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| Service Delivery Models for Individuals With Intellectual and Developmental Disabilities and Severe Problem Behavior |
| Wednesday, November 15, 2017 |
| 10:30 AM–12:20 PM |
| Forum ABC, Niveau 1 |
| Area: DDA; Domain: Applied Research |
| Chair: Cynthia M. Anderson (May Institute) |
| Discussant: Cynthia M. Anderson (May Institute) |
| Abstract: 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. |
| Instruction Level: Intermediate |
| Keyword(s): developmental disabilities, problem behavior, treatment outcome |
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| Using Positive Behavioral Interventions and Supports to Deliver Evidence-Based Services to Students With Autism |
| TODD HARRIS (Devereux Advanced Behavioral Health) |
| Abstract: 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. |
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| Intensive Outpatient Service Model for Treatment of Severe Problem Behavior |
| PATRICIA F. KURTZ (Kennedy Krieger Institute), Julia T. O'Connor (Kennedy Krieger Institute), Michelle D. Chin (Kennedy Krieger Institute) |
| Abstract: Individuals with intellectual and developmental disabilities who exhibit severe behavior problems (i.e., self-injury, aggression, or destructive behavior) are often removed from their homes and schools to receive behavioral treatment in inpatient or residential settings. In this presentation we describe an alternative service delivery model at Kennedy Krieger Institute: an applied behavior analysis, clinic-based intensive outpatient (IOP) program for individuals with severe problem behavior and their families. Services were provided by clinical staff/trainees supervised by doctoral level psychologists/BCBAs. The IOP model included completion of preference assessments, functional analyses, treatment evaluation, parent training, and community generalization. We summarized outcomes for over 100 individuals. Preliminary results of function-based treatment for a subset of 42 cases indicated an 89.4% mean reduction in problem behavior. Treatment generalization to non-clinical settings was demonstrated, and nearly all cases completed successful training of caregivers. Using the IOP model, the typical course of assessment and treatment was under one month; this has important implications for service delivery. The benefits and challenges of this treatment model will be discussed. |
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| Inpatient Services for Treatment of Severe Problem Behavior |
| LOUIS P. HAGOPIAN (Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute) |
| Abstract: The Inpatient Neurobehavioral Unit (NBU) at Kennedy Krieger Institute provides hospital-based treatment of severe problem behavior displayed by individuals with intellectual and developmental disabilities. The program has been in existence for over 30 years, and has served individuals from over 35 states. This presentation will describe how clinical services, research, and training are fully integrated and inform one another. The NBU has been the site for hundreds of clinical research studies and numerous federally funded research grants. The NBU also provides training in advanced applied behavior analysis to doctoral interns and postdoctoral fellows. The neurobehavioral model of interdisciplinary assessment and treatment will be reviewed, highlighting behavioral and psychiatric approaches. Our outcome data indicate that 88% of patients achieved at least an 80% reduction in aggression, self-injury, property destruction, or other targeted behaviors; also, 86% of patients maintained behavior reductions at 3- and 6-month follow-up observations. Case examples will be presented, and parent training and generalization of treatment gains will be discussed. |
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| Residential Service Delivery Models and Outcomes for Persons With Severe Behavior Problems |
| MAURO LEONI (Fondazione Sospiro Onlus), Serafino Corti (Fondazione Sospiro Onlus), Roberto Cavagnola (Fondazione Sospiro Onlus), Gioseppe Chiodelli (Fondazione Suspiro Onlus), Francesco Fioriti (Fondazione Suspiro Onlus), Maria Galli (Fondazione Suspiro Onlus), Giovanni Miselli (Fondazione Suspiro Onlus), Michela Uberti (Fondazione Suspiro Onlus) |
| Abstract: 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. |
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