Preview
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 RECEIVED NYSCEF: 08/23/2021
The premier community resource for people with disabilities and their families
Behavior Plan
Name: Tegan Brown Date of Plan: 7/21/21
DOB: /2002
Background Information:
Tegan is a 19-year-old individual who presents with ADHD, Mild ID secondary to Down
Syndrome and seizure disorder. Tegan communicates using simple words and phrases. He also
has hearing loss in his left ear. He lived previously at home with his father in Plattsburgh, NY
before being admitted to CVPH Medical Center in April 2021. Tegan transitioned to residential
placement with Saratoga Bridges, Saratoga NY in July 2021.Tegan’s father is a support and stays
in contact by phone. Tegan enjoys playing memory game, basketball and video games, dancing,
hiking, music/videos and swimming. Tegan graduated from Beekmantown Central School
District in December of 2020. Tegan has a primary Care provider and a neurologist/psychiatrist
who prescribe medication for seizures and behavior.
Tegan does not have documented significant behavioral challenges from when he was living
with his father or during school. He would require reminders for appropriate social behavior
especially with females (calling them his girlfriend, touching and personal space). His
challenging behavior has increased since he was admitted to CVPH Medical Center. He
exhibited aggression, property destruction and unsafe behavior that required medication and staff
to physically intervene to maintain Tegan’s safety and the safety of others. While with Saratoga
Bridges, Tegan has exhibited aggression towards peers and staff, property destruction,
elopement, non-compliance and inappropriate behavior.
Rationale for the Plan:
The following plan is being implemented to provide staff with a consistent approach in
supporting Tegan, and to teach and reinforce replacement behaviors as a means of reducing
target behaviors. This plan was developed in consultation with the staff who will be responsible
for implementing the plan and is based on Tegan’s preferences. It has yet to be determined if
Tegan can provide informed consent for his behavior plan and psychotropic medications. His
father Chad Brown provides informed consent on behalf of Tegan.
Tegan currently presents with a short attention span, difficulty redirecting and setting boundaries.
This can lead to agitation and challenging behavior that escalates quickly when he does not
receive attention he is seeking or when limits are set.
16 Saratoga Bridges Boulevard Ballston Spa, New York 12020 (518) 587-0723 (518) 583-9607 fax
www.saratogabridges.org info@saratogabridges.com
Saratoga Bridges, NYSARC, Inc. Saratoga County Chapter
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 Brown,
RECEIVED Tegan08/23/2021
NYSCEF:
Behavior Plan
7/21/21
Behaviors to increase (Replacement behaviors):
Effective Communication: Tegan will increase his ability to express his wants and needs.
Schedule: At the start of each day, Tegan will plan his schedule with staff. Tegan will review his
schedule at least once daily.
Precursor Behavior:
“Leave me alone”
Saying “Fight”/Requests to call cops
Asking to call Dad
Becomes quiet/putting head down
Behaviors to decrease (Target Behaviors):
Physical Aggression: hitting, scratching, kicking, biting, pulling hair, spitting.
Property Destruction: throwing objects, breaking windows and electrical boxes.
Non-compliance: not responding to requests, directions, or verbal prompts. This includes
saying “No” and pulling fire alarms.
Elopement: actively moving away from staff to unsupervised areas and locations.
Inappropriate behavior: sexualized gestures/comments, unwanted touching (especially with
female staff). This includes swearing and other inappropriate language and jokes.
Baseline data: (from 7/1/21- 7/21/21):
Effective communication: no current data
Schedule: no current data
Physical Aggression: 9 episodes
Property Destruction: 9 episodes
Non-compliance: 12 instances
Elopement: 3 instances
Inappropriate behavior: 5 instances
Functional Assessment:
Based upon direct observation, information and data collected from team members and a review
of his record, the following details have been gathered about Tegan’s behavior:
Common antecedents/setting events to Target Behavior:
Lack of attention
Limits on access to preferred activities (i.e. rap videos on YouTube)
Redirection
Unable to comply with Tegan’s requests
When told “No”
2
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 Brown,
RECEIVED Tegan08/23/2021
NYSCEF:
Behavior Plan
7/21/21
Tegan has a short attention span and will request changes in activities multiple times per hour at
times.
Staff will work with Tegan to establish a schedule at the start of his day and then follow the
schedule with some flexibility within the structure of the schedule.
Hypothesized function of behavior:
Physical Aggression: The hypothesized function of aggression is attention secondary to escape
and access to tangibles.
Property Destruction: The hypothesized function of property destruction is sensory/automatic
secondary to attention.
Non-Compliance: The hypothesized function of non-compliance is escape.
Elopement: The hypothesized function of elopement is escape.
Inappropriate behavior: The hypothesized function of inappropriate behavior is attention.
Consequences that maintain behavior:
When Tegan engages in target behavior, he is communicating that he is upset or is not getting
enough attention, or an object activity he wants, so staff support him and provide 1:1 attention
and verbal prompts to calm and express himself. By this process, Tegan gains attention, gains
sensory input and avoids/delays less desired tasks/activities as well as utilizing his own coping
methods to meet his needs.
Current Medication: (as of 7/21/21)
Clonidine MDD .4 mg
Dextroamphetamine-amphetamine ER MDD 2 tabs
Divalproex MDD serum level 120 ug/mL
Gabapentin MDD 900 mg/d
Olanzapine zidis (MDD 40 mg)
Reference MAR for Current medication regimen
Teaching Strategies:
Remind Tegan of the purpose of his schedule and use “First-Then” language
For example “First word search Then basketball”
Encourage Tegan to set up a schedule that alternates between less preferred and more
preferred activities.
Discuss the importance of having safe hands and being a gentleman.
Give Tegan 1-2 step directions so he is able to process and be successful.
Preset Tegan when transitioning to a new activity or setting a limit:
“2 more minutes of video game then time for lunch”
3
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 Brown,
RECEIVED Tegan08/23/2021
NYSCEF:
Behavior Plan
7/21/21
Proactive Techniques:
Offer choices to Tegan from options provided by staff.
Use upbeat approach when discussing next activity and have positive affect.
Offer Tegan the use of a weighted vest at least twice a day. He can also request it independently.
Instead of saying “no” tell Tegan what he can do. Example: “We don’t yell but we can sing”
Don’t crowd Tegan and give him time to make a choice after he has been given options.
Compliment Tegan on his appearance, clothing or shoes and use to start a positive conversation.
“I like your Nike shoes. Do you like Under Armor too?
Reinforcement of Replacement behavior:
Tegan benefits from frequent praise both verbally and physically.
Provide Tegan with praise when he complies with a verbal prompt or redirection from staff.
Provide Tegan with verbal praise and make it specific to what he did well:
“Tegan you did a great job helping clean up after dinner”
“You have been making great choices all day”
“When you use nice words, you make people smile”
Staff can offer Tegan a “fist bump” or a thumbs-up with verbal praise.
If Tegan has an idea for an activity add it to his schedule or options for future planning and
praise him.
Intervention Procedures:
Physical Aggression:
1. If Tegan begins to show signs of aggression, staff should ask him to be safe and
remind him of what safe means.
2. Request that he take deep breaths or count to 10.
3. Prompt Tegan to have “safe hands and feet” while giving him space (i.e. arms length)
4. If aggression continues staff will use deflection and blocking techniques.
5. Staff will remove other individuals from the area and move objects away that may be
thrown.
6. Staff will prompt Tegan to sit and take a break.
7. If Tegan sits allow him space and time to calm.
8. Once calm, ask Tegan if he is ready and how you can help him be safe.
9. If Tegan continues to be aggressive staff will call MOC and 911 if in immediate
danger.
10. No Physical Interventions are permitted in this plan at this time.
Property Destruction:
1. If Tegan begins to throw items prepare to block or protect others and yourself if an
object is thrown.
2. Move other objects that could pose a threat if thrown.
3. Verbally prompt Tegan to be safe and request that he sit or take a break.
4. If Tegan goes towards dangerous objects (i.e. electrical box) staff will put themselves
in between the object and Tegan.
5. Verbally redirect Tegan away from the object.
6. If Tegan is in immediate danger call MOC/911.
7. If Tegan becomes aggressive refer to Physical Aggression (above).
4
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 Brown,
RECEIVED Tegan08/23/2021
NYSCEF:
Behavior Plan
7/21/21
Non-Compliance:
1. If Tegan does not comply with request/verbal prompt give him 5-10 seconds to
process your request.
2. Prompt Tegan again or ask him if he needs a break.
3. If he says “Yes” or “Break” praise him and come back to him in 2-3 min.
4. If possible, have a different staff verbally prompt Tegan and remind him of something
positive he has done in the day so far and something fun that is coming up on his
schedule. Example: “You have been so helpful today and I know you are looking
forward to __________ later.”
Elopement:
1. If Tegan begins to leave a supervised area prompt him to stay with staff.
2. Staff will verbally set an appropriate boundary “Please don’t go past _________.”
3. If he complies with the verbal prompt praise Tegan.
4. If Tegan continues to elope staff will communicate with other staff and follow Tegan.
5. Continue to verbally prompt Tegan stay safe and tell staff what he wants/needs.
6. Staff will ensure Tegan’s safety at all times and contact MOC/emergency if you are
unable to redirect Tegan.
Inappropriate behavior:
1. Remind Tegan that we don’t do/say that.
2. Remind Tegan of personal space (i.e. inappropriate touching)
3. Provide minimal attention to the inappropriate behavior (i.e. burping, farting)
4. Redirect Tegan’s attention to an activity
5. Once he redirects provide attention and praise when engaged in appropriate behavior.
Data Collection:
Staff will document in Therap the use of replacement behaviors and incidents of target
behaviors, recording if and when target behaviors occur, the length, interventions used, how they
responded. Data will be reviewed by the behavior specialist and shared with the team and
psychiatric service provider on a regular basis.
Fading Criteria:
Plan:
This plan will be reviewed for the effectiveness of the interventions, including the use of
intermediate and/or restrictive interventions at least every 6 months.
Medication:
The rationale for maintaining medication use, including the possibility of reduction or
elimination will be left to the provider’s discretion and will be reviewed at least every 6
months.
5
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412
NYSCEF DOC. NO. 25 Brown,
RECEIVED Tegan08/23/2021
NYSCEF:
Behavior Plan
7/21/21
Signatures:
7/22/2021
__________________________________ __________________________________
Date Date
Guardian/Advocate Behavior Intervention Specialist
7/22/21
__________________________________ __________________________________
Rachel Mann Rosan, Ph.D. Date Human Rights Committee Date
Consulting Licensed Psychologist
6
Preview
FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 RECEIVED NYSCEF: 08/23/2021 The premier community resource for people with disabilities and their families Behavior Plan Name: Tegan Brown Date of Plan: 7/21/21 DOB: /2002 Background Information: Tegan is a 19-year-old individual who presents with ADHD, Mild ID secondary to Down Syndrome and seizure disorder. Tegan communicates using simple words and phrases. He also has hearing loss in his left ear. He lived previously at home with his father in Plattsburgh, NY before being admitted to CVPH Medical Center in April 2021. Tegan transitioned to residential placement with Saratoga Bridges, Saratoga NY in July 2021.Tegan’s father is a support and stays in contact by phone. Tegan enjoys playing memory game, basketball and video games, dancing, hiking, music/videos and swimming. Tegan graduated from Beekmantown Central School District in December of 2020. Tegan has a primary Care provider and a neurologist/psychiatrist who prescribe medication for seizures and behavior. Tegan does not have documented significant behavioral challenges from when he was living with his father or during school. He would require reminders for appropriate social behavior especially with females (calling them his girlfriend, touching and personal space). His challenging behavior has increased since he was admitted to CVPH Medical Center. He exhibited aggression, property destruction and unsafe behavior that required medication and staff to physically intervene to maintain Tegan’s safety and the safety of others. While with Saratoga Bridges, Tegan has exhibited aggression towards peers and staff, property destruction, elopement, non-compliance and inappropriate behavior. Rationale for the Plan: The following plan is being implemented to provide staff with a consistent approach in supporting Tegan, and to teach and reinforce replacement behaviors as a means of reducing target behaviors. This plan was developed in consultation with the staff who will be responsible for implementing the plan and is based on Tegan’s preferences. It has yet to be determined if Tegan can provide informed consent for his behavior plan and psychotropic medications. His father Chad Brown provides informed consent on behalf of Tegan. Tegan currently presents with a short attention span, difficulty redirecting and setting boundaries. This can lead to agitation and challenging behavior that escalates quickly when he does not receive attention he is seeking or when limits are set. 16 Saratoga Bridges Boulevard Ballston Spa, New York 12020 (518) 587-0723 (518) 583-9607 fax www.saratogabridges.org info@saratogabridges.com Saratoga Bridges, NYSARC, Inc. Saratoga County Chapter FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 Brown, RECEIVED Tegan08/23/2021 NYSCEF: Behavior Plan 7/21/21 Behaviors to increase (Replacement behaviors): Effective Communication: Tegan will increase his ability to express his wants and needs. Schedule: At the start of each day, Tegan will plan his schedule with staff. Tegan will review his schedule at least once daily. Precursor Behavior: “Leave me alone” Saying “Fight”/Requests to call cops Asking to call Dad Becomes quiet/putting head down Behaviors to decrease (Target Behaviors): Physical Aggression: hitting, scratching, kicking, biting, pulling hair, spitting. Property Destruction: throwing objects, breaking windows and electrical boxes. Non-compliance: not responding to requests, directions, or verbal prompts. This includes saying “No” and pulling fire alarms. Elopement: actively moving away from staff to unsupervised areas and locations. Inappropriate behavior: sexualized gestures/comments, unwanted touching (especially with female staff). This includes swearing and other inappropriate language and jokes. Baseline data: (from 7/1/21- 7/21/21): Effective communication: no current data Schedule: no current data Physical Aggression: 9 episodes Property Destruction: 9 episodes Non-compliance: 12 instances Elopement: 3 instances Inappropriate behavior: 5 instances Functional Assessment: Based upon direct observation, information and data collected from team members and a review of his record, the following details have been gathered about Tegan’s behavior: Common antecedents/setting events to Target Behavior: Lack of attention Limits on access to preferred activities (i.e. rap videos on YouTube) Redirection Unable to comply with Tegan’s requests When told “No” 2 FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 Brown, RECEIVED Tegan08/23/2021 NYSCEF: Behavior Plan 7/21/21 Tegan has a short attention span and will request changes in activities multiple times per hour at times. Staff will work with Tegan to establish a schedule at the start of his day and then follow the schedule with some flexibility within the structure of the schedule. Hypothesized function of behavior: Physical Aggression: The hypothesized function of aggression is attention secondary to escape and access to tangibles. Property Destruction: The hypothesized function of property destruction is sensory/automatic secondary to attention. Non-Compliance: The hypothesized function of non-compliance is escape. Elopement: The hypothesized function of elopement is escape. Inappropriate behavior: The hypothesized function of inappropriate behavior is attention. Consequences that maintain behavior: When Tegan engages in target behavior, he is communicating that he is upset or is not getting enough attention, or an object activity he wants, so staff support him and provide 1:1 attention and verbal prompts to calm and express himself. By this process, Tegan gains attention, gains sensory input and avoids/delays less desired tasks/activities as well as utilizing his own coping methods to meet his needs. Current Medication: (as of 7/21/21) Clonidine MDD .4 mg Dextroamphetamine-amphetamine ER MDD 2 tabs Divalproex MDD serum level 120 ug/mL Gabapentin MDD 900 mg/d Olanzapine zidis (MDD 40 mg) Reference MAR for Current medication regimen Teaching Strategies: Remind Tegan of the purpose of his schedule and use “First-Then” language For example “First word search Then basketball” Encourage Tegan to set up a schedule that alternates between less preferred and more preferred activities. Discuss the importance of having safe hands and being a gentleman. Give Tegan 1-2 step directions so he is able to process and be successful. Preset Tegan when transitioning to a new activity or setting a limit: “2 more minutes of video game then time for lunch” 3 FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 Brown, RECEIVED Tegan08/23/2021 NYSCEF: Behavior Plan 7/21/21 Proactive Techniques: Offer choices to Tegan from options provided by staff. Use upbeat approach when discussing next activity and have positive affect. Offer Tegan the use of a weighted vest at least twice a day. He can also request it independently. Instead of saying “no” tell Tegan what he can do. Example: “We don’t yell but we can sing” Don’t crowd Tegan and give him time to make a choice after he has been given options. Compliment Tegan on his appearance, clothing or shoes and use to start a positive conversation. “I like your Nike shoes. Do you like Under Armor too? Reinforcement of Replacement behavior: Tegan benefits from frequent praise both verbally and physically. Provide Tegan with praise when he complies with a verbal prompt or redirection from staff. Provide Tegan with verbal praise and make it specific to what he did well: “Tegan you did a great job helping clean up after dinner” “You have been making great choices all day” “When you use nice words, you make people smile” Staff can offer Tegan a “fist bump” or a thumbs-up with verbal praise. If Tegan has an idea for an activity add it to his schedule or options for future planning and praise him. Intervention Procedures: Physical Aggression: 1. If Tegan begins to show signs of aggression, staff should ask him to be safe and remind him of what safe means. 2. Request that he take deep breaths or count to 10. 3. Prompt Tegan to have “safe hands and feet” while giving him space (i.e. arms length) 4. If aggression continues staff will use deflection and blocking techniques. 5. Staff will remove other individuals from the area and move objects away that may be thrown. 6. Staff will prompt Tegan to sit and take a break. 7. If Tegan sits allow him space and time to calm. 8. Once calm, ask Tegan if he is ready and how you can help him be safe. 9. If Tegan continues to be aggressive staff will call MOC and 911 if in immediate danger. 10. No Physical Interventions are permitted in this plan at this time. Property Destruction: 1. If Tegan begins to throw items prepare to block or protect others and yourself if an object is thrown. 2. Move other objects that could pose a threat if thrown. 3. Verbally prompt Tegan to be safe and request that he sit or take a break. 4. If Tegan goes towards dangerous objects (i.e. electrical box) staff will put themselves in between the object and Tegan. 5. Verbally redirect Tegan away from the object. 6. If Tegan is in immediate danger call MOC/911. 7. If Tegan becomes aggressive refer to Physical Aggression (above). 4 FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 Brown, RECEIVED Tegan08/23/2021 NYSCEF: Behavior Plan 7/21/21 Non-Compliance: 1. If Tegan does not comply with request/verbal prompt give him 5-10 seconds to process your request. 2. Prompt Tegan again or ask him if he needs a break. 3. If he says “Yes” or “Break” praise him and come back to him in 2-3 min. 4. If possible, have a different staff verbally prompt Tegan and remind him of something positive he has done in the day so far and something fun that is coming up on his schedule. Example: “You have been so helpful today and I know you are looking forward to __________ later.” Elopement: 1. If Tegan begins to leave a supervised area prompt him to stay with staff. 2. Staff will verbally set an appropriate boundary “Please don’t go past _________.” 3. If he complies with the verbal prompt praise Tegan. 4. If Tegan continues to elope staff will communicate with other staff and follow Tegan. 5. Continue to verbally prompt Tegan stay safe and tell staff what he wants/needs. 6. Staff will ensure Tegan’s safety at all times and contact MOC/emergency if you are unable to redirect Tegan. Inappropriate behavior: 1. Remind Tegan that we don’t do/say that. 2. Remind Tegan of personal space (i.e. inappropriate touching) 3. Provide minimal attention to the inappropriate behavior (i.e. burping, farting) 4. Redirect Tegan’s attention to an activity 5. Once he redirects provide attention and praise when engaged in appropriate behavior. Data Collection: Staff will document in Therap the use of replacement behaviors and incidents of target behaviors, recording if and when target behaviors occur, the length, interventions used, how they responded. Data will be reviewed by the behavior specialist and shared with the team and psychiatric service provider on a regular basis. Fading Criteria: Plan: This plan will be reviewed for the effectiveness of the interventions, including the use of intermediate and/or restrictive interventions at least every 6 months. Medication: The rationale for maintaining medication use, including the possibility of reduction or elimination will be left to the provider’s discretion and will be reviewed at least every 6 months. 5 FILED: SARATOGA COUNTY CLERK 08/23/2021 05:50 PM INDEX NO. EF20212412 NYSCEF DOC. NO. 25 Brown, RECEIVED Tegan08/23/2021 NYSCEF: Behavior Plan 7/21/21 Signatures: 7/22/2021 __________________________________ __________________________________ Date Date Guardian/Advocate Behavior Intervention Specialist 7/22/21 __________________________________ __________________________________ Rachel Mann Rosan, Ph.D. Date Human Rights Committee Date Consulting Licensed Psychologist 6