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Implementation Drivers for Organization-Wide Positive Behavior Support: Supporting People with Intellectual and Developmental Disabilities

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Title: Implementation Drivers for Organization-Wide Positive Behavior Support: Supporting People with Intellectual and Developmental Disabilities
Language: English
Authors: Rachel Freeman, Jennifer Jeffrey-Pearsall, Dani Dunphy, Jessica Simacek, Stacy Danov, Ashley MacSuga-Gage, Margaret Moore
Source: Intellectual and Developmental Disabilities. 2025 63(4):344-357.
Availability: American Association on Intellectual and Developmental Disabilities. P.O. Box 1897, Lawrence, KS 66044-1897. Tel: 785-843-1235; Fax: 785-843-1274; e-mail: AJMR@allenpress.com; Web site: https://meridian.allenpress.com/aaidd
Peer Reviewed: Y
Page Count: 14
Publication Date: 2025
Document Type: Journal Articles
Reports - Descriptive
Descriptors: Positive Behavior Supports, Quality of Life, Students with Disabilities, Intellectual Disability, Developmental Disabilities, Daily Living Skills, Supported Employment, Day Programs
DOI: 10.1352/1934-9556-63.4.344
ISSN: 1934-9491
1934-9556
Abstract: Organization-wide positive behavior support (OW-PBS) is a framework for improving quality of life and preventing challenging behaviors for children and adults with intellectual and developmental disabilities (IDD). This tiered PBS framework has been adapted from schools for use in disability services. Supporting people with IDD involves a variety of services (family and home, independent living skills, supported employment, and day programs) and requires a values-based approach. Although the process of translating PBS from education to disability service organizations requires adaptations to the technical assistance tools and resources, the foundational implementation science drivers--and challenges--are analogous. In this article, the mechanisms for adapting the PBS framework into disability service organizations is discussed, with considerations for ensuring person-centered, culturally inclusive and responsive practices.
Abstractor: As Provided
Entry Date: 2025
Accession Number: EJ1481105
Database: ERIC
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  Value: <anid>AN0187281715;[394c]01aug.25;2025Aug14.05:22;v2.2.500</anid> <title id="AN0187281715-1">Implementation Drivers for Organization-Wide Positive Behavior Support: Supporting People With Intellectual and Developmental Disabilities </title> <p>Organization-wide positive behavior support (OW-PBS) is a framework for improving quality of life and preventing challenging behaviors for children and adults with intellectual and developmental disabilities (IDD). This tiered PBS framework has been adapted from schools for use in disability services. Supporting people with IDD involves a variety of services (family and home, independent living skills, supported employment, and day programs) and requires a values-based approach. Although the process of translating PBS from education to disability service organizations requires adaptations to the technical assistance tools and resources, the foundational implementation science drivers—and challenges—are analogous. In this article, the mechanisms for adapting the PBS framework into disability service organizations is discussed, with considerations for ensuring person-centered, culturally inclusive and responsive practices.</p> <p>Keywords: evidence-based practices; MTSS; implementation science; systems change; positive behavior support; culturally responsive systems change</p> <p>Evidence-based practices (EBPs) for individuals with intellectual and developmental disabilities (IDD) are used to improve quality of life, address social and communication skills, and actualize effective self-regulation and self-determination ([<reflink idref="bib49" id="ref1">49</reflink>]). Environmental settings that are predictable, culturally inclusive, person-centered, and promote effective communication, self-management, and self-determination skills are more likely to be associated with optimal and above average quality of life outcomes for people with IDD ([<reflink idref="bib7" id="ref2">7</reflink>]). The sustainable, wide-scale implementation of these EBPs with fidelity, however, remains elusive ([<reflink idref="bib13" id="ref3">13</reflink>]). Organizations providing services to people with IDD face a myriad of challenges making it difficult to achieve proactive and positive environments ([<reflink idref="bib32" id="ref4">32</reflink>]). Staff attrition and shortages, considered to be a crisis for the disability field before the COVID-19 pandemic, have currently reached dire levels nationally ([<reflink idref="bib24" id="ref5">24</reflink>]). The attrition of personnel in disability services reflects larger societal trends associated with the "Great Resignation," ([<reflink idref="bib33" id="ref6">33</reflink>]). With the current staffing crisis in disability services, provider organizations are facing increases in stressful conditions for staff, interruptions in programs due to funding issues, and unpredictable environmental conditions ([<reflink idref="bib24" id="ref7">24</reflink>]).</p> <p>The term <emph>challenging behavior</emph> has been challenged by autistic self-advocates responding to behavioral services and supports in the IDD field ([<reflink idref="bib4" id="ref8">4</reflink>]). A key issue mentioned in ASAN's 2024 report is that the term challenging behavior is misleading because it can be defined by the person themselves ("I have a habit that is interfering with my life"), the people immediately around the person ("as a parent, I am worried that I can't keep my child safe at home"), or by society in general ("I have been arrested and charged with property destruction"). The ASAN report recommends using precise definitions in order to avoid confusion and/or attributing negative behaviors to a person when the real problem is that services and supports are not adequately tailored to meet an individual's needs. We believe the generic use of terms (such as challenging, interfering, problem behavior) should only be used when addressing the topic in a general manner. Thus, the term challenging behavior is used herein to reflect the varying types of behaviors all humans engage in that may interfere with quality of life while recognizing that each individual's point of view must be considered first. We believe that all people have the right to define what behaviors, if any, they consider to be interfering with their quality of life.</p> <p>Individuals receiving services who engage in challenging behavior resulting in injury to self or others represent 5% to 15% of the IDD population ([<reflink idref="bib35" id="ref9">35</reflink>]). Challenging behaviors are often occasioned by factors associated with the environment and social interactions as well as genetic, physiological, and behavioral health issues ([<reflink idref="bib9" id="ref10">9</reflink>]). Many challenging behaviors are maintained by socially mediated functions representing attempts by children and adults with IDD to communicate what they need to others ([<reflink idref="bib7" id="ref11">7</reflink>]). Service systems supporting individuals with IDD often do not adequately meet these needs. Children and adults who engage in challenging behavior face poor quality of life outcomes, fewer opportunities to participate meaningfully in their communities, lower levels of employment, and more restrictive environments ([<reflink idref="bib1" id="ref12">1</reflink>]).</p> <p>Positive behavior support (PBS) is a framework for restructuring environments, increasing quality of life and preventing challenging behavior using a continuum of interventions that increase in intensity ([<reflink idref="bib7" id="ref13">7</reflink>]). The goal of this article is to describe how one type of PBS framework for improving quality of life and preventing challenging behaviors has been translated from school systems and applied within provider organizations using the science of implementation. Outlined in this article are the key elements for promoting effective, sustainable implementation of person-driven PBS at a scale of significance in human service systems. We discuss creating a positive climate, which requires everyone (administrators, direct support staff, management and supervisors, people receiving services, and caregivers) to work together to improve communication, nurture relationships, celebrate differences, and change systems. To create a positive, inclusive, and equitable climate, we propose the centering of culturally responsive and social and disability justice focused practices—defined here as a model of cultural inclusivity—at each stage of translation of PBS practices into organization-wide positive behavior support (OW-PBS). Understanding how each person within an organization can contribute to implicit bias expressed as ableism and racism requires a multipronged approach with ongoing opportunities for self-reflection and an emotionally supportive climate for change.</p> <p>OW-PBS is a value-driven effort that focuses on person-centered and culturally-responsive implementation. We define the term <emph>value-driven</emph> as any actions taken to intentionally implement EBPs in ways that are based on the core beliefs, perspectives, and culture of the people involved and directly impacted. Changes made in value-driven efforts focus on (a) the practices that everyone agrees reflect the collective beliefs and viewpoints held by all individuals within an organization, not just one dominant subgroup; (b) encouraging collaboration, feedback, and participation via systems within the organizations as well as the larger community; and (c) collecting data that will help ensure practices remain focused on these beliefs and viewpoints.</p> <hd id="AN0187281715-2">History of PBS and Emerging Equity Concerns</hd> <p>The field of PBS emerged in the early 1990s as an alternative approach to the use of aversive strategies to control or manage behavior. PBS was designed based on the foundational elements of applied behavior analysis, biomedical research, person-centered practices, and other EBPs with the major goal of empowering people with IDD to build their own self-determined lives in the community ([<reflink idref="bib25" id="ref14">25</reflink>]). PBS is a values-based and evidence-driven practice used to improve a child or adult's quality of life thereby reducing and/or preventing challenging behaviors ([<reflink idref="bib8" id="ref15">8</reflink>]). Carr and his colleagues defined PBS as a set of strategies focusing on four elements: (<reflink idref="bib1" id="ref16">1</reflink>) personally held values and person-centered outcomes, (<reflink idref="bib2" id="ref17">2</reflink>) validated procedures, (<reflink idref="bib3" id="ref18">3</reflink>) behavioral and biomedical science, and (<reflink idref="bib4" id="ref19">4</reflink>) the use of systems change.</p> <p>The term school-wide positive behavioral interventions and supports (PBIS) describes one type of PBS that is well documented as an EBP ([<reflink idref="bib26" id="ref20">26</reflink>]). PBIS is a proactive and preventative framework that evolved in the 90s based on the school-wide research efforts of Sugai ([<reflink idref="bib48" id="ref21">48</reflink>]), and the work of early PBS founders ([<reflink idref="bib25" id="ref22">25</reflink>]). PBIS is not a curriculum or a scripted program, but rather a framework promoting a process for capacity building among professionals along with continuous engagement in professional development ([<reflink idref="bib28" id="ref23">28</reflink>]). Thus, the goal of PBIS is to develop efficient and effective systems to identify students in need of behavior support ([<reflink idref="bib46" id="ref24">46</reflink>]).</p> <p>The intensity of instruction and supports is determined by student data and responsiveness to intervention ([<reflink idref="bib26" id="ref25">26</reflink>]). PBIS relies on three tiers of prevention and intervention: universal (Tier 1), secondary (Tier 2), and tertiary (Tier 3). At the universal Tier 1 level, teams develop school-wide behavioral expectations and procedures for teaching and reinforcing social and emotional skills in all settings within the school while creating consistent ways in which to respond to challenges that arise. School-wide data used for decision making include office discipline referrals (ODR), suspension data, attendance patterns, nurses and counselor visits, grades, and individual measures of behavior are then used to identify students not responding to universal supports. Students can choose options for Tier 2 interventions, which are often delivered in a group setting (e.g., social skills lessons) or involve efficient structured interventions that provide additional access to, and practice with, Tier 1 strategies (e.g., Check In, Check Out; [<reflink idref="bib11" id="ref26">11</reflink>]). Serious challenging behaviors involve more individualized and intensive Tier 3 supports. Students and family members meet regularly with an individualized team providing support to discuss each of the three tiers and oversee implementation and make data-based decisions ([<reflink idref="bib28" id="ref27">28</reflink>]).</p> <p>Although many positive outcomes are reported in PBIS research ([<reflink idref="bib22" id="ref28">22</reflink>]), concerns remain that disparities related to Black Indigenous, and Other People of Color (BIPOC) are disproportionately represented in special education referrals related to emotional behavioral disorders and harsher disciplinary actions ([<reflink idref="bib40" id="ref29">40</reflink>]). This leads to reflection about whether PBIS has been supportive of all students and to what extent it includes culturally responsive practices. Although PBS has included research targeting racism and disparities over the years ([<reflink idref="bib2" id="ref30">2</reflink>]; [<reflink idref="bib47" id="ref31">47</reflink>]), a more wide-scale and intentional effort to integrate and embed culturally responsive strategies as a core feature of PBIS is now considered essential ([<reflink idref="bib40" id="ref32">40</reflink>]). For example, one equity-focused PBIS intervention model introduces staff to implicit bias and how to neutralize it by teaching them how become more aware of their automatic responses and replacing these automatic behaviors with a more culturally responsive approach (ReACT; [<reflink idref="bib37" id="ref33">37</reflink>]). The ReACT model includes an ongoing review of disaggregated school-wide discipline data to monitor racial and ethnic demographics coupled with root cause analysis. ReACT includes culturally responsive strategies at the universal level of PBS (e.g., strategies to strengthen relationships between students and educators).</p> <p>A key tenet for establishing culturally responsive and nonableist strategies in the implementation of PBS and PBIS involves recognizing the need for the use of sensitive, respectful, and inclusive language. Advocates within the neurodiversity and advocacy movements recommend that the field of PBS address this important issue ([<reflink idref="bib16" id="ref34">16</reflink>]). A review of past seminal work in PBS provides examples of how language has not always been sensitive to people on the Autism spectrum and with IDD ([<reflink idref="bib8" id="ref35">8</reflink>]). If implemented as intended, children and adults who seek out individualized PBS begin with a person-centered plan and are empowered to choose their own team and to guide their planning process with quality of life measurement tools ([<reflink idref="bib7" id="ref36">7</reflink>]). However, it is clear that PBS as well as any other practices are, at times, implemented with poor fidelity and without attention to cultural adaptations ([<reflink idref="bib10" id="ref37">10</reflink>]).</p> <p>There is a need for a renewed focus by PBS and PBIS leaders on the person-driven values that are more closely associated with earlier research and technical assistance efforts reflected during the nonaversive advocacy and deinstitutionalization period in the 1980s and 1990s ([<reflink idref="bib36" id="ref38">36</reflink>]). Clearly, children and adults are still at risk for institutionalized settings, albeit in the form of hospital discharge delays in acute care settings. Although early PBS efforts were based on, and coincided with, the civil rights movement, mostly White, middle-class people with IDD benefited from this practice for many years. Current social and disability justice advocates encourage a more inclusive message that combines efforts to address both ableism and racism in a unified approach to address inequities in today's society ([<reflink idref="bib3" id="ref39">3</reflink>]).</p> <hd id="AN0187281715-3">Translation of Essential PBIS Features to OW-PBS</hd> <p>Although the systems, data, and practices vary, the PBS framework used in schools is now being adapted in a wide variety of settings including early childhood and juvenile justice ([<reflink idref="bib36" id="ref40">36</reflink>]). There are only a few examples of these adaptations into human service organizations currently available ([<reflink idref="bib17" id="ref41">17</reflink>]). The core elements shared by schools and human service settings that enhance the transfer of effective implementation include (a)forming an organization-wide team; (b) assessing readiness; (c) conducting an assessment of organizational strengths and needs related to systems for preventing challenging behavior: (d) creating an action plan; and (e) evaluating effort, fidelity, and outcome data. Both education and human services emphasize action plans that result in (a) making policy and procedural changes; (b) teaching, modeling, and encouraging social and emotional skills; (c) responding consistently to challenging social interactions using conflict management and behavioral principles for preventing escalation; (d) establishing ongoing coaching and mentoring of staff; (e) engaging in efforts to reach out to the community; and (f) using data to drive decision making, including the explicit review of disaggregated data on race/ethnicity.</p> <p>The contrasts in implementation across schools and human service settings are most evident in (a) the focus of person-driven values held within the disability field; (b) the 24-hr nature of services occurring in homes and in employment settings; and (c) the diversity of family systems and homes as smaller units within the larger organizational context. Adaptations to the PBIS methods used by schools at Tier 1 applied to home and community-based settings reflect the varying cultural perspectives held between educational and human service systems. Schools are tasked with managing large groups of students whereas home and community services are supporting children and adults who are living their personal lives in the manner in which they determine. The systems, tools, and language associated with teaching children are very different compared to what is needed to support independent self-determined adults in home, work, and community settings. Universal strategies for teaching, modeling, and practicing positive social and emotional skills with adults require a sensitivity and flexibility with respect to the language used across these different adult service settings.</p> <p>For instance, some individuals with IDD have prior negative experiences associated with terms such as "rules and expectations" and will actively avoid any language that appears to be driven by an attempt to manage or modify their behavior ([<reflink idref="bib17" id="ref42">17</reflink>]). However, in other situations, adults with IDD who are living with another roommate may indicate that they appreciate the process of identifying group-held rules and expectations for living together in harmony. <emph>The key message is that people with IDD have the right to determine the use of language throughout implementation of PBS as well as the manner in which all practices are implemented.</emph> The complexity of home, work, and community contexts vary considerably and, therefore, Tier 1 strategies must reflect this diversity. For this reason, Tier 1 involves bringing everyone together within a setting to identify the person-driven values that are the best cultural fit for a setting. Once identified, these values are then operationally defined with behaviors identified in specific routines or settings and strategies for equally addressing the behavior of family, caregivers, and staff and people supported.</p> <p>In OW-PBS, providers supporting adults with IDD are responsible for making changes in the language used in mission and vision statements, policies, procedures, training and coaching systems, as well as adding measures that help teams to better understand the perspectives and viewpoints of people with lived experience, families, and community partners across the various cultural groups represented. Fidelity of implementation measures within OW-PBS require teams to provide evidence that these changes were made. Examples from prior implementation include (a) evidence that teams have replaced terms such as "client" and "consumer" with the insertion of each person's name; (b) plain language materials are shared describing EBPs; (c) decreases are made in the complexity and length of reports shared with individuals and their families so that they are easier to understand; and (d) people with IDD are included as co-trainers, team members, and leaders in systems change efforts ([<reflink idref="bib17" id="ref43">17</reflink>]).</p> <p>Another element that contributes to the need for adaptations to the original PBIS model is based on the fact that provider organizations may support children and adults with IDD across the lifespan and often deliver services to individuals with other diagnoses including traumatic brain injury and various diagnoses of mental illnesses. Organizational systems are designed in different ways to address supports across the life span from early childhood to 65+ services. The size and complexity of organizations also vary as do the types of services being offered. Residential supports, independent living services, employment and day services, family-based supports, family foster care, respite, crisis services, senior care are just a few examples of services where PBS is implemented. All of these variations in systems create challenges that make it difficult to use existing school-based PBIS assessment tools and resources. Therefore, guidance in the process, tools, and language involved in the change process is tailored to the unique people, age ranges, characteristics, and systems involved. Outcome measures addressing the challenges that providers encounter vary compared to PBIS, some measures are similar while others are quite different from educational settings.</p> <p>A number of fidelity of implementation tools are adapted from PBIS for human services and are currently used by teams to evaluate the extent to which provider organizations are implementing a tiered model of PBS ([<reflink idref="bib17" id="ref44">17</reflink>]; [<reflink idref="bib43" id="ref45">43</reflink>]), although these fidelity measures are still undergoing psychometric validation. Assessment tools used to assess organizations exist at the Tier 3 level and to evaluate quality of life ([<reflink idref="bib5" id="ref46">5</reflink>]; [<reflink idref="bib44" id="ref47">44</reflink>]). Tools are available to assess the policies, training, supervisory systems, perceptions of different groups involved, cultural responsiveness, and climate in human service settings ([<reflink idref="bib18" id="ref48">18</reflink>]).</p> <p>Systems for data-based decision making are established at each tier. To translate data practices from school-based settings to IDD-serving organizations, analogous forms of outcome data can be helpful. SW-PBIS research studies explore the validity of office discipline referrals as a measure of change ([<reflink idref="bib30" id="ref49">30</reflink>]), and we believe provide a rationale for using incident reports for evaluation purposes in human services. Incident reports are used to document the occurrence of problematic situations (aggression towards others, self-injury, property destruction, etc.) that arise in provider organizations. The incident report is used to evaluate information such as the types of challenging behavior, location of incidents, individuals involved, time of day, and why challenging behavior is occurring. The data provide important information that can be used to implement interventions across an organization, to focus onboarding and ongoing staff training, change policies, and re-allocate resources for preventing or decreasing challenging behavior. Other forms of data collected by agencies serving people with IDD at Tier 1 include (a) individual quality of life measures; (b) staff and consumer satisfaction, stress, and climate surveys; (c) organizational data related to staff attrition, retention, injury, sick days, and workers compensation; (d) 911 calls and emergency room visits, use of mechanical restraint and human rights committee reviews; and (e) other forms of data.</p> <p>In order to continuously monitor and intervene when inequities are observed, data reviews by teams in OW-PBS should include processes to disaggregate by race and ethnicity. Embedding this process into team training for data acquisition and on-going explicit review will help to identify whether negative outcomes—such as overuse of 911 calls or use of mechanical restraint—are disproportionally being used with BIPOC populations. Teams also require training in the use of what to do to intervene when challenges related to inequities are identified. The root cause analysis recommended by [<reflink idref="bib37" id="ref50">37</reflink>] and [<reflink idref="bib38" id="ref51">38</reflink>] provides one potential strategy to help teams problem solve challenges that arise.</p> <p>The next section of this article addresses how implementation science developed by Fixsen and his colleagues (2005) is applied to PBS in provider organizations. In 2005, Fixsen conducted an important systematic review that broadened the exploration of key elements of effective EBPs. As authors and early students during the time PBIS was established, we observed PBIS and implementation science evolve independently as part of a "Zeitgeist," or spirit of the moment in human services. During this period of time, attention was directed towards how EBPs are deployed as part of a call for a larger systems framework for supporting sustainable change across the education, behavioral health, and human service fields.</p> <hd id="AN0187281715-4">OW-PBS Through Implementation Science and Cultural Inclusivity in Provider Organizations</hd> <p>Organizations providing services to children and adults in home and community settings who are invested in effective implementation of PBS, person-centered practices, and other EBPs experience a nonlinear evolution in the types of activities, priorities, and systems-change efforts that are considered priorities ([<reflink idref="bib14" id="ref52">14</reflink>]). The stages of implementation outlined by Fixsen and his colleagues are applied to organization-wide PBS in this section. Four stages are described by [<reflink idref="bib13" id="ref53">13</reflink>]: exploration, installation, initial implementation, and full implementation. The <bold><emph>exploration stage</emph></bold> refers to the steps involved for an organization-wide team still assessing the readiness of people receiving services and staff to move forward with PBS or other EBPs. The <bold><emph>installation stage</emph></bold> occurs when teams actively select PBS, secure resources needed for implementation, and begin developing the initial training systems. When an organization-wide team is at the <bold><emph>initial implementation stage,</emph></bold> efforts often reflect a large learning curve as new practices are introduced and integrated into daily work. A team is at <bold><emph>full implementation</emph></bold> when over half of the staff and services targeted are being implemented at a high level of fidelity and evaluation data are reported regularly.</p> <hd id="AN0187281715-5">Implementation Science: Organizational, Competency, and Leadership Drivers</hd> <p>Implementation science leaders have identified core components that are commonly associated with successfully embedding practices irrespective of whether the setting of interest is in education, IDD mental health, juvenile justice, or any other human service organization ([<reflink idref="bib13" id="ref54">13</reflink>]). These core components are called <emph>implementation drivers</emph> ([<reflink idref="bib41" id="ref55">41</reflink>]). Three major drivers are related to staff competency, organizational issues, and leadership-level skills. Figure 1 describes how cultural inclusivity is integrated within provider organizations across each of these drivers.</p> <p>PHOTO (COLOR): Figure 1 Implementation Science Drivers Note: From Key Features of Tiered Positive Behavior Support Across the Lifespan, by R. Freeman, J. Jeffrey-Pearsall, D. Dunphy, J. Simacek, S. Danov, A. MacSuga-Gage, and M. Moore, 2024, presented at the 21st Annual Conference for Positive Behavior Support. Copyright 2024 by the Institute for Community Integration, University of Minnesota. Reprinted with permission.</p> <hd id="AN0187281715-6">Competency Drivers</hd> <p>Competency drivers refer to the actions, mechanisms, and resources needed to improve the necessary knowledge and skills of people receiving services, staff, managers/supervisors, and administrators implementing tiered support models ([<reflink idref="bib13" id="ref56">13</reflink>]). The four competency drivers outlined by Fixsen and his colleagues (2005) include performance assessment, selection, training, and coaching (see Table 1).</p> <p>Table 1 Examples of Implementation Drivers for Integrated Efforts in Organizations</p> <p>PHOTO (COLOR)</p> <hd id="AN0187281715-7">Performance Assessment</hd> <p>At the top of Figure 1, performance assessment is highlighted as an important element of implementation science. Performance assessment involves evaluating the fidelity of implementation, or the degree to which each EBP is being implemented in the manner intended ([<reflink idref="bib21" id="ref57">21</reflink>]). Fidelity of implementation at the systems level uses both external evaluation and self-assessment ([<reflink idref="bib29" id="ref58">29</reflink>]; [<reflink idref="bib39" id="ref59">39</reflink>]). External evaluation provides an objective outsider's view of implementation whereas self-assessment strategies can be used to guide a team's progress and are easier for teams to complete. At Tiers 2 and 3, performance assessment is focused on the accurate implementation of group, targeted, and individualized plans ([<reflink idref="bib42" id="ref60">42</reflink>]). In provider organizations, children and adults are involved in PBS at Tiers 2 and 3 as part of their own choice with interventions chosen based on each person's self-determined goals ([<reflink idref="bib15" id="ref61">15</reflink>]). Tier 2 and 3 systems are assessed for evidence that interventions are function based, although functional assessment varies in intensity at tiers 2 and 3. Teams establishing Tier 2 and 3 systems evaluate the fidelity of implementation of the data, systems, and practices designed to launch and sustain PBS over time.</p> <hd id="AN0187281715-8">Selection</hd> <p>The different roles within tiered support models (planning team members, EBP trainers, coaches, and facilitators) require a variety of skills, experiences, and foci. Recruiting people to take on these responsibilities requires an understanding of what is needed for each role. For instance, some individuals will be well suited to become peer coaches whereas others may feel uncomfortable in this type of role. Larger systems issues related to selection include the extent to which funding is available to invest in training for teams, coaches, trainers, and other roles ([<reflink idref="bib13" id="ref62">13</reflink>]). In small organizations and more rural settings within a state, organizations struggle to address selection challenges, especially when only a few people are involved in implementation efforts while holding multiple job roles within the organization. It is not uncommon to hear administrators in provider organizations state that the degree of staff attrition makes implementation challenging. Selecting managers and supervisors who represent lower turnover patterns for roles that require more expertise (trainers and mentors) can be an important intervention to avoid loss of capacity due to staff attrition. Coaches and trainers who reflect the diversity of the organization will build a more culturally responsive and inclusive climate which, in turn, can help address attrition by addressing feelings of isolation by staff.</p> <hd id="AN0187281715-9">Training</hd> <p>The types of training needed to help staff representing different roles and positions within an organization implement PBS will vary in length and complexity. Intensive instruction on the designing functional behavioral assessment is unnecessary for individuals who may only require awareness-level information about PBS and other practices. For this reason, onboarding new staff involves introducing key concepts of PBS. Ongoing staff training systems build on these introductory learning opportunities in a variety of ways (embedding additional content into staff meetings, peer coaching, providing self-driven learning opportunities that prompt staff to check in with more experienced individuals, etc.).</p> <p>An important element of training is the intentional integration of person-centered and culturally responsive practices into PBS. Opportunities to learn about and practice empathy in an authentic manner can be challenging to orchestrate but is an important element within PBS. Pairing training in empathy with direct observation and the opportunity to reflect on one's practice with others can provide a deeper level of self-awareness and an understanding of others.</p> <hd id="AN0187281715-10">Coaching</hd> <p>An important part of systems change involves offering continual learning experiences so that staff members can try new skills and reflect on their experiences while continuing to master key concepts in everyday practice ([<reflink idref="bib31" id="ref63">31</reflink>]). Coaching systems can be designed as a peer-based learning process where staff with a little more experience share what they know with their colleagues or can be delivered by someone with expertise who works with staff members in their job every day ([<reflink idref="bib45" id="ref64">45</reflink>]). Coaching is used to support a number of roles and activities. Coaches are needed to guide the organization-wide team meetings, introduce universal Tier 1 strategies, and to support individual professionals who are learning specific skills at Tiers 2 and 3. Trainers receive mentoring from others as they continue to learn how to impart knowledge and sustain coaching systems ([<reflink idref="bib31" id="ref65">31</reflink>]). Tools for guiding coaches in culturally responsive practices have been increasing ([<reflink idref="bib34" id="ref66">34</reflink>]), with activities built into team fidelity of implementation tools ([<reflink idref="bib17" id="ref67">17</reflink>]).</p> <hd id="AN0187281715-11">Organization Drivers</hd> <p>Organization drivers are the foundational elements used by teams in establishing an infrastructure needed to support an EBP and implement systems change ([<reflink idref="bib41" id="ref68">41</reflink>]). These elements are used to monitor progress and maintain feedback communication loops that allow teams to share information in a transparent manner ([<reflink idref="bib6" id="ref69">6</reflink>]). Data-based decision-making systems, facilitative administration, and systems interventions are three important elements of organization drivers.</p> <hd id="AN0187281715-12">Data-Based Decision-Making Systems</hd> <p>Team self-assessment and action planning is driven using data to guide problem-solving. Establishing reliable, current sources of effort and outcome data can help an organization understand how well PBS is being implemented and maintained over time. Some types of measures mentioned earlier in this article include quality of life data, incident reports, staff attrition and retention, injury, sick days, and workers compensation. Data are reviewed by teams on a regular basis using organization-wide as well as data at an individual level. An array of tools is available in the IDD field to guide teams in assessing strengths and needs of the organization and evaluating the implementation of each EBP ([<reflink idref="bib18" id="ref70">18</reflink>]).</p> <p>Organizations investing in different sources of data to monitor cultural responsiveness can improve climate issues within an organization. These data can help teams identify issues related to equity and provide a way to begin building a climate of trust with staff representing marginalized communities. Examples of data used to understand equity issues related to race and ethnicity beyond the assessment of incident reports, include surveys of relationship quality, perceptions of trust, quality of the climate, and other similar variables. Research in PBIS suggests that sharing data without additional culturally responsive interventions will have little impact on the quality of equitable change ([<reflink idref="bib40" id="ref71">40</reflink>]). A more comprehensive approach is needed, one that involves actively listening to the stories and experiences of people within the organization and facilitating partnerships ([<reflink idref="bib12" id="ref72">12</reflink>]).</p> <p>Another strategy for evaluating change is direct observation. Direct observation can be used as a part of supervisory and staff performance systems to provide support and understand whether changes in staff behavior are occurring over time. For example, a simple interval recording measure is used as part of the annual Tiered Onsite Evaluation Tool ([<reflink idref="bib17" id="ref73">17</reflink>]). Teams use community-based assessment and action planning to build natural supports and/or encourage relationships in community settings ([<reflink idref="bib18" id="ref74">18</reflink>]). Active support is needed for teams to master the use of data-based decision making in meetings, select tools for evaluation, and use this information to maintain PBS efforts. One evidence-based approach in schools used to systematically teach data-based decision making to teams, referred to as the Team Initiated Problem Solving (TIPS; [<reflink idref="bib27" id="ref75">27</reflink>]), has been adapted for use in community service organizations.</p> <hd id="AN0187281715-13">Facilitative Administration</hd> <p>The active leadership and guidance involved in implementing PBS is referred to as facilitative administration ([<reflink idref="bib13" id="ref76">13</reflink>]). Facilitative administration refers to the actions taken by leaders to guide decisions about incorporating key values into the mission and vision statement of an organization, altering existing policies and procedures, and providing teams with opportunities to meet and review data and engage in problem solving. Strong systems change involves leadership at different levels ([<reflink idref="bib21" id="ref77">21</reflink>]). People receiving services, trainers, administrator(s), coaches, supervisors and managers, and other individuals are involved in facilitative administration at different levels within an organization or system. Strong facilitative administration contributes to building relationships based on trust with everyone and ensures culturally responsive communication is maintained.</p> <hd id="AN0187281715-14">Systems Interventions</hd> <p>Changes that occur at federal, state, regional, organizational, and community levels can impact the culture and context, policies and procedures, and political context in which PBS is implemented ([<reflink idref="bib13" id="ref78">13</reflink>]). Organizations that are effective at systems change actively consider how systems can help or create barriers for sustainable implementation. Another systems intervention is to form local and regional partnerships to support ongoing PBS efforts and leverage limited funds. For example, provider organizations in one state shared the costs for onboarding new staff by allowing individuals to attend trainings across organizational sites. Each organization scheduled onboarding trainings at set times throughout the year. This meant that when new staff need training, an organization could review the schedule and send staff to another organization already providing the training instead of relying on their own trainers to do so.</p> <hd id="AN0187281715-15">Leadership Drivers</hd> <p> <emph>Technical challenges</emph> and <emph>adaptive challenges</emph> are terms that refer to the issues that come up during implementation requiring different types of leadership and problem-solving skills ([<reflink idref="bib41" id="ref79">41</reflink>]). Technical challenges require basic management and facilitative administrative skills that are part of coordinating implementation efforts. Adaptive challenges, however, tend to involve more complex social and contextual problems.</p> <hd id="AN0187281715-16">Technical Challenges</hd> <p>Technical challenges are easily addressed using active management, training, and coordination skills. A technical challenge can be understood, defined, and addressed with little ambiguity. For example, the team may be seeking a way to address implicit bias but are unsure what tools are available that can be used as a way to increase knowledge and awareness of staff. This technical challenge (the need for tools related to implicit bias) requires someone with expertise to guide the team.</p> <hd id="AN0187281715-17">Adaptive Challenges</hd> <p>Adaptive challenges may not be immediately visible or apparent and are, therefore, more difficult to solve. Adaptive challenges are typically <emph>not</emph> resolved through traditional management-level coordination and problem solving. An example of an adaptive challenge occurs when a team member, who is also a person with lived experience receiving services, raises concerns in a Tier 1 team meeting about the term <emph>challenging behavior</emph>. This person states that behaviors that some direct support staff are describing as challenging are really just expressions of who the person is, and that, in her opinion, these behaviors should be considered part of a natural range of self-expression. The person goes on to ask the group, "who decides what a challenging behavior is within someone's own home?" In response, another team member representing other family members and guardians responds in a defensive manner indicating that if someone is engaging in a behavior that is interfering with their child's life then the behavior should be considered challenging because it isn't fair to others.</p> <p>Adaptive leaders help teams navigate the differences in values, cultural beliefs, emotional responses, frustrations, and other strong emotions that are being expressed as part of the change process. Skills associated with this type of leadership include suspending one's own opinions, active listening, and working with team members to bring everyone together to create positive change. To address "what is a challenging behavior," an effective leader may lead the group through a process that starts with the values the group is expressing as important, and guiding the group as they work together to define examples and nonexamples of what is considered challenging behavior. When everyone within the organization has a chance to contribute to decisions about these matters, the group moves can move closer to consensus. Effective leaders must be able to identify whether adaptive challenges are hidden among everyday problems since a common mistake is to apply technical leadership skills under conditions that require adaptive leadership ([<reflink idref="bib23" id="ref80">23</reflink>]).</p> <hd id="AN0187281715-18">Conclusion</hd> <p>Systems change is difficult and there are no "roadmaps," or set standard steps that can be taken by all organizations to achieve a positive and culturally responsive climate ([<reflink idref="bib20" id="ref81">20</reflink>]). Adaptive leadership is one element that will assist in culturally inclusive improvements. Real change occurs when a group of people works together to support each other, expresses empathy towards each person involved, and is able to unify their values and beliefs to achieve the outcomes they seek. In the previous adaptive leadership example, this difficult conversation could not have even occurred without earlier actions taken to include people with lived experience in the team process where they are contributing to leadership-level decisions. Each element of the implementation science process requires the spirit of inclusiveness and values-driven implementation. [<reflink idref="bib19" id="ref82">19</reflink>], a leader in education stated this well by saying <emph>"you can't mandate what matters, the more complex a change effort is, the less likely you can force individuals to become involved in the process."</emph> (p. 21). Systems change literature emphasizes the need to bring people together to establish a moral purpose that will provide individuals with unified values, a vision for moving forward, and the identification of goals that are driven by jointly held beliefs ([<reflink idref="bib20" id="ref83">20</reflink>]).</p> <p>Holding systems accountable for a value-driven EBP implementation can occur at state, regional, and/or local levels. There are an increasing number of state-driven efforts with documented policies and procedures for providing training in OW-PBS including Maryland, Massachusetts, Minnesota, and Missouri as well as large provider organizations from across the United States involved in implementation science efforts ([<reflink idref="bib17" id="ref84">17</reflink>]; [<reflink idref="bib43" id="ref85">43</reflink>]). Active participation of administrators, CEOs and leaders of provider organizations is considered a requirement for effective implementation because it helps establish accountability ([<reflink idref="bib17" id="ref86">17</reflink>]). The leaders involved in designing these training and technical assistance infrastructures for supporting OW-PBS are using implementation science to coach and mentor adaptive leaders who are implementing culturally inclusive practices as described in Figure 1 and guiding teams in implementing the actions provided in Table 1.</p> <p>Freeman and her colleagues (2023, 2024) described the first steps in one state where people with IDD are considered leaders at all levels of the systems change process in the implementation of OW-PBS. Changing the way in which organizations implement PBS requires the direct involvement and participation of people with lived experience who consult in statewide and regional oversight of OW-PBS, assist in the development of plain language materials and visibility of EBPs, co-train on curricula, and actively attend OW-PBS team action-planning meetings. Family members and caregivers are also important partners in the implementation of OW-PBS at statewide, regional, and local levels to ensure people with IDD who may choose not to participate or may have more severe disabilities experience equitable supports and services.</p> <p>Although the diversity of home and community services prevents us from providing a standard list of actions that can be adopted by all systems, we highlight the actions in Table 1 as examples that can be generalized to different services and contexts. Teams need to be comprised of members who represent the cultural diversity within an organization including those served vary by ethnicity, race, religion, people with lived experience, the lesbian, gay, bi-sexual, trans, queer, intersex, asexual communities, geographic differences where people are served, immigrant status, for equitable change to occur. Trainers who reflect the diversity of the people around them will increase the likelihood of effective use of PBS by providing people with the opportunity to learn and reflect with those who reflect on implementation holding similar cultural values. Meaningful social and disability justice efforts shift how organizations perceive ableism and racism. 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Header DbId: eric
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An: EJ1481105
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Implementation Drivers for Organization-Wide Positive Behavior Support: Supporting People with Intellectual and Developmental Disabilities
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Rachel+Freeman%22">Rachel Freeman</searchLink><br /><searchLink fieldCode="AR" term="%22Jennifer+Jeffrey-Pearsall%22">Jennifer Jeffrey-Pearsall</searchLink><br /><searchLink fieldCode="AR" term="%22Dani+Dunphy%22">Dani Dunphy</searchLink><br /><searchLink fieldCode="AR" term="%22Jessica+Simacek%22">Jessica Simacek</searchLink><br /><searchLink fieldCode="AR" term="%22Stacy+Danov%22">Stacy Danov</searchLink><br /><searchLink fieldCode="AR" term="%22Ashley+MacSuga-Gage%22">Ashley MacSuga-Gage</searchLink><br /><searchLink fieldCode="AR" term="%22Margaret+Moore%22">Margaret Moore</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Intellectual+and+Developmental+Disabilities%22"><i>Intellectual and Developmental Disabilities</i></searchLink>. 2025 63(4):344-357.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: American Association on Intellectual and Developmental Disabilities. P.O. Box 1897, Lawrence, KS 66044-1897. Tel: 785-843-1235; Fax: 785-843-1274; e-mail: AJMR@allenpress.com; Web site: https://meridian.allenpress.com/aaidd
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 14
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2025
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Descriptive
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Positive+Behavior+Supports%22">Positive Behavior Supports</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+Life%22">Quality of Life</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Developmental+Disabilities%22">Developmental Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Supported+Employment%22">Supported Employment</searchLink><br /><searchLink fieldCode="DE" term="%22Day+Programs%22">Day Programs</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1352/1934-9556-63.4.344
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1934-9491<br />1934-9556
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Organization-wide positive behavior support (OW-PBS) is a framework for improving quality of life and preventing challenging behaviors for children and adults with intellectual and developmental disabilities (IDD). This tiered PBS framework has been adapted from schools for use in disability services. Supporting people with IDD involves a variety of services (family and home, independent living skills, supported employment, and day programs) and requires a values-based approach. Although the process of translating PBS from education to disability service organizations requires adaptations to the technical assistance tools and resources, the foundational implementation science drivers--and challenges--are analogous. In this article, the mechanisms for adapting the PBS framework into disability service organizations is discussed, with considerations for ensuring person-centered, culturally inclusive and responsive practices.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2025
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1481105
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1481105
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  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1352/1934-9556-63.4.344
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 14
        StartPage: 344
    Subjects:
      – SubjectFull: Positive Behavior Supports
        Type: general
      – SubjectFull: Quality of Life
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Developmental Disabilities
        Type: general
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Supported Employment
        Type: general
      – SubjectFull: Day Programs
        Type: general
    Titles:
      – TitleFull: Implementation Drivers for Organization-Wide Positive Behavior Support: Supporting People with Intellectual and Developmental Disabilities
        Type: main
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      – PersonEntity:
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            NameFull: Rachel Freeman
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            NameFull: Jennifer Jeffrey-Pearsall
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            NameFull: Margaret Moore
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            – D: 01
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              Type: published
              Y: 2025
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            – Type: issn-print
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              Value: 63
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              Value: 4
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            – TitleFull: Intellectual and Developmental Disabilities
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