Best Practice in Positive Behavior Supports

1
Best Practice in Positive Behavior Supports

• Robert W. Ricketts, M.S., BCBA
• Southwest Center for Applied Behavior Analysis
• Consultant Betty Hardwick Center

2
Introduction

• Evolution of ABA Positive Behavior Supports

3
Introduction

• Evolution of ABA Positive Behavior Supports
• Behavior Modification of the 1950s into the
  80s.

4
Introduction

• Evolution of ABA Positive Behavior Supports
• Behavior Modification of the 1950s into the
  80s.
• In 1982, Behavior Analysis begins with
  publication of Toward a Functional Analysis of
  Self-Injurious Behavior (Iwata, et. al.).

5
Introduction

• Evolution of ABA Positive Behavior Supports
• Behavior Modification of the 1950s into the
  80s.
• In 1982, Behavior Analysis begins with
  publication of Toward a Functional Analysis of
  Self-Injurious Behavior (Iwata, et. al.).
• Aversive vs. Positive debate of the 1980s/1990s.

6
Introduction

• Evolution of ABA Positive Behavior Supports
• Behavior Modification of the 1950s into the
  80s.
• In 1982, Behavior Analysis begins with
  publication of Toward a Functional Analysis of
  Self-Injurious Behavior (Iwata, et. al.).
• Aversive vs. Positive debate of the
  1980s/1990s.
• In 1999, Behavior Analysts are Certified by the
  Behavior Analyst Certification Board (BCBA).
• BCBA becomes the accepted credential for minimal
  standards of competency.

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Maturation of ABABehavior Analyst Certification
as a Standard of Practice

• Behavior Analyst Certification Board established
  in1999

8
Maturation of ABABehavior Analyst Certification
as a Standard of Practice

• Behavior Analyst Certification Board established
  in1999
• Presently approximately 6,000 Certificants

9
Maturation of ABABehavior Analyst Certification
as a Standard of Practice

• Behavior Analyst Certification Board established
  in1999
• Presently approximately 6,000 Certificants
• In 2001 fewer than 20 Universities with programs
  in ABA
• Today, there are more than 120 Universities with
  programs in ABA.

10
Maturation of ABABehavior Analyst Certification
as a Standard of Practice

• Behavior Analyst Certification Board established
  in1999
• Presently approximately 6,000 Certificants
• In 2001 fewer than 20 Universities with programs
  in ABA
• Today, there are more than 120 Universities with
  programs in ABA.
• On May 5th, 2009, Oklahoma becomes first state to
  License Behavior Analysts.

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An Important Best Practice Standard

• If a professional represents themselves as having
  expertise or a specialty in any given area, they
  are expected to have the recognized professional
  credentials for that area.

12
An Important Best Practice Standard

• If a professional represents themselves as having
  expertise or a specialty in any given area, they
  are expected to have the recognized professional
  credentials for that area.
• A professional who presents themselves as having
  expertise in Applied Behavior Analysis, should
  have their certification as a BCBA.

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Some Critical Issues in the Effective Practice of
ABA

• Direct, Frequent, On-Going Involvement of a BCBA
• Time Intensive

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Some Critical Issues in the Effective Practice of
ABA

• Direct, Frequent, On-Going Involvement of a BCBA
• Time Intensive
• Treatment must be responsive to rapidly changing
  conditions

15
Some Critical Issues in the Effective Practice of
ABA

• Direct, Frequent, On-Going Involvement of a BCBA
• Time Intensive
• Treatment must be responsive to rapidly changing
  conditions
• Effective Staff Training
• Is not classroom based
• The BCBA needs to work on the floor.

16
Some Critical Issues in the Effective Practice of
ABA

• Direct, Frequent, On-Going Involvement of a BCBA
• Time Intensive
• Treatment must be responsive to rapidly changing
  conditions
• Effective Staff Training
• Is not classroom based
• The BCBA needs to work on the floor.
• BCBAs should be involved in teaching.
• Home Living Skills
• Vocational Skills
• Leisure Skills

17
Some Critical Issues in the Effective Practice of
ABA

• Direct, Frequent, On-Going Involvement of a BCBA
• Time Intensive
• Treatment must be responsive to rapidly changing
  conditions
• Effective Staff Training
• Is not classroom based
• The BCBA needs to work on the floor.
• BCBAs should be involved in teaching.
• Home Living Skills
• Vocational Skills
• Leisure Skills
• Positive Behavioral Supports
• Environments which support Quality of Life

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Written Behavior Programs Barriers to Effective
Treatment?
19
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.

20
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.
• Focus on reducing problem behavior, which is
  often not the problem.

21
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.
• Focus on reducing problem behavior, which is
  often not the problem.
• Rarely address replacement behaviors in any
  meaningful way.

22
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.
• Focus on reducing problem behavior, which is
  often not the problem.
• Rarely address replacement behaviors in any
  meaningful way.
• BTPs focus on the person, not the environment.

23
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.
• Focus on reducing problem behavior, which is
  often not the problem.
• Rarely address replacement behaviors in any
  meaningful way.
• BTPs focus on the person, not the environment.
• BTPs may include emergency restrictive
  procedures which are inappropriately placed in a
  training objective.

24
Written Behavior Programs Barriers to Effective
Treatment?

• Written BTPs often function as barriers to
  effective intervention.
• Are static and unresponsive.
• Focus on reducing problem behavior, which is
  often not the problem.
• Rarely address replacement behaviors in any
  meaningful way.
• BTPs focus on the person, not the environment.
• BTPs may include emergency restrictive
  procedures which are inappropriately placed in a
  training objective.
• BTPs are a relic of the era of Behavior
  Modification, and often hinder/discourage
  effective use of present-day Behavior Analytic
  methodologies.

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Positive Behavior Supports are not an Add-On
Service.

• Behavior Supports consist of everything that
  gives an individual Quality of Life.

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Positive Behavior Supports are not an Add-On
Service.

• Behavior Supports consist of everything that
  gives an individual Quality of Life.
• Behavior Intervention Strategies should be the
  persons regular activities/objectives.

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Positive Behavior Supports are not an Add-On
Service.

• Behavior Supports consist of everything that
  gives an individual Quality of Life.
• Behavior Intervention Strategies should be the
  persons regular activities/objectives.
• The BCBA must partner with all other persons
  responsible for the provision of services.
• Program Staff
• Support Staff

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What are Positive Behavior Supports?

• Positive Behavior Supports
• Formal Assessment/Intervention Strategies based
  on the principles of ABA.
• Those strategies which require a BCBA.

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What are Positive Behavior Supports?

• Positive Behavior Supports
• Formal Assessment/Intervention Strategies based
  on the principles of ABA.
• Those strategies which require a BCBA.
• Quality of Life Environments
• Physical (home and work environments)
• Social
• Work
• Leisure
• Quality of Social Interactions

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Importance of Quality of Life in Positive
Behavior Support

• Effective behavioral strategies must teach new
  behavior.

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Importance of Quality of Life in Positive
Behavior Support

• Effective behavioral strategies must teach new
  behavior.
• Options for new/alternate/desired behavior is
  directly related to the Quality of the
  Environment.

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SIB, HIT, SIT, or Urinate. Those are the
choices. What should we teach?
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Importance of Quality of Life in Positive
Behavior Support

• Without a Quality Environment, or Positive
  Behavior Supports, the probability of effective
  intervention (behavioral or otherwise) is greatly
  reduced.

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Positive Supports Living Environments (Singh,
1997)

• An Engaging Environment
• Teaching and Maintaining Functional Skills
• Reducing or Preempting the Occurrence of Behavior
  Problems
• Least Restrictive Living Environment
• Stable Environment
• Safe Environment
• Choice of Residential Placement

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An Engaging Environment

• For example, some individuals do not find
  anything in the environment that is reinforcing
  enough to attract their attention. (Singh, 1997,
  p.10)

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An Engaging Environment

• For example, some individuals do not find
  anything in the environment that is reinforcing
  enough to attract their attention. (Singh, 1997,
  p.10)
• Given that there is a negative correlation
  between engagement and problem behavior, some of
  the problem behaviors exhibited by these
  individuals may be related to the fact that the
  environment is not responsive to their needs.
  (Singh, 1997, p.11)

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Teaching and Maintaining Functional Skills

• In acceptable treatment environments, training
  is conducted not in discrete, artificial training
  sessions, but in settings, times, and activities
  that are functional for the individual. (Singh,
  1997, p.11)

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Least Restrictive Living Environment

• The basic question is How normalized is the
  living environment?
• Lack of privacy.sharing bedrooms.
• Personal belongings on walls, in rooms.
• Do not have a homelike environment.
• Spontaneous activities.
• Restriction of civil liberties in lieu of
  effective behavioral and/or psychopharmalogical
  management.

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Reducing or Preempting the Occurrence of Behavior
Problems

• The longer a problem behavior remains in an
  individuals repetoire, the less acceptable is
  the treatment environment. (Singh, 1997, p.11)

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Safe Environment

• Incidence of Self-Injury/Aggression
• Incidence of Abuse/Neglect
• Lack of acceptance and insensitivity by members
  of the community.

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Stable Environment

• Is there predictability and continuity in terms
  of services and personnel?
• Unstable environments
• Unfamiliar Staff
• Changes in how programs are implemented
• Changes in expectations/rules

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Choice of Residential Placement

• Do people choose to live in their current
  environments?

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Do people choose their own roommates?
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Choice of Residential Placement

• Do people choose to live in their current
  environments?
• Do people choose their own roommates.
• We must never forget that living in the
  community is not inherently better (than living
  in an institution) if the services we provide to
  individuals in the community are not of the same
  quality as those we provide to ourselves.
  (Singh, 1997, p.14)

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BACB Guidelines for Responsible Conduct
46
BACB Guidelines for Responsible Conduct

• 2.09 Treatment Efficacy.
• (a) The behavior analyst always has the
  responsibility to recommend scientifically
  supported most effective treatment procedures.
  Effective treatment procedures have been
  validated as having both long-term and short-term
  benefits to clients and society.
• (b) Clients have a right to effective treatment
  (i.e., based on the research literature and
  adapted to the individual client).

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BACB Guidelines for Responsible Conduct

• 3.02 Environmental Conditions that Hamper
  Implementation.
• If environmental conditions hamper implementation
  of the behavior analytic program, the behavior
  analyst seeks to eliminate the environmental
  constraints, or identifies in writing the
  obstacles to doing so.

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BACB Guidelines for Responsible Conduct

• 6.06 Conflicts with Organizations.
• If the demands of an organization with which
  behavior analysts are affiliated conflict with
  these Guidelines, behavior analysts clarify the
  nature of the conflict, make known their
  commitment to these Guidelines, and to the extent
  feasible, seek to resolve the conflict in a way
  that permits the fullest adherence to these
  Guidelines.

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Summary

• Best Practice consists of
• Professionals with appropriate credentials
• Quality environments
• A structure such that Formal Behavior
  Strategies are part of the persons daily
  routines and programs.
• A view that the person is not the problem.

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Im Finished!

• Questions?
• Comments?
• Discussion?