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    Objectives
    • Define intensive interventions.
    • Describe the benefits of family-centered, comprehensive, assessment-based supports.
    • Describe what IEPs and IFSPs are and how they may be involved in targeted supports or intensive behavior support planning.
    • Describe the steps of the intensive behavior support planning process.

    Learn

    Learn

    Know

    Consider the following scenarios:
    • A 1-year-old does not like to touch wet or messy items. She screams whenever her hands touch materials like play-dough or water.
    • A 2-year-old cries and runs away from the group during every transition in the classroom.
    • A preschooler moves quickly around the room dumping bins of toys on the floor.
    • A 5-year-old imitating what appears to be sexual acts
    • A 7-year-old consistently calls other children “babies” and creates complex, ever-changing rules for who can and cannot play with her on the playground. Other children regularly complain to staff of hurt feelings and exclusion.
    What do these situations have in common?

    They all involve behaviors that may confuse, concern, or even frustrate adults. Some of these behaviors may be severe enough to require intensive intervention for the child or their family. Others may be addressed through thoughtful adjustments to the environment and targeted supports. This lesson helps you learn how to decide when a child may need intensive intervention, Tier 3 of the Pyramid Model.

    Adults must learn to distinguish between behaviors that are developmentally appropriate, concerning, and unsafe. You might see the following types of behaviors in children and youth (adapted from the Army Child, Youth, and School Services Operational Guidance for Behavioral Support):

    Challenging Behavior

     

    Pre-Toddlers

     BitingScreaming
    Unsafe Behavior

    Immediate Harm

    Biting and breaking the skin

    Screaming while scratching one’s own skin

    Concerning Behavior

    Potential Harm

    Biting and leaving marks multiple times

    Screaming for long periods of time

    Developmentally Appropriate

    Expected Behavior

    Putting teeth on another child; biting one time and leaving marks

    Screaming for a few minutes

    Toddlers

     Banging HeadRunning
    Unsafe Behavior

    Immediate Harm

    Banging head on floor or other hard surface

    Running through the gate when teachers are not looking

    Concerning Behavior

    Potential Harm

    Banging head on pillow at rest time

    Running away from the group in the hallway while smiling at teachers

    Developmentally Appropriate

    Expected Behavior

    Throwing body down on cot when upset; jumping or squirming on cot

    Running to a different area of the room when asked to clean up

    Preschool

     Difficulty WaitingThrowing
    Unsafe Behavior

    Immediate Harm

    Throwing other children off the bikes with an intense level of force

    Throwing wooden blocks toward provider or other children

    Concerning Behavior

    Potential Harm

    Pushing other children out of the way to get to the bike

    Throwing toys into an empty corner

    Developmentally Appropriate

    Expected Behavior

    “Cutting” in line for bikes

    Throwing coat into cubby, throwing balls inside or throwing paper towel toward garbage can

    School-Age

     WordsAttention
    Unsafe Behavior

    Immediate Harm

    Telling someone you are going to hurt them

    Twisting a staff member’s arm

    Concerning Behavior

    Potential Harm

    Name calling

    Pushing past a staff member to get away from them

    Developmentally Appropriate

    Expected Behavior

    Experimenting with profanity

    Temporarily ignoring a staff member or walking away

    Middle School

     AfraidHitting
    Unsafe Behavior

    Immediate Harm

    Saying they are afraid to go to school

    Hitting with a closed fist and force

    Concerning Behavior

    Potential Harm

    Calling self stupid

    Playful hitting (casual jab toward a friend with no force behind it)

    Developmentally Appropriate

    Expected Behavior

    Making jokes about a peer’s grades or school performance

    Roughhousing or playful wrestling

    Teens

     PosturingDrugs
    Unsafe Behavior

    Immediate Harm

    Punching a peer

    Attending the program while under the influence of marijuana

    Concerning Behavior

    Potential Harm

    Posturing at a peer who looked at him or her wrong

    Talking about marijuana use

    Developmentally Appropriate

    Expected Behavior

    Posturing at a peer who insulted a girlfriend or boyfriend

    Jokingly asking a friend whether he or she is high

    You may have noticed that sometimes there’s little difference between developmentally expected, concerning, and unsafe behaviors. What sets these categories apart are differences in frequency, duration, and intensity. Adults should ask themselves whether the behavior happens more often than expected (e.g., the toddler who bites multiple times per day), lasts longer than for other children (e.g., the preschooler who cries for 90 minutes at drop-off each day), or whether it seems disproportionate to the situation (e.g., the preteen who punches someone for looking at him wrong).

    Remember, all of these behaviors require some kind of action on the part of adult caregivers and teachers. Unsafe behaviors require immediate action and will often require intensive interventions. Behaviors that are sexual in nature are discussed in detail in the Focused Topics course Sexual Development and Behavior in Children and Youth. In this course you will learn how to distinguish between normative and problematic sexual behaviors, how to prevent and respond to these types of behaviors, and potential interventions for children and youth who experience sexual behavior challenges.

    Defining Behavior

    Let’s begin by defining a few important terms. We will use the following definitions consistently throughout this and the following lessons:

    • Behavior: Any action that can be seen or heard
    • Concerning behavior: Behavior that interferes with the child or youth’s participation in programs or affects the child or youth’s relationships with others
    • Unsafe behavior: An action that puts the individual or others at risk for immediate harm
    • Persistent unsafe behavior: An unsafe behavior that continues despite your program’s documented efforts to address the behavior

    It may be helpful to think of these behaviors like a thermometer (Army CYS Operational Guidance for Behavior Support p. 4-1):

     
    Unsafe Behavior

    Puts the child or others at risk or immediate harm (e.g. 3-year-old pushes a child to the ground and jumps on his stomach)

     
    Concerning Behavior

    Outside of expectations based on frequency, duration, or intensity of the behavior (e.g. 3-year-old pushes children to the ground on average 10 times a day)

     
     
    Developmentally Appropriate

    Reflects the child or youth is working on typical communication and social skills for their particular age (e.g. 3-year-old pushes a child after he knocked down her tower.)

    All behavior communicates meaning. Children and youth may behave a certain way when they do not have the words or social skills to communicate in a way that adults find most acceptable. Behavior is often a message that the child is hurting, angry, overwhelmed, confused, bored, or lonely. When you view behavior as communication, it is easier to identify supports that will help the child communicate in more appropriate ways. Behavior is also an opportunity to connect with the child or youth. Their challenging behavior may mean that a child is struggling in relationships with others. Children or youth whose behavior is concerning or unsafe are often the children or youth who are most in need of positive relationships with you.

    Observing Behavior

    When you work with a child or youth whose behavior concerns you, it is common to feel overwhelmed. It might feel like the behavior happens all the time. It might feel like the behavior is completely unpredictable or happens for no apparent reason. Fortunately, this is rarely true. You have the skills and resources to help you make sense of even the most challenging situation. The most important skill is one you likely learned very early in your career: observation.

    Observation is “the examination of another person’s actions or practices to be used to develop new skills, strategies, or ideas” (Rush & Sheldon, 2011, p. 9). While that definition of observation was originally developed for coaches, it applies to your role as a child and youth professional as well. You observe a child or youth’s actions in a way that will help you use the information to come up with new ways to support the child. Remember, you are never alone in this endeavor. Your coach, trainer, or administrator are also your important resources.

    When observing behavior, use the same principles that guide any observation of children or youth: observations must be objective and specific. Objective observations are descriptions of exactly what happened without any opinions or inferences. Specific observations are detailed descriptions of the actions, words, movements, or responses of the child or youth and those around them. Consider these examples:

    Specific and objective:

    Brady walked over to the block area and knocked down the tower. When Alicia yelled at him, Brady grabbed a block and threw it at her.

    General and subjective:

    Brady was mad and stormed across the room. He destroyed the block area and was out of control. Everybody started yelling and throwing things.

    There is a unique observation strategy for behavior. It is known as an A-B-C observation. A-B-C stands for antecedent-behavior-consequence. This means you will observe more than just the child’s behavior. You will observe what comes before and what comes after a behavior. You are observing to help you understand why a behavior happens. This helps you respond appropriately. Consider this example:

    A

    Antecedent

    Alicia had built a tall tower in the block area. Brady walked over.

    B

    Behavior

    Brady knocked down the tower. Brady threw a block at her.

    C

    Consequence

    Alicia yelled at him. An adult came over and told Brady to walk away.

    The goal of an A-B-C observation is to determine the function of behavior. Function means purpose or reason. You can also think of function as the message a child is trying to communicate through their behavior. There are several typical functions of behavior in children, youth, and adults:

    Function: To get something
    • Attention from adults or other children or youth
    • A desired object or material
    • A sensory or body need (food, stimulation, etc.)
    Function: To get out of something
    • Undesired attention from adults or other children or youth
    • Undesired activity
    • Undesired sensory experience (too hot, too cold, sitting still, doesn’t like texture of food, relief from an unpleasant noise, etc.)

    There are many different ways to think about the function of a child or youth’s behavior, but these two categories (get something or get out of something) illustrate a very simple and useful way to start. You can collect informal A-B-C data about each instance of behavior across a day or week. Write down your specific, objective observations as soon as possible after the behavior occurs. You might use a notebook or index cards to jot down your observations. You can also use a form like the one created by the National Center for Pyramid Model Innovations: https://challengingbehavior.cbcs.usf.edu/docs/ttyc/TTYC_EventsandFunctionsAssociatedwithProblemBehavior.pdf

    When you collect a number of A-B-C observations, look for patterns and make a hypothesis about the function. Consider this example from the observation notebook Brady’s preschool classroom used:

    Date & Time
    A

    Antecedent

    B

    Behavior

    C

    Consequence

    2/4 9:05amBrady enters room at drop-off time.He runs by the cubbies, grabs several coats, and throws them on the ground.Mom stays at sign-in board, Carla (staff) says, “Brady that is not OK. Pick those up.” Carla takes his hand and helps him pick the coats up. (Wants attention? Doesn’t want to transition into school?)
    2/4 10:02amTeacher says, “2 minutes until group time.”Brady dumps four bins in the block area onto the floor. He starts to run toward the games area and begins to grab boxes.Carla goes to him and says, “It’s time to clean up. Come back to blocks.” (Attention? Doesn’t want to transition?)
    2/5 12:45pmCots are laid out and lights are off. Children moving from bathroom to cots. Brady stands up by his cot.Brady tries to flip his cot over. It hits another child.Child begins to cry. Carla comes over and says, “That is not safe. It’s time to rest.” Resets cot, physically helps him lay down, begins patting his back. (Attention? Doesn’t want to transition?)

    What do you notice about the team’s observations of Brady’s behavior? When do behaviors seem likely to occur? What is your hypothesis about the function of Brady’s behavior?

    You might have noticed several things:

    • Brady’s behaviors seem to happen during transitions.
    • An adult consistently comes to Brady after his behaviors.
    • An adult helps Brady follow through with transitions.

    It seems like Brady’s behavior might be serving several functions for him: he may be trying to get out of hard transitions, and he may be telling his team that he wants or needs attention. A few of Brady’s behaviors are unsafe, so they can use this information to begin planning simple supports that will work for Brady across the day. You can review the targeted supports discussed in Lesson Four to remind yourself about ways one could help Brady. If his behavior continues or gets worse, the team would then have the observation data they need to request more intensive intervention and support.

    This lesson is about intensive intervention that will meet the needs of the small percentage of children who are not thriving with universal support and targeted support (Tiers 1 and 2).   

    Intensive Intervention

    What are Intensive Supports?

    Intensive supports are highly individualized strategies to prevent challenging behavior, respond to challenging behavior, and promote new skills.
    Examples of intensive supports include:

    Early Childhood
    • Adult physically close to child
    • Adult prepares a child for an activity, interaction, transition (Example: visual schedules, individual prompts or social story)
    • Adult provides individual support for communication, coping, or social interactions (Example: first-then boards, pictures)
    • Adult teachers child a new skill (Example: child is taught to verbally request help, attention, a break, or to play by saying "I want. . ." or "I need. . .)
    • Anticipate & cue child to use new skill, ensure safety, and offer positive reinforcement (Example: guide child to a calm-down space, offer behavior-specific praise when child uses new skill)
    School-Age
    • Adult physically close to youth or child
    • Adult prepares a child for an activity, interaction, transition (Example: individual directions and prompts given to child or youth, break down directions of an assignment into smaller parts, verbal reminder of classroom rules or rules about touch)
    • Adult provides individual support for communication, coping, or social interactions (Example, noticing cues, break cards, least preferred activity followed by most preferred)
    • Adult teaches child or youth a new skill (Example: verbally request help, a break, attention, to participate with others by saying “I want to work here” or “I need a break from this assignment”)
    • Anticipate and cue child or youth to use new skill, provide behavior specific praise when replacement skill is used or implement consequence in response to behavior (Example: assignments not completed at school will be completed at home and signed by a family member)

    Responding in the Moment to Unsafe Behavior

    Despite effective prevention strategies, it is still possible that unsafe behavior may occur. If you feel that a child’s actions pose a risk to the safety and well-being of others, use these steps to keep yourself and children from harm:

    1. Stay calm.
    2. Call your administrator, coach, trainer, or a nearby staff member for help.
    3. If necessary, remove other children and youth from the area.
    4. Stay an arm’s length away from the child or youth whose behavior is unsafe. If you get too close, the child may become defensive or more agitated. If possible, turn slightly away from the child. You should still be able to see the child, but avoid eye contact.
    5. Use a calm voice and give the child or youth space. Yelling or threatening only makes the situation worse. If it feels appropriate, you can say what the child feels, “You are very upset right now.”
    6. Maintain line of sight supervision. If you feel the child may run from the building, make sure staff members are in front of doors or other areas that may be unsafe.
    7. Watch for signs the child or youth is regaining composure. Their breathing may slow and their muscles may relax. Redirect to another activity or ask the child, “What do you need?”
    8. When the child is able to tell you what they need, follow through on getting what they want or need in the moment.
    9. Remember, your goal is to help the child feel calm and safe. This is not a moment for teaching new skills or making demands.

    Pulling it All Together: Behavior Support Planning that is Family-Centered, Comprehensive, and Assessment-Based

    In the previous lesson, you learned about targeted supports that are useful for all caregivers and teachers to have on hand for the small number of children who do need extra help. When there are ongoing concerns about behavior or persistent unsafe behavior, set aside time for a more formal observation of the child. This should only happen after you have notified your coach, trainer, or administrator and had conversations with the child or youth’s family. Your coach, trainer, or administrator will observe at times that you agree upon together. The purpose of this observation is to more clearly determine the function of the child or youth’s behavior.

    Next, a behavior support plan is developed based on the observation data. This is a formal document that helps you and the family prevent and address the concerning or unsafe behavior(s). A team-based support plan meeting will take place with the purpose of developing the plan. You, a program leader, and the child or youth’s family typically attend this meeting. Other people may attend as well, based on your program’s policies or family preference. At the meeting, reflect on what is going well, your use of effective practices, and the child’s or youth’s strengths. This is also the time when you will share ideas about areas in which a child or youth needs continued and additional support in order to have the best learning outcomes.

    A program leader will take notes and write the formal behavior support plan. Spend time reading it and work together as a team to put it in place. Remember, behavior change takes time. And sometimes behavior can get worse before it gets better. Plan to spend at least a month carefully using the strategies in the plan. Then check back in with your program leadership to discuss how the plan is working and to share observations about the child’s progress.

    This entire process should be family-based. This means that families are key team members. You are working together to figure out what the child is trying to communicate and to identify the strategies that will help the child build stronger relationships and social skills. Families may share their own observations, offer ideas about strategies that work at home, and try new strategies at home. Your program should share success stories with families and encourage them to share progress seen at home as you share progress seen in the program.

    The process is also comprehensive. This means that you and the team recognize that behavior is influenced by environments and relationships. You consider the child across their whole day and all their environments. You also consider the whole child. Medical conditions, biological changes, lifestyle changes such as deployment or permanent change of station, and transitions at school can all affect a child’s behavior.

    Finally, the process is assessment-based. No behavior support plan is “one size fits all.” The plan is based on the specific observations and needs of the individual child or youth. Each plan should be different. Some plans may have similar elements (the same evidence-based practices are likely to work for multiple children), but the plans should be uniquely suited to each individual. And this is only possible when careful assessment takes place. Typically, this involves several observations of the child or youth across days, times, and settings. It also involves interviews or discussions with staff and family members about what they have seen and experienced.

    In the Do Section of this lesson, you will have a chance to explore sample behavior support plans. A sample behavior support plan is provided in this lesson, however, please refer to Service specific documentation and guidance on behavior support planning for additional information.

    Key Concepts in Targeted and Intensive Supports: Understanding IEPs and IFSPs 

    Sometimes, behavior issues are resolved through careful observation, planning, and intervention. Other times, behavioral or social issues are severe enough that the child qualifies for special education services through a local education agency or school district. It is also possible that teams may be concerned about the behavior of a child or youth who already receives special education services. To be an effective child or youth professional, you must understand basic concepts about special education services.

    Special education services are considered when there are concerns about a child’s development or educational progress. This can happen at any age. Some children are diagnosed at birth with a disability. This happens in the case of genetic or physical disabilities such as Down syndrome or cerebral palsy. Other concerns begin to emerge as a child grows. For example, autism spectrum disorder is often diagnosed between the ages of 2 and 8. Parents and caregivers may notice that a child avoids social interactions or has atypical language skills. Some children begin receiving special education services in elementary school when it becomes clear that they are having difficulties learning to read, write, or do math.

    When there are concerns about a child’s development or learning, they may be referred for evaluation. Evaluation is a process of determining whether a child is eligible for special education services. With the families’ permission, a team of professionals will evaluate the child.

    A child determined to be eligible for services will receive a formal service plan. For infants and toddlers, this is known as an individualized family service plan (IFSP). For preschool and school-age children and youth, this is known as an individualized education program (IEP). IFSPs and IEPs are legal documents that describe the family or child’s annual goals and educational objectives. IFSPs and IEPs are developed by a team that consists of the family, special educators, general educators or providers, related services professionals (therapists), administrators, and other designees. For school-age youth, the youth is also part of the IEP team.

    If a child or youth in your care has an IEP/IFSP, familiarize yourself with the plan when possible. A child’s IEP/IFSP may provide you with valuable information and guidance when developing a behavior support plan for the child or youth. A special educator will be responsible for documenting the child’s annual progress, but you may play a part in implementing portions of the IEP. For example, social goals may be addressed during meal or play times. A special educator, occupational therapist, physical therapist, speech therapist, social worker, or behavior analyst may come to your program to work with you or the child. When these types of professionals are involved in a child’s care, you will collaborate as a team working in the best interest of the child or youth, and their family. Collaborating with other professionals in the implementation of behavior support strategies provides consistency between home, school and the program. The professionals may provide training or coaching to you about specific strategies to support the child. They may model strategies for you, or they may work directly with the child. They may ask you about your observations of the child’s progress, and they may work with you to adjust the child’s plans. When you work with other professionals, remember to:

    • Ask questions. You spend a great deal of time with the child or youth, so it is important that you understand the strategies you are being asked to use. Special education is full of abbreviations and acronyms. If someone uses jargon, ask about it. If you don’t know what an acronym means, ask.
    • Ask for written instructions or checklists. These professionals implement very specific, research-based strategies. If you are being asked to implement them too, ask for written instructions to help you.
    • Provide feedback about what is realistic. It may not seem possible to balance some highly individualized strategies with all of your other responsibilities. Work with the team to figure out ways to adjust, delegate, or think creatively about how and when to implement strategies.
    • Ask for training. Most of the professionals who work with children on IEPs or IFSPs are also trained to consult with other adults. They can help you learn how to use the strategies. They can model while you observe, and they can observe you and provide feedback.

    To learn more about IEPs or IFSPs, please refer to the Center for Parent Information & Resources.

    What does a behavior support plan look like? Review the Sample Behavior Plan in the Learn attachment below. What features do you notice? See if you can find the following in each plan:

    • The function of the behavior. This may also be called the purpose or the message of the behavior.
    • Foundational supports to promote positive relationships with the child.
    • Environmental supports that make adjustments to schedules, spaces, or routines; or ways the rules or expectations are made clearer; or changes to the ways directions are given.
    • Targeted supports that help the child learn new social, communication, coping, or self-help skills.
    • Intensive supports that change the amount, type, or frequency of adult support.

    See

    To develop effective intensive interventions for children with challenging behaviors, you will need to understand why and in what contexts these behaviors occur. As you listen to the video, reflect on the process or tools you currently use to understand children’s challenging behaviors.

    Determining the Function of Behaviors

    Listen as an expert and a teacher explain how to determine the functions for children’s behaviors.

    Do

    When you are concerned about a child or youth’s behavior, reach out for support. You have a responsibility to:

    • Keep yourself and the children or youths safe.
    • Learn about the Pyramid Model.
    • Form a positive relationship and build trust with each child or youth.
    • Look at all behavior as communication.
    • Know that concerning and unsafe behaviors mean the child or youth needs help.
    • Tell the program administrator when a child or youth uses concerning or unsafe behavior.
    • Talk to the family about the child’s or youth’s strengths as well as challenges.
    • Be a part of the support plan meeting.
    • Change the environment to support the needs of the group.
    • Ask for help putting supports in place when you need it.

    (Source: Army CYP Operational Guidance for Behavior Support)

    Explore

    Explore

    Complete the Behavior Sort activity to reflect on behaviors you may observe in your program and to plan your responses.  

    Apply

    Apply


    Review the Immediate Response to Unsafe Behavior tip sheet below. You may find it helpful to post this in your learning area to remind you or your team of the steps.

    Glossary

    TermDescription
    AntecedentOccurs before the behavior and may act as a trigger
    BehaviorAn action that can be seen or heard
    Behavior Support PlanThe formal plan developed with staff, the trainer, and family members
    Concerning behaviorBehavior that interferes with participation or relationships
    ConsequenceOccurs after the behavior and makes it more or less likely to occur again
    FunctionThe purpose of the behavior or the need it is filling for the child; the message the child or youth is trying to communicate with their behavior
    Unsafe behaviorBehavior that puts the individual or others at immediate risk of harm

    Demonstrate

    Demonstrate
    Assessment

    Q1

    True or false? Sometimes it’s hard to tell the difference between behaviors that are developmentally expected, concerning, and unsafe. However, one way to determine between these categories is to look at frequency, duration, and intensity of the behaviors.

    Q2

    Teacher Fernanda responds in the moment to Zane’s unsafe behavior. Select which strategy is not helpful.

    Q3

    Select which elements describe the behavior support plan.

    References & Resources

    Center for Parent Information and Resources. (n.d.). Retrieved from https://www.parentcenterhub.org/

    Center on the Social and Emotional Foundations for Early Learning. (n.d.). Retrieved fromhttp://csefel.vanderbilt.edu/

    Dunlap, G., Wilson, K., Strain, P., & Lee, J. (2013). Prevent-Teach-Reinforce for Young Children. Baltimore, MD: Paul. H. Brookes.

    Dunlap, G., Iovannone, R., Kincaid, D., Wilson, K., Christiansen, K., Strain, P., & English, C. (2010). Prevent-Teach-Reinforce: The School-Based Model of Individualized Positive Behavior Support. Baltimore, MD: Paul. H. Brookes.

    Kids Included Together (KIT). (2019). Retrieved from https://www.kit.org/who-we-are/our-work/

    Lentini, R., Vaughn, B. J., & Fox, L. (2008). Creating Teaching Tools for Young Children with Challenging Behavior [CD-ROM], Tampa, FL: University of South Florida, Technical Assistance Center on Social Emotional Intervention for Young Children.

    Military One Source: About EFMP. (n.d.). Retrieved from https://www.militaryonesource.mil/family-relationships/special-needs/exceptional-family-member/the-exceptional-family-member-program-for-families-with-special-needs

    Military One Source: About FAP. (n.d.). Retrieved from https://www.militaryonesource.mil/family-relationships/family-life/preventing-abuse-neglect/the-family-advocacy-program

    Military One Source: About MFLC. (n.d.). Retrieved from https://www.militaryonesource.mil/confidential-help/non-medical-counseling/military-and-family-life-counseling

    National Center for Pyramid Model Innovations. (n.d.). Retrieved from https://challengingbehavior.cbcs.usf.edu/

    Pyramid Model Consortium. (2016). Retrieved from http://www.pyramidmodel.org/

    Rush, D. D., & Shelden, M. L. L. (2011). The Early Childhood Coaching Handbook. Baltimore, MD: Paul. H. Brookes.

    Simonsen, B., Freeman, J., Goodman, S., Mitchell, B., Swain-Bradway, J., et al. (2015). Supporting and Responding to Behavior: Evidence-Based Classroom Strategies for Teachers. Retrieved from https://www.pbis.org/common/cms/files/pbisresources/Supporting%20and%20Responding%20to%20Behavior.pdf

    U.S. Army, Child, Youth and School Services. (n.d.). Operational Guidance for Behavior Support.