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