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| Best Outcomes: Systematic Fading of Restrictive Procedures in the Treatment of Severe Behavior Disorders |
| Saturday, September 3, 2022 |
| 9:00 AM–9:50 AM |
| Meeting Level 1; Liffey Hall 2 |
| Area: AUT/DDA; Domain: Applied Research |
| Chair: Haley Steinhauser (Melmark New England; Regis College) |
| Discussant: Brad Stevenson (Melmark New England) |
| CE Instructor: Haley Steinhauser, Ph.D. |
| Abstract: The aim of behavior analytic practice and interdisciplinary collaboration is to use the least restrictive and most effective programming. At times, the least restrictive and effective option will involve restrictive procedures such as protective equipment, medication, and physical restraint to ensure the safety and well-being of the individuals receiving services. Restrictive procedures require both data-driven implementation following unsuccessful alternatives and systematic fading and modifications, with the consistent objective of utilizing the least restrictive procedures that promote best outcomes. This symposium will address this topic from various angles. The first presentation will provide an overview of an organizational clinical system on restrictive programming across state divisions. The second presentation will provide examples of fading restrictive programming related to behavioral-pharmacological interventions including (1) an interdisciplinary review team (IRT) approach to medication management and (2) a behavioral-pharmacological intervention corresponding with an increase in successful transitions and decrease in aggression-contingent restraints. The symposium will end with a discussion of how approaches to fading restrictive programming align at both the individual and organizational levels. |
| Instruction Level: Basic |
| Keyword(s): Medication Management, Organizational Systems, Restrictive Procedures |
| Target Audience: Behavior analyst with a foundational understanding of the use of restrictive procedures including ethical considerations. Behavior analysts working with individuals who engage in severe behaviors such as aggression and self-injurious behavior. |
| Learning Objectives: Participants will be able to: 1. Describe organizational metrics that allow for the monitoring of restrictive procedures. 2. Discuss the collaboration between clinical programming and medication management in the reduction of restrictive procedures. 3. Identify appropriate measures when fading restrictive procedures. |
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| Restrictive Procedures: An Organizational Approach to Monitoring and Reduction |
| SHAWN P. QUIGLEY (Melmark), Brad Stevenson (Melmark New England), Jill Harper (Melmark New England), Frank L. Bird (Melmark New England), Helena L. Maguire (Melmark New England) |
| Abstract: The application of behavior analysis varies by population (e.g., child, adult, employee), setting (e.g., community, clinic, home), and need (e.g., social skills, challenging behavior, safety). The differences in application create a context for differential application of behavioral principles, strategies, and technologies. For example, a safety application might involve behavioral skills training, performance rewards (e.g., enhanced pay for following safety practices), and utilization of technology to reduce risk (e.g., motorized lift as opposed to manual lift). Practitioners that serve individuals with complex behavioral challenges must also consider differential application of principles, strategies, and technologies to improve safety for the individuals, family members, and employees. Dependent upon local, regional, and governmental regulations, some applications might be considered restrictive, therefore requiring additional oversight. The purpose of this presentation is a brief review of restrictive procedures, examples of restrictive procedures, and an organizational approach to monitoring and reducing the need for restrictive procedures. |
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| Interdisciplinary Review Team Approach for Medication Management and Behavioral-Pharmacological Intervention Case Study |
| HALEY STEINHAUSER (Melmark New England; Regis College), Frank L. Bird (Melmark New England), James Luiselli (Melmark New Egland), Andrew Shlesinger (Melmark New England), Silva Orchanian (Melmark New England), Jaime Alyssa Scibelli (Melmark New England), Frederick Scibelli (Melmark New England), Julia Hrdina (Melmark New England
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| Abstract: The use of psychotropic drugs for individuals with developmental disabilities is common practice (Jobski et al., 2016; Wink et al., 2018). The interdisciplinary review team (IRT) model was created to establish a continuum of medication management for individuals with complex needs. Core features of the model are multi-disciplinary team members, data-driven decision-making, and high-level administrative support. The objectives of each individual review are: to review current clinical status and needs, foster team discussion, advocate for medication change that maximizes benefits for the individual, and minimize simultaneous treatment changes and risk. Multiple data sets from the IRT process will be presented, demonstrating the effectiveness of this approach to make clinically informed medication decisions. Additionally, a behavioral-pharmacological intervention case study with an 18-year-old diagnosed with ASD and high-frequency aggression will be presented. The behavioral-pharmacological intervention involved a multicomponent behavior support plan with differential reinforcement, environmental modification, and physical management procedures, combined with neuroleptic medication (aripiprazole). The intervention eliminated care provider implementation of aggression-contingent physical restraint and increased transition compliance during the school day. Clinical safety components emphasized comprehensive care provider training, continuous supervision, function-based treatment, and prevention-focused strategies. Intervention effects were long-standing and care providers rated the training, procedures, and outcomes favorably. |
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