” FAB Strategies® is an evidence-based curriculum of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies for improving the functional behavior of children, adolescents and young adults with complex behavioral challenges FAB Strategies ERIC document Complex behavioral challenges involve a combination of inter-related mental health, developmental, sensory and environmental challenges. The FAB Strategies® curriculum is individualized by occupational, physical, speech and mental health therapists for coordinated use in conjunction with the client, their family and teachers.  The FAB Strategies®curriculum emphasizes the use of a coordinated multidisciplinary approach that addresses specific goal-directed functional behaviors in the natural environment.

FAB Strategies® is useful for guiding integrated individual, group, and home program intervention by teachers, family members, as well as occupational, physical, speech and mental health therapists. Teachers, therapists and familys face the challenge of helping students develop the behavioral skills that support learning. This challenge has become more difficult given the increasing academic demands and numbers of students with complex behavioral challenges. It is crucial to help students with complex behavioral challenges because their behaviors interfere with these students’ and their classmates learning. The “Functionally Alert Behavior” FAB Strategies® curriculum can improve self-control in students with complex behavioral challenges.

The FAB Strategies Form guides therapists in developing an individualized program for improving the client’s functional behavior fab-stratform Section A environmental adaptations provide the structural foundation for FAB Strategies. The child’s response related to his functional goal guides the use of environmental adaptations. Environmental adaptations include adaptive equipment such as fidgets, visual schedules and adaptive techniques.

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Environmental enrichment through adaptive equipment, visual schedules, and adaptive techniques reduces aggression in children with behavioral challenges and developmental disabilities. When developing environmental adaptations, it is important to consider the dynamic relationship between the child’s behavioral, sensory, cognitive, and environmental challenges. Environmental structure and behavioral demands are interacting variables, with greater sensory demands suggesting the need for more structure. When children show improved self-control or demands are decreased, structure is reduced to promote independence.

Section B sensory modulation strategies help lower stress and enhance self-regulation, with the massage activities included in this section. Sensory modulation includes body awareness, basic mindfulness, touch, and motor self-control strategies. The Pagano FAB Trigger & Coping forms use pictures visually representing common environmental and body triggers as well as sensory coping strategies for children with behavioral, developmental, and sensory challenges.

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Section C positive behavioral control strategies improve behavior and communication skills. Learning social and communication skills significantly improves the behavior of children with developmental and behavioral challenges. Functional communication can be supported and rewarded through socially embedded reinforcers. For example, when a child says or signs “jump”, the therapist takes the child’s hands and jumps with the child. Section C also includes the FAB Turtle Technique, where a child notices his triggers and does his individualized self-calming strategies in the sensory coping area.

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Section D physical sensory strategies promote attention, behavior, and social skills through cardiovascular, dynamic balance, sensory motor, and sequential bilateral tasks. Children with developmental challenges are motivated to participate in sensory activities, making them an effective means for promoting behavioral change. FAB Strategies attend to a child’s arousal level so he can play without becoming overly excited. For example, if a child rates his energy level as “uncomfortably high” following play ground tasks he is assisted in calming down before returning to class.

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“Functionally Alert Behavior” FAB Strategies® offers an evidence-based curriculum of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies for improving the functional behavior of children, adolescents and young adults with complex behavioral challenges.  Application of the FAB Strategies®curriculum emphasizes ta coordinated multidisciplinary approach that addresses specific goal-directed functional behaviors in the natural environment.

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Applying FAB Strategies

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I developed FAB Strategies (Functionally Alert Behavior Strategies) to help children, adolescents and young adults who have complex behavioral challenges.  The FAB Strategies Form guides the use of environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies.  The FAB Strategies forms enable teachers, families as well as occupational, physical, speech/language and mental health therapists to work towards the same functional behavioral goals using consistent strategies.  The copyrighted FAB strategies forms are offered free of charge to therapists for use in developing home programs that improve functional behavior.

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FAB Strategies combines positive behavioral support and sensory processing strategies to improve behavior.   School occupational therapists can effectively team with parents and school staff to reduce school aggression, restraint and seclusion.

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Occupational Therapy in Adolescent Mental Health

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I was recently honored to present Grand Rounds at Solnit Children’s Center, the adolescent psychiatric hospital where I work. GrandRoundsOT Outline Our dynamic transdisciplinary team over the past 5 years was able to significantly reduce the use of restraint and seclusion.OT role in Restraint Reduction Solnit which was celebrated by making a bench for the hospital grounds from restraint beds (which are no longer used).

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Occupational Therapy is a vital intervention for adolescents with mental health, PTSD and developmental challenges.  Occupational therapists address adolescent mental health in schools, outpatient mental health clinics, youth psychiatric hospitals, and juvenile detention facilities. Occupational Therapy (O. T.) focuses on promoting adolescent’s occupations, the things they want or need to do. Adolescent’s occupations typically include school,

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activities of daily living (e.g., grooming, keeping their room clean), prevocational activities, sports, exercise, and social activities. For example, intervention on developing occupations is needed by some adolescents recovering from drug addiction, where their primary activities of taking drugs and doing illegal activities (to earn money for drugs) must be replaced by a new lifestyle with more functional occupations.  I am repeatedly impressed by my client’s and their families’ ability to confront the challenges of mental illness, and their unique gifts as individuals http://www.behindthelabel.co.uk

Occupational therapy offers unique contributions to adolescent mental health intervention due to its foundations in neurology, physiology, psychology, development, human occupations, and sensory processing. At Solnit Children’s Center the primary frames of reference used include: mindfulness, sensory processing, sensory massage, trauma informed care, Pivotal Response Training (a research proven form of Applied Behavioral Analysis), exercise, and developmental intervention. Occupational therapy is a vital component of transdisciplinary team intervention for adolescents with mental health challenges.

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FAB Strategies® to Improve Self-Control

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FAB Strategies® are Functionally Alert Body Strategies that can be used by parents, teachers, as well as Occupational, Speech, Physical, and Mental Health therapists to improve youngster’s functional behavior.  FAB Strategies® were developed to guide transdisciplinary intervention for individuals with developmental, mental health, post traumatic stress disorder, and sensory processing challenges. FAB Strategies® combines developmental, sensory processing, behavioral, touch pressure, mindfulness, movement and neuropsychology interventions to help individuals with complex behavioral challenges.

The four sections of FAB Strategies® are environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies. While reducing aggression in special needs students FAB Strategies® simultaneously facilitates attention, learning, and parental involvement in typical students. FAB Strategies® can be used for regular class teaching as well as small group and individual intervention sessions. Many typical students lack adequate seated attention, self-control, and sensory-motor skills to master their academic learning requirements. FAB Strategies® are fun active learning tasks that engage students’ musical, visual-spatial, auditory, interpersonal, and bodily-kinesthetic intelligence to improve learning.

FAB Strategies® are guided by the FAB Strategies® to Improve Self-Control form FAB STRATEGIES FORM and FAB Strategies® for Pre-K and Kindergarten form FAB StrategiesPre&KForm. The FAB Strategies® forms list strategies organized into four sections addressing: environmental adaptation, sensory modulation, positive behavioral support, and physical self-regulation strategies. The teachers and therapists develop a functional goal and choose at least one strategy from each section for goal attainment. Strategies chosen are checked and underlined for use across disciplines.

The FAB Strategies® forms can be used as a checklist of helpful activities to consider when developing transdisciplinary interventions for students with behavioral challenges. The FAB Strategies® forms were also designed as an efficient way to develop home programs and provide a list of effective strategies when students transfer to other teachers and therapists. The FAB Strategies form enables teachers and therapists to individualize interventions that improve behavior in response to each student’s developmental level and individual needs.

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FAB Coping Card Strategy

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The FAB Coping card gives clients, teachers and therapists a visual support strategy for achieving their goals. Based on Power Cards, coping cards use the child’s preferred interest to guide goal-directed behavior. Clients use an index card to depict their preferred interest, behavioral goal, coping strategies, and reinforcement schedule. Constructing and displaying the coping card focuses the client and staff on their individual goal, coping strategies, and reinforcement schedule while using their preferred interest to help achieve the goal.

For example, a student who frequently bit his hand constructed a coping card by depicting his goal (e.g., keep safe hands by not biting myself when I get upset), preferred interest (e.g., Sponge Bob), coping strategies (e.g., chewy, weighted blanket, and basket ball) and reinforcement schedule (e.g., 10 minutes of safe hands=1 sticker). The goal is written and/or drawn, stickers or drawings depict the preferred interest, and coping strategies are visually represented (colored, cut out, and pasted on an index card using the FAB Trigger & Coping forms).

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On the reverse side of the coping card the reinforcement schedule is written: “Safe hands for 10 consecutive minutes earns one sticker, while five stickers=1 toy car)”.  The index card is laminated and fastened to the desktop or worn as a necklace. Through their process of constructing the coping card clients and staff develop an effective functional goal, preferred interest, coping strategies, and reinforcement schedule.

Making a coping card helps teach clients how to use adaptive equipment to achieve their goal. The process of constructing the coping card focuses the client and staff on the goal and plan for achieving it.  The coping card helps to quickly remind clients and staff of the individualized program for achieving their goal.  Coping cards quickly guide busy teachers and therapists in addressing functional goals of students with significant behavioral challenges. Coping cards also encourage professional collaboration in goal development and implementation.

Reference:

Spencer, V., Simpson, C., Day, M., Buster, E. (2008).  Using the power card strategy to teach social skills to a child with Autism.  Teaching Exceptional Children Plus, 5(1), 1-10.

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School Sensory Modulation Strategies

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Sensory modulation strategies, a component of sensory integration intervention, help improve behavior and reduce the need for harsh discipline in schools. Sensory modulation strategies teach students to be aware of and regulate their arousal levels for appropriate behavior and learning.  Sensory modulation strategies are particularly useful for students with behavioral, mental health, trauma history, developmental, and/or sensory processing challenges.

Sensory modulation strategies help students adjust their arousal level for improved self-control. They learn to notice whether their arousal level is low (they feel numb), medium (just right for learning) or high (too hyper to pay attention) and use coping strategies to adjust their energy level.

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Most students learn best when they’re in a quiet alert state rather than overly relaxed or excited.

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Maintaining appropriate arousal levels also involves social skills, as different levels of arousal are expected during class and at recess.  Occupational and mental health therapists can team with teachers to use sensory modulation strategies with students who have self-control challenges. Clinical research shows that sensory modulation strategies can improve behavior and reduce the need for restraints and other harsh discipline methods.

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Sensory modulation strategies are especially affective for students with severe behavioral, mental health, trauma history, developmental, and/or sensory processing challenges.  Students are taught to identify when they begin experiencing environmental and body triggers to use their most affective sensory coping strategies http://www.sensoryconnectionprogram.com/what_helps_poster_activity.pdf

 

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If sensory modulation or behavioral interventions alone are not working, combining both strategies using picture reminders can be helpful.

Busy teachers may sometimes attend to disruptive and ignore appropriate behavior, and reversing this can make a huge difference. For some students, individual sessions with an occupational and/or mental health therapist are used to teach sensory modulation, while others learn sensory modulation strategies by therapists working with the teacher or leading groups. Sensory modulation strategies can include teaching students to do pushups for self calming when they’re hyper or going to a quiet area for a few minutes to calm down so they won’t misbehave and are able to learn. Therapists need to try various strategies with students to find what works best.  Sensory modulation strategies in schools may involve the use of a quiet area in the class room,

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a sensory coping room

 

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adaptive equipment

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or bulletin boards reminding students of class rules  and sensory coping strategies.  Working together therapists and teachers can use sensory modulation strategies to improve their students’ behavior and learning.

Reference:

Chalmers, A., Harrison, S., Mollison, K., Molloy, N., & Gray, K. (2012). Establishing sensory-based approaches in mental health inpatient care: a multidisciplinary approach. Australasian Psychiatry, 20(1), 35-39. www.rompa.com/media/free-resources/establishing_sensory-based_approaches_in_mental_health.pdf