Association for Behavior Analysis International

The field of Applied Behavior Analysis (ABA) is facing tumultuous discussion regarding ethics, quality, and organizational status (Silbaugh & El Fattal, 2021). Clinical quality at large ABA agencies requires alignment unilaterally from the executive team through the individual provider to be effective. Identifying and adopting a model that aligns with evidence based practice, safety, compassion, dignity and respect may provide a guiding compass for organizations looking to improve the quality of their services and achieve meaningful outcomes. This symposium includes four presentations that will outline how a nationwide organization has integrated the values of the Practical Functional Assessment (PFA) and Skill Based Treatment (SBT) to develop a Response to Intervention model, called the Foundations to Care, that starts with an entry level behavior intervention plan for all clients, then utilizes the PFA and SBT as components for the assessment and treatment of interfering behavior. The first presentation provides an outline of the major components of the entry level behavior plan, the Foundational Plan and preliminary data from its adoption across initial training and implementation efforts. The second presentation will describe the adoption of the PFA as a functional analysis to inform treatment and organization-wide data supporting its effective and efficient use. The third presentation will highlight the impact of Skill Based Treatment across interfering behaviors and skill acquisition domains. The fourth presentation will provide an overview of the mentorship model used to train clinicians in all components of the Foundations of Care and its effect on clinical practice. The discussant will comment on large-scale adoption of evidence-based, values driven care which leads to socially valid changes in the lives of clients and their families.

Audience members should have foundational skills in the area of behavior intervention, building interventions from assessment, program design, shaping, and an understanding of functional analysis

The Foundational Plan (FP) is part of a tier one Response-to-Intervention (RTI model) aimed at improving treatment implementation and reducing barriers to learning skills (Hughes & Dexter, 2011). The Foundational Plan identifies optimal teaching opportunities by first identifying what Happy-Relaxed-Engaged (HRE) looks like for the client and then establishes best practices for introducing learning opportunities, creating an enriched environment, reducing aversive stimuli, setting boundaries, and creating therapeutic alliance. In line with values of client-centered care, there are specific instructions related to necessary routines and how to respond to interfering behaviors in a way that focuses on prevention and de-escalation (Holburn, 1997). The FP has been a successful standalone intervention for some clients with significant drops in high intensity and dangerous behaviors; data highlighting the impact of this tier one intervention on a large scale will be presented.

The Practical Functional Assessment is a functional analysis methodology that identifies strong control of interfering behavior utilizing ecologically relevant and synthesized reinforcement contingencies (Jessel et al., 2016). Given its effectiveness as a component of a functional assessment model, the PFA may provide clinicians with a practical and replicable approach that can inform treatment (Hanley et al., 2014). More importantly, the evidence of efficacious outcomes suggests that the PFA has strong utility in the treatment of interfering behaviors (Rajaraman et al., 2022). This presentation will describe a decision making model for evidence based practice and apply that to the ethical decisions we should make surrounding functional analysis throughout clinical practice (Spencer et al., 2012). Organizational wide data describing the use of functional analyses, its safety, efficiency, outcomes, and practical application will be discussed supporting the findings of Jessel et al. (2016).

Within the current climate of ABA services, implementation of best practices are not always sufficient at producing lasting change and widespread adoption of interventions by those who regularly engage with the individuals we serve. Selection of effective treatment packages must also consider the social validity, contextual fit of interventions in order to align with evidence based practices (Slocum et al., 2014). SBT is an evidence-based intervention which has demonstrated significant social validity across implementers, clients, and families (Hanley et al., 2014). Throughout the progression of this treatment, core skills of communication, toleration, and cooperation are targeted through contingency based reinforcement thinning with safety as its top priority (Jessel et al., 2018). Within this presentation, data surrounding the impact of SBT on overall client progress towards skill mastery and reduction of interfering behavior, as well as an analysis of social validity from clients, caregivers, and staff will be discussed.

Utilizing the PFA and SBT process for assessment and treatment of interfering behaviors has resulted in safe and practically informed function-based treatments, substantial reduction in levels of interfering behaviors, and the acquisition of socially significant skill repertoires (Hanley et al., 2014; Jessel et al., 2018). Often, the training of these procedures is isolated in agencies to those with direct, ongoing access to a trainer and relevant resources, or those who have invested resources into independently learning the process. In order to shift a large organization spanning multiple states towards new practices, methods must be developed to support efficient and effective scaling of these practices while ensuring fidelity and socially valid outcomes from a distance. While efforts have been made to investigate various training modalities on these processes (Pollack et al., 2021; Whalen et al., 2021), the effects of incorporating multiple modes of remote training and consultation have not been investigated. The presenter will provide a brief overview of a remote mentorship model consisting of synchronous and asynchronous training, individual and group consultation to train clinicians in the implementation of the PFA and SBT processes. The effects and social validity data of this model will be presented