Positive Behavior Supports Assessment Guide
“Positive Behavior” refers to the skills a supported individual has or may learn that increase
their likelihood of satisfaction and success across all settings and endeavors. “Positive Behavior
Support” refers to the skills those supporting an individual have or may learn to expand and
enhance opportunities for mutual satisfaction and success. The combined “Positive
Approaches” informs all aspects of support and services with the intention of enhancing quality
of life, based on:
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Supporting the individual to explore and pursue a life they enjoy and find meaningful.
Supporting the individual to be as independent as possible.
Supporting recovery from trauma.
Defining and pursuing goals of their choosing with assistance as needed.
Learning and practicing alternative means for expressing displeasure, pain, or other
communicative intent.
 Behavior is understood from a functional perspective.
 Teaching, modeling, encouraging, and reinforcing desirable behavior.
 Using effective prevention and intervention strategies when challenging behavior occurs.
The Behavior Support Consultant (BSC) has the essential responsibility for identifying key
aspects of positive behavior and positive behavior support. They lead the continuous discovery
of antecedent conditions-the who, what, where, and when of all behavior; the why regarding
motivation and behavioral function; and generate prevention and intervention strategies. Their
contribution is documented primarily through the Positive Behavior Supports Assessment
(PBSA) and Positive Behavior Supports Plan (PBSP).
Positive Behavior Supports Assessment (PBSA)
The PBSA documents the BSC’s identification and analysis of the personal attributes and
interpersonal, environmental, and activity factors that influence positive and challenging
behavior. The PBSA describes the essential findings upon which behavioral interventions and
positive support are based. The findings are based on observation and/or interviews with the
individual, their family, and other team members; a review of available documents; and a
functional behavioral assessment. The PBSA contains references to information sources
addressing the individual’s history, background information, current life circumstances, and
describes his/her current behavioral challenges. The BSC is encouraged to highlight and/or
briefly reiterate historical information and events that continue to shape the individual’s
experience, perception, and behavior. Following this examination the BSC must present the
reasoning behind the request for allocation or non-allocation of BSC resources including
consideration of clinical necessity criteria, fading factors, complexity factors, crisis and risk
screening factors.
A. REFERRAL INFORMATION
1. REASON FOR REFERRAL: Describe the challenges, obstacles to support, and
questions posed by the referral source.
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2. DIFFERENTIAL DIAGNOSTIC CONSIDERATIONS: Describe any medical and/or
psychiatric issues that have been considered, and either ruled out as causative factors or
that are still under consideration as contributing factors.
3. REFERRAL SOURCE: Identify referring individual, their role with the individual and
whether they represent the Interdisciplinary Team (IDT)
4. INDIVIDUALS/PROFESSIONALS CONTRIBUTING INFORMATION: Describe
varying perspectives and where consensus and/or disagreement may occur among
contributors
5. RECORD REVIEW: List documents reviewed (including dates produced) and highlight
any continuing need for historical documents; in recommendations indicate any other
assessments that may be needed now or in the future to inform treatment issues further.
B. RELEVANT FACTORS/DOMAINS
The following outlines the essential information considered when identifying: 1) Factors
assessed to increase the likelihood of positive behavior and/or decrease the likelihood of
challenging behavior; and 2) Factors assessed to increase the likelihood of challenging behavior
and/or interfere with positive behavior. Factors assessed to prompt concerns meeting necessity
clinical criteria for on-going BSC must be embedded throughout the PBSA. (Clinical Necessity
Criteria attached may be found in the Attachments to this document)
Information gathered is expanded upon and uniquely highlighted in each subsequent section of
the PBSA.
1. INDIVIDUAL ATTRIBUTES
These areas describe the person from a holistic perspective representing past and current
experience and status. Personal assets, strengths, and liabilities should be included.
Information in readily available documents may be referred to, attached, or cited rather
than repeated. The suggested items are neither exclusive nor exhaustive but may be
considered for most individuals. The information gathered will be considered when the
PBSP is developed.
a. Biological and/or physiological factors: Describe identified syndromes, an
examination of trauma, wellness, acute and chronic emotional and/or physical pain,
and mental health issues. Identified Axis diagnoses must be included with reference to
the diagnostician and the BSC impression of the accuracy of included or neglected
diagnoses. Psychotropic medications must be noted with prescribing intent and
effectiveness when available. The impact on the person’s current status and
functioning, from the BSC perspective, should be included.
b. Problem-solving capacity and means. How does the person resolve conflict, cope with
novel activities and settings and generalize learning?
c. Intellectual status: This should exceed reported levels of cognitive ability/disability
and include an assessment at how the person organizes information about their world
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and whether that organization is useful to them in desirable ways. Identify particular
areas of strength as well as limits.
d. Cultural issues: Ethnicity and race are important factors for some individuals. For
others, the culture of their community, family, and institutional settings may be more
relevant.
e. Spiritual beliefs: This should exceed religious convictions and practices to larger issues
of how the person considers nature, the arts, and aesthetics.
2. RELATIONSHIPS AND ASSOCIATED SKILLS:
These areas describe the person’s interest and support needs in regards to social
relationships. Again – relevant assets, strengths and liabilities should be included.
Information from readily available documents may be referenced, attached, or cited
rather than being repeated. The suggested items are neither exclusive nor exhaustive but
may be considered for most individuals. The information gathered will be considered
when the PBSP is developed.
a. Communication: Describe expressive and receptive communication capacity, styles,
unique methods, and motivation to engage with others.
b. Social competence: Relationships and associated social skills including family,
friends, and paid support. Describe who, what and why the individual is drawn to
some individuals and avoidant of others. Intimacy and sexuality issues must be
identified.
c. Self regulation: Describe how, where, and from whom the person seeks comfort or
management when distressed.
d. Emotional status: Describe the person’s emotional repertoire and typical
expression.
3. ENVIRONMENTAL FACTORS
In this area consider the nature of the places available to the individual throughout their
day. The following may be considered for most individuals and will be critical for others.
a. Settings: A complete description of the settings the person finds physically and
psychologically safe.
b. Social Density: Optimal density of people.
c. Lighting and Noise: Noise and light stimulation and reaction
d. Movement: Opportunities for movement vs in-place activities.
e. Exercise: Opportunities to exercise independence.
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f. Participation: Opportunities to engage in participatory activities.
g. Satisfaction: Perceived level of satisfaction.
4. Activity Factors consider the options and expectations held for the person
throughout their day. Questions to consider include:
a. Whether the person is supported to make and follow through on choices?
b. Is there a balance between familiar routines and more challenging expectations?
c. Are desired outcomes appropriate and compatible with longer ranging individual
preferences and quality of life issues?
d. Do support providers understand the person’s dominant learning style and can they
adapt their interactions?
e. Does the person derive a sense of meaning or purpose from their activities?
C. ASSESSMENT OF EFFECTIVENESS INDICATORS
The Office of Behavior Support (OBS) contends that enduring behavior change is contingent
upon thorough consideration of the following Effectiveness Indicators. We base this on over a
decade of analyzing the factors that consistently emerge as critical to increasing positive
behavior and/or decreasing challenging behavior. We considered observed, reported, inferred,
and documented information in reaching the Effectiveness Indicators. The collective findings are
heavily, but not exclusively, based on individuals receiving support in New Mexico. The PBSA
serves as a foundation for considering the indicators while the PBSP provides guidance toward
pursuing the following:
1.
2.
3.
4.
Community Integration/Quality of Life Effectiveness Indicator
Skill Development Effectiveness Indicator
Challenging Behavior Effectiveness Indicator
Interdisciplinary team Effectiveness Indicator
1. COMMUNITY INTEGRATION/QUALITY LIFE EFFECTIVENESS INDICATOR:
The BSC explores the current opportunities an individual has to participate in a range of
experiences, events, and settings with a variety of people according to his/her interests, skills,
and pace. The most varied and effective range of resources is available through authentic,
individualized community integration. However, the same standards of individual interest,
preferences, and tolerance are applied when considering roles and activities at home and in
segregated settings. The individual’s overall satisfaction with their usual and exceptional events
is considered.
The BSC findings are reported in a brief narrative or list citing essential motivators and factors
drawn from and expanding on the Basic Information above that are specific to community
participation and quality of life consistent with the individual’s ISP goals and objectives. This
will serve as a reference to the who, what, when, where, and how a expectations and daily
opportunities for participation are determined.
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Please consider the following questions while interviewing the individual, or their proxy.
a.
b.
c.
d.
e.
f.
g.
What kinds of things do you do on your own that you enjoy?
What do you need or get help to do?
Are there things you have to do that you prefer not to?
Who are your friends?
What do you do together?
What do you talk about with your friends?
Who helps you do things and have friends?
The following worksheets, developed for the Friends and Relationship curriculum, are useful
tools to inform this section as well.
a. I Am Somebody Worksheet
b. Self-reliance Skills Worksheet
2. SKILL DEVELOPMENT EFFECTIVENESS INDICATOR:
OBS observes an inverse relationship between skill and behavior. Individuals with on-going
support and opportunities to use existing skills and directed teaching strategies to learn new
adaptive skills demonstrate the most dramatic and enduring behavioral changes. The BSC guides
staff and family to continually set the stage for desired existing behavior and skill development
that enhances all adaptive domains, most critically communication and social skills. Ideally, this
may also include specific substitute behaviors that satisfy the motivating function of challenging
behaviors.
3. CHALLENGING BEHAVIOR EFFECTIVENESS INDICATOR:
The BSC describes the individual’s current patterns of challenging behavior and recommends a
hierarchy of direct intervention. Three critical considerations are an analysis of antecedent
conditions specific to a behavior; a thorough description or data derived baseline of the
intensity/severity, frequency, episode duration, and intervals between episodes; and, a proposed
assessment of the adaptation or function that the behavior represents to the individual. This
serves as a reference to how and why certain patterns of relating and behavior are established and
maintained. The proposed adaptation or function is supported by observation, report, and/or data.
The BSC describes the starting point from which progress and support effectiveness will be
determined. The individual’s family and staff capacity to understand and observe factors
contributing to challenging behavior is enhanced as well. Ideally, the individual and full IDT
contribute to identifying which behaviors to specifically address and/or whether to consider
behavior with similar functions to be grouped according to outcome severity as determined by if
and how it interferes with the person’s quality of life. (See attached descriptions of distracting,
disruptive, and destructive behavior).
4. INTERDISCIPLINARY TEAM EFFECTIVENESS INDICATOR:
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The goal of enhanced quality of life is founded on underlying values that are essential to positive
approaches. The foundation values are:
a. Supports and services are person-centered and rely on specialized and generic resources.
b. Individual rights and dignity are respected and protected.
c. Individuals are protected from undue health and safety risks and are free from abuse,
neglect, coercion, and exploitation.
d. Behavior is understood from a broad ecological context.
The BSC contributes to the IDT’s holistic understanding of the individual from a current and
historical perspective that guides team planning and subsequent support. The individual’s family
and staff will have enhanced confidence and capacity for responding to challenging behavior as
well. This is observed regardless of impact on traditional behavioral topographies. The BSC is
responsible for assessing the IDT’s current perspective and understanding regarding relationship,
environmental, and activity issues. Team strengths reflecting perspectives, practices, and
understandings the BSC finds are consistent with positive behavior support should be noted.
Perceived team perspectives, practices, and understandings inconsistent with Positive
Approaches should be identified. The needs are then addressed in the PBSP.
D.
RESOURCE ALLOCATION DETERMINATION
In this section the BSC must clearly present the case for how BSC hours will be requested and
potentially allocated. This is not meant to be a re-statement of the information contained in the
main body of the PBSA but is a brief summation of relevant factors that are clearly supported by
the information contained throughout the main body of the PBSA. This relates directly to the
completion of the BSCPAR and will ease the Prior Approval process for both the BSC and the
PA Agency.
Please refer to the Clinical Necessity Criteria documents and the Resource Allocation Model for
BSCs for more thorough descriptions of some of the factors below.
1. CLINICAL IMPRESSIONS:
The BSC is responsible for summarizing their assessed impression of the individual’s
status, positive support needs, and facilitating a discussion with IDT members. Again, the
BSC and team must refer to the Clinical Criteria for on-going services to determine
whether prior approval should be requested. The PBSA will be the principal document
supporting that decision.
2. CLINICAL NECESSITY CRITERIA:
Using the Clinical Necessity Criteria Guidelines the BSC must determine if the current
status of the individual and IDT meets the definition(s) of any of the 3 inclusion
categories AND does not meet any of the 6 exclusion categories.
In this section the BSC will outline which specific inclusion criteria (if any) apply and
describe any applicable exclusion criteria present at the time of the assessment.
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Note: If via the PBSA process the BSC determines that no inclusion criteria are fulfilled
OR any exclusion criteria are fulfilled the BSC will skip sections D.3 – D.6 and state the
recommendation for no BSC services in section E.
3. FADING FACTOR OR RETAIN/RETURN TO CORE HOURS
The BSC must propose whether or not to move to fading of BSC units.
Fading is assumed to be in effect unless:
 This is the first year the individual has received BSC services; or
 The individual has not had BSC services in any portion of the previous 2
ISP terms; or
 The individual has a new place of employment or a significantly different
position at his/her job; or
 The individual has recently moved to customized in-home supports from
Family Living or Supported Living; or
 Completely new BSC goal that is related to an ISP goal; or
 There is a new diagnostic issue with a related health/safety concern; or
 There is an ongoing severe psychiatric or behavioral condition that may
make fading of BSC unsafe for self or others
o This condition must be clearly justified/represented in the body of
the PBSA
If any of the above factor(s) is/are present the BSC must clearly describe said factor(s)
and state the need to return or retain the core hours. If not – please state that the Fading
Factor applies.
4. COMPLEXITY FACTOR
Certain situations, patterns, or attributes (either ongoing or newly occurring) create a
clinical complexity that may necessitate an increased involvement of BSC observations,
interventions, trainings or other direct clinical services. These factors must be clearly
justified/represented in the body of the PBSA and may include:
 Complex service needs including poorly managed mental health symptoms, trials
of psychotropic medication, or specialized staff training in specific/complicated
interventions
 Significant change in psychiatric or medical condition(s)
 Development of new significant safety issues
If any of the above factor(s) is/are present the BSC must clearly describe said factor and
state the need for the Complexity Factor add-on. If not – please state that this section is
not currently applicable.
5. PRELIMINARY RISK SCREENING AND CONSULTATION (PRSC)
The (PRSC) add-on only applies if the individual has already completed a Preliminary
Risk Screening consultation with an OBS approved contractor AND the written
summation of the PRSC indicated the need for a Risk Management Plan.
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If this PRSC has been completed and a RMP has been recommended the BSC may
request:
 1st PRSC add-on if this is the first iteration of the RMP
 Ongoing PRSC add-on if this budget year includes a revision of a previously
compiled RMP
If in the clinical judgment of the BSC the individual and IDT may benefit from the PRSC
process then the BSC must state this recommendation in section E below. Once the PRSC
process has been completed the BSC may resubmit a revised PBSA and BSCPAR
reflecting this adjustment.
Please note – there may be situations wherein a PRSC is recommended and completed
but there is no recommendation for a Risk Management Plan. In these cases the PRSC
Add-On will not apply.
If the PRSC process is not applicable please state so.
6. CRISIS SUPPORTS
The Crisis Supports Add-On only applies if the individual has already been approved for
Crisis Supports by OBS.
If requesting the Crisis Supports Add-On please provide a description regarding how the
additional 20 hours will be utilized.
Please note: Ongoing Crisis Supports may only be approved for two 6-month periods. If
after this period the situation continues to require additional supports then the IDT may
request a Category H assignment. Assignment to Category H will be determined by
DDSD on a case-by-case basis.
E. SERVICE RECOMMENDATIONS AND REQUEST FOR UNITS
Regardless of the determined need for BSC services the BSC may provide a statement of
recommendations regarding potential ancillary services or community supports that may
be of benefit to the individual or IDT.
a. If the BSC has determined that any Exclusion Criteria are applicable (as reflected in
Section D.2):
 Provide recommendations regarding changes in services, training needs, and/or
addition/continuation of community behavioral/mental health services
 Provide tentative therapeutic goals to pass on to community behavioral/mental
health service provider
 OR provide a statement that no ancillary services or community supports are
currently recommended
b. If the BSC has determined that the current status fulfills clinical necessity criteria (as
reflected in Section D.2):
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
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State the recommendation to formulate/continue BSC support and intervention
strategies (i.e. create/continue Positive Behavior Support Plan; conduct trainings;
on-site visit frequency)
State any recommendations for PRSC or Crisis add-ons that are not already
present
Provide any additional recommendations regarding services as in section E.a
above
Utilizing the formulas/process of the BSCPAR provide a brief statement of the number of
hours requested for BSC services
Sign and date the document, submit with the BSCPAR and any other
applicable/requested documentation.
Attachment A-Distracting, disruptive and destructive behavior
Distracting Behavior-Means behavior that others find annoying, “pesky,” negative, and
undesirable that do not imminently cause significant harm. These behaviors may occur at a
frequency and intensity that maintaining family and peer relationships and retaining staff are
compromised. Distracting behavior may also exclude participation and presence in community
settings. Active examples include perseverative questioning and comments, offensive language
or gestures, constant touching, and unusual self-regulating behavior. Passive examples include
refusing to participate in activities, refusing to enter/exit vehicles or settings, and physical and
personal withdrawal.
Disruptive Behavior-Means behavior that interrupts habilitation, creates a potential vulnerability
for the individual, is potentially harmful to self or others, and calls significant negative attention
to the individual. Disruptive behavior suspends desired support for the individual and their peers.
Support is increasingly organized around intervention and management with decreasing attention
to enhancing positive behavior and pursuing habilitation goals identified in the Individual
Support Plan (ISP). Examples include verbal aggression, including threats and patently obscene
and offensive language; risky decisions about health and safety; self neglect, including extremely
poor personal hygiene; problematic choices of friends and/or sexual partners; financial disregard;
illicit drug and alcohol abuse; minor property damage; and chronic refusal of services required to
satisfy Medicaid DD Waiver regulations.
Destructive Behavior- Means behaviors that result in physical injury and/or great emotional
harm. The individual, peers, staff, family, and community members may each or all be
jeopardized. A typical result is that support is increasingly reactive and designed to control the
person and their behavior. The individual is usually given fewer relationship options, activities,
and environment choices due to the real or perceived risk. Examples range from reparable tissue
damage to potentially lethal acts. The extreme episodes may be intermittent or chronic. Some
episodes of substantial property damage, such as fire starting, are also included.
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