Planning, Applying, and Evaluating a Treatment Program

1
Planning, Applying, and Evaluating a Treatment
Program

• Chapter 24

2
A Problem Has Been Referred Should You Design A
Program?

• Questions to answer
• Was the problem referred primarily for the
  benefit of the client?
• Can the problem and the goal be specified such
  that you are dealing with a specific behavior or
  set of behaviors that can be counted, timed, or
  measured in some way?
• Is the problem important to the client or to
  others?
• Have you eliminated the possibility that there
  are complications involved in this problem that
  would necessitate referring it to another
  specialist?
• Is the problem one that would appear to be easily
  manageable?
• If the goal is reached, might it be easily
  generalized and maintained?
• Can you identify significant individuals in the
  clients natural environment who might help to
  record observations and manage controlling
  stimuli and reinforcers?
• If there are individuals who might hinder the
  program, can you identify ways of minimizing
  their potential interference?
• On the basis of your tentative answers to these
  eight questions, do your training qualifications,
  daily schedule, and available time seem adequate
  for you to participate in the program?

3
Selecting and Implementing and Assessment
Procedure

• For reliable baselining, define the handicap in
  precise behavioral terms.
• Select an appropriate baselining procedure that
  will enable you to
• monitor the problem behavior
• identify its current stimulus control
• identify the maintaining consequences of the
  problem behavior
• monitor relevant medical/health/personal
  variables
• identify an alternative desirable behavior
• Design recording procedures that will enable you
  to log the amount of time devoted to the project
  by the professionals working on it
• Ensure that the observers have received
  appropriate training in identifying critical
  aspects of the behavior, applying the recording
  procedures, and graphing data
• If the baseline is likely to be prolonged, select
  a procedure for increasing and maintaining the
  strength of the record-keeping behavior of the
  data recorders
• Select a procedure for ensuring the reliability
  of the baseline observations
• After beginning to collect baseline data, analyze
  those data carefully to select an appropriate
  intervention strategy and decide when to
  terminate the baseline phase and begin
  intervention

4
Considerations for Assessment Procedures

• What daily times can the mediator(s) schedule
  this project?
• Will others in the situation help or hinder your
  data collection?
• Will the surroundings help or hinder your
  assessment?
• What is the frequency of the existing behavior?
• How rapidly should the behavior change?

5
Strategies for Program Design and Implementation

• Define the goal, identify the target behaviors
  and their desired amount and stimulus control
• Identify individuals who might help to manage
  controlling stimuli and reinforcers. Also
  identify those who might hinder the program
• Examine the possibility of capitalizing on
  antecedent control. Can you use
• Rules?
• Goal setting?
• Modeling?
• Physical guidance?
• Situational inducement?
• Motivating operations?
• If you are developing a new behavior, will you
  use shaping, fading, or chaining? What motivation
  establishing operation will you use?

6
Strategies for Program Design and Implementation

• If you are changing the stimulus control of an
  existing behavior, can you select the controlling
  SDs such that they
• are different from other stimuli on more than one
  dimension?
• are encountered mainly in situations in which the
  desired stimulus control should occur?
• evoke attending behavior?
• do not evoke undesirable behavior?

7
Strategies for Program Design and Implementation

• If you are decreasing behavioral excess
• Can you remove SDs from the problem behavior?
• Can you withhold reinforcers that are maintaining
  the problem behavior, or present motivation
  abolishing operations for those reinforcers?
• Can you apply DRL?
• Can you apply DRO, DRI, or DRA?
• Should punishment be used?
• Specify the details of the reinforcement system
• How will reinforcers be selected?
• What reinforcers will be used?
• How will reinforcer effectiveness be continually
  monitored, and by whom?
• How will reinforcers be stored and dispensed, and
  by whom?
• If a token system is used, what are the details
  of its implementation?

8
Strategies for Program Design and Implementation

• Specify the training setting.
• Describe how you will program generality of
  behavior change by
• Programming stimulus generalization. Can you
• Train in the test situation?
• Vary the training conditions?
• Program common stimuli?
• Train sufficient stimulus exemplars?
• Establish a stimulus equivalence class?
• Programming response generalization. Can you
• Train sufficient exemplars?
• Vary the acceptable responses during training?
• Use behavioral momentum to increase low
  probability responses within a response class?
• Programming behavior maintenance. Can you
• Use natural contingencies of reinforcement?
• Train people in the natural environment?
• Use schedules of reinforcement in the training
  environment?
• Give the control to the individual?

9
Strategies for Program Design and Implementation

1. Specify the details of the daily recording and
   graphing procedures
2. Collect the necessary materials
3. Make checklists of rules and responsibilities for
   all participants in the program
4. Specify the dates for data and program reviews
   and identify those who will attend
5. Identify some contingencies that will reinforce
   the behavior modifiers and mediator
6. Review the potential cost of the program as
   designed and judge its merit against cost
   reprogram as necessary
7. Sign a behavioral contract
8. Implement the program

10
Program Maintenance and Evaluation

• Monitor your data to determine whether the
  recorded behaviors are changing in the desired
  direction
• Consult the people who must deal with the
  behavioral handicap, and determine whether they
  are satisfied with the progress
• Consult other sources to determine if your
  results are reasonable in terms of the amount of
  behavior change during the period the program has
  been in effect
• If 1, 2, 3 are satisfactory, proceed to step 8
• If 1, 2, 3, are unsatisfactory, answer the
  following questions
• Have the reinforcers hat are being used lost
  their appeal?
• Are competing responses being reinforced?
• Are the procedures being applied incorrectly?
• Is there outside interference that is disrupting
  the program?
• Are there any subjective variables that might be
  adversely affecting the program?
• If none of the answers to questions are yes,
  check if additional programming steps need to be
  added or removed
• If the results are now satisfactory, proceed to
  guideline 8 otherwise consult with a colleague,
  or consider changing a major aspect of program,
  or redoing functional analysis

11
Program Maintenance and Evaluation

1. Decide how you will provide appropriate program
   maintenance until the behavioral objective is
   reached
2. Following attainment of the behavioral goal,
   outline an appropriate arrangement for assessing
   performance during follow-up observations and
   assessing social validity
3. After successful follow-up observations have been
   obtained, determine the costs for the behavioral
   changes that occurred
4. Where possible and appropriate, analyze your data
   and communicate your procedures and results to
   other behavior modifiers and interested
   professionals

12
Token Economies

• Chapter 25

13
Some Definitions

• Conditioned Reinforcers
• Not originally reinforcing but becomes reinforcer
  after being paired with other reinforcers
• Tokens
• Conditioned reinforcers that endure, can be
  accumulated and exchanged for backup reinforcers
• Token Economy
• Behavior Modification program that uses tokens

14
Advantages of Token Economies

• Can be given immediately
• Paired with many different backup reinforcers
• Can be administered to large diverse groups

15
Setting up a Token Economy

• Decide on target behavior
• Define behaviors so that all involved can
  identify instances of appropriate and
  inappropriate behavior
• Take baselines
• Baseline data important to know what is needed
• Data can help with selecting backup reinforcers
• Select backup reinforcers
• Identify backup consequences through direct and
  indirect assessment
• Use wide variety of backup reinforcers
• Can use response-cost procedures to punish
  inappropriate behavior

16
Setting up a Token Economy

• Select the type of tokens to use
• Can take many forms, but should be
• Durable
• Easy to handle
• Difficult to steal
• Difficult to counterfeit
• Can have graded value for tokens
• Can associate different types of tokens with
  different behaviors

17
Setting up a Token Economy

• Identify available help
• Depending on the situation, different people may
  need to help
• Ex teachers, volunteers, behaviorally advanced
  peers, etc.
• Choose the locations
• Some locations are better than others, but often
  do not have a choice of location
• Managing Consequences
• Ensure backup reinforcers are on hand
• Clearly describe criteria for earning and
  exchanging tokens
• Award tokens as immediately as possible
• Use reinforcers such as praise with tokens
• Keep accurate records
• Provide bonuses for high-level performance
• Train those administering tokens

18
Specific Implementation Procedures

• Must decide on procedures for
• Keeping data
• What kinds of sheets?
• Who will record the data?
• When will recording take place?
• The reinforcing agent
• Who will administer the reinforcement and for
  what behaviors?
• Number or frequency of tokens to Pay
• More tokens to start
• Gradually decrease number of tokens
• Less pleasant activities might earn more

19
Specific Implementation Procedures Continued

• Managing the Backup Reinforcers
• How frequently will backup reinforcers be made
  available?
• Frequency high in the beginning
• How much will each reinforcer cost?
• Should be related to monetary cost
• High demand items should cost more
• Low cost for backup reinforcers that have
  therapeutic value
• Possible Punishment Contingencies
• Can use tokens to administer punishment through
  fines
• May need to teach clients how to accept fines in
  a nonaggressive, relatively nonemotional way

20
Specific Implementation Procedures Continued

• Supervision of Staff
• Duties must be clearly spelled out
• Staff must be monitored closely
• Reinforcement must be offered for appropriate
  behavior
• Handling Potential Problems
• Problems must be planned for in advance
• Likely problems
• Confusion
• Staff shortages
• Attempts by clients to get tokens they have not
  earned or backup reinforcers for which they do
  not have enough tokens
• Clients playing with tokens in distracting ways
• Failure to purchase backup reinforcers

21
Preparing a Manual

• Token Economy Manual
• Written set of rules describing exactly how the
  economy is to run
• Includes
• Definite procedures for evaluating whether or not
  the rules are being followed adequately and
  procedures for ensuring that they are
• Methods for arbitrating disputes about rules
• Should be detailed
• Should be given to all staff members

22
Programming Generality to the Natural Environment

• Token economy should be designed so that social
  reinforcement gradually replaces tokens
• Weaning from tokens
• Eliminate tokens gradually
• Gradually make the schedule of token delivery
  more and more intermittent
• Decrease token value gradually
• Gradually decrease amount of backup reinforcement
  that a token can purchase
• Or, gradually increase the delay between getting
  tokens and purchase of backup reinforcements
• Gradually transfer control to the clients

23
Ethical Considerations

• Must take precusions to avoid abuse
• Making the system completely open to public
  scrutiny may ensure that no abuse happens

24
Ethical Issues

• Chapter 30

25
Historical Implications

• Cultural history and personal experiences with
  others abusing power, taught people to react
  negatively to behavior modification
• This term evokes many negative feelings

26
Behavioral View of Ethics

• Ethics standards of behavior developed by
  culture to promote the survival of that culture
• Ethical guidelines are an important source of
  behavioral control when immediate reinforcers
  influence individual to behave in a way that
  leads to aversive stimuli for others
• When members of the same culture learn to follow
  the same ethical guidelines, the guidelines exert
  rule-governed control over behavior

27
Arguments Against Deliberately Controlling
Behavior

• Because of history and experiences, some have
  argued that all attempts to control behavior are
  unethical
• Goal of any social help profession involve change
  in behavior and behavior control
• It is often necessary to change, manage,
  influence, or control behavior
• It is necessary to ensure that it is done
  ethically

28
Ethical Guidelines

• Organizations that have addressed ethical
  guidelines involved in behavior modification
• Association for the Advancement of Behavior
  Therapy (AABT)
• American Psychological Association (APA)
• Association for Behavior Analysis (ABA)

29
Ethical Guidelines

• Based on
• 1977, Behavior Therapy, publication of set of
  ethical questions to ask
• 1978, Stolz Associates, a comprehensive report
  on ethical issues involved in behavior
  modification
• 1988, Van Houten et al., The Behavior Analyst,
  published a statement of clients rights
• 2002, American Psychological Associations
  Ethical Principles of Psychologists and Code of
  Conduct

30
Ethical Considerations

• Qualifications of the Behavior Modifier
• Must receive appropriate training academic and
  supervised practical training
• Procedures being used are the most up-to-date
• Steps to ensure countercontrol and
  accountability
• Supervision by members of ABA, AABT, or both
• Various certification programs

31
Ethical Considerations

• Definition of Problem and Selection of goals
• Target behaviors selected must be most important
  for client and society
• Emphasis on teaching functional, age-appropriate
  skills
• For those with handicaps, focus on teaching
  skills that promote independent functioning
• Goals should be consistent with the basic rights
  of the client to dignity, privacy, and humane
  care
• Steps to ensure countercontrol and
  accountability
• Require behavior modifier to clearly specify his
  or her values relating to client's problems
• Client as an active participant in the selection
  of goals and identification of target behaviors

32
Ethical Considerations

• Selection of Treatment Method
• Use the most effective, empirically validated
  methods with the least discomfort and fewest
  negative side effects
• Use least intrusive and restrictive interventions
• No agreement on a continuum of intrusiveness or
  restrictiveness
• Interventions based on positive reinforcement
  considered less intrusive than interventions
  based on aversive control
• Intrusive and restrictive sometimes refer to the
  extent to which clients are given choices and
  allowed freedom of movement in a therapeutic
  environment
• Intrusive and restrictive sometimes refer to the
  extent to which consequences are deliberately
  managed as opposed to naturally occurring
• Steps to ensure countercontrol and accountability
• Informed consent
• Ethical review committees

33
Ethical Considerations

• Record Keeping and Ongoing Evaluation
• Maintenance of accurate data throughout the
  program
• Behavioral assessment before the program
• Ongoing monitoring of target behavior
• Possible side-effects
• Appropriate follow-up evaluation after treatment
• Confidentiality to be respected at all times
• Steps to ensure countercontrol and
  accountability
• Client access to records
• Frequent discussions with client about progress
  in the program
• Periodic peer evaluation of data