|Treating Dangerous Problem Behavior and Teaching Skills Without Physical Management: Enhanced Choice Model Extensions
|Monday, May 25, 2020
|10:00 AM–11:50 AM
|Walter E. Washington Convention Center, Level 1, Room 103
|Area: DDA/AUT; Domain: Applied Research
|Chair: John E. Staubitz (Vanderbilt University Medical Center, TRIAD)
|Discussant: Nicole Heal (Margaret Murphy Center for Children)
|CE Instructor: Nicole Heal, M.Ed.
The Practical Functional Assessment and Skill-Based Treatment process has been shown to reduce problem behavior by teaching individuals functional communication, toleration of delays to reinforcement, and contextually appropriate behavior during those delays. Teaching procedures typically involved some form of escape extinction. Some settings and circumstances, however, have necessitated the development of procedures that do not rely on escape extinction for their efficacy. One promising model, called the Enhanced Choice Model (ECM, Rajaraman, et al. 2019), involves the participant having the choice to (a) participate in treatment sessions, (b) leave the treatment sessions and access reinforcers noncontingently, or (c) leaving the treatment context altogether (e.g., going back to their regular classroom). This current symposium highlights extensions of this model to a public-school setting in which three educators learned and implemented treatment components as a means of generalizing treatment outcomes. The second presentation will examine specific mands as a generalized outcome of the public school application. The third presentation describes a distance-based telehealth case in which the caregivers implemented all assessment and treatment components. The final presentation will be a literature review on the tendency for individuals to prefer contingent reinforcement, a potential factor in the efficacy of the ECM model.
|Instruction Level: Intermediate
|Keyword(s): choice, functional assessment, problem behavior
The target audience for this session includes practicing behavior analysts who oversee behavior change programs that address severe problem and behavioral scientists who would like to learn more about the extent to which organisms will allocate their responding to contingent vs. non-contingent access to reinforcement when concurrent schedules of reinforcement are available.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) Describe the Enhanced Choice Model of Skill-Based Treatment (ECM-SBT), with an improved understanding of the procedures that would reduce severe problem behavior in a client without escape extinction (2) Describe and discriminate between the different training steps and techniques used to teach ECM-SBT assessment and treatment procedures for the purpose of treating severe problem behavior to caregivers without formal training in behavior analysis through teleconferencing and behavior skills training (3) Describe the outcomes of the ECM-SBT treatment with respect to trained functional communication, tolerance of denials, and engagement with contextually appropriate behavior, as well as the pre- and post-treatment prevalence of untrained function-specific mands.
|Evaluating a Behavior Skills Training Package for School-based Implementers of Skill-Based Treatment
|MARNEY SQUIRES POLLACK (Vanderbilt University), Johanna Staubitz (Vanderbilt University), Blair Lloyd (Vanderbilt University)
|Abstract: Skill-Based Treatment (SBT) uses synthesized contingencies to teach alternative responses that will compete with problem behavior (Hanley et al., 2014). Though effectively implemented in home settings (e.g., Beaulieu et al., 2018), school-based application of these procedures has required modifications to mitigate the collateral effects of extinction (Taylor et al., 2018). One promising variation is the Enhanced Choice Model of SBT (ECM-SBT; Rajaraman et al., 2018), which involves programming two concurrently operating alternatives to problem behavior besides the trained responses. We present three school-based replications of ECM-SBT, in which the programmed alternatives include (a) entering a ‘hangout’ area where evocative conditions are suspended and the client may access all preferred items and activities as well as low-quality attention from the therapist and (b) leaving the session entirely to return to the classroom. We discuss methodological deviations from the Rajaraman study, as well as outcomes and implications of ECM-SBT in a public special day school for children who engage in severe and persistent problem behavior.
Specific Mands as a Generalized Outcome of an Enhanced Choice Model of Skill-Based Treatment
|JOHANNA STAUBITZ (Vanderbilt University), John E. Staubitz (Vanderbilt University Medical Center, TRIAD), Michelle Mahoney Hopton (Vanderbilt University Medical Center, TRIAD), William P Martin (Vanderbilt University Medical Center, TRIAD)
Skill-based treatment (SBT) is a promising intervention package in which alternative responses to problem behavior, including an ‘omnibus’ mand (e.g., “excuse me, may I please have my way?”), are evoked and reinforced using synthesized contingencies (Hanley et al., 2014). A critical component of synthesized reinforcement in SBT is therapist compliance with (i.e., reinforcement of) all reasonable client mands. Thus, although specific mands are not explicitly trained via SBT, they may be strengthened as a byproduct of procedures for reinforcing explicitly taught alternatives to problem behavior. In this two-part study, 6 elementary students with emotional/behavioral disorders participated in an Enhanced Choice Model of SBT (Rajaraman et al., 2018). Novel therapists conducted specific mand assessments at baseline and post-treatment time points to evaluate the extent to which students emitted specific mands and problem behavior when single-contingency establishing operations were presented and the first response observed (i.e., specific mand or problem behavior) was reinforced. Results indicated problem behavior was more likely at baseline, while specific mands were more likely post-treatment. These preliminary data suggest specific mands may emerge or be strengthened over the course of ECM-SBT. Assessment and treatment procedures, proximal and generalized student outcomes, and implications for practice will be discussed.
Distance-Based Collaborations for Assessing and Treating Problem Behavior
|RACHEL METRAS (Western New England University; FTF Behavioral Consulting), Gregory P. Hanley (Western New England University; FTF Behavioral Consulting)
Santiago, Hanley, Moore, and Jin (2016) showed that the interview-informed synthesized contingency analysis (IISCA; see Hanley, Jin, Vanselow, & Hanratty, 2014) and skill-based treatment process can result in socially validated outcomes when caregivers serve as interventionists during treatment sessions. However, many families who would benefit from receiving similar functional analytic services do not have access to professionals trained to implement functional analyses or function-based treatments. Advancements in teleconferencing technology may allow families without access to local professional support to receive functional analytic services. For example, Suess et al. (2016) demonstrated that when a BCBA provides implementation support via teleconference, parents can assess and treat their children’s problem behavior in their homes. We taught parents of children with autism to implement the IISCA and skill-based treatment process in their homes exclusively through teleconference support. To address additional safety concerns in the home setting, the enhanced choice model of treatment (Rajaraman et al., 2019) was used with one participant. Parents achieved differentiated functional analyses and a 100% reduction in problem behavior relative to baseline.
|On the Generality and Implications of the Tendency to Prefer the Contingent Aspect of Reinforcement
|HOLLY GOVER (Western New England University; FTF Behavioral Consulting ), Gregory P. Hanley (Western New England University; FTF Behavioral Consulting )
|Abstract: Reinforcing events can be experienced either following responding (contingently) or independent of any particular response (noncontingently) in both the laboratory and in nature. Both human and non-human animals tend to prefer contexts involving contingent reinforcement, but the generality of this phenomenon and its implications have not yet been articulated. The purpose of this review is to summarize studies that have evaluated relative preference for contingent versus noncontingent reinforcement to provide a summary of the outcomes and then to (a) provide the details on the experimental subjects, reinforcer types, response topographies, and contexts included in these particular preference analyses, present implications for cross-disciplinary concerns regarding the use of reinforcement, (b) discuss the outcomes of the Enhanced Choice Model in light of the present studies, and (c) discuss implications of outcomes related to expanding behavior analyst’s ability to design preferred contexts involving programmed reinforcement.