Association for Behavior Analysis International

Applied Behavior Analysis has played an important role in the history of brain injury rehabilitation and its development of today´s neurobehavioral services. The first neurobehavioral rehabilitation programs in the United States, Canada and United Kingdom were developed or co-developed by behavior analysts. Despite this rich history and the role of behavior analysis in the development of brain injury rehabilitation less than one percent of all board-certified behavior analysts work within the brain injury rehabilitation field. With this symposium we hope to facilitate an increased interest in this subfield of Applied Behavior Analysis and want to show interested clinicians and researchers that brain injury rehabilitation is a venue for international collaboration and knowledge share. This symposium will present research on topics such as staff training within neurobehavioral rehabilitation programs, program evaluation of Applied Behavior Analysis best practice within neurobehavioral rehabilitation centers, delay discounting and links to challenging behavior in a sample of men with brain injuries, and, verbal behavior assessment of people with brain injuries.

Appropriate for all BCBA and BCBA-D

As acquired brain injury rates continue to increase, the ongoing need for efficient and effective treatment within neurobehavioral rehabilitation settings is clear. Some evidence suggests certain treatment components may be very important to incorporate into service delivery models (e.g., multidisciplinary). However, program evaluation literature and the uptake of complimentary intervention strategies, like applied behavior analysis (ABA), in existing neurobehavioral settings remains largely unexplored. The purpose of this project was to: (1) develop and implement a simple, systematic program evaluation informed by best-practices (i.e., research) to assess service delivery models of several neurobehavioral rehabilitation settings, and (2) survey the current use of ABA by participating neurobehavioral agencies. The program evaluation tool was applied to the charts of randomly selected past and current clients (referred to as participants). A secondary research assistant independently reviewed the charts to conduct interobserver agreement across 29% of the charts. Interobserver agreement was 80% (range, 53%-100%). Average program evaluation total percentage score was 33% (range, 4% - 63%), and program evaluation items describing ABA-uptake suggested the incorporation of ABA was low. We discuss service model areas of strengths and areas for improvement as specified by tool outcomes, as well as in relation to quality improvement implications.

Policies and training have traditionally focused on crisis management to respond to challenging behaviors and to decrease incidents of Workplace Violence. However, behaviour is a continuum that progresses from calm, to agitation, to escalation, to de-escalation, to recovery. A focus on crisis management can result in missed opportunities and does not directly lower incidences of behaviour escalation. Hospital units where staff are trained in Acquired Brain Injury (ABI) rehabilitation often have incidents where patients escalate to abuse and/or aggression to staff resulting in staff injury. Use of a preventative approach is well supported in the literature. When taught theory behind Applied Behavior Analysis (ABA) preventative strategies, staff still had difficulty in implementing the skills to reduce incidences of workplace violence and aggression from patients. Systemically assisting ABI staff in 2 Greater Toronto Area (GTA) hospitals to respond to challenging behavior in ABI inpatient settings using a BST model of ABA strategies increased interdisciplinary staff’s confidence and ability to respond to challenging behaviors and decrease incidents of Workplace Violence in the ABI Inpatient Rehabilitation Services while building a robust support system of staff who deliver training using the same methodology to incorporate sustainability.

People with brain injuries often experience deficits of self-control and some engage in challenging behavior. Delay discounting research and brain injury rehabilitation have received limited attention from behavior analysts. Additionally, no investigations have focused on discounting parameters and their association with challenging behavior to date. This study investigated the stability of responses of the Monetary Choice Questioner (MCQ) over time in a large sample of men with brain injuries and compared discounting parameters with the participants´ assessment outcomes on the Questions About Behavior Functions (QABF) and Comprehensive Executive Functioning Inventory Adult (CEFI-A). Results demonstrated that responses on the MCQ were stable over time, that MCQ and assessment scores on QABF were tentatively linked, yet executive functioning was not linked significantly to discounting parameters on the MCQ. Implications of these results are discussed with regards to potential clinical interventions and how future research can improve our understanding of the link between self-control and challenging behavior within brain injury rehabilitation.

Language deficits are common following neurocognitive disorder (NCD), yet behavior analysts serving this growing population do not have a validated, function-based assessment to guide language programming. Gross, Fuqua, and Merritt (2013) developed and piloted the Verbal Behavior Assessment Battery (VBAB) to evaluate language deficits for older adults with dementia, but researchers have yet to replicate this study or evaluate this tool for adults following acquired brain injury (ABI). We expanded the VBAB to better capture the complex changes that may occur following ABI. We conducted the revised assessment with five adults with severe ABI and matched control participants and found 1) varying deficits across ABI participants, 2) significant differences between the performance of ABI and control participants, 3) acceptable test-retest reliability, and 4) evidence for both functional independence and interdependence of verbal operants. Our discussion will focus on methodological considerations and potential refinement of the assessment for future clinical use.