Behavior Modification as a Tool 9/3/2020

Among all the acronyms and differently named psychosocial support methodologies in use for helping families and kids, Behavior Management (B-Mod) is a time-tested tool to improve interactional conflicts in human groups. In pediatrics, B-Mod, can provide families opportunities to resolve conflicts and advance healthier psychosocial functioning.
When applied to parenting, the technique uses positive reinforcements to induce a structured dialogue between parents and children, improving communication and encouraging growth in confidence and responsibility over time. When effective B-Mod works bi-directionality to help parents grow as well.
B-Mod’s contextual basis is founded on two principles:
1. Punishment is a poor motivator for change
2. Appropriately structured rewards for positive behaviors encourages cooperation and collaboration

Requirements for implementing B-Mod program are minimal and include:
1. A System for Tracking Behavior
2. Rewarding Positive Behaviors
Both the goals and the rewards must be negotiated between the parent(s) and the child. With successful compliance with the chosen goals, the child earns credits to trade in for a desired (and parentally sanctioned) awards. Typically progress (or lack thereof) is recorded in the evening each day.
A sample Tracking document for a younger child might look like:
Name: James                                                                      Week of ___________
Is successful when he:                                                Mon   Tues   Wed   Thu   Fri   Sat   Sun
Completes morning routines and ready for
carpool by 7:55___________________________________________________________
Discusses his school day experience and
reports any problems or concerns______________________________________________
Helpful with younger brother with chores_________________________________________
Tells parents calmly if/when he is upset or
Home from play with peers on time for dinner______________________________________
Talks about his day at dinner, helps clear table______________________________________ Homework done and ready for bed by 9:00________________________________________

Of note, the targeted behaviors are all positively and affirmatively framed and all are realistic goals. With increasing maturity, the complexity and number of targeted behaviors can be increased and more nuanced. Even very challenging issues can be addressed—for example, a youth can be encouraged to request a time out or seek parental intervention when conflicts with siblings start to get heated or insecurities or negative feelings emerge because of other life challenges.

For goals achieved, the youth earn credits which can then be traded in for rewards.
1. Pick dessert for family on Saturday night                          15
2. Earn $ 1.00 for personal use                                                20
3. Special activity with mom or dad on Sunday morning   30
4. Have friend over for weekend overnight                            50
5. Trip to SeaWorld with best friend                                       125

Rewards also can be nuanced as the child matures— materiel rewards work best for younger children but a transition to social rewards and ultimately to internalized reinforcements can be achieved.
While the conceptual basis of a B-Mod system is fairly straightforward, implementation does require careful preparation of the parents so that a reorientation toward positive reinforcement occurs. The parent’s capacity to shift from responding punitively to negative behaviors to assume a pre-emptive positive orientation is critical and ongoing support and encouragement is often required.
When effectively implemented and supported B-Mod interventions can support families (and other social groups) focus on common goals that enhance functioning and healthy development.

The following Web Resources provide both theoretical and practical information that may be helpful for primary care providers and the families they serve:

4 Proven Behavior Modification Techniques with Examples

REFERENCE: Discipline Without Anger: A Program for Managing Children’s Behavior, Jerry Adams, Ph.D.; Kaiser Permanente Pediatrics, ca 1975

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