6-BIP, Flashcards by Kathleen Dugan

List the behavior only

Response definition- problem behavior

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these typically include antecedent and behavior, since the antecedent condition is motivationally tied to the functional consequence

Functional response definitions – Behavior

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A very common mistake is made in the construction of behavior programs We look more at topography then…

When you scream in pain, or scream to get attention, or scream because you want someone to leave you alone, are all these screams the same?
What is different?….

Scream for pain:
 Pain is a UEO, that establishes it’s own
termination as a reinforcer: Auto SR-

When you scream for attention. NO attention (or some likely CEO-T) increases value of social engagement: Soc. Med. Sr+

When you scream to make someone leave, person is a CEO-R: Soc. Med. Sr-

function

THE ANTECEDENT!

Section- Problem behavior (Reduction targets) And the BIP

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Related to the previous flash card, screaming for different different antecedents, Should not get the same consequential intervention.

Should not have a Single response definition for screaming, without specifying the condition under which screaming occurrence.

different antecedents for the same behavior with different maintaining consequences Equals

 Different functional Response classes..  You need different functional response definitions.

Section: Problem behavior:behavior reduction

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Screaming in task
Use interventions specific to behavior maintained by soc. mediated negative reinforcement:; ……..

Screaming when out of task;
Use interventions specific to bx maintained by soc. mediated positive reinforcement:……..

DNRA, Response blocking, Stimulus (task) fade in, Hi-P

Extinction, NCR, Mand training, etc.

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Considered by some to be optional, but it should not be so

Through…….. (and the related process of direct reinforcement assessment), intervention strategies based on positive reinforcement are MUCH more likely to be effective

Section 8: Preference Assessment: Describe the usefulness of a preference assessment in a behavior intervention plan

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Replacement behavior should usually be functionally equivalent

When a target behavior is reduced, this means a member of a functional response class has been weakened

We have an ethical responsibility to provide the individual a way to address that functional need…we must teach a replacement behavior

FEABs? FERBs? Fair pairs; ( If take away, give something back)

Section: replacement behavior, acquisition, and the BIP

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Sometimes a target replacement behavior can’t be functionally the same as the target behavior for reduction

A problem response may need to be replaced with a response that has a different function. can be tricky, but necessary
Ex: Example: If escaping task is the function of hitting others, we can teach a new, appropriate way to escape. But what if the task is tooth-brushing? Ongoing escape from brushing teeth is not an acceptable result. cannot just keep reinforcing “manding for escape”.

DRIs can strengthen functionally unrelated alternative responses, but “washing hands” rather than hitting is still not brushing teeth!  Not functionally equivalent.We have to teach in a way that makes presentation of the tooth brushing task stop evoking escape-related responses.      Change the evocative effect of the task.  ANTECEDENT INTERVENTIONS focus on just such problems

Section 9: Replacements

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If an antecedent condition (e.g., task presentation) functions as an EO for escape, that antecedent’s function must be….Altered and Change to a…

SD for Positive SR+

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Andy and the Baco-bits

Changed the function of the table

Changing an Antecedent Function: A Story

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Stimulus fade-in

Hi-P

Errorless teaching

NCR; but be careful: it can have an AO effect not intended
E.g., baco-bit satiation

Some Antecedent Interventions for Behaviors

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The development of functional skills must be part of any behavior plan

They DO NOT have to be directly tied to reductive targets, but will enable the person to function more independently and with greater access to natural reinforcement

This leads to behavioral cusps (such as manding, reading, using money, etc…)

Other Target Skills for Development/Strengthening

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Here is where all of the prior work culminates in an action plan

In the formal program, interventions are outlined in formal terms
E.g., “When in task, shouting obscenities will be addressed through a combination of least-to-most prompting, DNRA, and ratio-based reinforcement for successful task completion”

Section 11: Three main elements of a formal intervention plan

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Antecedent-based interventions
Procedures/environmental adjustments to prevent the occurrence of problem behavior and/or promote appropriate responses
Consequence-based interventions
Procedures to decrease the problem behavior over time
Teaching strategies/protocols
Procedures to teach alternative responses and other skills

The Plan Addresses 3 Elements

Three main elements of a formal intervention plan

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The 3 elements (antecedent, consequence, and teaching interventions) are included in BOTH plans

The difference is the way the steps are outlined and described

The formal plan does not need to be overly specific when the attached step-by- step plan provides a scripted task analysis of exactly what to do before and/or after a target response occurs

The Formal Plan and The Step-by-Step Plan

Action: three main elements of a formal intervention plan

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Target behaviors for increase and decrease are listed

Precursors may be included in this section

Broad intervention strategies are listed (“DRA”, or “FR-1 for task completion”)

Some intervention steps may be listed, but not in a format or language that is usable by most caregivers

The Formal BIP Approach

Section: three main elements of a family dimension plan

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This document is typically attached to the formal BIP, but is far more user friendly and specific in terms of describing how plan implementers must execute the BIP

 This plan constitutes the technological dimension of Applied Behavior Analysis

We will discuss this in depth in a later objective

A Note on Step-By-Step Plans

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This section simply states where the behavior plan will be in effect

Target environments include settings such as:
At home  In school  At work  On a bus

Section 12: Target Environments

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A tool used to numerically quantify the behavior so it can be tracked and evaluated over time

The measure is selected based on assessment of:
environment,
characteristics of the target response,
available resources

Major types:
 Dimensional quantities (e.g., Rate, IRT)
 Dimensionless quantities (e.g PIR, WIR)

Response measures yield Data

Once the response measure has been determined, the plan must specify how data will be collected and reported

Section 13:Response Measure(s)

The response measure is

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Basically you’re Seeing if there is interobserver agreement whether the person is taking data on the occurrence of the problem behavior as you see it. Comparing to see whether the person is getting good data.

Reliability checks, while often missing in programs, should in fact be done semi- regularly. If written into the plan as a regular task for the behavioral provider or a designee, they will become routine, and will help insure treatment integrity.

    E.g., “Data reliability checks will be conducted at least once a month, and be reported in the monthly progress note”

Data Reliability Checks

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Describes how data will be collected
This includes:
 Who will collect the data
What type of data will be collected
 When collection periods will occur
 How long data collection periods will

Outlines data processes in the abstract, but may have data sheets attached

Identifies how the data will be reported, and to whom

Graphing intervals (weekly, bi-weekly) should be specified
  For example:
         “Data will be graphed on a weekly basis. Data charts will be kept in the consumer central record. Data will be reported monthly to the support coordinator, along with the monthly progress note.”

(Specifics of Data Collection)

The Formal BIP

Recollection a response measures in the BIP

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Does not list who, what, where, and when, but rather gives precise instructions on specific data collection procedures, as a ready reminder for daily use

The step-by-step intervention plan

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While this is not a formal part of the written plan, it should be the underlying reality:
The data you are reporting MUST continuously inform your decision making about the plan. Should it continue as is, or be revised?
If the data tell you your plan is not effective, find out why…

REVISE!
DO NOT PERSONALIZE!

Data Reporting and Decision Making

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Caregivers/teachers/parents/direct line staff should be involved in the development process

However, once the plan is designed and written, clear training protocols help to insure that everyone is consistent in their implementation of the plan

Section 14: Training Plan for Program Implementers

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The training plan should include information on all of the following: ```  What will be trained  Who will be trained  Where the training will occur  How long the training will last  Type of competency check ``` Competency-based training is best:  A person must demonstrate competency in implementing the plan and collecting data to “pass” the training  This can also apply to program plan monitors

Training Plan Characteristics/ Competency

They Define how the program plan will be monitored in the various treatment environments to insure treatment integrity ``` These plans indicate the following  Who will monitor  How often What monitoring tool will be used  To whom the monitoring data will be reported  How feedback will be provided ```

Section 15: Monitoring Plan and Treatment Integrity Checks

This ties directly to the seven dimensions of ABA This is probably one of the most poorly executed sections in a lot of behavioral plans – nearly missing in many Stimulus and response generalization components are often programmed in via training protocols, but the broader idea of generalization is an afterthought

Section 16: Generalization and Maintenance

The true purpose of this section is to:  Outline a list of procedures to use to obtain generalization of the broad behavior plan results – based on Stokes and Baer (1977)  Identify a plan for treatment fade out and eliminate the need for behavioral services  Increase the independent functioning of the recipient of services! The plan can be best developed by: Identifying the eventual target environment for the individual Identifying the responses the individual needs to learn to be successful in that setting

Purpose of Generalization and Maintenance

Planning for generalization and maintenance should begin immediately, not after treatment has been occurring for a long time! Train loosely; program common stimuli; arrange for natural contingencies of reinforcement The “Favorite Staff” Phenomenon

Generalization and Maintenance: Plan from the Start

The plan should include a recommendation for services BCBA, BCaBA, and behavioral assistant services may be required, and a proposed plan should be included – whenever this makes sense

Section 17: Service Authorization Recommendation

This typically comes either at the very end of a behavior plan, or as a cover sheet Signatures provide authorization for implementing the plan, and indicate consent They must be dated, and obtained at least annually

Section 18: Signatures and Consents

 The author of the plan  The supervising behavior analyst (if one is required or involved)  The consumer  The guardian if needed (or consumer advocate, if the consumer so desires)  The chairperson of a peer review committee or other oversight body, if the plan requires it.

Section 18: Signatures and Consents The list of signatures should include:

This is the second form of the behavior plan. It is the one that the caregivers use, every day, to implement the plan. The formal behavior intervention plan does not serve this purpose. The language is too dense. Nobody will be able to read through it quickly.

Step-By-Step Intervention

Written in easy to understand language Is a functional task analysis of the behavior plan procedures: Thus, “step- by-step”. Bullet points! Says what to do and what NOT to do Is in column form, the behavior (with brief definition) on the left, the procedural steps listed on the right Each procedure box always ends in “mark the data sheet” as the last step

The Step-by-Step Plan Characteristics

One of the most useful and effective techniques for plan improvement is to identify, define, and set procedures for behavior which is a precursor to a problem behavior. Precursors tell you the EO for the problem behavior is present. Use this!

Step-by-Step Plan: A Note on Precursors

Prior training is usually necessary to teach the person an alternative response when the EO is not present When the precursor occurs, prompt the alternative response that you have practiced with the person. Interrupt the chain and deflect the individual onto a more constructive path

Step-by-Step Plan: | The EO as a Teaching Opportunity

This plan should be embedded in the formal plan Everyone who reviews the plan should see this version Even peer review committees and human rights advocates will be grateful for the clarity and simplicity of the language

Step-by-Step Plan: Who Needs to See It

In this version (a mock version, and one which is at least 15 years old, so it shows some age), note that the plan is also color coded.  Red is what to do. BOLD RED is what to say. Blue is what NOT to do. Green addresses the data collection See picture

Example of step-by-step plan

A flow chart version of this type of plan can be very useful It can be easily followed, does not require a lot of reading and is a good quick reference in a crisis. What follows is a simple program: a ribbon removal procedure Recall, “Lori Crying and Moaning”? See pics

A Flow Chart Plan

A Little Example of Task J-11 Program for stimulus and response generalization The three behaviors in the top section (graph) of the following slide are target behaviors for reduction: aggression, repeatedly calling staff, and grabbing others The bottom graph is baseline on an untreated behavior, yelling. See pictures

A Little Example of Task J-11

``` Can serve as quick reminders to help caregivers recall:  Target behaviors  Target behavior definitions  Basic intervention plan elements  Other key programmatic information ``` Should be based on program plan specifics. Standard data sheets are not as effective as individualized forms Data collection should be based on specific program components and individualized response measurement requirements. This is true for all forms of data collection, including ACQUISITION data

Data Sheets and Acquisition Sheets Data are Direct Links to Behavior Plans

A standard Task Analysis?  Any standardized compendium of steps for the training of various common skills (e.g., hand-washing) is a useful tool, but may not provide the best final data forms  The breakdown of steps must be based on an individual’s skill level and need

Acquisition data

Continuous and discontinuous measures: Can they be combined? •Complexity of the data sheet must be matched to the: •Individual’s clinical/behavioral need •Resource allocation – the realistic expectation for data in that setting •Caregiver’s training – data skills Review data sheet structure on a regular basis, and revise as needed ``` Data sheet revisions are based on:  Accuracy of data •Reliability checks (IOA)  Data collector input •Caregivers experience the flaws ```

More on Data Sheets

REMOVE RIBBON FOR THESE BEHAVIORS: AGG: AGGRESSION (Hit, Bite, Scratch, Pinch, Push, Throw Object at Another Person) INAP TOUCH: INAPPROPRIATE TOUCH (Touch Staff on Breast, Buttocks, Genital Area) YELL NAME: YELL STAFF NAME REPEATEDLY (Loudly Call Staff Name More Than 3 Times in 15 sec) DO NOT REMOVE RIBBON FOR THESE BEHAVIORS PICA: EAT INEDIBLE OBJECT YELL (OTHER): ANY YELL (NOT INCLUDING “YELL STAFF NAME”) (Screams, Screeches, Shouts) CRY: CRY, MOAN LOUDLY, WHINE (*IMPORTANT NOTE*: Check last blood level if crying lasts more than 5 min. Also check her palms for sweat and see if she is turning pale. If so, check her blood level.)

TARGET BEHAVIOR DEFINITIONS:

Well-constructed data sheets are often vital to consistent program implementation They can remind caregivers of program components and act as prompts

Data Sheet

BACB® Professional and Ethical Compliance Code 2.0: Behavior Analysts’ Responsibility to Clients BACB Coode elements are not in the Task List because they are considered fundamental, and woven through every task related to the delivery of behavior analytic services

Professional and Ethical Compliance Code: 2.0

Consent to provide behavioral services are obtained from the consumer or the consumer’s guardian Informed Consent is based on competency, a complex topic This is discussed in great detail in a previous course You may read about this in the Ethics chapter of Cooper, Heron, and Heward

Consent

Behavior program plans require WRITTEN consent The ABA practitioner explains the program components in plain language Risks and benefits of providing treatment, and of not providing treatment are discussed The consumer or consumer’s guardian (or other surrogate if the consumer’s capacity to consent is compromised) must be able to answer specific questions about the plan, in order to demonstrate a basic understanding of the proposed plan The plan is then signed and dated by all parties (consumer, guardian if one is involved, ABA practitioner, etc.) This must be done at least annually, or sooner if any major changes in program procedures are proposed

Consent for Behavior Programs

Consent provides prior approval from the consumer and/or the consumer’s guardian Sometimes however, additional approvals may be required from entities who bear some direct legal responsibility for consumer safety E.g., Program administrators, designated providers of state oversight, school officials, courts, medical personnel

Prior Administrative Approval

Consent provides prior approval from the consumer and/or the consumer’s guardian Sometimes however, additional approvals may be required from entities who bear some direct legal responsibility for consumer safety  E.g., Program administrators, designated providers of state oversight, school officials, courts, medical personnel

Prior Administrative Approval

Prior administrative approval is often required under two conditions: 1. Program procedures are restrictive enough to necessitate outside approval before the program is implemented 2. Consumer’s behavior is so dangerous that outside administrative involvement is needed from the outset

Conditions Requiring Prior Approval

These are interventions which restrict an individual’s rights in some way:  They may be part of a behavior plan, emergency measures, or medical  Some people call these “restricted procedures” but “restrictive” is better  Definitions can vary by state, so be aware of the laws which regulate your practice!

Restrictive Procedures

Punishment Negative reinforcement Certain MO manipulations (deprivation of certain stimuli, such as food) Restrains (especially contingently applied) This is not a comprehensive list

Types of Restrictive Procedures

Most punishment procedures: •Time-out (especially exclusionary), response cost, contingent exercise, loss of level (privileges in a molar program), overcorrection, possibly even simple correction, social disapproval •Certain types are banned by statute (e.g., corporal punishment, shock)

Restrictive Punishment

Behavior maintained by negative reinforcement means there MUST be an antecedent aversive (even if it is only a warning stimulus, as in avoidance), which becomes reinforcing by its removal or termination Escape extinction and DNRA •”Keeping the person in an aversive situation” Why isn’t Extinction Considered restrictive? Extinction of behavior maintained by positive reinforcement is, essentially, doing nothing – this is not restrictive It is NOT neglect, since extinction procedures require careful monitoring, prior training, and (as needed) protective back-up measures (e.g., neutral non-verbal response blocking)

Restrictiveness of SR- and Sr-

This is a complex area however, the basic rule of thumb is: Unless you have a VERY good reason, with VERY strong documentation of the specific need, limitations on basic goods and services (e.g., food, water, bathroom access, phone access) are simply not allowed. However, there are exceptions:  E.g., Prader-Willi syndrome

EO Manipulations

Three main types: 1. Supportive and protective devices (medical or behavioral) 2. Contingently applied behavior restraints (behavior program-based) 3. Emergency procedures

Restraints

Medical necessity Used for: • Strictly MEDICAL reasons (e.g., drop seizures) • BEHAVIORAL reasons (e.g., post surgical possible retinal detachment) Many states have different guidelines for each Typically short term. Signed off by a doctor.

Supportive/Protective Devices

Restraints used contingently are some of the most highly regulated procedures anywhere Some states ban (or nearly ban) the use of physical or mechanical restraint as a programmatic contingent intervention Mechanical or physical restraints should NOT be used as a form of punishment Rather they block the occurrence of dangerous behavior while placing the individual in a condition where that person can not do any more physical damage Physical restraint is meant to be a “firm but gentle hold” of some kind; no pain or discomfort to the person Behavioral restraints are meant to protect and calm the person, and be removed as soon as possible Be very cautious in using these: side effects abound (e.g., tissue breakdown over chronic use, accidental bruising)

Contingently Applied Behavior Restraints

These are not programmatic or behavioral procedures, although a program plan may reference this type of procedure Crisis management procedures are used in the absence of a behavioral response Specific and significant training involved Medical oversight and incident reports Types of emergency procedures  Supportive and protective devices  Emergency physical containment  Chemical restraint – under strict medical oversight, and not related in any way to a behavioral program State-specific definitions ``` Programs can (and should!) target the removal of chronic protective devices  E.g., Helmets, arm limiters, gloves ``` Move towards the Least restrictive alternative!

Emergency Procedures Reduction and Removal of Restraints

 Occurs before implementation  Ongoing  Competency based  Provide opportunity for feedback  Supervisor-involvement in live setting whenever possible

Behavior Plan Training; Characteristics of behavior plan training:

The behavior analyst often probes procedures to evaluate their efficacy • See what works, what is realistic Experienced caregivers can be vital, but can also be obstacles • Enlist assistance • Respect prior history

Behavior plan Implementation

Meet with caregivers and discuss program progress and challenges Review all current data charts •Connects the program plan to the data collection process Discuss data representativeness Administrative support needed Meetings must be:  Regularly occurring  Scheduled in advance  A safe place to discuss (honestly and openly) program ideas and failures  Documented; group decisions and agreements are POSTED in writing  Have everyone initial the notes! The Key to Implementation ; Regular program meetings with all caregivers must be a central part of the behavior program process. No Substitute!

Program meetings

Program not working? DO NOT PERSONALIZE It is not anyone’s “fault” Probe, observe, meet with staff, review charts together, discuss Revise program as needed GET NEW CONSENTS as needed

Troubleshooting

Generally refers to individuals outside of the direct treatment team who monitor the effectiveness of the behavior program A behavior analyst’s clinical supervisor is somewhere in the middle, part treatment team member and part program monitor.. Dual role/conflict of interest

Monitoring and Oversight of Behavior Plan

Peer Review Committee Human Rights Treatment Committee Advocacy groups State identified oversight boards (e.g., statewide Program Review Committee) Legal counsel (in rare cases) IRBs and HRCs (research oversight)

Who Provides Oversight?

A group of behavior analysts who review behavior programs in their local area  May provide feedback  Usually provide some kind of formal approval  NOT identified in the Task List or the Professional and Ethical Compliance Code! Benefits: Requires the behavior analyst to present program plans and data to an outside impartial panel •The panel is comprised of behavior analysts (see HRTC which follows) Identifies potential problems the behavior analyst might have missed Ensures program services show progress, or that barriers to success are identified May assist in resolving issues (such as obtaining additional necessary resources) Provides the practitioner with back- up in case of investigations/legal proceedings

Peer Review

Serve a different role than the Peer Review Committee, but sometimes review programs, with required approval Protect consumers’ basic rights  Constitutional  Legal (e.g., ADA) Provide social validity •What treatments are acceptable to the public at large

Human Rights Treatment Committees (HRTC)

Behavior plans are not natural! The goal of any plan is to make itself unnecessary The fade plan should be planned by the practitioner from the beginning Setting clear objectives (both short term and intermediate) provides landmarks, prompting fade out

Fading a Behavior Plan

Thin reinforcement schedules from FR to VR to VI to other complex intermittent schedules, eventually transferring control to the natural environment Fade face-to-face time with client Fade face-to-face time with caregivers, then fade other contacts Fade data collection requirements

Types of Fading

Programs are teaching tools The new learning must generalize to the natural environment, anywhere in which the new learning should apply Follow Stokes and Baer (1977) Write specifics of a generalization plan into your program

Generality

Once the program has been faded, a few final contacts are necessary This is termed “follow-up” The behavior analyst is checking up to see if the program effectiveness has been maintained over time If there are problems, troubleshoot, fix the issue, and reinitiate fade

Maintenance and Follow-up

Termination means you end the case This must be done as soon as the identified quantified objectives of treatment are reached, and the fade- out plan is completed Continued contact with the consumer is not recommended  Do you still go see your surgeon?

Termination

BACB® Professional and Ethical Compliance Code 4.11(a): Discontinuing Behavior-Change Programs and Behavior-Analytic Services •Behavior analysts establish understandable and objective (i.e., measurable) criteria for the discontinuation of the behavior change program and describe them to the client (See also, 2.15 Interrupting or Discontinuing Services). 4.11(b): Discontinuing Behavior-Change Programs and Behavior-Analytic Services • Behavior analysts discontinue services with the client when the established criteria for discontinuation are attained, as in when a series of agreed-upon goals have been met (See also, 2.15 Interrupting or Discontinuing Services).

BACB® Professional and Ethical Compliance Code

In case of litigation, you and your records may be subpoenaed Never write anything anywhere (including professional email or social media postings) that you are not willing to see on the front page of the local paper Storage of client records must be secure (lock and key/password protected) These are sensitive confidential documents All consent-related requirements remain in effect as long as case files are maintained

Maintenance of Records Storage of Records

At some point, files pertaining to a particular consumer must be fully destroyed  You may keep some programs, charts, etc., as exemplars for training purposes, but consumer-identifying information must be redacted or changed to prevent identification Generally, case-related files are maintained for (i.e., destroyed after a period of) 7 years •In some states, this time period may be shorter Know your state law, if one pertains

Destruction of Documents

Acceptable A bonded confidential file-destruction service Shredding (cross cut is best) Deletion of files from computer Unacceptable Ripping up Throwing out Putting in a box for later destruction

Modes of Destruction

6-BIP, Flashcards

(78 cards)