|Advances in Behavior Analysis: Past, Present, and Future
|Sunday, May 24, 2020
|5:00 PM–6:50 PM
|Walter E. Washington Convention Center, Level 1, Salon B
|Area: CBM/DDA; Domain: Translational
|Chair: Michael F. Cataldo (Kennedy Krieger Institute)
|Discussant: Patrick C. Friman (Boys Town)
|CE Instructor: Louis P. Hagopian, Ph.D.
For over four decades, the Kennedy Krieger Institute has provided significant advances to the field of Behavior Analysis (e.g., through continuous NIH research support exceeding $126 mil., 900+ research studies, 800+ trainees, 9 of the last 13 editors of JABA, clinical services to some 94,000 families, and over $900 mil. in revenue). This symposium will supplement previous reports to the ABAI community. In lieu of reporting individual studies, this update will describe current and developing innovative programs, their rationale, critical components, research challenges, and funding opportunities. Specifically, Presentation 1 will describe the strategic approach at KKI for addressing the most difficult problems, which has resulted in such advances as Functional Analysis, Preference Assessment, and now success with Treatment Resistant cases; Presentation 2 will provide methods for the integration of the ABA research and practice communities, and treatment accountability through the use of consumer data; Presentation 3 will describe our Tele-Behavioral Health Program in terms of preparation of practitioners, privacy safeguards, research designs to justify support (the comparison of clinic based vs. tele-behavioral health), and the current opportunity for worldwide implementation; and Presentation 4 will provide programmatic details and data on addressing Pediatric Pain and the implication for the opioid crisis.
|Instruction Level: Intermediate
|Keyword(s): opioid crisis, telehealth, treatment accountability, treatment-resistant behavior
BCBAs, practitioners, clinical researchers
|The Neurobehavioral Programs and the Culture of Obligation to Serve, Learn, and Share
|LOUIS P. HAGOPIAN (Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute)
|Abstract: The Neurobehavioral Programs provide a continuum of care for individuals with developmental disabilities and severe behavioral dysfunction. Serving individuals with the most treatment-resistant problems continually tests the limits of our knowledge. Past and present faculty, staff, and trainees have played a pivotal role in advancing knowledge of and care for severe problem behavior. Examination of the efficacy of our assessment and treatment procedures has identified limitations of these procedures, and occasioned efforts to improve those procedures and develop new ones. We have also refined methodologies for large-scale evaluation of clinical procedures and for identification of variables that predict response to treatment. Findings have been disseminated in over 400 clinical and translational research articles. These and other achievements have been made possible by arranging contingencies to support the integration of clinical service and research. This requires systems for capturing data as a by-product of delivering clinical care, and analyzing those outcomes to inform continuous improvement of clinical services and inspire clinically relevant research. Critical to this process is creating a culture where there is an obligation to learn from past clients to improve the treatment of current and future clients, and to share that knowledge through dissemination and training.
Integration of Research and Practice, Treatment Accountability, and Consumer Data
|HELEN YU-LEFLER (Kennedy Krieger Institute), Jessica L Becraft (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Chelsea Rolinec (Kennedy Krieger Institute), Joseph Wakeman-Linn (Kennedy Krieger Institute), Kara Clark (Kennedy Krieger Institute), Usai Bah (Kennedy Krieger Institute), Patricia F. Kurtz (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), anne riley (Johns Hopkins University School of Public Health)
Vital to the continued viability of behavior analysis are the linkages between theory, research, and clinical application. This presentation will report on efforts over the past five years at the Kennedy Krieger Institute Department of Behavioral Psychology to develop methods for creating linkages between the research and practice segments of Behavior Analysis. These efforts focus on the use of parent-collected data as the functional bridge between these two important groups. We evaluated the reliability and affordability of various methods of data collection. In addition, we have begun to establish the validity of parent data by comparing it to trained observers. We will present data on efficient methods for acquisition, analysis, and use in clinical treatment. These activities have culminated in a department-wide initiative to collect treatment outcome data from parents via text messages prior to, during, and after treatment. We will demonstrate our approach to clinical accountability within and across clinics, discuss challenges of implementing this system, and make recommendations for service providers.
|How to Develop and Demonstrate the Impact of Tele-Behavioral Health
|JENNIFER L. CROCKETT (Kennedy Krieger Institute), Michelle Bubnik (Kennedy Krieger Institute)
|Abstract: Much of what occurs during behavioral assessment and treatment does not require the professional and client to be physically present in the same place. Therefore, using video and internet technology can provide access to certified behavior analysts and centers of excellence to millions who otherwise would not receive such services. But careful consideration has to be given for the best way to develop such a program and the most powerful and analytic approach to understanding the true benefit of telebehavioral health. This presentation will provide considerations on therapist onboarding, sequential steps in the development of a telehealth program, and data on treatment comparisons of clinic-based and telehealth modalities, as well as when no treatment is obtained. The data show that behavior change outcomes and consumer satisfaction are comparable for clinic-based and telehealth treatment. The presentation will also report on recent advances in obtaining funding support for therapists to provide worldwide telehealth treatment.
Behavior Analysis, Pediatric Pain, and the Opioid Crisis
|KEITH J. SLIFER (Kennedy Krieger Institute, Johns Hopkins University School of Medicine), Caitlin Thompson (Kennedy Krieger Institute), Margaret Tunney (Kennedy Krieger Institute), Alyssa Day (Kennedy Krieger Institute)
The opioid crisis in the United States is a serious health problem with complex causes. One factor related to opiate addiction, and the crisis, is treating chronic pain with opiates. Child and adolescent chronic pain is a growing problem, often misdiagnosed and improperly treated with opiates. Among the essential treatment modalities for pediatric chronic pain is a Behavior Analytic approach. This presentation will review pediatric chronic pain, treatment modalities, the role of Behavior Analysis, and implications for the opioid crisis. It will describe the Pediatric Pain Program at Kennedy Krieger led by the Behavior Analysis group, including specific Behavior Analysis procedures and outcome data. The data indicate the program avoided prescribing opiates, and patients using opiates prescribed elsewhere, had their medication weaned. For the inpatient program, child ratings of functional disability, depression, anxiety, pain catastrophizing and intensity significantly decreased, as did parent ratings of functional disability and depression. Staff ratings of functional ability significantly increased. For the day treatment program, child and parent ratings of functional disability significantly decreased along with child ratings of depression and pain catastrophizing. Follow-up data show increased school attendance and participation in community activities at 3 and 12 months and was at 100% by 24 months.