Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human Services

IMPORTANCE OF FUNCTION-BASED INTERVENTIONS 1 1

“Why” the behavior is occurring What is the individual trying to get/accomplish? “Function”?

Functions of Behavior Attention Escape Tangible Automatic Multiple or Combination

Escape 38% Automatic 26% Attention 23% Multiple 5% Tangible 3% Undifferentiated 5% 152 children with developmental disabilities Self Injurious Behavior Iwata et al. (1994)

~500 individuals with developmental disabilities SIB, aggression, disruption, etc. Hanley et al. (2003) Multiple 14% Tangible 10% Undifferentiated 4%

Geiger, Carr, & LeBlanc (2010)

Function-Matched Interventions Best practice -select interventions matched to the identified/hypothesized function of problem behavior Directly addresses the contributing antecedents & reinforcing consequences of problem behavior Often incorporates selecting and increasing a functionally equivalent replacement behavior Can be combined, or used in a sequential fashion

BASICS of EVIDENCE-BASED INTERVENTIONS 2 2

Teach Problem Behavior No Longer Results in Desired Reinforcer Extinction Differential Reinforcement of 0 Rates/Occurrenc es of Problem Behavior (DRO) Reduce Motivation to Engage in Problem Behavior Environmental Engineering/Restru cturing (revising curriculum/instructi on, choice, increase access to preferred contexts) Noncontingent Reinforcement (NCR) Teach Different/New Behaviors for Getting Desired Reinforcer Functional Communication Training (FCT) Differential Reinforcement of Alternative Behavior (DRA) 3 Main “Types” of Interventions

Antecedent-Based: Non-Contingent Reinforcement (NCR) Environmental/Curricular Restructuring: Increased Choice Opportunities Demand Fading Common Function-Based Treatments

Consequence-Based: Extinction Differential Reinforcement of Other (DRO) Differential Reinforcement of Alternative (DRA) Functional Communication Training (FCT) Common Function-Based Treatments

EVIDENCE-BASED INTERVENTION SELECTION 3 3

Evidence-Based Practice Effective Client Outcomes Client Context & Values Best Available Evidence

Critical Considerations Individual Level of Independence /Quality of Life Safety Individual’s deficits/nee ds Individual’s strengths/preferences Contextual Fit (resources, acceptability)

Intervention Selection -Published Guides Escape Maintained Problem Behavior Geiger, Carr, LeBlanc (2010) Attention Maintained Problem Behavior -Appropriate for Tangibly Maintained Grow, Carr, & LeBlanc (2009)

Task type (preferred), task level (difficulty), pacing, duration of instructional periods, level of required independence, competing contingencies Instruction Interaction type, interaction level, frequency, levels/duration of required interaction, competing contingencies Social Interactions Noise level, temperature, structure/lack of structure, transitions Environmen t Escape Function -Very common function (most or second most, depending on source)

Intervention Descriptions Table with Strengths & Limitations Decision- Making Flow Chart Description of Intervention Selection

Consider Intervention Options Identify Problem Bx Functional Assessment Fx = Escape ESCAPE-MATCHED INTERVENTION OPTIONS Tx Selection –Escape Maintained Geiger, Carr, LeBlanc (2010) Antecedent-Based Consequence-Based

Using the Intervention Selection Guide Tx Selection –Escape Maintained Geiger, Carr, LeBlanc (2010) Question 5: focuses on selecting the optimal terminal intervention Question 4: focuses on determining if minimizing time away from instruction is paramount Question 3: focuses on determining if establishing compliance with demands is paramount Question 2: focuses on determining if immediate suppression of the problem behavior is paramount (interventions can be implemented with or without extinction) Question 1: focuses on determining if diminishing the value of escape and teaching appropriate prerequisite skills is paramount

Using the Intervention Selection Guide Tx Selection –Escape Maintained Geiger, Carr, LeBlanc (2010) CAUTION REVISIT FLEXIBILITY -Some interventions can be combined -Interventions can be individualized (e.g., with and without extinction, faded in slowly) -Implement intervention indicated early on in model > success > revisit and go through model again -Caution: Avoid FCT and NCE at same time -Wait until NCE has been significantly faded or discontinued to implement FCT

Adults Specific Adult Peers Person is “Busy” or Giving Attention to Other Person Delivering Tone of Voice Volume Facial Expressions Physical Proximity Gestures Duration Quality of Attention Attention Function -Another very common function

TREATMENT SELECTION for ESCAPE MAINTAINED BEHAVIOR EXAMPLE

Male 10yrs Old (but very large) Autism Referred for: Severe Aggression

Attention Function -A Thought AttentionTangible SOCIAL POSITIVE

Intervention Descriptions Description of Intervention Selection Case Example Using Flow Chart Decision- Making Flow Chart

Identify Problem Bx Functional Assessment Fx = Attention Consider Intervention Options NCR Classroom Restructuring CWPT Extinction FCTDRA ATTENTION-MATCHED INTERVENTION OPTIONS Antecedent-Based Consequence-Based Tx Selection –Attention Maintained Grow, Carr, LeBlanc (2009)

Tx Selection –Attention Maintained Grow, Carr, LeBlanc (2009) Using the Intervention Selection Guide Question 4: focuses on determining what type of appropriate behavior needs to be taught/strengthened Question 3: focuses on determining if behavior needs to be strengthened Question 2: focuses on determining if temporary increases in occurrences of prob bx is acceptable Question 1: focuses on determining if extinction/ignoring prob bx is appropriate/possible

Using the Intervention Selection Guide Tx Selection –Escape Maintained Geiger, Carr, LeBlanc (2010) CAUTION REVISIT FLEXIBILITY -Some interventions can be combined -Interventions can be individualized (e.g., with and without extinction, faded in slowly) -Implement intervention indicated early on in model > success > revisit and go through model again -Caution: Avoid FCT and NCR at same time -Wait until NCR has been significantly faded or discontinued to implement FCT

TREATMENT SELECTION for ATTENTION MAINTAINED BEHAVIOR EXAMPLE

Male 13yrs Old (but very small for age due to pre- mature birth) Multiple Dx CP Visual Impairments

TREATMENT –Functional Communication Training

TREATMENT SELECTION for TANGIBLY MAINTAINED BEHAVIOR EXAMPLE -Using Attention Intervention Selection Guide

MaNo 5 Anxiety, ADHD, potential Autism Referred for noncompliance: yelling/noncompliance, aggression (tantrums)

TREATMENT –Functional Communication Training

INTERVENTION PLANNING 4 4

REVIEW STEPS FUNCTION of PROBLEM BEHAVIOR? INTERVENTION SELECTED? IMPLEMENTATION

Implementation OPTION 1 JUST DO IT –The “Hand Off” OPTION 3

Implementation Components

Planning Assess Available Resources Staffing (number, skill level, ability to learn needed skills, perceptions & attitude) Physical (space, materials) Timing Create Clinical Materials Intervention Protocol Data Sheets Treatment Integrity Checks & Data Collection Checks Create Training Materials Job Aids & Other Supports Sample Data Sheets Videos (if possible)

Implementing Training Train Implementation of Procedures Train How to Train Others (if needed) Train Data Collection Train Data/Progress Reporting Initial Implementation Have Materials Organized and Ready Plan Appropriate Initial Support

Telling instead of Teaching No opportunity to see skill being used No opportunity to practice/demonstrate mastery No systematic feedback, or poor feedback LEADS TO: Trial & error implementation Development of bad/incorrect habits/practices Implementing COMMON ERRORS IN TRAINING

Parsons et al Implementing -Behavioral Skills Training (BST)

InstructionsModelingRehearsalFeedback Continue until Mastery – You know the individual is done when s/he demonstrates the skill! Implementing -Components of BST

Supporting Check-Ins -In Person - -Text -Phone -Notes Treatment Fidelity and IOA Checks Praise, Praise, Praise Retraining (if needed)

Evaluate effects of intervention Desired reduction of problem behavior Desired increase of appropriate behavior Desired generalization Desired maintenance Evaluate Need to Modify Advance the intervention Slow down the intervention Modify the intervention Evaluate Need for Additional or Advanced Staff Training Reviewing

Implementation Components Risk of not completing Continued Prob. Bx or Increase Loss of Time Risk of Injury Potential to Increase Resistance to Future Interventions

RESOURCES 5 5

Reviews/Summaries Best-Practice Guidelines Practice Recommendations

RESOURCES - Provided to you Geiger, Carr, & LeBlanc (2010) Grow, Carr, & LeBlanc (2009) Attention Tx Selection Blank Escape Tx Selection Blank Intervention Planning Clinical Protocol Template

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