Association for Behavior Analysis International

In recent years, technology has proven to be more helpful than ever when it comes to the assessment and treatment of problem behavior (Schieltz & Wacker, 2020). This symposium highlights the use of technology to minimize time spent in analysis, train practitioners to implement skill-based treatment, and provide consultation at a distance. The first presentation will share the emerging technology of the Problem Behavior Multilevel Interpreter (PB.MI), a computer programed designed to provide real time visual displays of functional analysis data. The PB.MI allows practitioners to efficiently make decisions about when the exact moment functional control is achieved to minimize exposure to potentially unsafe situations. The second presentation will describe the effects of a computer-based instruction (CBI) program designed to teach practitioners to implement skill-based treatment with integrity. The third presentation will describe Balance, a parent-implemented problem behavior prevention program delivered entirely through telehealth and an online platform. Finally, the last presentation will provide a behavior-analytic conceptualization of safety and trust. The presenter will describe how the commitments of trauma-informed care can be applied to the treatment of problem behavior in a telehealth service delivery model.

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Asynchronous skill training programs can produce results comparable to those of in-person behavioral skills training (Geiger et al., 2018), yet have many practical advantages, including on-demand accessibility and independence from a live trainer. When complex skills are addressed asynchronously, computer-based instruction (CBI) including multiple components (e.g., instruction, video models, interactive activities, feedback) may be most likely to support mastery (Gerencser et al., 2021). We conducted an underpowered randomized control trial to evaluate the effects of CBI on Board Certified Behavior Analysts’ mastery of and adherence to a skill-based treatment protocol adapted from Rajaraman and colleagues (2021). We measured treatment integrity at two time points for 17 participants, eight of whom were randomly selected to complete the CBI. The CBI had a significant and strong effect on level of mastery attained (p = .002, Cohen’s d = 2.08). Mean improvement in treatment integrity was greater in the training versus control group on all five domain scores and a composite variable, though between-group differences were not significant at an alpha value of p = .01. Limitations and future directions relate to assessing generalization and maintenance of skills, effect of trainee characteristics on response to CBI, and training component analysis.

The American Academy of Pediatrics (2014) recommends individuals with a diagnosis of autism spectrum disorder (ASD) receive applied behavior analysis (ABA) services as soon as they are diagnosed. Ruppel et al. (2021) demonstrated that a parent-implemented problem behavior prevention program, Balance, was effective in reducing problem behavior and increasing social, communication, and cooperation skills in all four participants under the age of six. Access to effective intervention, like Balance, is critical, but waitlists for early intervention services can be long or the individual may reside in an area where ABA services are not readily available (Antezana et al., 2017). In these instances, the use of telehealth may be useful for supporting caregivers as they implement behavior-change programs. This study evaluated the effects of Balance implemented via telehealth using a multiple baseline design nested within a randomized control trial with children aged three and six years. Preliminary results indicate that emerging problem behavior remined high and skills were not acquired for the children randomly assigned to the control group (i.e., delayed intervention). By contrast, children in the test group who received immediate intervention engaged in zero to low levels of problem behavior and social and communication skills were high. Strategies for supporting caregivers attempting to prevent the development of problem behavior via telehealth will be discussed.

Ensuring safety and trust when providing therapeutic services is a core commitment of trauma-informed care. This commitment has implications for the assessment and treatment of dangerous behavior in that different approaches to intervening upon problem behavior may be associated with differential levels of experienced safety and perceived trust. One example of a potential violation of perceived trust pertains to the physical management of individuals exhibiting dangerous behavior, and these concerns are ostensibly exacerbated when services are delivered remotely via telehealth. During this presentation, after providing a behavior-analytic conceptualization of the constructs of safety and trust, we share findings from a survey regarding practitioner experiences and opinions on the use of physical management procedures in ABA practice. Findings suggest that there are varied opinions regarding the safety and feasibility of such procedures, with a majority advocating for reduced use in everyday practice. We connect these findings to an evaluation of a systematic replication of the enhanced choice model of skill-based treatment—initially described by Rajaraman et al. (2021)—that importantly avoids the use of physical management, and that was delivered via telehealth consultation. Survey and single-subject data are discussed in the context of exploring trauma-informed approaches to addressing dangerous behavior.