Challenging Dogma

...Using social sciences to improve the practice of public health

Saturday, April 21, 2007

Failure of the PBIS (Positive Behavior Intervention and Support) to correct risky health behavior among high school students – Babajide Sotunbo

One of the trends in public health is that often we are forced to take on the onerous task of developing solutions for the laxities and inactions of other members of the society. Sarcastically this burden is being dropped at our doorstep by those guilty of creating those problems. A major public health concern of the moment is a complex myriad that began with a high rate of high school dropouts that has resulted in an increasing statistic of street violence, increasing number of young adult in correctional facilities, an increase in teenage pregnancy, and other negative behaviors associated with poor health. The inability to keep teenagers in schools has been blamed on teens’ lack of necessary behavioral and social skills needed to foster effective learning and successful transition in young adulthood.

In order to correct this perceived shortcoming among high school teenagers a behavioral intervention was developed called the Positive Behavior Intervention and Support (PBIS) (1). PBIS was designed as a systems approach to preventing and responding to school and classroom discipline problems. PBIS was developed as school-wide systems that support staff to teach and promote positive behavior in all students. Accordingly it is believed that by reducing behavioral problems, PBIS creates and maintains safe learning environments where teachers can teach and students can learn (1).

“PBIS was developed as an alternative to aversive interventions used with students with significant disabilities who engaged in self-injury and aggression but has been expanded to include for other students and entire schools"(2) (3).

PBIS integrate principles and approaches of behavioral science, practical interventions, social values and systems perspective factors. PBIS applies behavioral science to understand the dynamics of the development of human behaviors and how environmental social and cognitive factors influence the development and durability of disruptive and dangerous behaviors that affect learning and overall child development (4)(5)(6).
This quantitative and qualitative understanding of human behavior has led to the development of practical interventions which consist of practical strategies for prevention and reduction of problematic behaviors depending on age groups, contexts, and behavior attribute of the student subject.(7)(8)(9).

The outcomes of such strategies are calibrated against social values as part of the process of appraisal. Social values and expectations of school, families larger communities help define what is acceptable and what is abhorred, the conformity of the student subjects to such standards implicate the success of the program. They serve as goals and targets that are aimed to be achieved in the process of transformation of the subject’s behavior (10).

A systems perspective provides support for the adoption and sustained use of effective school practices, without a systems approach, identification of practices is limited, adoptions are incomplete, and attention to school initiatives to address discipline is episodic and short term (11)(12). Data collected and collated from relevant sources are also used to guide the smooth execution of the PBIS.

In practice, PBIS has failed to properly frame and estimate the problem of negative behavior among teenage high school students. It has wrongfully limited the origin of negative behavior among high school students within the walls of the school building rather than as a product of the mixture of influence that include the social community, the home, and the media (television, internet, and magazines). When students get messages in their classrooms that conflict with those from the outside of school environment in their most delicate transformative years, they are bound to react and develop their own coping strategies, which are perceived as negative behaviors.

The dissemination of PBIS intervention consists of programs that hardly incorporate or make provision for situations that affect learning skills and cognition of students but are outside of the school system. It essentially puts the primary responsibility of effective learning in the hands of students and makes little room to question the staff’s and system’s involvement in successful learning. The student subjects in most PBIS programs have been misclassified and misrepresented and have turned out to be victims of the same program designed to correct them. Subjects are looked upon as learning disabled and socially dysfunctional by other members of the school. The negative effects of this assault to their mental well-being often prove unredeemable.

According to Lorraine, who is an Anger Management counselor at a middle school, these technical faults has to be corrected if the program is to achieve progressive success. She cited that her anger management program class is located at a secluded part of her school and it is treated as a mini-prison- other students referred to it as “school prison.” Students who attend the program are treated as little less than outcast by their fellow students, classroom teachers, school police officers, and even the school nurse. Students are referred to the class after they manifest antisocial behaviors in class or on the school premises. Any antisocial behavior committed outside the school premises is not potentially considered to warrant referral to the anger management program, even if it involves a student and another member of the school community. Failure of affected students to respond positively to the program results in suspension and this threat is very often communicated to the students (13). The PBIS as an essential behavioral science tool would be more effective if it is expanded to accommodate the experiences of students outside the walls of the public school system and the peculiar psycho-social needs of teenage high school students.

Understanding the student’s psychological needs and psycho-social phase

For the most part, students do not think their actions are risky to their health. They think they are undergoing a normal developmental phase of growth when they exhibit those behaviors, which are perceived by their teachers and authorities as risky behaviors. The transition from childhood through to adulthood is known to involve a very important adjustment at adolescence. The period is considered to be difficult and critical because of the numerous qualitative shifts that take place at this time, which at times assume the character of a radical break with the previous properties, interests, and the relationships of the child. They begin to question what they have always accepted, crave for acceptance and association; they occasionally lose interest in their normal schedules and they strive to develop their own identity and ambition.

Adolescents’ exigencies of meeting their psychological need is supported by the Maslow's Hierarchy of Needs which proposed that as
humans meet 'basic needs’; they seek to satisfy successively 'higher needs' that occupy a set hierarchy (14). He constructed a pyramid of needs with different strata and contends that higher level needs such as self-actualization which he described as growth needs would not be met until lower level needs which he described as deficiency needs. Deficiency needs according to Marslow include safety, love, acceptance, and self-esteems. Until adolescents feel they have achieved the attributes of growth needs they do not develop inclination to strive for self-actualization which is more often propagated in report cards, grade acquisition and other meritocratic attributes of the school system. In general PBIS ends up in the traditional deterrence theory of punishment and rebuttals-which most adolescents can not comprehend with in their quest for survival and self identity.

The challenge of this new phase sometimes overwhelms them and they respond through anger and venting their frustrations. The more challenged teenagers could experience an outburst of emotions in response to a perceived barrier on their path to social identity (15) (16). These ideas are part of- the Social Identity Theory constructed by psychoanalyst Erik Erikson, who contended that identity was formed by passing through a series of eight role transitions from infancy to old age. At each stage there would be a resolution conflict, the outcome of which would influence the achievement of identity. Erikson's main focus was at the fifth, adolescent stage, where an individual would have the opportunity to experiment with different responses to social roles and expectations (16).

Unfortunately the PBIS fail to recognize this theory. The psychosocial needs of these students are not taken into consideration (16). They seek to be respected, accepted and develop a healthy self-esteem, all of which are crucial to successful learning. They sometimes achieve this in social niches like sport activities, field trips and other more informal settings. Students tend to compensate for their inability to succeed in classroom settings through these avenues. An absence of positive classroom experiences could potentially damage their trust and valuation of the classroom experience. Increasing research points out that successful learning cannot be achieved without motivation, behavioral adjustment and a trust in the school system by those students (17) (18) Lorraine cites an example of a student who threatened an instructor at the neighborhood grocery store, this reinforce the self esteem and confidence of the student to make up for his perceived weakness within the school building (13). Behavioral changes can be extended to the school sport activities circle and field trips so as to meet the dynamic nature of teenagers psychosocial quest. Expression is core to this phase of transition, an experience that the PBIS denies its students. Most of the programs always leave the students at the receiving end when their need is to be heard. Often when teenagers are denied this perceived right of theirs, they responded by refusing to listen to those entities or structures they perceives as barriers to their own self-expression.

PBIS lacks the understanding, responsiveness and structures that foster the needs of these young adults for a successful learning experience which is needed to effectively transition into safe adulthood.

Child’s Behavior as a product of Social Mechanism

Most students that exhibit negative/ risky health behavior think it is hard for them to change due to the precedence of such behaviors in their race, family history, or other cultural background.
Although the core statement of the PBIS acknowledges the fact that families and societies have large influence on the overall teenage development, it has failed to incorporate this knowledge into development of its programs. Teachers and instructors would not accept that the average teenage mind is very efficient at processing information that is overtly stated or subtly conveyed in his/her environment. They take clues from their parents and adult members of their ethnical and racial background. They absorb the message of class and caste system in the larger society and the stratification of the society along economic, racial/ethnic and academic lines. They begin to understand what is acceptable and superior in different segment of the society. More importantly, they try to assume their rightful stratum - where they rightly belong in the society. The process of initiation into these strata could mean membership into gang, encounters with law-enforcement authorities, sex, alcohol, and smoking experimentation. Based on what they see in their homes, neighborhood, and cultural background media they begin to develop their own set of behaviors. The process of molding their behavior positively would have to be broader than their school walls. Lorraine states that one of her students is the son of a gang lord fleeing the State of New York. Drugs, narcotic substances, guns, and crime are a part of his everyday life. Lorraine says these issues are larger than these children and they cannot help themselves. Of all nine students in her anger management class, eight of them are males and all of them are African Americans (13). Almost all of them are from dysfunctional homes. Current studies have pointed out that celebrity figures affect the health, behavioral, personality development, attitude acquisition, and social decisions of teenage boys and girls. Girls' behaviors worsen more than boys' when neighborhood conditions deteriorate: boys are adversely influenced by family factors, such as parental education, a family member's incarceration and parents' work behavior. "For males, it is not so much low income per se, but low income as a result of lack of employment for household heads in the context of family disruption that negatively influences behavior”(22).

This concept is central to the Social Learning Theory (SLT) which theorizes that individuals either accept or reject images and thoughts by watching other groups engage in particular experiences and activities to see what results of those experiences(18) (19). However, all hope is not lost to negative forces in the socialization process. A second theory gives insight into the cognitive process of character and behavioral formation among young adults, Social Cognitive Theory which theorizes that internal determinants affect behavior. External stimuli are not the sole reasons a person will perform a particular behavior in hopes of receiving a desired result. Instead, a person’s beliefs and ideas, or cognition, contributes to their action (18) (19). PBIS ignores the importance of these theories which give insight into how the socialization process can be utilized to positively mold behavior among teenagers.

Ineffective Communication Bridge
Some of the personnel involved in the programs are ineffective at communicating with the students. Likewise, the students do not trust the personnel. The personnel look upon the students as adamant and unwilling to change hence they may doubt their own interventions. Most parents of affected children think their children are either victims of discrimination or structural prejudice; hence they may view the authorities’ effort to help their children as hypocritical or inadequate. This situation is mostly due to the inability of the authorities to effectively communicate their approach and methodologies to the parents.

There is always a need to package a message effectively and efficiently to the recipient such that the intended content is not misinterpreted or mismanaged at the receiving end. A popular maxim says “WHAT you are saying is never more important than HOW you are saying it.” Teenagers constantly long to be involved in a double-ended communication channel where they want to obtain information, process, and analyze such information before regurgitating the product of the assimilated information so as to affirm the maturity of their thought process. Systems that consistently relegate them to the recipient partner status and less participatory is often viewed with hostility.

The inability to communicate successfully to today’s adolescent have been described as a resultant effect of politics of culture. “Traditional culture provides the conceptual space in which youth is constructed, experienced, and struggled over”(23). Culture is the primary terrain in which adults exercise power over young people both ideologically and institutionally (23). Hence they develop a hostile and inhospitable reaction to this established framework of culture. They therefore develop their own system of culture with its own intricacies mostly around their peer. According to a UNESCO report on peer sex education they observed that young people prefer to receive reproductive health information from peers rather than from adults and that involvement of peer promoters significantly increases referrals for contraceptive services at a fixed site. Peer education and leadership while excluding adults and other authoritative figures also provide opportunities for these young adult to handle responsibilities and utilize their skills in social settings (24).

The school system misrepresent students in such PBIS programs as abnormal and less intellectually and socially incompetent as compared to other students. This animosity by the other members of the school is always greeted with hostility in the affected students causing them to result to reactionary negative tendencies. The skepticism of the programs by the teachers and other members of the school board decreases their effectiveness in performing their duties to these teenagers. Lorraine affirms that out of the three staff members posted to the anger management program, only she alone believes that the students in the program can turn into positive adults. But, she also thinks their adjustment is not going to happen in the program. The anger management class is located at the least dignifying part of the school and she always has to go drag the affected students to come to the class. She has a more cordial relationship with the students such that one of them showed her weapons he had brought to school and would share his personal experience with her due to the sense of trust, security, friendship and comfort they share with her. These ideas are in accordance with the Advertising Theory, which suggests that messages are created in order to change the awareness, knowledge, and attitude of consumers towards a specific product offered.

Teenagers tend to idolize a particular role model who they imitate and confide in to serve as guide and example for them as they evolve their own personality. This role model is often someone they view as almost perfect and whose judgment they think is always right. Occasionally, it could be a parent, older sibling, a grandparent or uncle-someone who they perceive as hardly judgmental on them.

In the most common cases celebrity personalities always appeal to them the most. Celebrities can be likened to salespersons, they subconsciously alters the thoughts of their publics particularly adolescents, this is noticeable through celebrity endorsements, press interviews, apparel worn during public events, items favored by celebrities, celebrity-branded products and celebrities overall brand image all of which create epidemics of societal acceptance among various social groups in particular teenagers (25). Positive attitudes, behaviors and messages from these celebrity role models would be imbibed by these young adults. The use of these avenues would help foster the right attitudes and health behavior among young adults.

It suggests that one needs to be aware of their condition before considering to change .This leads to reaffirmation of the need to change and then a confirmation of the need to make use of the intervention in changing which in turn lead to action. Consequently, the actions would eventually be reinforced to lead to a more lasting change in behavior (26).The PBIS does not effectively help most students to work through the process needed to foster these changes.

While it is true that the school system can not influence all the elements that contribute to modeling of the child’s behavior, the PBIS has to take into consideration the complex and intricate process of teenage development and develop strategies that would not be antagonistic to the transition from childhood into adulthood in the process of positive behavioral modeling.

The prerogative for the creation of the PBIS is no doubt a noble endeavor, if it would be reorganized to correct the aforementioned oversights. If the growth needs and prevailing environmental conditions around the learning and transitional process into young adulthood of adolescent are carefully considered, PBIS would be most effective and instrumental in the successful passage of adolescents into responsible, well-behaved and healthy adults.

Consequently, the abundance of discoveries emanating from psychological and psychosocial developmental science of adolescents should be included into the mainstream training of all staffs directly involved in the school system, this should include teachers, school nurses and counselors, police, sport coaches and instructors, and other disciplinary figures. Schools should begin to monitor the overall psychological and psycho-social development of their students’ populations using such indicators, such as needless absenteeism, rates of fights among students, reported assaults among students, noticeable depression rates, and withdrawal. These would serve as performance indicators of the overall students while amendments and interventions can be sought in cases of abnormally high frequency of occurrence of such indicators.

School boards should come together and clamor for more funding to keep students in after-school programs that engender positive social developments such as sports, activities groups, career developments, vocational opportunities and summer camps during after school seasons. The facilitators of such social programs would be recommended to limit their roles to more of supervisory than participatory responsibilities. The students should be given more opportunities to take-on more responsibilities and role playing such that their self-esteem and self confidence would be effectively molded in the presence of their colleagues. Participation in student associations such as guilds and scouts should also be encouraged among these adolescents as an avenue for them to express themselves and be more active contributors in their own learning experience rather than receptors and listeners.

Schools in the same neighborhoods should be encouraged to form alliance in a bid to generate social avenues of interaction between their students, this brings them in contact with other students in their neighborhood and help them ease tensions they might be having from seeing and relating with their classmates and schoolmates day-in day-out, avenues such as field trips to the local museum, local public library, meeting a local sport or media celebrity are sources of motivations to these adolescents and they can be explored either by individual schools and/or in conjunction with other schools in the neighborhood. These celebrity idols can be use to propagate such important messages as school completion, delaying sexual debut, right attitude development, anti-smoking and substance/drug abstinence, career development, and right dietary options/choice selection.

My optimistic impression is that if the above are included into the mainstream programs of PBIS, our public high school system would be a place for nurturing and incubation for the development of wholesome and responsible adults.

(2) Durand, M. V., & Carr, E. G. (1985). Self-injurious behavior: Motivating conditions and guidelines for treatment. School Psychology Review, 14, 171-176.
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Childhood (Apr., 1973), pp. 129-135
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(20) Eyal, K. & Alan, R. (2003, March). Viewer aggression and homophily identification and parasocial relationships with television characters, 77-98. Journal of Broadcasting and Electronic Media, 47,1
(21) Miller, L. (2003, August). The little book of social theories, 49 -50.
(22)Ng I, Family history, neighborhood affect teen behavior problems
(23) Giroux, H. A. (2000). Stealing Innocence: Youth, Corporate Power, and the Politics of Culture. New York: St. Martin’s Press.
(25) Gladwell, M (2000). The tipping point. London: Oxford Printing Press.
(26) Mayfield D, Advertising Theory

(13) Lorraine Adeyemi is an Anger Management Counselor at Randolph Middle School. Many thanks to her for granting an interview and a case study for this write-up.

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