Positive Behavior Supports

Larry Ringer: Herb, in your book, you seem to reject many of the typical interventions or… or practices that people who work with people with severe and profound disabilities use, behavioral modification or behavioral management, making rewards contingent on certain behavior

Have you always felt that that was an inappropriate way of interacting with people with disabilities?

Herb Lovett: I wasn't trained to. And I should make one qualifier to that, in that, I have no argument with behavior modification and I have no argument with… contingencies so long as they're socially ordinary.

Larry Ringer: What do you mean by that?

Herb Lovett: For instance, there are programs where if you don't… if you have a bad day at work you can't watch television at night. That doesn't make any sense to me for adults. I mean that just isn't a socially ordinary contingency. But if you… if you want to go on a picnic with somebody and you've just beaten them up, chances are they're going to be less eager to go have a sandwich with you. That feels like an ordinary… And it's not, it's not a pre-designed, rigorously pursued thing. It's just I don't want to do that.

Larry Ringer: Do those tend to be powerful enough contingencies or re-inforcers so that they really have the impact you want to in eliminating the negative behavior or establishing better behavior?

Herb Lovett: If they don't, then it's really saying what… what your relationship is about. I mean there… there are some… there are people in some relationships where a raised eyebrow causes a change in pulse and respirations and saying, What did I do? And I think we respond to each other as much as we value each other. And it's… And it's that sense that… But if I walk in off the street and say, Well, what a wonderful afternoon. You're going on a picnic with me. You may look forward to that, but you might not too. I don't see that as… But oftentimes that's described as positive social experience and it sounds nice, but it may not be nice.

Larry Ringer: Was there a time when you were less concerned about whether response to somebody's behavior was socially ordinary?

Herb Lovett: I think what happened was I got into the business… I started out, I went to graduate school to be a clinical psychologist, I had all of this clinical background, and I got to meet people with developmental disabilities by force. I was assigned to do a couple of days a week. And I didn't understand… I didn't understand any of it. I had no experience in that field. And I got there, and it was a large institution, people were being locked up and I couldn't understand what had happened. Why was this? And these were people that I would walk in and have a cup of coffee with, sit down and chat, and yet they were under lock and key. And the… the whole idea was that if… if their behavior became fussy or people were disturbed by it, that I was to write a program to control it. And that was… that was my mission, and I never did very well with it.

Larry Ringer: Why not?

Herb Lovett: I just couldn't understand… One of the first things that happened to me was a man, who, and I understood this perfectly, liked to drink coffee. And they had used… They had used coffee as a reward for him for in seat behavior in his day wasting program.

Larry Ringer: For what type of behavior?

Herb Lovett: In seat, which is a vital skill. And here's this man in his mid-20s, and he was sorting plastic chips into buckets. And he was expected to do that all day, and he occasionally would get up and wander. And so to reinforce him, they were giving him coffee. The problem was he really liked the coffee, he started running into offices, stealing it from people. And he was…he was a bit of a health hazard because he would take like a pot of coffee that was really hot and just spill it all over himself. He could get burned. The… There was a little meeting about, Well, how are we going to control this? And people had been escorting him arm in arm around the building so that he wouldn't do this. And he got seriously hurt at one point in the struggle.

Larry Ringer: He was getting no coffee at this point?

Herb Lovett: Well, he could have one at break and one at lunch, and three cups a day, which is all anyone needs.

Larry Ringer: Are you being facetious?

Herb Lovett: Yes, of course. I mean some us have three cups before we get out of bed, if we can arrange it. So here's this man struggling to get something, and they wanted to struggle back. And it seemed that it was awfully naive, what I asked them to do was go over to the shopping center and buy a Mr. Coffee, go to the market, buy the coffee, teach him how to make it. And this way he would have a coffee machine there. He would learn that you drink coffee when you want it and when it's available, and you don't have to steal. And he stopped stealing. But people get very resentful that why should he have a coffee machine when we don't? And the program got discontinued. What I should have done was taken the people who were providing the services over to the shopping center and bought them a coffee machine, but…

Larry Ringer: So what finally happened to the man?

Herb Lovett: It was interesting. They stopped that. They said it was unfair, why should he have coffee when no one else has the coffee, etc., etc., and they… they took it away, and he did not go back to being so aggressive. It was almost as if having learned enough, having had coffee on his own terms for enough, that he went back to having it at the times they controlled for him and accommodated. Which is too bad.

Larry Ringer: So is the message there that we can allow somebody to have control in their lives for a while and then we can take it back away from them and it will be okay?

Herb Lovett: No. I think I see it as more the generosity of spirit for some people or that they've learned that once in a while you get what you want in life and… and it's worth hanging in there for. Yeah, that's a dangerous story in a lot of ways just for the moral you drew. But, you know, my interest was not to control his drinking coffee; my interest was to provide him, again, with a kind of setting where… I mean, there's no coffee shortage where he lived. It was the need to teach him that if he needs something in this world and it's available, get it.

Larry Ringer: But if the rules of that particular company where he was working is that people can drink coffee when they have their break and they can't drink coffee at other times, aren't we enabling him to live a more normal life if he follows the same rules everybody else does?

Herb Lovett: Um-hmm. That's a very powerful argument except that the so-called company he worked for was a state institution. He was not getting any money. He was living under lock and key. He was… It was a non-paid training program. What did he get? He was… Furthermore, he was not only working at a job he didn't choose and I don't think particularly liked. It wasn't even a job. It was meaningless, these plastic chips. Living in… Living in a place with 29 other men that he, all he had in common was society's label. And then to turn around and say, But if he were to get a job out in the community, then he would be expected to do that, so we'll start that now. I would like to see what would he be like if… First off, let's get him out there. And if… And if he's running around, if he's working for IBM or some reputable corporation and running around stealing things, stealing coffee, that's going to be pretty damaging to his reputation. And it's there that you could establish the context that here we drink at break. But most of the jobs I've had, you can pretty much drink coffee when you feel like it.

Larry Ringer: Is it reasonable, in your mind, to assume that if somebody's behavior is not meeting our standards and is, we think, dangerous in a very restrictive setting that they're not ready to go into a less restrictive setting?

Herb Lovett: Oh, that's the most… That is one of the worse scenarios in the business. It's, in fact, the people who… What they're saying is that they're not ready to live in an institution and what they need is to get… get out and get into a much more typical place. One of the powerful contributors of behavioral modification was that the environment is… is a strong teacher. So why would you expect somebody living 50 miles from nowhere to understand social behavior when they have no models for it?

Larry Ringer: Have you had direct experience with individuals whose behavior was a very serious problem when they were living in an institutional setting and where that behavior become a much less serious problem when they moved into a more normalized kind of setting?

Herb Lovett: Sure, many times

Larry Ringer: Would you talk about a couple of those?

Herb Lovett: A gentleman who was breaking glass all the time, doing it with his head, and he was getting to the point where he was near death. Or he was near to dying because there was nothing left to stitch.

Larry Ringer: Where was he living at the time?

Herb Lovett: When I met him, he was living in a little, tract house in the suburb, and he had been a ward of the state. Grown up in an institution all of his life. And he got there, and they did the same things in this house that they were doing in the institution. The behavior was identical. And it was… The interesting turning point for him was two things. One was I didn't know him, so I wasn't going to talk to him about this, but I asked, you know, who feels closest to him, most comfortable? Talk to him, ask him, Why do you break these… Why do you go through windows? And… very sociable young man. And, the woman asked him, and he said, I don't know. You know, nobody ever asked, which was bad. And the next thing we asked him was, they asked him was, Given that breaking glass seems to be important to you, is there some way you can do it safely? Because we don't really care about the glass, if it comes to that. It's you… Which is something they'd never said to him. And he came up with an idea of taking jelly jars and wrapping them up in a newspaper, putting them in a paper bag and stomping on them. And so he'd broken glass but he'd done it safely. I would never have invented that. It was by asking him and… and he taught us how he could live more calmly.

Larry Ringer: Did the behavior of breaking glass with his head stop?

Herb Lovett: Um-hmm. And I don't know where he learned that, but somewhere in his head, that meant… it was a satisfying experience. So it's… Instead of wrestling with him about, We'll keep you away from doing it, it's provide people with what they want but do it in a way that doesn't make them look foolish or doesn't get them hurt. This doesn't seem like such a very complicated concept to me, but for some reason, it's been hard for people to… People see that as somehow as giving in or making concessions or… or admitting defeat when I'm, while I'm seeing this as a way of learning how to cooperate with people that we haven't taken the time to understand very well.

Larry Ringer: Realistically, aren't there many people who don't have disabilities who are doing jobs they hate, who are living in situations they don't like because of financial realities and because of lack of skills?

Herb Lovett: That's the… That's the, that's an extension of the argument that… that people sometimes give me too and is, Well, if we do this with this one person, then we'd have to do it for everyone, and we can't so let's not do it for anyone. And I'm not sure that the culture profits from having any group of people oppressed on the strength of a label. And, yes, there… there are, of course, you know, there are people who lead lives of noisy desperation everywhere. But they're not looking to, human services to support their lives, although if they did it might refresh their perspective. But, I mean, the larger social problem is… is how to empower people to feel more confident. But I'm talking about people who are looking, say, to me. I certainly am not going to endorse putting someone in a situation that's unpleasant for them when I know otherwise and could do otherwise.

Larry Ringer: Let me… Let me run a scenario buy you that… that I was involved with. It was a young man who'd come out a state hospital and who was attending, he was in the last couple years of his high school program. And he had, learned to smoke, needed to smoke, and was very unhappy if he couldn't smoke, and it was real… It was one of the most important things in his life was that he had access to cigarettes and that he could, in fact, smoke. And the school said, Well, you know, we have rules. Nobody here is allowed to smoke. If we're going to treat this young man normally, number one, we can't allow him to smoke. Number two, you know, if we allowed him to smoke, we're going to have to let everybody else smoke. And number three, we're going to really be stigmatizing him if we allow him to do things nobody else can do. So what happened was an ongoing battle went on about the cigarettes. He was not allowed to smoke. He kept running away to try to have a cigarette. Eventually the young man returned to the state institution because his behavior got worse and worse.

Herb Lovett: So in Minnesota you can be incarcerated for smoking?

Larry Ringer: If you do it in the wrong building, actually you can. No, I think the view of the people was, you know, these are reasonable expectations. If this young man is going to grow up at all normally, he's going to have to learn to follow the rules. These are the rules in this school. We're not going to change them for him, so, I mean, he wasn't… he wasn't… he wasn't re-institutionalized because he smoked…

Herb Lovett: Oh.

Larry Ringer: …he was re-institutionalized because his behavior…

Herb Lovett: He didn't understand…

Larry Ringer: …Got worse and worse as their behavior got worse and worse.

Herb Lovett: Yes.

Larry Ringer: How… How do you react to that, Herb?

Herb Lovett: Well, a couple of things. First off, the… the teachers never went into the student lavatory ever? I mean, the boys' room, no one? He was the only student in this school that ever smoked?

Larry Ringer: He was the only student with a disability who ever smokes

Herb Lovett: So he was probably much more likely to get caught than other kids. The other kids were smoking, they just weren't being found.

Larry Ringer: He had several objectives in this… on his IEP that addressed the whole issue of him smoking or not smoking in school. His data were taken regularly.

Herb Lovett: Yes, yes. Well, when in doubt, take data. Well, I'll tell you. First off, that… that's a rule. If the school wants to establish that and get away with it, it's not such a bizarre thing that anyone would lose sleep. The problem is… is that all the other kids coming to that school have come out of more or less typical families, whatever they are, and understand, had a lot of experience as to what social expectations are. And not only do they understand social expectations, they understand the payoffs for… for adhering to them. This guy is coming out of an institution where basically life revolves around cigarettes and coffee. And that's… That holds true for the people who work there as well for the people who live there, in my experience. So that you're taking… It would be… Well, I can't think of an analogy. That what you're doing is, is you've given this man the one quality to life that makes it satisfying for him, or endurable even, and saying, You can't do that here because it would be stigmatizing. What the guy would need is a lot of experience on understanding that… that there are things out there in the world that are worth having, other things than cigarettes. And so that if you know why you go six hours of the school day without a cigarette because you're going to get all these other riches, other benefits, that would have been much easier for him to understand. Whereas these other kids had not been locked away for years on end and not been taught to smoke or probably had access to a lot of other recreations that… that smoking had been the one sum total for… for him. Does that make sense?

Larry Ringer: On a concrete level, what does that all mean about the school's behavior? What… What do they… Does that mean they allow him to… to smoke or to drink coffee during class or, you know, act in other ways which are not considered generally acceptable while you're working on that or…?

Herb Lovett: This some kind of finishing school where… where people were (something) items?

Larry Ringer: It's high school.

Herb Lovett: Okay. Not what I learned in high school, certainly. If their real goal was to teach kids and this guy has a very special history, I mean, he has a different history than the other kids. If he had come in speaking Cambodian, would they have insisted that he only speak English perfectly or not at all?

Larry Ringer: Unfortunately, that many times is true.

Herb Lovett: Wow. Okay. I… My interests for someone who came in speaking another language would be to recognize they probably don't have a lot of English. Teach it to them. And it would have been much more interesting to teach this guy why we don't smoke here, why that's an issue here. But meanwhile since it is for you, let's find some way to accommodate this. The teachers didn't smoke in the building either?

Larry Ringer: They were teachers.

Herb Lovett: Yeah. And, you know, I mean, it's recognizing individual histories and… and needs that makes a lot of sense to me, as opposed to just saying, Well, if we're going to, make everyone normal, then… then everyone has to conform as of January 1st. That's… Life doesn't work that way.

Larry Ringer: Let me give you another example, which again, is a real example. A young woman who, had… her expressive language was very difficult to understand and she was just really developing her expressive language. She was, ah, 14 years old at the time. And the teachers became very concerned because when they would try to engage her in conversation, many times she wouldn't, as they put it, talk about what they wanted to talk about. And so they would keep working with her and working with her to try to get from her what they want… to talk about what they wanted to talk about. And oftentimes her behavior would get very bad and then she'd be… have to be put into timeout because, she was beginning to bang things and throw things because she wouldn't talk about what they wanted to talk about. How does… Does that situation at all exemplify some of your concerns about the ways in which traditionally we have dealt with the needs of people with, severe and profound disabilities?

Herb Lovett: Yeah. I mean that's… that's just… Oh, my word. I taught high school. I found it not uncommon for students not to want to talk about what I wanted to talk about. And I somehow got around that without recourse to a timeout room. It's… Why… Why do people lose perspective on what they're trying to achieve to the point of abusing people? It… It's… If this girl who's got a different learning style, has a different history, and is at that point in her life learning something, why not celebrate that, why not go with that? And the fact that she was talking at all, would be very exciting, and support her, and just having the experience of having speech come from inside her out, as opposed to being told that it's something you parrot back and that we put into you? And that loss… And then to punish her for not wanting to collaborate with that agenda is very, very… that's disturbing.

Larry Ringer: Parents oftentimes at this point find themselves in a position of advocating for either their child or their adult… their adult offspring, in trying to encourage staff to become more flexible and to become more responsive to the choices that the person makes. Do you have any… any advice or recommendations to parents, as to how they can help encourage, staff, help teach staff to become more flexible in their approach and to be more willing to respect the choices that are made by the person who has a disability?

Herb Lovett: Just one really common sense strategy is to ask, What do you want to accomplish here? Just as I say, a lot of times in this work people end up arguing about how to do things. And we forget entirely but what is it we're trying to do? And what are you… What are you trying to teach this person? What do you… What do you want to see in five years? If irrespective of how you go about it, what's the picture going to look like? And oftentimes people will say, Well, we're putting this person into timeout so that they'll have better social skills. There's something wrong with that sentence. And it's usually easier for people to realize maybe my… my goals and my means can be congruent, and they don't have to be so… so antithetic… you know, they're oppositional. So if we really are… For instance, if we really are trying to teach the person good social skills, the value of cooperation, then maybe the best way to teach that would be modeling and asking people… Well, for parents and for… for teachers alike, I think asking each other, Well, what are we trying to do here? And does it really fit in with… with our attitude towards this person? I really don't know how you can throw someone into a timeout room and say that you're doing it for their own good. I mean, it's pretty clearly designed to take away an irritating student from the people doing the service. I don't know what you're teaching the person when you do that except that people bigger than you can… can have their way.

Larry Ringer: In your opinion, Herb, is behavior modification, which is implemented by, by providing negative kinds of consequences to a person who doesn't do what we want them to do or what we think they should do. Is that always inappropriate?

Herb Lovett: Always is a loaded word. I would… I would, defer to Dr. Skinner, who just recently said that he just didn't see why you would use punishment, why you would use negative strategies for people if you're trying to teach them. He said his life has been dedicated… he's 83 now, but his life has been dedicated to advancing the power of positive reinforcement. And if you're going to… If you believe the founder of the whole thing, then the answer to that is, no, you don't ever need to do that.

Larry Ringer: If you make a token available to a person when they behave in a particular way…

Herb Lovett: Now this is a person who's going to go on a subway?

Larry Ringer: No, no. I'm talking about traditional kinds of… of, of chips or…

Herb Lovett: Uh-huh.

Larry Ringer: …you know, a little piece of… of cardboard that's got a happy face on it or whatever that can be used to purchase something else.

Herb Lovett: Uh-huh.

Larry Ringer: If you've got something, whatever kind of economy… Well, let me… Let me back up. Can I assume from your reaction that sort of traditional token economies, are not what you consider to be a very appropriate way for providing instruction?

Herb Lovett: Well, if… if you could go into McDonald's and turn in five happy faces for a cheeseburger, then it would make sense to me. But why are we teaching people these… these artificial things when what we've said they… they have trouble learning one thing? Why… Why would you make them learn to do that, as well as to manage real money? I mean, the point would be to teach people skills and… and have experiences that… that are out there. The implication of that being you go out there to teach it too.

Larry Ringer: Let's change it a little. Let's make it a little bit different then. Let's assume that we give somebody a quarter if their behavior reaches a certain standard for half-hour period a day.

Herb Lovett: Uh-huh.

Larry Ringer: And we give them the quarter if they act in the way we… we've set out and we withhold the quarter if they don't. Is that positive reinforcement or is that punishment?

Herb Lovett: I think it's degrading, is the issue. I have a good friend who's 45 who if she's good, a good girl, as she explains it, for a week, she gets to go for coffee with her supervisor. Now, I mean, if you left her IQ out of that story and sent it in to Ms. Magazine, would they say, Oh, this sounds like a useful strategy for teaching social behavior? I mean, it's insulting. And, I'm really not interested in almost if… whether it's, because they… there are all… the technology to behavior modification can get so that can't tell whether it's a positive punishment or a negative reinforcement. But all that aside, what's the context for that? I mean, to whom are you giving this quarter for… for good behavior right? I… It would seem more socially real to me that people value one another to the extent that they respond to each other out of respect for the person and not for the quarter. And if the person doesn't have that, then the implication from that is then you need to teach this person that people are valuable and worth having around.

Larry Ringer: So how do you use behavior modification in a way that isn't degrading or insulting, to person whose behavior you're trying to shape?

Herb Lovett: I think trying to shape someone else's behavior tends to be pretty condescending in a programmatic way. I mean in a socially natural way, that's something we do all the time. The way behavior modification seems most powerful to me is in teaching things. Programmed instruction, little computer programs where, that start out with very simple questions or even books or…or talking where you ask people very simple question. They get the answer, and you say, Yup, you got that one. Terrific, let's go on to this. And you lead people through program instructions through, very complicated things that they might not have learned. That's very powerful and that's in the context of the teacher. Teacher-student, I mean, if I'm the teacher, I have this information I want you to have it. It doesn't have to be condescending, but I do have a slight edge on that relationship. But for social behavior, which a lot of these behavior modification programs do, I think it's rude. It just doesn't make sense.

Larry Ringer: So if you've got a child who, or an adult, who frequently either hits himself or hits other people, are you saying that behavior modification is not an appropriate way to address that behavior?

Herb Lovett: It could be. It's not my first response.

Larry Ringer: What is?

Herb Lovett: What kind of a life does this person lead that beating up other people or… or yourself makes sense? Because if you think… I tend to think that people… most people do things to make themselves feel better or to feel at least comfortable, and they don't do things to be… to be hurtful. They certainly don't do things to make their lives more unpleasant on purpose. So if you start with that, then you have to ask, Where did this start making sense to them? And you look at the lives of people who hurt themselves or other people, and typically it starts off as something very minor and people decide, We're going to draw the line here and we'll control it. And the person says, Well… It's almost as if they say, Sure, go ahead. And it escalates and escalates and escalates, and as we've been saying, you know, the worse your behavior is, the worse the service behavior becomes to the point where there are places in this… in North America where people are routinely tied up, routinely subjected to cattle prods, ammonia in their noses. And all of this is under the bland name of aversives. But it's basically, if it needs… need be, we'll inflict pain on you to control you.

Larry Ringer: What does the word control mean to you?

Herb Lovett: You do it because it's my idea. And I really don't care if you understand why I want you do it or not. As opposed to cooperation where, Do you understand why this is useful? I really want this. What do you think? And we hammer it out.

Larry Ringer: But do you have the luxury of that kind of a dialogue if you've got somebody who is currently dangerous to other people and hurtful to other people?

Herb Lovett: Yup. It's just, it… What you do in an emergency sit… If I walked into a room and somebody was about to hurt themselves, I probably would physically restrain them on the spot. But I wouldn't call that a program; I'd call that emergency intervention. I mean if you're doing that for years on end, you may question it. Yeah, as people do. And you may question, well, why… why do you think that's an interesting intervention all the time?

Larry Ringer: Can you give an example of a real life situation you've been involved with where a person was engaging in some fairly serious and dangerous behavior and you or people you are familiar with were able to intervene and help that person to change that behavior without having to use quote unquote behavior modification approach?

Herb Lovett: Yeah. Um, a gentleman that I got to meet. He was living in a ICF. He was banging his face with his fist in a real way. I was told, I didn't count, up to a thousand times a day. And the, they'd tried drugs, they'd tried tokens, they'd tried all of these ways to control him. And the next step was to mechanically restrain his… arms to his waist on his belt, wrist straps. The short version of that story is basically what we did was we spent the day asking, Where has this guy been? Who was he seeing? What do you think he thought? Put it into words. If… So one of the characteristics of this man, and people came up with wonderful things like, he was isolated, he was lonely, he was chronically misunderstood. So if that's the case, what do you need? You need people to listen to you and then, who are these people going to be? And it turned out that his family really liked him, but they had… They were being… First they were used as a reinforcer for good behavior and then they restricted visits because it wasn't working, so they thought they were contributing. So we got him re-hooked up with his family. Some friends who used to take him horseback riding. He had real foods that he liked. Just let's make a life here that makes sense.

Larry Ringer: How long did that process take?

Herb Lovett: The planning took a day, but for him to respond to it took about a week.

Larry Ringer: So within a week?

Herb Lovett: I'm not saying he went to zero, because I don't know that. They called and said that the dramatic change of just their attitude toward him, of asking him, Do you want to take your bath now? Just little things like that, that he started responding much more directly. He did not have language, by the way. And, this guy feels much better.

Larry Ringer: And for how long, if you know, had they been trying to use more… more typical behavior management kinds of techniques in getting rid of the, self-injurious behavior?

Herb Lovett: He was 19 when I met him, so he'd had a good 10 years of it. By the way, I… The one part of that story I don't like is the idea that, fast acting, effective, do this and in one week everything will work. My interest was not necessarily to make him do anything. My interest was the life he was living was unbearable, and he had to have a life that was worth getting out of bed for. And my hunch was that once you have a life that's worth having, you don't beat your face. But that was only a hunch, and I would not have said, Well, gee, the horseback riding didn't work, so let's stop that and go to drugs again.

Larry Ringer: In your opinion, is it… When you're using the approach that you just described where you really try to give a person choices and you treat them with respect and you treat them with respect for their choices, do you… do you continue to gather data? Or are data not helpful in that kind of situation?

Herb Lovett: If you can do it in a way that doesn't interfere with the person. I mean, if you're sitting with a clipboard staring at them, that says something. But if you have an unobtrusive way to… to do that, I think data is a good way to validate that you feel better about things. Sometimes programs make us who do the service feel better, but I'm not sure if it has any impact for the person we're concerned about. Sure, data… It's not like that's the enemy; it's just that for a lot of people, it becomes the obsession.

Larry Ringer: Keeping in mind the fact that you feel so strongly that the need for individual choices, that individual choices and the need to make them needs to be respected and that therefore individual decisions need to be made, what three or four values which you have for the goal or the purpose of the services we provide to people with severe and profound disabilities?

Herb Lovett: I think my only… my only criterion in the end is that if it's a real service, the person values it. And if they don't, maybe we should stop.

Larry Ringer: Okay. Thank you.

Herb Lovett: Yup.