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| Bridging the Gap: Behavior Analysts' Consideration of Medical Needs in Client Care |
| Saturday, May 25, 2024 |
| 10:00 AM–11:50 AM |
| Convention Center, 100 Level, 113 C |
| Area: AUT/DDA; Domain: Translational |
| Chair: Johanna F Lantz (The Center for Discovery) |
| Discussant: Tracy L. Kettering (Bancroft) |
| CE Instructor: Johanna F Lantz, Ph.D. |
| Abstract: The symposium "Bridging the Gap: Behavior Analysts' Consideration of Medical Needs in Client Care" aims to explore the intersection of behavioral science and medical needs, showcasing the vital insights and practices that behavior analysts can contribute to improving the overall well-being of their clients. This symposium will feature a collection of presentations, each highlighting various aspects of the consideration of medical needs and collaboration between behavior analysts and the medical community. We will delve into the significance of considering medical conditions during assessment and when designing and implementing behavior intervention programs, thereby creating more comprehensive and effective strategies for individuals with diverse needs. Key topics to be discussed during the symposium include: 1. A review of existing literature on behavior analysis and the consideration of client medical needs, including common comorbid conditions, current recommendations, resources, and case examples. 2. The result of a recent survey focused on assessing the current practices of behavior analysts in the consideration of medical needs of their clients. 3. Examples of and considerations for relationships between client self-injury topography, function, and medical diagnoses. 4. Examples of and considerations for how to leverage the behavior analytic skill set to better understand possible medical influences on client behavior. 5. Ethical Considerations: Presentations will touch on the ethical obligations of behavior analysts in managing client medical needs and how to navigate potential challenges in this intersection. |
| Instruction Level: Intermediate |
| Keyword(s): Interdisciplinary Collaboration, Medical Comorbidities, Self-injury |
| Target Audience: Intermediate |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: 1. List resources that may be helpful when there is reason to believe that a referred behavior is influenced by a medical condition 2. Provide examples from the literature showing the relationship between challenging behavior and medical variables 3. Discuss the potential relationship between medical severity, adaptive behavior, and self-injury 4. Utilize the behavior analytic skill set including behavior measurement and data analysis to evaluate possible connections between medical conditions and interfering behaviors. |
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| Medical Considerations and Challenging Behavior: A Call to Action |
| (Theory) |
| KARISHA BRISTOW (Bancroft), Ashley Marie Fuhrman (Trumpet Behavioral Health), Tracy L. Kettering (Bancroft), Johanna F Lantz (The Center for Discovery) |
| Abstract: Individuals with autism and other intellectual and developmental disabilities are more likely to experience health conditions, such as neurological disorders, including epilepsy, gastrointestinal (GI) conditions, severe headaches, allergies, ear infections, metabolic disorders, and sleep disturbances (Bauman, 2010; Soke, 2018), that can be difficult to outwardly observe and thus may not be recognized by healthcare professionals prior to referral for behavior analytic treatment. Additionally, examples of correlational and causal relationships between health conditions and problem behavior have been described in the academic literature for over 20 years (May and Kennedy, 2010). Behavior analysts acknowledge that ethical practice involves ensuring medical needs are addressed if they are likely to influence behavior (Behavior Analyst Certification Board, 2020), yet there is little guidance for behavior analysts to recognize behavioral manifestations of comorbid health issues despite literature suggesting this may be a key piece in understanding some clients’ behavior. This presentation will review the existing literature and summarize the various documented influences that health conditions have had on problem behavior as well as serve as a call for a more comprehensive perspective and interdisciplinary approach when assessing and treating challenging behavior. |
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| A Survey of Current Practices of Behavior Analysts’ Consideration of Client Medical Needs |
| (Applied Research) |
| JENNIFER ROEDER (Trumpet Behavioral Health), Ashley Marie Fuhrman (Trumpet Behavioral Health), Tracy L. Kettering (Bancroft), Sean Smith (SUNY Upstate Medical University), Lisa Alberts (Lasalle University) |
| Abstract: This symposium will include the presentation of the results of a survey conducted with Board-Certified Behavior Analysts (BCBAs), Doctoral Board-Certified Behavior Analysts (BCBA-Ds), and Assistant Board-Certified Behavior Analysts (BCaBAs) to gather data on their current practices regarding consideration of medical needs within behavior-analytic assessment and treatment. The study aims to bring attention to and guide further practice in ruling out medical factors in intervention as well as to provide direction for the development of resources for behavior analysts to improve practices surrounding the consideration of medical needs in behavioral interventions. A variety of demographics of behavior analysts with varying primary area of behavior-analytic practice and years of experience as a credentialed behavior analysis completed the survey. The results indicated varying themes surrounding behavior analysts’ active collaboration with medical professionals, confidence in considering medical needs of clients, practices surrounding how to analyze potential underlying medical conditions, and preferences for future clinical resources on the topic. Further, the results indicate the continued need for collaboration among varying professionals within the individual’s interdisciplinary team to ensure that all contributing factors to behavior are considered to result in the best outcomes for clients. The implications of results, limitations of the study, and directions for future research will be discussed. |
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| Medical Conditions and Self-Injury: A Preliminary Investigation of the Relationships Between Topography, Function, and Medical Conditions |
| (Service Delivery) |
| VALERIE MONICA COLANTUONO (A.J. Drexel Autism Institute, St. Christopher's Hospital for Children), Autumn Austin (Drexel University), Giacomo Vivanti (Drexel University), Tracy L. Kettering (Bancroft) |
| Abstract: Autistic individuals experience a higher prevalence of medical conditions and engage in self injurious behavior (SIB) more frequently compared to neurotypical peers. In the current study, we conducted a retrospective analysis of medical records for children and adults with autism and intellectual and developmental disabilities receiving day or residential services at a large non-profit organization (N = 472). Data on demographics, SIB topography and function, medical diagnoses, and adaptive behavior scores from the Adapted Behavior Scales - 3rd Edition (ABAS-3) were collected from participant’s electronic health record (EHR). An additional derived variable for medical severity was coded following (Gur et al., 2014)’s index of the overall severity of medical conditions. Preliminary results found that individuals who had lower ABAS-3 raw scores were more likely to engage in SIB, and some topographies of behavior were more likely to be displayed by individuals with a higher medical severity score. The present study will expand on these preliminary correlational analyses, and discuss relationships between specific topography and function of SIB, specific medical diagnoses, and adaptive behavior. |
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| Leveraging the Behavior Analytic Skill Set to Better Understand Medical Influences on Behavior |
| (Service Delivery) |
| JOHANNA F LANTZ (The Center for Discovery), Jenny Foster (The Center for Discovery), Conor Anderson (The Center for Discovery), Tania Villavicencio (The Center for Discovery) |
| Abstract: The BACB Ethics Code guides behavior analysts to assess possible medical or biological factors that may influence a referred behavior. Behavior analysts have the ability to use skills such as functional behavior assessment, behavior measurement and data analysis to evaluate connections between medical conditions and interfering behaviors. Despite our ethics code and skill set, behavior analysts have not made significant contributions to the knowledge base in this area compared to other disciplines. Behavior analysts can evaluate medical variables previously demonstrated to impact behaviors such as seizures (Viscidi et al., 2014), sleep (Cohen et al., 2018), menses (Carr et al., 2003), gastrointestinal disorders (Peters et al., 2014), medications (Strzelczyk & Schubert-Bast, 2022), pain (Courtemanche, Black, & Reese, 2016) and acute illness (Carr & Owen-Deschryver, 2007) alongside of behavior data to see impacts at the individual and population levels. Such examination can inform both individual treatment and the field more broadly. During this presentation, I will share how we leverage our comprehensive data set at the Center for Discovery to better understand medical complexity and its relationship to interfering behaviors in our severely affected residential population. Examples will consist of single-subject case studies, aggregated group data, and machine learning approaches to predict the likelihood of interfering behaviors. |
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