Association for Behavior Analysis International

There is a limited spectrum of behavioral services available to individuals with intellectual and developmental disabilities (IDD) who also exhibit severe problem behavior such as self-injury, aggression, and property destruction. In this symposium, presenters will describe four different service delivery models for this particular population. Within these four programs, a range of clinical and research activities are conducted. The first presentation reviews a school-based service model that incorporates the use of Positive Behavioral Interventions and Supports with students with Autism Spectrum Disorder. The second paper describes a brief, but intensive, assessment and treatment model for severe problem behavior that is provided in an outpatient clinic. The third presentation provides an overview of a hospital-based inpatient unit that serves individuals with the most severe problem behavior. The fourth presentation reviews residential services and outcomes for adults with IDD and problem behavior. Finally, our discussant will provide comments on the efficacy of these four treatment models; the impact on service delivery and outcomes for persons with severe problem behavior; and the need for continued research and program development.

Positive Behavioral Interventions and Supports (PBIS) is a values-based technology, rooted in applied behavior analysis that emerged in the early 1980s as an alternative to escalating concerns over the use of aversive consequences with individuals with developmental disabilities. Today, that same technology is being applied to many different populations, young and old, as well as whole systems (e.g., schools, families) to produce more meaningful and sustainable outcomes. This presentation will provide an overview of Devereux's application of the PBIS model for students with autism spectrum disorder. Included in the presentation will be a description of the three-tiered autism model as well as the needed systems to ensure success, with particular attention being paid to how to best train and supervise direct care professionals and teachers to optimize outcomes. Data on key milieu performance indicators will also be presented, including the following measures: student engagement levels; the use of praise; opportunities to communicate; the use of nonverbal prompting procedures; and the use of visual support systems for communication, reinforcement, and scheduling. Last, a summary of outcomes and future directions will be discussed.

Residential services dedicated to persons with intellectual disabilities (ID) and severe problem behavior remain a big challenge: data on existing services are neither consistent nor reliable; institutions are significantly present; use of physical and chemical restraints is excessive; and evidence-based treatments are not used. We will present data from 10-year experience conducted in group of residential services for adults with ID and behavior problems located in Northern Italy, where an overall process of deinstitutionalization has evolved into the implementation of behavioral treatments into a broader Quality of Life (QOL) approach. First, we will illustrate the service delivery model: starting from the "house" as natural relational environment, we shifted towards a more structured context (Micro-Unit Approach plus QOL Models). Examples are shown on how to adapt ABA treatment to residential services. Then, we will present outcome data: 1) Procedural: implementation of life opportunities and activities; increase of learning opportunities dedicated to staff members (BA consistent); 2) Clinical: increase in adaptive functioning; treatment of behavior problems (reduction of challenging behavior, reduction of psychoactive medications, cut of physical restraints, increase of behavioral procedures, reduction of staff injuries); increase of behavioral satisfaction indices; extreme reduction of the risk of stress and burnout for staff.