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Applied Behaviour Analysis: Contributions to BestPractice Residential Services

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University of Auckland ABA Programme Staff. and Graduates ... ABA approach to problems in 21st Century ... Cooper, J. O., Heron, T. E., & Heward, W. L. (2007) ... – PowerPoint PPT presentation

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Title: Applied Behaviour Analysis: Contributions to BestPractice Residential Services


1
Applied Behaviour Analysis Contributions to
Best-Practice Residential Services
  • Oliver Mudford,
  • I-Chen Sharon Ho, Kylie Jeffrey,
  • Sheree Adams, Katrina Phillips
  • University of Auckland ABA Programme Staff
  • and Graduates

National Residential Intellectual Disability
Conference Auckland. February 14th 2008
2
Outline
  • What is Applied Behaviour Analysis?
  • ID residential services, social policy and ABA
    Brief history
  • ABA approach to skill teaching
  • Examples of increasing skills
  • ABA approach to problems in 21st Century
  • Examples of decreasing problems
  • Encouraging evidence-based practices in ID
    services

3
What is ABA?
  • A science that . . .
  • applies procedures derived from the principles of
    behaviour . . . (especially, reinforcement)
  • systematically . . . (not randomly)
  • to improve socially significant behaviour . . .
    (important for person)
  • to a meaningful degree . . . (that is, improves
    lifestyle)
  • and to show that the procedures used were
    responsible for the improvement. (. . . that is,
    provides evidence)

4
ID services, social policy,
and ABA
5
What happened to ABA in 1990s?
  • ID services de-professionalised
  • Teaching people skills for living will occur
    naturally by contact with community (. . . not
    true for many)
  • Problem behaviours would not occur with good
    values and community living (. . . not supported
    by evidence)
  • Training courses to provide skills to staff ended
  • Psychologists (some were ABA) not needed
  • ABA psychologists moved to other populations
  • Clinical Psychology lost interest in ID (and ABA)
  • ABA teaching in NZ universities declined
  • - No new ABA specialists trained

6
Meanwhile, ABA advances from late-1980s to present
  • Research on individualising reinforcers for
    increasing behaviours and teaching new skills
    preference and reinforcer assessment
  • More research on individualising interventions
    for problem behaviours almost eliminating need
    for 1970s treatments that fail services values
    check e.gs., functional analysis, NCR, FCT
  • ABA practitioner credentials established
    internationally Behavior Analyst Certification
    Board (BACB) from 2000
  • University courses specialising in ABA
    re-established - from 2003 in NZ

7
ABA approach to skill teaching
  • Examples of increasing skills
  • Teaching and training conducted for clients and
    staff of residential services in Auckland
  • Further examples on website (address at end)

8
Teaching a Man with ID and Vision Impairment to
Use His Radio
  • Kylie Jeffery, MSc, PGDipAppPsych
  • ABA Graduate 2007
  • Now at Essdee Behaviour Specialists, Taupiri

9
Background
  • Client Goal
  • Support Equipment
  • Task Analysis
  • Baseline
  • Training
  • Prompting
  • Reinforcement
  • Staff
  • Independence
  • Maintenance

10
Task analysis for forward chaining radio use.
  • 1 Go to bedroom
  • 2 Close bedroom door
  • 3 Go to stereo
  • 4 Touch top left hand corner of stereo
  • 5 Push 'on/off' button
  • 6 Feel for push 'radio/turner' button
  • 7 Listen to radio 
  • 8 Push 'on/off' button

11
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12
Figure 1. Percentage of steps completed
independently, across sessions for radio use.
13
Conclusion
  • Task analysis successful with other goals
  • Success verified with client, family and staff
  • 26 sessions over 1 ½ months to teach a skill that
    leads to a lifetime of independent activity

14
Increasing Independent Engagement with Household
Chores
  • I-Chen Sharon Ho, MSc, PGDipAppPsych
  • ABA Graduate 2007
  • Now at IDEA and Blomfield School, Whangarei

15
Background
  • Client Wyatt
  • Goal To increase clients independence when
    engaging in chores.
  • Goal rationale

16
Programme
  • Behavioural Momentum
  • What is it? 
  • Can we make the strategy more efficient?

17
Figure 1. Time spent vacuuming independently
across sessions for compliant task-related
behaviour as a function of changing criterions.
18
Increasing Meaningful Engagement in Adults with
Intellectual Disabilities
  • Sheree Adams, MA, PGDipAppPsych
  • ABA Graduate 2007
  • Now at Centre for Autism Related Disorders

19
Introduction
  • I compared two methods to increase engagement
    levels of four men with developmental
    disabilities who live in staffed residential
    care.
  • Engagement in worthwhile leisure and domestic
    activities

20
Method
  • Participants were four men aged 25-35 and six
    staff aged 28-55
  • The study consisted of four phases, baseline,
    alternating treatments, single treatment and
    follow-up.
  • Both resident (levels of engagement) and staff
    behaviour (interactions with residents) were
    recorded during all observations
  • The interventions were administered in an
    alternating fashion, on the same day. One in the
    morning and in the afternoon .

21
Two Interventions
  • In Treatment A the staff were told there is not
    enough activity going on, would you do something
    to increase it please?
  • In Treatment B staff were told the above and
    given a written list of over 50 suggested
    activities and asked to approach clients and
    offer a choice of activity. The list was removed
    at the end of the observation.
  • Staff were thanked regardless of the level of
    subsequent activity

22
PERCENTAGE OF INTERVAL
Intervention A
Level of engagement
Figure 1 Percentage of session spent engaged for
all individuals. Lines represent level of
engagement across all conditions. Bars represent
the percentage of intervals staff spent
attempting to engage individuals and prompting
them to maintain engagement, for all staff,
across baseline, treatment and follow up phases.
F/U is follow-up.
26
23
Conclusion
  • Baseline levels of client engagement were very
    low across all individuals
  • Intervention B (provision of a list) was more
    effective, therefore it is necessary to give
    staff a written list of suggested activities and
    to offer the individuals a choice of activities
    to obtain a stable increase in engagement levels
  • Prompting and reinforcement was necessary to
    increase engagement levels with one individual
    (PN)

24
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25
Goals for residents guided by
  • Discussion, prioritising, and agreement with
    resident, staff, and family
  • Active participation busy
  • high activity highly reinforcing living
    environment
  • Teach and maintain functional skills
  • Increasing signs of happiness
  • cont . . . .

26
Guiding principles for goals (cont)
  • Minimise disruptive behaviours
  • Replace with functional skills
  • Minimise restrictions
  • Encourage and teach choice
  • Create and maintain a stable environment
  • not chaotic, for residents and staff
  • Maximise safety
  • from own or others behaviour
  • ABA in practice is not really a values-free
    activity is it?

27
ABA approaches to reducing problems
  • Examples of decreasing behaviours
  • Note that these rely on changes in reinforcement
    not punishment
  • Teaching and training conducted for clients and
    staff of residential services in Auckland

28
Comparison of Interventions to Decrease Grabbing
by a Man with Intellectual Disabilities
  • Katrina Phillips, MSc, PGDipAppPsych, BCBA
  • ABA Graduate 2007
  • Now at Rescare Homes Trust and UoA

29
Programme
  • Function of behaviour
  • Social Positive Reinforcement
  • Decreasing problem behaviour over two time
    periods using
  • NCR (non-contingent reinforcement)
  • Activity engagement
  • Extinction (i.e., ceasing to reinforce)
  • Combinations of the above

30
Figure 1. Frequency of BNs grabbing during the
morning shift (90 mins). Graph shows four
different interventions baseline (no
intervention), task engagement and extinction,
task engagement, extinction and NCR, or
extinction and NCR.
31
Conclusion
  • Grabbing of other residents reduced to zero with
    a combination of providing engaging activities
    for BN, non-contingent attention systematically
    every 5 minutes, and attending minimally to
    instances of grabbing

32
Communication Training and Decreasing Food
Stealing
  • I-Chen Sharon Ho, MSc, PGDipAppPsych
  • ABA Graduate 2007

33
Background
  • Client Alf
  • Goal To increase Alfs ability to request for
    food using a picture card
  • Goal rationale and function of challenging
    behaviour (food stealing)

34
Programme
  • Picture Exchange Communication
  • Extinction, i.e., stopping food stealing
  • Block Alfs reach for others food
  • Teach others to move their food out of Alfs
    reach

35
Figure 1. Percentage of independent correct
responses across sessions as a function of
picture exchange communication systems training.
36
Figure 2. Frequency of stealing attempts across
sessions as a function of extinction.
37
  • Before behavioural reinforcement procedures were
    widely used with individuals with severe or
    profound intellectual disabilities, those
    individuals were frequently medically sedated and
    warehoused living zombies . . . But once
    systematic reinforcement programmes began to be
    used, these individuals could be taught many
    important skills, independent eating, dressing,
    and hygiene behaviours and vocational and
    recreational behaviour of which they were
    previously thought to be incapable. Consequently
    their freedom increased now they could dress
    themselves, and decide what to wear now they
    could feed themselves and decide what to eat.
    Systematic reinforcement procedures . . .
    increased their freedom.
  • Stephen Flora (2007) in Taking America Off
    Drugs

38
How do staff become trained to use systematic
procedures in 2008 in NZ?
  • Well, perhaps they dont
  • Why not? The design of modern individually
    tailored systematic reinforcement procedures is
    complex
  • Too sophisticated to be learned in a 1, 2, or 3
    day workshop which produce superficial (or mis-)
    understanding
  • Application of the individualised procedures is
    not so complex, and staff can be trained to do
    them
  • ID services need to employ qualified individuals
    to train others to implement behaviour change
    procedures effectively

39
ABA provides evidence-based practices EBP for
services for people with ID
  • ID sub-groups, e.g., MoH/MoEd ASD EBP guidelines
  • 100s of research articles showing benefits
  • Applications of ABA for ID overall
  • 1000s of research articles
  • This evidence is not well-known to ID services
  • maybe too complex to interpret
  • or perhaps known, but ignored
  • or denigrated by those recommending alternatives
    that have no sound evidence base

40
Encouraging evidence-based practices EBP in ID
services
  • Recognise that ABA has changed since the 1980s
    behaviour mod days
  • ID services should consider committing to using
    EBPs, such as ABA
  • Encourage, nurture support training to develop
    NZ expertise with EBPs
  • Recruit ABA expertise to educate management (and
    MoH, NASCs, etc.) and to train residents and
    staff
  • Reward staff who use EBPs effectively
  • NRID? lobby MoH on these issues
  • Like Queensland Government have adopted EBP for
    ID

41
  • "Current Internationally-Accepted Best Practices
    for Helping People with Intellectual and Other
    Developmental Disabilities"
  • Professors Wayne Fisher and Cathleen Piazza
  • (University of Nebraska Medical Center
  • and Munroe-Meyer Institute)
  • July 24th and 25th, 2008 at the University of
    Auckland Tamaki Campus

42
Website address for presentation
  • http//www.psych.auckland.ac.nz/postgraduate-progr
    amme/ABA.htm
  • Includes references, Fisher Piazza flyer, and
    further examples

43
References
  • Behavior Analyst Certification Board
    www.BACB.com
  • Bailey, J., Burch, M. (2006). How to think like
    a behavior analyst Understanding the science
    that can change your life. Mahwah, NJ Lawrence
    Erlbaum.
  • Favell, J. E., McGimsey, J. F. (1993).
  • Defining an acceptable treatment environment.
    In, R. Van Houten S. Axelrod (Eds.), Behavior
    analysis and treatment (pp. 25-45). New York
    Plenum Press.
  • Cooper, J. O., Heron, T. E., Heward, W. L.
    (2007). Applied Behavior Analysis (2nd ed.).
    Upper Saddle River, NJ Pearson.
  • Flora, S. R. (2007). Taking America off drugs.
    State University of New York Press
  • Jacobson, J. W., Foxx, R. M., Mulick, J. A.
    (Eds.) (2005). Controversial therapies for
    developmental disabilities Fads, Fashion, and
    Science in Professional Practice. Mahwah, NJ
    Lawrence Erlbaum Associates.

44
More examples from University of Auckland ABA
students and graduates work for ID services
  • Increasing skills
  • Residents clean own rooms,
  • Make cups of tea for self and visitors,
  • Increase range and persistence with leisure
    activities
  • Improve compliance with reasonable requests from
    teachers, parents, and staff
  • Independent bus riding
  • Money identification
  • Knowledge and compliance with rules for playing
    8-ball pool
  • Using CD player
  • Increase exercise
  • Increase walking
  • Shoelaces tying
  • Teaching computer use
  • Making sandwiches, baking cakes,
  • Hand washing
  • Teeth brushing
  • Communication training, e.g., PECS, signs
  • Increase activities in vocational training groups
  • Using washing machines

45
More examples continued
  • Decreasing problems
  • Reduce aggression
  • Reduce tantrumous outbursts
  • Reduce self-injury e.g., regurgitation,
    head-hitting, pica
  • Reduce property destruction
  • Reduce restraints
  • Eliminate fear of open spaces, thus increasing
    social activity
  • Monitor effects of medications on behaviours
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