Behavioral Services

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Behavioral Services

• Presented by
• Pat Nowotniak, Ed.D., BCBA
• Jennifer Russell, BCBA
• Leah Koehler, BCBA
• Barbie Schulz, BCBA

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Topics for Discussion

• Certifications held by behavior analysts
• What are they?
• What do they mean?
• Indicators that services may be needed
• Elements of a behavior assessment
• Why are they necessary?
• Elements of a behavior support plan
• Why are they necessary?

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Behavior Analysis Services

• Level of general education varies, from a high
  school diploma to a doctorate degree
• Level of education in behavior analysis varies,
  from having taken a class to having taken
  numerous classes and having obtained a Masters
  Degree in Behavior Analysis
• Level of experience in behavior analysis varies,
  from no experience to numerous years

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The Behavior Analyst Certification Board, Inc.
(BACB)

• http//www.bacb.com/becom_frame.html
• The board delineates the certification
  requirements for behavior analysts, and addresses
  all issues related to certification

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Level 1 (Highest)

• Board Certified Behavior Analyst, (BCBA) with
  more than 3 years of experience post
  certification with a minimum of a Masters
  Degree, OR
• Someone licensed under Chapter 490 or 491, F.S.,
  (psychologist, school psychologist, clinical
  social worker, marriage and family therapist, or
  mental health counselor) with more than 3 years
  of experience, post certification

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Level 2

• Board Certified Behavior Analyst, (BCBA) with
  LESS than 3 years of experience post
  certification (not necessarily post education),
  minimum of a Masters Degree, OR
• Someone licensed under Chapter 490 or 491, F.S.,
  (psychologist, school psychologist, clinical
  social worker, marriage and family therapist, or
  mental health counselor) with LESS than 3 years
  of experience, post certification, OR
• A Florida Certified Behavior Analyst with a
  Masters or Doctorate, regardless of experience

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Level 3 (Lowest Level)

• Board Certified Assistant Behavior Analyst,
  (BCABA), with a minimum of a Bachelors Degree
• A Florida Certified Behavior Analyst (CBA) with a
  Bachelors degree or high school diploma,
  regardless of experience
• It is recommended by the Behavior Analyst
  Certification Board that BCABA receive
  supervision from a BCBA

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Behavior Expertise
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How Do You Select?

• Many things to consider
• Level of education
• Board Certified
• Expertise in behavior analysis
• Experience providing services
• Experience with specific age groups
• Experience with specific disabilities

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When Should You Get Behavioral Services?

• Is the behavior(s) harmful to the individual or
  to others?
• Likely to result (or has resulted) in injuries
• to self or others
• Numerous scars
• Medical care needed
• Baker Acted
• Numerous Incident Reports filed

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When Should You Get Behavioral Services? (cont.)

• Is the behavior(s) harmful/threatening to the
  caregivers or to others?
• Injuries to caregivers
• Police have been called
• Noticeable property destruction
• Does the individual require the use of
  psychotropic medications to control behaviors
  secondary to an Axis I disorder
• Frequent changes in psychotropic medications for
  behavior control

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When Should You Get Behavioral Services? (cont.)

• Does the behavior(s) occur at the wrong time,
  place, or with the wrong people?
• Does it happen too often, not often enough, or
  for too long?
• Does it impact or impede their life or others?
• The behavior is too intense, is annoying, and/or
  threatening to others
• Not getting along with caregivers, peers, or
  housemates?
• Leading others to separate?

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When Should You Get Behavioral Services? (cont.)

• Do the appropriate behaviors happen enough or
  when they should?
• Do you have to provide numerous prompts?
• Have there been frequent life changes?
• Frequent changes in residence, providers, schools
• High staff turnover

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When Should You Get Behavioral Services? (cont.)

• Does the individual isolate themselves?
• Do they participate in activities, group outings,
  etc.?
• If they do participate, are their social skills
  appropriate?
• Are their behaviors age appropriate?
• Can the individual communicate their wants
• and needs?
• Poor expressive communication skills
• Can others in the community understand them?

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What Do Behavioral Services Include?

• Behavior Assessment
• Behavior Support Plan
• In-services
• Data Collection
• Monitoring
• Updates, progress notes

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Behavior Assessment

• A systematic gathering of information to
  determine why and how a challenging behavior is
  maintained or increased.
• The purpose is to predict problem behaviors
  through the identification of events that happen
  before and after the behavior. This enables us to
  be able to develop treatment recommendations.

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Functions of Behaviors

• What is the function (s) of the behavior?
• 1) Automatic-sensory, rocking, flicking,
  repetitive vocalizations
• 2) Automatic-pain, hitting head, ear ache,
  scratching
• 3) To get something, attention, tangible, social
  positive reinforcement
• 4) To stop or avoid something, escape or
  avoidance, social negative reinforcement

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What Does a Behavior Assessment Tell Us?

• Under what circumstances do the problem behavior
  occur?
• Under what circumstances do the problem behavior
  not occur?
• How do people respond when the behavior occurs?

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What a Behavior Assessment Tells Us

• How is the person communicating their needs?
• What are the reinforcing consequences? (we need
  to know that because we want to stop them)
• What else could the person learn to do, that
  would accomplish the same as the problem
  behavior?

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Indirect Methods for Descriptive Assessment

• Record Review Reviewing documentation provided
  
• previous assessments, plans, school records,
  incident reports, medical records, written notes,
  etc.
• Functional Assessment Interviews-conducted with
  someone who knows the person best, often
  open-ended questions, may include
• Motivational Assessment Scale (MAS) (Durand
  Crimmins, 1992)
• Functional Analysis Screening Tool (FAST) (Iwata,
  1995)
• Functional Analysis Interview (FAI) (ONeill,
  Horner, Albin, Sprague, Storey, Newton, 1987)

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What Information Does the Functional Assessment
Interview Provide?

• Socially significant behaviors
• Variables within the environment
• Precursor behaviors, does one behavior typically
  precede others?
• Possible maintaining functions
• Behavioral chains, do certain behaviors occur
  together?
• Describes problem behaviors

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Direct Methods of Descriptive Assessment

• Narrative recording (writing what is happening)
• Gathering ABC data (Antecedent, Behavior,
  Consequence)
• Scatter plot

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Gathering ABC Data

• Antecedent (A) What is happening before the
  problem behavior?
• Behavior (B) What does the problem behavior look
  like?
• Consequence (C) What happens right after it?
• Example Pat is asked to wash the dishes, Pat
  hits her head, sister takes her to the couch to
  relax.

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ABC Analysis
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Scatterplot

• Times of the day are written vertically in order
  from getting up time to going to bed time
• Days of the month are written across,
  horizontally

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Preference Assessment

• A method for identifying preferred items, places,
  people, activities, etc.
• The purpose of a preference assessment is to
  determine what the individual likes and aids in
  the identification of possible reinforcers for
  inclusion in the Behavior Support Plan.
• A reinforcer is a stimulus that follows some
  behavior and increases the probability that the
  behavior will occur.

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What is a Reinforcer?

• It is an enjoyable or desirable event, object, or
  a response, that follows something we did, that
  will strengthen a behavior and make it more
  likely it will happen again. Money is for many of
  us a reinforcer in the aspect that it increases
  the likelihood we go to work. With money we
  obtain objects, access events that we find
  desirable. At work we may also access other
  reinforcers.
• We are all unique what is reinforcing to one
  person may not be for another
• This is why it is so essential to identify the
  reinforcers for each person

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Preference Assessment (Cont.)

• Asking the person and people who know the person
  well what they like
• Using a survey, such as the Reinforcer Assessment
  for Individuals with Severe Disabilities (RAISD)
  (Fisher, Piazza, Bowman Amari, 1996)
• Asking the person to make choices

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Summary Purpose of an Assessment

• Identify the antecedents and consequences
• Identify the functions of the behaviors
• Identify the reinforcers
• Identify appropriate replacement behaviors for
  each function identified during the assessment
• A fluid process, the assessment should be an
  on-going process

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Behavior Support Plan

• Demographic information
• Assessment information
• Functions of the behaviors
• Medical and health conditions
• Target behaviors for reduction
• Replacement behaviors
• Interventions for problem behaviors

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Behavior Support Plan

• In-service training
• Generalization
• Maintenance
• Data collection
• Data reliability
• Program integration
• Informed consent
• Fading plan

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Purpose and Destination

• You want the problem behaviors to go down
• You want the appropriate skills to go up
• Sometimes we call them replacement behaviors,
  sometimes the acquisition of skills
• There are numerous methods to teach skills

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Replacement Behaviors

• Those are the appropriate behaviors you want a
  person to use INSTEAD of being aggressive,
  self-injurious, destructive, etc.
• Knowing the function of the problem behavior
  helps a behavior analyst identify an alternate or
  a replacement behavior
• For example, Joe becomes aggressive when he is
  asked to clean his room. The function is to
  escape the request. An appropriate replacement
  would be to teach him to comply with a request,
  delay a request, negotiate a request, etc.

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Where Do I Go From Here?

• CARD, local school districts, Childrens Medical
  Services, Early Steps, and numerous other
  organizations dedicated to provide assistance,
  support and guidance
• Medicaid waiver services Apply first for
  eligibility services through the Agency for
  Persons with Disabilities http//apd.myflorida.co
  m/customers/
• Private pay, behavior analysts can be identified
  in the BACB website, certificant registry
• http//www.bacb.com/becom_frame.html

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Conclusion

• Early Intervention
• Behavior services should be provided as soon as
  possible
• The newer the problem the easier the solution
• Behavior services can lead to
• Reduction of challenging behaviors
• Increase of appropriate responses
• Increase in quality of life

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THANK YOU
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Have a great day !