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| Promoting and Enhancing Safety While Providing Services to Individuals With Unsafe Problem Behavior |
| Sunday, May 25, 2025 |
| 10:00 AM–11:50 AM |
| Marriott Marquis, M4 Level, Capitol & Congress |
| Area: DDA/OBM; Domain: Applied Research |
| Chair: Eli T. Newcomb (The Faison Center) |
| Discussant: Byron J. Wine (The Faison Center; University of Virginia) |
| CE Instructor: Eli T. Newcomb, M.Ed. |
| Abstract: Providing services to individuals who engage in self-injurious and aggressive behavior necessitates layered approaches to maintaining safety while function-based treatment is carried out. Approaches must account for the safety of clients, all staff involved in the provision of services, and caregivers at home. Furthermore, they must consider assessment, treatment, and discharge phases of care. Layered approaches must also include risk assessment, application of least-to-most intrusive methods to keep stakeholders safe, and data-based methods for selecting and implementing protective measures. This symposium will illustrate multiple interconnected approaches to promoting and enhancing safety while providing services to individuals presenting with dangerous behavior. It will include a scoping review of protections used while conducting functional analyses of self-injurious behavior, a description of a novel organizational safety assessment, an overview of a data-based procedure for managing aggressive behavior towards staff, and an examination of home-environmental modifications for caregivers during the discharge process. The discussant will identify common themes and offer recommendations about how to integrate multiple safety-focused approaches into a cohesive, organization-wide effort. |
| Instruction Level: Advanced |
| Keyword(s): dangerous behavior, employee injuries, protective procedures, safety |
| Target Audience: The target audience for this symposium is BCBAs and BCBA-Ds with experience assessing and treating problem behavior and overseeing staff who provide services to individuals with problem behavior that be pose harm to themselves or others. Attendees should possess an understanding of functional assessment and treatment, behavior-based safety, and distinguish between treatment vs. safety protocols. |
Learning Objectives: 1. Identify various, contextually relevant protective measures that may be considered for application during a functional analysis of self-injurious behavior.
2. Describe a foundational methodology for analyzing injuries related to the provision of services; and map out future steps to mitigate injuries through data-based decision-making.
3. Arrange conditions to examine efficacy of protective procedures designed to promote safety in service provision.
4. Describe the core elements involved with assessing client and caregiver safety in the home setting. |
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| Protective Procedures in Functional Analysis of Self-Injurious Behavior: An Updated Scoping Review |
| MICHELLE A. FRANK-CRAWFORD (Kennedy Krieger Institute), Drew E. Piersma (Kennedy Krieger Institute), Nathalie Fernandez (Kennedy Krieger Institute), Savannah Tate (Kennedy Krieger Institute), Erik Bustamante (Kennedy Krieger Institute) |
| Abstract: Despite the efficacy of functional analyses in identifying the function of challenging behavior, clinicians report not always using them, partly due to safety concerns. Understanding how researchers employ safeguards to mitigate risks, particularly with dangerous topographies like self-injurious behavior (SIB), is important to guide research and practice. However, results of a scoping review of functional analyses of SIB conducted by Weeden et al. (2010) revealed that only 19.83% of publications included protections. We extended the work of Weeden et al. to determine whether reporting has improved. We observed increases in all but two types of protections reviewed by Weeden et al. Additionally, we included new protections not reported by Weeden et al. In total, 69.52% of the studies included at least one protective procedure and 44.39% specified the protections were used for safety. It appears that reporting has increased since Weeden et al. called for improved descriptions of participant protections. |
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| Safety Assessment in a Human Service Organization |
| KELCIE MCCAFFERTY (University of Florida), Jessica Nastasi (Bancroft), Nicole Gravina (University of Florida), Williams Adolfo Espericueta Luna (University of Florida) |
| Abstract: In recent years and post-COVID, injuries to human service staff are on an increasing trend (United States Bureau of Labor Statistics, 2020; United States Bureau of Labor Statistics, 2021). Behavior analysis direct service providers spend a majority of their time working closely with clients. Tasks that human service providers engage in are associated with an increased risk of injury (Thompson, 1998). The present study analyzed Occupational Safety and Health Administration (OSHA) reportable injuries that were occurring with direct service staff in an Applied Behavior Analysis organization. Existing OSHA-reportable incidents were analyzed and coded by type of injury, the body part injured, and number of resulting absences. A codebook was developed to analyze data by injury type, student involvement, occurrence of challenging behavior, and restraint use. Results indicated that the most common injuries were to the face, head, and neck. Notably, injuries were found to be most likely to occur when clients engaged in challenging behavior. Recommendations were provided to improve the reporting process and decrease injuries. |
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| “Aggression – Versatile Response Training” and Managing Unsafe Behavior in Human Service Settings |
| ELI T. NEWCOMB (The Faison Center), Byron J. Wine (The Faison Center; University of Virginia), Matthew R Osborne (The Faison Center), Karen Salazar (The Faison Center), Kimberley Roberts (The Faison Center) |
| Abstract: One noteworthy challenge that arises in the provision of behavior analysis services to individuals presenting with dangerous aggression is that staff directly involved in rendering those services are at risk for injury. Although there are a number of commercially available crisis training programs, there is very little empirical research on behavior management procedures and techniques for staff to use when confronted with aggression that cannot successfully be deescalated or evaded. Further complicating the issue is that a segment of this service recipient demographic requires staff to be in close proximity due to needs surrounding daily living skills and other problem behavior such as elopement or wandering. This produces greater risk in that when aggression occurs, staff may be within arm’s length. This presentation will provide further rationale for empirical research in this area, overview a brief procedure referred to as “aggression – versatile response training,” share related data from between and within-subjects research, and provide a demonstration and practical recommendations for practitioners serving individuals with dangerous aggressive behavior. |
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Improving Safety for Children and Their Caregivers: Examining Home Environmental Modifications |
| SAMANTHA HARDESTY (Kennedy Krieger Institute), Dorian Lanni (Kennedy Krieger Institute), Aila K. Dommestrup (Kennedy Krieger Institute; Johns Hopkins University School of Medicine), Brittney Nicole Workman (Kennedy Krieger Institute; Amigo Care ABA), Trey Ximenez (Western Michigan University) |
| Abstract: Individuals with autism and intellectual disabilities have an increased risk of developing challenging behaviors such as self-injury and aggression (Mazurek et al., 2013). Some forms of challenging behavior (e.g., elopement) can be so dangerous that it can lead to injury or even death (Anderson et al., 2012). Caregivers may also have an increased likelihood for injury; however, there is little research on safety concerns of families in the home setting (Sahin & Colak, 2023). On an individual level, identifying and ameliorating risk factors in the home environment can ensure children remain in the least restrictive setting and safely under parental care. Collectively, these data can identify frequently encountered safety concerns which can be used to inform advocacy efforts. This study aimed to assess the home safety needs of families following their child’s discharge from an intensive behavioral program. Data were collected on environmental modifications, use of personal protective equipment, and costs associated with recommendations. In an effort to help providers identify the needs of their clients, pertinent patient demographic information (i.e., topographies and function of challenging behaviors, age and size) will also be shared. Implications will be discussed for funding sources and state regulators. |
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