Association for Behavior Analysis International

Missouri Division of Developmental Disabilities is addressing the shortage qualified behavior analysts, increasingly challenging behaviors and continued emphasis on positive, person-centered supports that improve quality of life through an organizational behavior management approach. Three systemic level interventions applying behavioral principles on a meta-level to a state system of services for intellectual disabilities will be discussed. These systemic interventions involve data, systems and practices to improve outcomes for individuals and services, especially Applied Behavior Analysis services across multiple providers, regions and situations. Thinking and applying behavior analysis on a meta-level is sometimes confusing and difficult, these projects utilize a public health, three tiered prevention model, and are demonstrating significant results. The projects involve prevention of crisis and problem behaviors through increasing implementation of strategies aimed at improving quality of life by service agencies, state level interventions that maximize limited skilled resources and evaluate easily available population data and variables, and the use of peer review to improve behavioral services at an individual level.

Intermediate and Advanced behavior analysts involved in administration or management or who are interested in working at a governmental level.

The public health model that emphasizes prevention and the overall health of a public rather than emphasizing the poor health of one, or poor health issues specifically. In contrast, traditional healthcare focuses on the health of one individual. The model addresses strategies and practices that maintain the health of the public and works to increase these as a primary prevention effort. We suggest that ABA tends to align with traditional healthcare in that a large effort in training new practitioners and in the provision of services focuses on deviant or problem behaviors rather than conditions necessary for healthy and desirable behaviors. The Missouri Division of Developmental Disabilities has adopted the public health model to focus on practices or services that result in higher quality of life for individuals and developing state level systems to promote and maintain these. Implementation science informs us as to the necessary efforts and conditions that change momentary interventions to “a way we do business”. Data for agencies adopting the process at a high degree of fidelity suggests that broad scope strategies can reduce behavior problems in the agency to a significant degree.

State systems such as Developmental Disabilities and Intellectual Disabilities spend a significant portion of the allotted funding on relatively few individuals who have significant challenges and needs. Approaching this issue with the public health model is helpful in moving efforts towards large-scale interventions maximizing limited resources. These include efforts such as implementing systemic changes like improved data collection and analysis, sharing data strategically, targeted training, intensive review of restrictive strategies and peer review committees. Missouri’s process of behavioral system analysis and systemic interventions will be discussed and the data for the past two years will be shared.

Peer review committees can effectively provide consultative feedback that both improves the behavior support for the person and quality of services in general. Missouri Division of Developmental Disabilities has a voluntary peer review committee. This process involves community behavior analysts reviewing plans and data using a standard checklist for individuals in high-risk categories. Data from this process includes the items on the checklist missed and post review changes in high-risk outcomes. Data for the checklist and commonly missing elements will be reviewed. The checklist items will be demonstrated as best practice standards referenced to ABA literature and BACB and state funding agency requirements. The data suggest that peer review improves both the plans and reduces the likelihood of an individual continuing to experience high-risk outcomes.