Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers,...

Evidence-Based Intervention Selection & PlanningUtah Behavior Support ClinicDr. Sellers, BCBA-DOctober, 2015

Idaho Partnerships Conference on

Human Services

IMPORTANCE OF FUNCTION-BASED INTERVENTIONS

1

“Why” the behavior is occurring

What is the individual trying

to get/accomplish?

“Function”?

Functions of BehaviorAttention

Escape

Tangible

Automatic

Multiple or Combination

Escape 38%

Automatic 26%

Attention 23%

Multiple5%

Tangible 3%

Undifferentiated 5%

• 152 children with developmental disabilities

• Self Injurious Behavior

Iwata et al. (1994)

• ~500 individuals with developmental disabilities

• SIB, aggression, disruption, etc.

Hanley et al. (2003)

Escape 33%

Attention 24%

Auto-matic 15%

Multiple14%

Tangible 10%

Undifferentiated 4%

Geiger, Carr, & LeBlanc (2010)

Function-Matched InterventionsBest practice -select interventions matched to the

identified/hypothesized function of problem behavior

Directly addresses the contributing antecedents & reinforcing consequences of

problem behavior

Often incorporates selecting and increasing a functionally equivalent replacement behavior

Can be combined, or used in a sequential fashion

BASICS of EVIDENCE-BASED INTERVENTIONS

2

Teach Problem Behavior No

Longer Results in Desired Reinforcer

• Extinction• Differential

Reinforcement of 0 Rates/Occurrences of Problem Behavior (DRO)

Reduce Motivation to

Engage in Problem Behavior

• Environmental Engineering/Restructuring (revising curriculum/instruction, choice, increase access to preferred contexts)

• Noncontingent Reinforcement (NCR)

Teach Different/New Behaviors for

Getting Desired Reinforcer

• Functional Communication Training (FCT)

• Differential Reinforcement of Alternative Behavior (DRA)

3 Main “Types” of Interventions

Ante

cedent-

Base

d:

Non-Contingent Reinforcement (NCR)

Environmental/Curricular Restructuring:

Increased Choice Opportunities

Demand Fading

Common Function-Based Treatments

Conse

quence

-Base

d:

Extinction

Differential Reinforcement of Other (DRO)

Differential Reinforcement of Alternative (DRA)

Functional Communication Training (FCT)

Common Function-Based Treatments

EVIDENCE-BASED INTERVENTION SELECTION

3

Evidence-Based Practice

Effective Client Outcomes

Client Context

& Values

Best Availabl

e Evidenc

e

Clinical Expertise

Cri

tica

l C

on

sid

era

tion

s

Individual

Level of Independence/Quality of Life

Safety

Individual’s deficits/nee

ds

Individual’s strengths/preferences

Contextual Fit

(resources, acceptability)

Intervention Selection-Published Guides

Escape Maintained Problem Behavior

Geiger, Carr,

LeBlanc (2010)

Attention Maintained Problem Behavior

-Appropriate for Tangibly Maintained

Grow, Carr, & LeBlanc (2009)

• Task type (preferred), task level (difficulty), pacing, duration of instructional periods, level of required independence, competing contingencies

Instruction

• Interaction type, interaction level, frequency, levels/duration of required interaction, competing contingencies

Social Interactions

• Noise level, temperature, structure/lack of structure, transitions

Environment

Escape Function-Very common function (most or second most, depending on source)

Intervention Descriptions

Table with Strengths & Limitations

Decision-Making Flow

Chart

Description of

Intervention Selection

Consider Intervention

Options

Identify

Problem Bx

Functional

Assessment

Fx = Escape

Curricular or

Instructional

Revision

Demand

Fading

Extinction

Noncontingent Escape

Activity Choice

DNRA / FCT DNRO

ESCAPE-MATCHED INTERVENTION OPTIONS

Tx Selection –Escape Maintained

Geiger, Carr, LeBlanc (2010)

Antecedent-Based Consequence-Based

Using the Intervention Selection Guide

Tx Selection –Escape Maintained

Geiger, Carr, LeBlanc (2010)Question 5: focuses on selecting the optimal terminal intervention

Question 4: focuses on determining if minimizing time away from instruction is paramount

Question 3: focuses on determining if establishing compliance with demands is paramount

Question 2: focuses on determining if immediate suppression of the problem behavior is paramount (interventions can be implemented with

or without extinction)

Question 1: focuses on determining if diminishing the value of escape and teaching appropriate prerequisite skills is paramount

Using the Intervention Selection Guide

Tx Selection –Escape Maintained

Geiger, Carr, LeBlanc (2010)

CA

UTIO

N

REV

ISIT

FLEX

IBIL

ITY-Some

interventions can be combined-Interventions can be individualized (e.g., with and without extinction, faded in slowly)

-Implement intervention indicated early on in model > success > revisit and go through model again

-Caution: Avoid FCT and NCE at same time -Wait until NCE has been significantly faded or discontinued to implement FCT

• Adults• Specific Adult• Peers• Person is “Busy”

or Giving Attention to Other

Person Delivering

• Tone of Voice• Volume• Facial Expressions• Physical Proximity• Gestures• Duration

Quality of Attention

Attention Function-Another very common function

TREATMENT SELECTION for ESCAPE MAINTAINED BEHAVIOR EXAMPLE

• Male• 10yrs Old (but very

large)• Autism• Referred for: Severe

Aggression

Attention Function-A Thought

Attention Tangible

SOCIAL POSITIVE

Intervention Descriptions

Description of

Intervention Selection

Case Example

Using Flow Chart

Decision-Making Flow

Chart

Identify

Problem Bx

Functional

Assessment

Fx = Attention

Consider Intervention

Options

NCR Classroom Restructuring CWPT Extinctio

n FCT DRA

ATTENTION-MATCHED INTERVENTION OPTIONS

Antecedent-Based Consequence-BasedTx Selection –Attention

MaintainedGrow, Carr, LeBlanc (2009)

Tx Selection –Attention Maintained

Grow, Carr, LeBlanc (2009)

Using the Intervention Selection Guide

Question 4: focuses on determining what type of appropriate behavior needs to be taught/strengthened

Question 3: focuses on determining if behavior needs to be strengthened

Question 2: focuses on determining if temporary increases in occurrences of prob bx is acceptable

Question 1: focuses on determining if extinction/ignoring prob bx is appropriate/possible

Using the Intervention Selection Guide

Tx Selection –Escape Maintained

Geiger, Carr, LeBlanc (2010)

CA

UTIO

N

REV

ISIT

FLEX

IBIL

ITY-Some

interventions can be combined-Interventions can be individualized (e.g., with and without extinction, faded in slowly)

-Implement intervention indicated early on in model > success > revisit and go through model again

-Caution: Avoid FCT and NCR at same time -Wait until NCR has been significantly faded or discontinued to implement FCT

TREATMENT SELECTION for ATTENTION MAINTAINED BEHAVIOR EXAMPLE

• Male• 13yrs Old (but very

small for age due to pre-mature birth)

• Multiple Dx• CP• Visual • Impairments

TREATMENT –Functional Communication Training

TREATMENT SELECTION for TANGIBLY MAINTAINED BEHAVIOR EXAMPLE-Using Attention Intervention Selection Guide

MaNo 5 Anxiety, ADHD,

potential Autism Referred for

noncompliance: yelling/noncompliance, aggression (tantrums)

TREATMENT –Functional Communication Training

INTERVENTION PLANNING

4

REVIEW STEPS

FUNCTION of PROBLEM

BEHAVIOR?

INTERVENTION SELECTED?

IMPLEMENTATION

Implementation

OPTION 1 JUST DO IT –The “Hand Off”

OPTION 3

Implementation Components

PlanningAssess Available Resources• Staffing (number, skill level, ability to learn

needed skills, perceptions & attitude)• Physical (space, materials)• Timing

Create Clinical Materials • Intervention Protocol• Data Sheets• Treatment Integrity Checks & Data

Collection Checks

Create Training Materials• Job Aids & Other Supports• Sample Data Sheets• Videos (if possible)

Implementing

Training• Train Implementation of

Procedures• Train How to Train Others (if

needed)• Train Data Collection• Train Data/Progress Reporting

Initial Implementation• Have Materials Organized and

Ready• Plan Appropriate Initial

Support

Telling instead of Teaching

Trial & error implementationDevelopment of bad/incorrect habits/practices

No opportunity to see skill being used

No opportunity to practice/demonstrate mastery

No systematic feedback, or poor feedback

LEADS TO:

ImplementingC

OM

MO

N E

RR

OR

S IN

TR

AIN

ING

Parsons et al. 2012

Implementing-Behavioral Skills

Training (BST)

Instructions

Modeling

Rehearsal

Feedback

Continue until Mastery –You know the individual is done when s/he demonstrates the skill!

Implementing -Components

of BST

SupportingCheck-Ins-In Person

-Email-Text

-Phone-Notes

Treatment Fidelity and IOA Checks

Praise, Praise, Praise

Retraining (if

needed)

Evaluate effects of intervention• D

esired reduction of problem behavior

• Desired increase of appropriate behavior

• Desired generalization

• Desired maintenance

Evaluate Need for Additional or Advanced Staff Training

Reviewing

Implementation Components

Risk of not completing

Continued Prob. Bx or Increase

Loss of Time

Risk of Injury

Potential to Increase

Resistance to Future

Interventions

RESOURCES

5

RESOURCES

Reviews/Summaries

Best-Practice Guidelines

Practice Recommendations

RESOURCES

-Provided to you

Geiger, Carr, & LeBlanc (2010)

Grow, Carr, & LeBlanc (2009)

Attention Tx Selection Blank

Escape Tx Selection Blank

Intervention Planning

Clinical Protocol Template

Next Class

Practitioner Resources for Applied Behavior Analysts

http://wmich.edu/autism/resources

Western Michigan UniversityAutism Center of Excellence