Applied Behaviour Analysis: Contributions to Best-Practice Residential Services

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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
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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

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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)

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ID services, social policy,
and ABA
1940s before Institutions ? 1980s ? Deinstitutionalisation ? 1990s ? Community and communities ? 2000s ? 2008 on ? Segregation custodial care ? ? training Normalisation ? Science out, values-based fads popular ? ? ? Evidence-based services? ABA started 1940s ? ? behaviour mod (punishment lollies) now unpopular ? Alternatives researched ? ? Alternatives found for most individuals ? ABA re-adopted?
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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

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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

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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)

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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

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Background

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

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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

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Figure 1. Percentage of steps completed
independently, across sessions for radio use.
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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

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Increasing Independent Engagement with Household
Chores

• I-Chen Sharon Ho, MSc, PGDipAppPsych
• ABA Graduate 2007
• Now at IDEA and Blomfield School, Whangarei

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Background

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

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Programme

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

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Figure 1. Time spent vacuuming independently
across sessions for compliant task-related
behaviour as a function of changing criterions.
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Increasing Meaningful Engagement in Adults with
Intellectual Disabilities

• Sheree Adams, MA, PGDipAppPsych
• ABA Graduate 2007
• Now at Centre for Autism Related Disorders

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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

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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 .

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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

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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.

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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)

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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 . . . .

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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?

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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

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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

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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

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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.
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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

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Communication Training and Decreasing Food
Stealing

• I-Chen Sharon Ho, MSc, PGDipAppPsych
• ABA Graduate 2007

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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)

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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

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Figure 1. Percentage of independent correct
responses across sessions as a function of
picture exchange communication systems training.
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Figure 2. Frequency of stealing attempts across
sessions as a function of extinction.
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• 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

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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

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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

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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

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• "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

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Website address for presentation

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

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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.

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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

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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