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| Adaptations to Functional Assessment and Treatment to Promote Safety and Security |
| Sunday, May 28, 2023 |
| 11:00 AM–12:50 PM |
| Convention Center Mile High Ballroom 1A/B |
| Area: DDA/AUT; Domain: Applied Research |
| Chair: Tara A. Fahmie (University of Nebraska Medical Center) |
| Discussant: SungWoo Kahng (Rutgers University) |
| CE Instructor: SungWoo Kahng, Ph.D. |
| Abstract: Both functional analyses (FA) and function-based interventions require the presentation of situations that may evoke dangerous behaviors. As such, various procedural decisions may be guided by a priority to maximize the safety of clients and clinicians. The current symposium includes four papers on the safety of functional approaches to problem behavior. The first talk presents a study on the identification and validation of response chains of severe behavior to improve assessment safety. The second talk presents a study evaluating trauma-related stimuli during FAs. A measure of heartrate was used to better understand the function of FA stimuli on the behavior of individuals with histories of trauma. The third talk presents a review of advancements to safety in FA over the past decade, including adjustments to data collection, contingencies, settings, people, equipment, conditions, and training. The final talk presents a randomized clinical trial on caregiver implementation of a function-based treatment to reduce elopement, which included a Home Elopement Safety Checklist. All four studies will be discussed by Dr. SungWoo Kahng, who has contributed to improvements in the safety of FAs for several decades. |
| Instruction Level: Intermediate |
| Keyword(s): clinical trial, elopement, FA safety, trauma |
| Target Audience: Basic understanding of functional analysis procedures, function-based intervention approaches |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) distinguish between a response class and response chain of severe behavior, (2) identify three categories of functional analysis adaptations to promote safety, (3) describe the benefit of considering trauma-histories when conducting functional analyses, and (4) identify environmental modifications that promote safe treatments for elopement |
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| Functional Analysis of the Earliest Member of a Response Chain |
| BRINEA CHARLES (University of Nebraska Medical Center), Tara A. Fahmie (University of Nebraska Medical Center), Lorraine A Becerra (Arizona State University ) |
| Abstract: Functional analysis (FA) has been used to determine the cause of problem behavior and to develop effective treatment (Hanley et al., 2003; Iwata et al., 1982/1994). Although this traditional method is effective, it may pose an increased risk of injury to the participant and others when the target of the assessment is a severe behavior (Smith & Churchill, 2002). A safer alternative is a precursor FA, in which reinforcement is contingent on a less severe behavior that reliably occurs prior to the severe behavior. Precursor behaviors may include those in a response class hierarchy, precurrent behaviors, or early responses in a behavior chain. Although several FA studies have explored the use and validity of using response class hierarchies, fewer studies have explored early responses in a behavior chain. The current presentation will describe a study designed to identify the earliest members of response chains of severe behavior and to validate their use in an FA. The presentation will also describe secondary measures, such as treatment integrity and response-chain latency, that may inform the clinical utility of an FA of the earliest member of a response chain. |
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An Evaluation of Trauma-Related Stimuli on Heartrate and Behavior During Functional Analysis |
| ELIZABETH JOY HOUCK (University of North Texas), Joseph D. Dracobly (University of North Texas), Melanie Bauer (University of North Texas), Danielle Pelletier (University of North Texas), Aaron Joseph Sanchez (University of North Texas), Richard G. Smith (University of North Texas) |
| Abstract: Traumatic events may alter the function of stimuli, such as neutral stimuli becoming aversive stimuli following a traumatic event. In some cases, these stimuli may be difficult or impossible for a person to avoid. Additionally, trauma-related stimuli may differentially affect both physiological measures and functional analysis outcomes, and thus, effective treatment. The purpose of this study was to evaluate the effects of trauma-related stimuli, which participants were unable to avoid in their regular lives, on heartrate and functions of problem behavior of adults with intellectual disability during a standard functional analysis. Our results indicate that the presence of trauma-related stimuli differentially affected heartrate and functional analysis outcomes for some participants. This analysis suggests that for people with significant trauma histories, differential function-based treatments may be needed to address problem behavior that occurs in the presence/absence of trauma-related stimuli. |
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A Decade of Advancements to the Safety of Functional Analyses |
| ISAAC JOSEPH MELANSON (University of Nebraska Medical Center's Munroe-Meyer Institute), Tara A. Fahmie (University of Nebraska Medical Center) |
| Abstract: Despite the clear benefits of conducting functional analyses (FA) of severe behavior, safety precautions may drive clinicians to seek alternative and less valid assessment methods. Several advancements in FA methodology over the past decade have focused on prioritizing safety while ensuring high validity of outcomes. The current presentation describes the outcomes of a review of safety risks, precautions, and adjustments to FA methodology that have been published between 2013-2023. Adjustments have included alterations to setting, data collection, stimuli inclusion, assessment duration, and contingency arrangement, among others. Based on the outcomes of our review, we will provide guidelines for FA planning and implementation and propose avenues for future research on FA safety. |
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| Implementation of an Elopement Safety Plan in a Clinical Trial of a Function-Based Elopement Treatment |
| ELIZABETH SHEA BUCKLEY (Marcus Autism Center), Mindy Christine Scheithauer (Marcus Autism Center), Joanna Lomas Mevers (Marcus Autism Center), Colin S. Muething (Marcus Autism Center), Sarah Slocum (Marcus Autism Center and Emory School of Medicine), Lawrence Scahill (Emory University School of Medicine and Marcus Autism Center), Nathan Call (Marcus Autism Center) |
| Abstract: Elopement is an incredibly prevalent and dangerous behavior among children with ASD. In addition to function-based interventions for elopement, there are several safety strategies available to either prevent elopement or improve safety if elopement does occur. However, the integrity with which caregivers can implement these strategies has not been evaluated. In the current study, children with ASD participated in a randomized clinical trial of a parent-mediated behavioral treatment for elopement (n= 76). For participants randomized to the treatment group, in addition to implementing a function-based treatment, clinicians created a detailed safety plan with caregivers. This included caregiver-training on each component and weekly check-ins. We evaluate the effectiveness of this program by comparing outcomes from a Home Elopement Safety Checklist to indicate which safety components are in place. We saw greater improvement in completed items for parents in the treatment compared to the control group. We discuss these results in the context of how safety antecedent strategies for elopement can facilitate behavioral treatments for this dangerous behavior. |
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