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| Show Me the (Assent) Data! |
| Monday, May 27, 2024 |
| 10:00 AM–11:50 AM |
| Convention Center, 100 Level, 103 B |
| Area: AUT; Domain: Service Delivery |
| Chair: Kerri L. Milyko (Centria Healthcare) |
| Discussant: Kerri L. Milyko (Centria Healthcare) |
| CE Instructor: Kerri L. Milyko, Ph.D. |
| Abstract: It is an exciting time when presentations and recent publications center around more ethical, humane, and compassionate care, particularly around an assent-based framework (e.g., Anderson, 2022; Breaux & Smith, 2023; Morris, Detrick, & Peterson, 2021). Many of these dissemination products center around establishing buy-in and teaching the audience about assent as a concept. While beneficial, conceptual understanding alone leaves the listener or reader with questions about logistics, procedures, and effectiveness. As the field of applied behavior analysis gains understanding and experience around assent, an opportunity arises to share details and data. As such, the present symposium unites clinical research utilizing an assent-based framework of intervention across different settings. The first paper includes assent in a descriptive functional analysis assessment leading to protocol modification and self-advocacy skill acquisition. The second paper evaluates assent and assent withdrawal behaviors with the inclusion of a token economy and the impact on interfering behaviors. The third paper shows data on a systematic approach for using an assent-based framework of intervention across 3,000 learners and how technology can aid in monitoring and responding to assent or assent withdrawal behaviors. Finally, the final paper sets the stage with helpful uses on how to provide services using this framework across multiple levels of data analysis. |
| Instruction Level: Intermediate |
| Keyword(s): Assent, Assent withdrawal, Functional Assessment, Learner Agency |
| Target Audience: Understanding the concept of assent, fluent with various interventions for skill acquisition and behavior reduction. |
| Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) list various measures that clinicians can use to track outcomes when focusing on assent; (2) provide 2+ examples of how to individualize assent-based interventions for learners; (3) describe how technology can assist scalable implementation of assent-based interventions; and (4) provide 2+ examples of assent-focused measures at all 4-levels of analysis. |
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Bringing Assent Into Behavior Analysis: Functional, Qualitative, and Meaningful |
| BRITTNEY PAULI (The Learning Consultants), Jeffrey Gesick (The Learning Consultants) |
| Abstract: Assent is an emerging topic within the field of behavior analysis with more formalized and comprehensive definitions of assent being developed (Breaux & Smith, 2023). Assent is described as observable participation that is given without coercion, and is not the absence of objection. It is a continuous event that can be given or withdrawn at any time, observed through a variety of communicative behaviors that vary by the individual (Breaux & Smith, 2023). Of 23,000 articles that were reviewed with regards to assent in behavior analysis, 28 used a descriptive definition of assent within the literature (Morris et al., 2021). The field lacks descriptive protocols for identification and measurement of assent behaviors within the clinical setting, with empirical data of procedures lacking. To address the gap in the literature, current descriptive functional behavior assessment procedures were adapted to develop topographical and functional definitions of assent behaviors (Hanley, 2012; Hanley et al., 2003; Bijou et al.,1968). All participants were children with formal Autism diagnoses ages four to eleven. Data on these behaviors were analyzed and used to modify protocols to reduce assent withdrawal, monitor client progress and teach self-advocacy skills within a clinical setting while remaining non-coercive. |
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Does Learner Agency Play a Role in the Effectiveness of a Token Economy System? |
| NICOLE E TAMURA (The Learning Consultants) |
| Abstract: There is a vast amount of research on the effectiveness of the token economy system on changing behaviors (Ghezzi et al.,2009); however, there is little to no research on what features of the token economy are considered to be effective in producing that behavior change. Learner agency is operationally defined as learners having the ability to be a part of the learning design and take action to intervene in the learning process (Gordon, 2018). In this study, we looked at the effects learner agency has on the effectiveness of token economies. We used an alternating treatment design to compare the effectiveness of two token economies on learner’s assent, learner’s refusal behavior, and the number of programs implemented in a three-hour session. One token economy was created by assessing learner preference for both the token type and the order of token delivery, and one token economy consisted of tokens that were chosen by the supervising clinician. One participant saw a significant decrease in the refusal behavior when using a token board created by learner preference and an increase in refusal behavior with clinician preference; there is insufficient data available for the second learner to formulate an informed conclusion. |
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Measuring and Monitoring Indicators of Assent in Applied Behavior Analysis (ABA) Therapy via Innovative Technology |
| CINDI KENNEDY (Centria Autism) |
| Abstract: Obtaining client assent is an ethical obligation, however, resources on how to effectively define, quantify and track data on assent is limited resulting in a lack of adoption by practitioners (Morris et al., 2021; Breaux & Smith, 2022). Assent has been defined as revocable agreement to participate by those unable to legally consent (Breaux & Smith, 2022). Difficulties include determining assent capacity, defining individualized indicators, and analyzing data. This presentation describes an approach to defining and measuring individualized assent used by an organization with over~3000 autistic clients. Clinicians are trained to identify and define topographies associated with assent and assent withdrawal and technology is used to record this data systematically. The technology provides additional guidance to technicians on how to engage in compassionate responses based on the level of assent or assent withdrawal that is recorded. This approach aligns with our ethical guidelines by providing a decision making model for assent in practice. |
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Tiered-Measurement Analysis: A Focus on Assent |
| KRISTIN SMITH SMITH (CentralReach), Kerri L. Milyko (Centria Healthcare) |
| Abstract: Assent-based intervention is a framework that is utilized when providing services with young learners or learners who legally cannot provide consent. This approach places emphasis on seeking voluntary participation in intervention in the absence of coercion (Breaux & Smith, 2023). While the nuances of when and how to honor assent withdrawal behaviors or to solicit for assent have been detailed (Breaux & Smith, 2023; Anderson, 2022; Morris, Detrick, & Peterson, 2021) as well as a list of possible assent-focused measures (Breaux & Smith, 2023), a systematic approach to collecting and evaluating those measures has yet to be presented. As such, the authors seek to discuss different dependent variables in a 4-tiered measurement system to evaluate outcomes of an assent-based intervention. Multiple examples and their implication of data analysis across micro-data, meta-data, meso-data, and macro-data will be provided. This system will prepare clinicians and researchers who are interested in gathering outcome data when an assent framework is applied to intervention. |
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