|Compassionate and Trauma-Informed Treatment of Dangerous Behavior in School Settings
|Sunday, May 28, 2023
|11:00 AM–12:50 PM
|Convention Center Four Seasons Ballroom 4
|Area: EDC; Domain: Applied Research
|Chair: Gina Richig (Vanderbilt University Peabody College)
|Discussant: Adithyan Rajaraman (Vanderbilt University Medical Center)
|CE Instructor: Cory Whelan, Ph.D.
Children with emotional/behavioral disorders, autism, or related disabilities who engage in dangerous behavior at school are at risk for a number of undesirable outcomes, such as limited access to educational services, limited time with peers, limited access to community activities, or referral to more restrictive settings. In addition, children who engage in dangerous behavior at school may also experience crisis procedures such as physical restraint, use of protective equipment, referral to a school resource (i.e., police) officer, or exclusionary time-out, all of which increase the risk of injury and trauma. Educators may struggle to address these behaviors while ensuring students’ Individualized Education Plans (IEP) are implemented. This symposium presents data from four studies that addressed dangerous behavior in a variety of classroom settings while simultaneously teaching appropriate skills and reducing use of crisis procedures. This includes the development and implementation of universal protocols for staff, practical functional assessment and skill-based treatment (SBT) of problem behavior (Hanley et al., 2014), and an enhanced choice model of SBT (Rajaraman et al., 2021). Interventions are described as compassionate and trauma-informed in that they focus on ensuring safety, building rapport, providing children with choices about their treatment, and addressing dangerous behavior without extinction.
|Instruction Level: Intermediate
|Keyword(s): Problem behavior, School-based intervention, Trauma-informed care
Audience members should have a thorough understanding of operant learning processes and procedures and an interest in school-based practice.
|Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. Describe universal protocols for minimizing dangerous problem behavior in school settings. 2. Describe an enhanced choice model for treatment in which treatment, noncontingent reinforcement, and business-as-usual contexts are concurrently available. 3. Describe distal outcomes of applications of skill-based treatment in school settings.
Reducing Physical Management in Public School Using Universal Protocol, Practical Functional Assessment, and Skills-Based Treatment
|CORY WHELAN (Vinfen), Heather Dawn Eigen (Andover Public Schools), Karen Butkovich (Andover Public Schools)
Students with autism who attend public school are expected to cooperate with a wide range of difficult instructions throughout the day. Students who engage in severe problem behavior might require physical management and even physical restraint if those instructions lead to episodes of dangerous behavior. Rajaraman et al. (2021) suggested that physical restraint should be considered potentially traumatizing for students in ABA programs and that those students might regularly experience such trauma. Following the break from school due to the COVID-19 pandemic, we implemented a universal protocol for all returning students with the goal of minimizing the need for any physical contact between staff and students. This presentation will provide a brief overview of how to implement that protocol as well as practical functional assessment and skills-based treatment (Hanley et al., 2014) in a public school setting. We evaluated the extent to which trauma-informed ABA practices could minimize the need for physical management in a public school ABA program. Data suggest that the adoption of a universal protocol for new students, the practical functional assessment process, and skill-based treatments lead to fewer physical restraints.
|Improving Safety and Engagement for Students and Educators Through Universal Protocols
|JOHN E. STAUBITZ (Vanderbilt University Medical Center, TRIAD), Holly Gover (Vanderbilt University Medical Center), Adithyan Rajaraman (Vanderbilt University Medical Center), Aislynn Kiser (Vanderbilt University Medical Center, TRIAD), Lauren A. Weaver (Vanderbilt University Medical Center, TRIAD), Emily Grace Johnson (Vanderbilt University), Rachel Hopp (Vanderbilt University Medical Center, TRIAD), Pablo Juárez (Vanderbilt University Medical Center)
|Abstract: When dangerous behavior such as aggression, self-injury, and elopement occur chronically and with high intensity in schools, educators may rely on restraint and/or isolation to manage crises, although these tactics can pose risks to students and staff alike. Other reactive procedures such as suspension, expulsion, and reduced school hours may also limit the opportunities students have to engage with school and learn more adaptive behaviors. Additionally, educators who must intervene with dangerous behavior on a regular basis are at risk for injury, burnout, and attrition. Universal protocols are a novel set of procedures that can be instituted by educators under the direction of a behavior analyst, which can reduce the occurrence of dangerous behaviors while increasing safety and engagement for high-risk students in school settings. In this presentation, after summarizing statewide prevalence and ubiquity of the use of reactive procedures in public school settings, we will describe the process for training staff to implement universal protocols, the methods of intervention, and the outcomes related to student safety, crisis management, and school discipline. Efficacy data related to universal protocol implementation suggest that this process may be an important first step for educators when chronic dangerous behavior is noted in school settings.
Examining Consecutive Applications of an Enhanced Choice Model for Students With Emotional/Behavioral Disorders
|DEYIN CHEN (Vanderbilt University), Johanna Staubitz (Vanderbilt University), Holly Gover (Vanderbilt University Medical Center), Adithyan Rajaraman (Vanderbilt University Medical Center), John E. Staubitz (Vanderbilt University Medical Center, TRIAD)
Emotional/behavioral disorders (EBD) are correlated with low socio-economic status and exposure to trauma. These vulnerabilities highlight the importance of systematically and formatively assessing client assent and preference while delivering treatment for dangerous problem behavior that impedes educational progress. The enhanced choice model of skill-based treatment (ECM-SBT; Rajaraman et al., 2021) involves concurrently offering skill-based treatment, access to enriched breaks, and regularly programmed instruction, allowing participants to move fluidly among contexts. In this presentation, we will describe procedures and outcomes of a retrospective consecutive controlled case series including nine elementary students with EBD, conducted in a public special day school. Application of ECM-SBT was associated with low levels of dangerous behavior during assessment and treatment and reduction of non-dangerous forms of challenging behavior. All participants mastered targeted alternative responses including functional communicative and delay acknowledgement responses, and cooperation with increasingly effortful chains of instructional demands, though trials to mastery varied by participant. Throughout treatment, participants allocated most responding to skill-based treatment versus alternative contexts. Future directions and implications to be discussed include potential interactions between language skills and response within phases of treatment, and allocation among ECM contexts as a means of informing programming and ensuring client assent.
|Long-Term and Secondary Effects of Skill-Based Treatment for Dangerous Behavior in a Specialized School Setting
|JESSICA SLATON (Nashoba Learning Group), Morgan Davis (Nashoba Learning Group), Kate Raftery (Nashoba Learning Group), David DePetris (Nashoba Learning Group)
|Abstract: One challenge associated with functional communication training (FCT) is the need to thin the reinforcement schedule to one supported by the individual’s typical environment, while also establishing a varied skill repertoire that allows the individual to participate in therapeutic and educational activities available to them. However, many published FCT applications occur under dense schedules of reinforcement without data on generalization and maintenance, and may not be conducted in a natural setting or with the individual’s natural caregivers (Ghaemmaghami et al., 2020). To address these particular gaps in the literature, we conducted practical functional assessments with six children with autism in a specialized school setting, and implemented FCT and schedule thinning following the skill-based treatment model described by Hanley et al. (2014). Treatment was conducted in each student’s classroom with their typical classroom staff, and continued until dangerous behavior was eliminated and skills were generalized across all relevant staff and goal areas of students’ IEPs. Crisis procedures (e.g., restraint) were eliminated for students who had been experiencing them pre-treatment. These effects were maintained at 1-year post treatment. Reductions in participant scores on the Modified Overt Aggression Scale (MOAS) were also observed at the end of treatment, and maintained 1 year later.