Association for Behavior Analysis International

Biobehavioral approaches towards assessment and intervention arguably represent best practices for solving complex medical and behavioral presentations. Hospital-based behavior analytic services provide many opportunities for multi-disciplinary interactions, including education, training, clinical service delivery, and research. Primary challenges to providing state-of-the-art behavior analytic services in multi-disciplinary settings include the relative novelty and scarcity of hospital-based behavior analysis as well as sources of variability inherent in medical settings. In addition, hospital patients likely represent a unique cohort of individuals who engage in “treatment resistant” behavior, which may occur as a function of complexity (e.g., separate and combined medical and behavioral influences on behavior), history (frequent relapse leading to enhanced response strength), or other multifaceted factors. This symposium focuses on describing how behavior analytic service programs may be developed and function in hospital settings, data supporting efficacy of behavior analysis in hospital-based settings, information about how behavior analysis may be integrated into medical services. And some future pathways for evolution.

Target audience members must be familiar with basic behavior analytic principles and the associated interventions based on these principles. In addition, audience members should have a firm understanding of the complexities involved in clinical behavior analysis. Those complexities may include issues related to functioning in a multidisciplinary team, treatment resistant problem behaviors, and environments in which is difficult to establish stimulus control.

Academic medical centers (AMCs) are responsible for providing medical education, conducting research, and delivering patient care across a diverse range of medical specialties (e.g., cardiology, gastroenterology, neurology). Historically, behavior analysis has not been considered a critical discipline within AMCs; however, this perception is changing as behavior analysts are increasingly serving a vital role in AMCs and doing so in diverse ways. The University of Iowa Healthcare is a large AMC with a long history of providing behavior analytic services for individuals who exhibit challenging behavior. Over the past decade, those services have continued to evolve, and a diverse array of new services have emerged. This talk will provide an overview of the behavior analytic services offered at the University of Iowa Healthcare and describe how services have expanded and become more integrated in many different medical specialties. The challenges associated with establishing a role for behavior analysis in AMCs and the benefits of integrating behavior analysis into medical specialties will be discussed.

Children with neurodevelopmental disorders (NDD) are over five times more likely to be diagnosed with a mental health condition than their typically developing peers (Connor et al., 2020). Within this population, mental health issues often co-occur with severe problem behaviors such as self-injury, aggression, destructive behaviors, and elopement. Addressing the complex needs of these individuals requires tailored support services that align with their varying intensities of need, ultimately aiming to prevent unnecessary hospitalization and facilitate transitions to lower levels of care. This presentation will examine a continuum of specialized behavioral health services for youth with NDD offered at a metropolitan pediatric hospital, spanning outpatient, partial hospitalization, and inpatient settings. Key challenges in delivering these services include developing specialized programs, ensuring staff safety, addressing psychiatric boarding, and maintaining staff retention. The authors will outline the establishment of these specialized services, highlight the challenges encountered, and present successful strategies for overcoming these obstacles, ensuring that youth receive the comprehensive care they require.

Patients referred for inpatient assessment and treatment for severe behavioral disturbances typically present with treatment-resistant behavioral histories. Psychiatric inpatient programs often focus on diagnostic clarity, medication evaluations, and behavioral stability prior to discharge. Behavior analytic services provide the opportunity for a synergistic bio-behavioral approach. Our goals include demonstrating the powerful effects of behavior analytic inventions, leading to integrating behavior analysis into day-to-day practice in a medical setting. Tactics include framing successful behavior analytic interventions to medical personnel as information for discriminating between biological and environmental influences on behavior, contributing to the reduction of unnecessary medication use, developing robust treatment implementation strategies in the hospital, and preparing patients for generalization of treatment effects outside of the hospital setting. The current presentation provides insight to the application of behavior analytic tactics (e.g., behavioral contracts, multiple-schedule arrangements) in the context of a medical setting. Our data suggest that powerful reinforcement-based behavior analytic interventions facilitate behavioral reductions as expected. However, focusing on reducing hospital “pain points” (e.g., occurrence of problem behavior) facilitates adoption of behavior analysis in multi-disciplinary settings.