© 2016 Institute for Applied Behavior Analysis,

slide1. © 2016 Institute for Applied Behavior Analysis,
Los Angeles, California. All rights reserved. Positive Practices in Behavioral Support 1 2016 D1-G © 2016 IABA 3/22/2022<br>
slide2. © 2016 IABA Basic Principles Presented by:

Institute for Applied Behavior Analysis 3/22/2022<br>
slide3. © 2016 IABA Introduction 3/22/2022<br>
slide4. © 2016 IABA ABA in Support of Values Social role valorization: The enablement, establishment, enhancement, maintenance, and/or defense of valued social roles for people--by using, as much as possible, culturally valued means (Wolfensberger, 1983) 3/22/2022<br>
slide5. © 2016 IABA ABA in Support of Values Community presence and participation, in ways that are age appropriate and valued by society
Autonomy and self determination, through the exercise of increasingly informed choice
Continuous involvement in the ongoing process of becoming
Increasing independence and productivity, to the point of economic self sufficiency
The opportunity to develop a full range of social relationships and friendships 3/22/2022<br>
slide6. © 2016 IABA Punishment The contingent presentation of a stimulus or event, resulting in a future decrease in response strength.
The contingent withdrawal of a stimulus or event, resulting in a future decrease in response strength. 3/22/2022<br>
slide7. © 2016 IABA Aversive A stimulus or event one would ordinarily act to avoid. 3/22/2022<br>
slide8. © 2016 IABA A Non-linear Model for Positive Behavioral Support 3/22/2022<br>
slide9. © 2016 IABA Why People Use Punishment Response Alternatives
Child Rearing Practices
Modeling Effect
Literature
Expert Consultation
Myth of Effectiveness
Reinforcement Histories 3/22/2022<br>
slide10. © 2016 IABA Responses to Problem Behavior Treatment
Protection
Emotional Expression 3/22/2022<br>
slide11. If we wish to change the basic strategies that we use, a longitudinal program of behavior change, with us as the learner, is necessary. © 2016 IABA 3/22/2022<br>
slide12. © 2016 IABA Ethical Considerations Conditions
Functionality 3/22/2022<br>
slide13. © 2016 IABA Administrative & Legal Considerations Legislation
Court findings
Agency rules & regulations 3/22/2022<br>
slide14. © 2016 IABA Empirical & Clinical Considerations 3/22/2022<br>
slide15. © 2016 IABA Empirical Considerations 3/22/2022<br>
slide16. © 2016 IABA Are Positive Practices Effective with Severe and Challenging Behavior? Foxx, 2005; Johnston, Foxx, Jacobson, Green & Mulick, 2006
_________________________________

Severe vs. not severe
Institutions vs. community
High rate vs. Low rate Behavior
Specialists needed
5. High cost vs. low cost 3/22/2022<br>
slide17. © 2016 IABA Literature Review of Type 3
Case Studies (Kazdin, 1981): Valid inferences:
Objective data for multiple Behaviors.
Continuous assessment.
Problems of long standing/stable histories and of the type that would not ordinarily improve without effective intervention.
Applied across various ages, diagnoses, and personal backgrounds. 3/22/2022<br>
slide18. © 2016 IABA Are Positive Practices Effective with Really Severe and Challenging Behavior? Donnellan, A. M., LaVigna, G. W., Zambito, J., and Thvedt, J. (1985). A time limited intensive intervention program model to support community placement for persons with severe behavior problems. The Journal of the Association for Persons with Severe Handicaps,

LaVigna, G. W., Willis, T. J., and Donnellan, A. M. (1989). The role of positive programming in non-aversive behavior management. In E. Cipani (Ed.) Behavioral Approaches to the Treatment of Aberrant Behavior. AAMD Monograph Series, American Association on Mental Retardation.

LaVigna, G. W., and Willis, T. J. (1992). A Model for multielement treatment planning and outcome measurement. In D.E. Berkell (Ed.), Autism: Identification, Education, and Treatment. Lawrence Erlbaum Associates, Hillsdale, New Jersey.

Willis, T. J., & LaVigna, G. W. (2003). The safe management of physical aggression using multi-element positive practices in community settings. The Journal of Head Trauma Rehabilitation. 3/22/2022<br>
slide19. © 2016 IABA Donnellan, A. M., LaVigna, G. W., Zambito, J., and Thvedt, J. (1985). The Journal of the Association
for Persons with Severe Handicaps All 16 were at imminent risk of institutionalization.
Five involved serious self-injury or physical aggression.
Others involved property destruction, extreme tantrums, inappropriate sexual Behavior, etc. 3/22/2022<br>
slide20. © 2016 IABA Excerpts from case files: …he became so assaultive and unmanageable that he had to be placed in a psychiatric hospital for two weeks.

…deep concern over the effects of their son’s (assaultive) Behavior on his younger sister’s physical safety.

…head butting.

…this client spent 90% of her waking hours at home in a straight jacket and/or locked in a wheelchair.

…the mother had to lock herself in the garage or bathroom to prevent herself from incurring severe bodily harm. 3/22/2022<br>
slide21. © 2016 IABA 3/22/2022<br>
slide22. © 2016 IABA Even though the ethical practice of ABA requires the least restrictive method, our referrals often involve people whose problems are serious and for whom a punitive approach has failed.

The next case involved a person for whom a wide range of aversive procedures were used unsuccessfully. Prior use of punishment 3/22/2022<br>
slide23. © 2016 IABA LaVigna, G.W., and Willis, T.J. (1992) Case Details 17-year-old boy with autism and hearing loss.
Target Behavior: SIB - striking his head or nose with his fist or against another object…
Previous treatment: the behaviors were initially controlled by aversive consequences, including bare-bottomed smacks, water squirts, pinches, and the like. Eventually, the consequences only escalated the problem, e.g., after more than a year, he received 177 bare-bottomed smacks in just one day. 3/22/2022<br>
slide24. © 2016 IABA 3/22/2022<br>
slide25. © 2016 IABA The 1989 study involved a person for whom a systematic, consistently applied Overcorrection procedure was ultimately unsuccessful.
___________________________________________ Prior use of punishment LaVigna, G. W., Willis, T. J., and Donnellan, A. M. (1989) The role of positive programming in non-aversive Behavior management. In E. Cipani (Ed.) Behavioral Approaches to the Treatment of Aberrant Behavior. AAMD Monograph Series, American Association on Mental Retardation. 3/22/2022<br>
slide26. © 2016 IABA The problem of physical aggression was resolved.

If Overcorrection could not produce durable results, the question remained as to whether or not the outcomes achieved through the positive plan were durable.

A 20-year follow-up was planned: 2004 Long Lasting Results 3/22/2022<br>
slide27. © 2016 IABA 3/22/2022<br>
slide28. © 2016 IABA Are Positive Practices Effective with Really Severe and Challenging Behavior? Hudson, A., Wilken, P., Jauernig, R, & Radler, G., (1995). Regionally based teams for the treatment of challenging Behavior: a three-year outcome study. Behavior Change.

Hudson, A., Jauernig, R., Wilken, P., & Radler, G., (1995). Behavioral treatment of challenging Behavior: a cost benefit analysis of a service delivery model. Behavior Change.

McClean, B., Grey, I. M., & McCracken (2005). An evaluation of positive Behavioral support for people with very severe challenging Behaviors in community-based settings. British Journal of Learning Disabilities.

McClean, B., Dench, C., Grey, I., Shanahan, S., Fitzsimons, E., Hendler, J., & Corrigan (2005). Person Focused Training: a model for delivering positive Behavioral supports to people with challenging Behaviors. Journal of Intellectual Disability Research. 3/22/2022<br>
slide29. © 2016 IABA Can Positive Practices be Implemented by Front Line Staff? McClean, Dench, et al. (2005):

Details: 138 individuals
67 physical aggression
31 self-injurious Behavior
10 property destruction
30 other 3/22/2022<br>
slide30. © 2016 IABA Results 77 % Reduction in Target Behavior*
22 Months of Follow-up Data Conclusion: With training/coaching, positive practices, including functional assessment, can be successfully implemented by direct care staff. *large institutions 3/22/2022<br>
slide31. © 2016 IABA Grey, I. & McClean, B. (2007) Service user outcomes of staff training in positive Behavior support using person-focused training: A control group study. Journal of Applied Research in Intellectual Disabilities. Control Group Study 3/22/2022<br>
slide32. © 2016 IABA Train the Trainers LaVigna, G. W., Christian, L., and Willis, T.W. (2005). Developing Behavioral Services to Meet Defined Standards within a National System of Specialist Education Services. Pediatric Rehabilitation. 3/22/2022<br>
slide33. © 2016 IABA Summary of Studies

Included LaVigna, G. W. & Willis, T. J. (2012). The efficacy of positive behavioural support with the most challenging behaviour:  The evidence and its implications. Journal of Intellectual and Developmental Disability 3/22/2022<br>
slide34. © 2016 IABA http://informahealthcare.com/toc/jid/37/3 PBS Special Issue Web Access 3/22/2022<br>
slide35. © 2016 IABA Nicola Crates, Matthew Spicer

Developing behavioural training services to meet defined standards within an Australian statewide disability service system and the associated client outcomes (31 +)



Brian McClean, Ian Grey

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour (4)

A component analysis of positive behaviour support plans (61) Additional Articles 3/22/2022<br>
slide36. © 2016 IABA Positive ABA practices can be
effective with severe target Behavior 513 Type 3 Case Studies, single subject design & control group comparison studies …and wide ranging clinical practice

Practice Based Evidence 3/22/2022<br>
slide37. © 2016 IABA Conclusions: A positive approach can be effective, even with the most challenging and high rate behavior.

This is empirically supported in the published literature.

This has implications for the ethical practice of ABA, given the principle of the “least restrictive procedure.” 3/22/2022<br>
slide38. © 2016 IABA Ethics Behavior Analyst Certification Board Guidelines for Responsible Conduct For Behavior Analysts©

(August 2004)

4.07
Least Restrictive Procedures.
The behavior analyst reviews and appraises the restrictiveness of alternative interventions and always recommends the least restrictive procedures likely to be effective in dealing with a behavior problem. 3/22/2022<br>
slide39. © 2016 IABA Clinical Considerations 3/22/2022<br>
slide40. © 2016 IABA Is Punishment Necessary for Effectiveness? Speed and Degree: over time and within an episode
Durability
Generalization
Side Effects
Social Validity
Clinical/Educational Validity 3/22/2022<br>
slide41. Speed &
Degree
of Effects Durability
of
Effects Generalization
of
Effects Side
Effects Social
Validity Educational/
Clinical
Validity Outcomes Over
Time Episodic
Severity © 2016 IABA 3/22/2022<br>
slide42. © 2016 IABA Support Plans 3/22/2022<br>
slide43. © 2016 IABA Assessment 3/22/2022<br>
slide44. Mediation © 2016 IABA 3/22/2022<br>
slide45. Breaking the Barriers to Social & Community Integration:A Non-linear ABA Framework for Research, Support and Training DEPENDENT VARIABLES ASSESSMENT FOCUSED SUPPORT SITUATIONAL MANAGEMENT POSITIVE PROGRAMMING ECOLOGICAL STRATEGIES PROACTIVE STRATEGIES REACTIVE SERVICE DESIGN SUPPORT PLAN MEDIATION SPEED &
DEGREE OF
EFFECTS SIDE EFFECTS SOCIAL
VALIDITY CLINICAL/
EDUCATIONAL
VALIDITY GENERALIZATION OF EFFECTS DURABILITY OF EFFECTS TRAINING SOCIAL
CHANGE AGENTS COMPLIANCE
NATURAL SPECIFIC GENERAL PROFESSIONAL SPECIALIZED INDEPENDENT VARIABLES OVER
TIME EPISODIC
SEVERITY © 2016 IABA 3/22/2022<br>
slide46. © 2016 IABA Support Strategies Presented by:
Institute for Applied Behavior Analysis 3/22/2022<br>
slide47. © 2016 IABA Ecological Strategies Changes in physical, interpersonal, and programmatic environments that better fit the person's characteristics & needs 3/22/2022<br>
slide48. © 2016 IABA Ecological Strategies Physical Factors
Examples
Setting
Light
Noise
Crowding
Implications 3/22/2022<br>
slide49. © 2016 IABA Ecological Strategies Interpersonal Factors
Examples
Peer respect
Communication / culture
Social interactions
Expectations
Implications 3/22/2022<br>
slide50. Jeff's Multi-Element Support Plan Ecological Strategies Positive Programming Focused Support Strategies Reactive Strategies © 2016 IABA 3/22/2022<br>
slide51. Jeff's Multi-Element Support Plan Ecological Strategies Positive Programming Focused Support Strategies Reactive Strategies Community based group home
Peer & staff sign language for primary communication
Interim increased intensive support - 30 hours/ week
Token reinforcement program © 2016 IABA 3/22/2022<br>
slide52. Jeff's Multi-Element Support Plan Ecological Strategies Positive Programming Focused Support Strategies Reactive Strategies Chronological age-appropriate & functional skill development
Discrete trial, differential reinforcement for compliance
General sign communication training
Signed request for self restraint © 2016 IABA 3/22/2022<br>
slide53. Jeff's Multi-Element Support Plan Ecological Strategies Positive Programming Focused Support Strategies Reactive Strategies Antecedent control gradually faded
DRO schedules © 2016 IABA 3/22/2022<br>
slide54. Jeff's Multi-Element Support Plan Ecological Strategies Positive Programming Focused Support Strategies Reactive Strategies No physical intervention was necessary
Signed "No - Wrong!"
Back up self-restraints © 2016 IABA 3/22/2022<br>
slide55. © 2016 IABA Results Rate
Per
hour Weeks of Treatment Staph
Infection Illness &
Staff
Changes Group
Home Surgery Staff
Changes 12 26 38 Months of Follow-up (.18) 3/22/2022<br>
slide56. © 2016 IABA Ecological Strategies Programmatic Factors
Examples
Choice, predictability & control
Motivational systems
Curriculum
Task difficulty
Instructional methods
Implications 3/22/2022<br>
slide57. Breaking the Barriers to Social & Community Integration:A Non-linear ABA Framework for Research, Support and Training DEPENDENT VARIABLES ASSESSMENT FOCUSED SUPPORT SITUATIONAL MANAGEMENT POSITIVE PROGRAMMING ECOLOGICAL STRATEGIES PROACTIVE STRATEGIES REACTIVE SERVICE DESIGN SUPPORT PLAN MEDIATION SPEED &
DEGREE OF
EFFECTS SIDE EFFECTS SOCIAL
VALIDITY CLINICAL/
EDUCATIONAL
VALIDITY GENERALIZATION OF EFFECTS DURABILITY OF EFFECTS TRAINING SOCIAL
CHANGE AGENTS COMPLIANCE
NATURAL SPECIFIC GENERAL PROFESSIONAL SPECIALIZED INDEPENDENT VARIABLES OVER
TIME EPISODIC
SEVERITY © 2016 IABA 3/22/2022<br>
slide58. © 2016 IABA Positive Programming Longitudinal instruction designed to teach skills & competencies that facilitate behavioral change for the purpose of social integration. 3/22/2022<br>
slide59. © 2016 IABA Positive Programming Variations
General Instructive Programming
Functional
Chronologically age-appropriate
Low inference 3/22/2022<br>
slide60. © 2016 IABA Positive Programming Teaching Functionally Equivalent Skills
Communications
Examples
Choosing augmentative systems
Instructional strategies
Independence 3/22/2022<br>
slide61. © 2016 IABA Positive Programming Teaching Functionally Related Skills
Discrimination
Choice
Predictability & control
Rules
Stimulus control 3/22/2022<br>
slide62. © 2016 IABA Positive Programming Teaching Coping Skills
Desensitization
Shaping
Relaxation training 3/22/2022<br>
slide63. © 2016 IABA The problem of physical aggression was resolved.

If Overcorrection could not produce durable results, the question remained as to whether or not the outcomes achieved through the positive plan were durable.

A 20-year follow-up was planned: 2004 Long Lasting Results 3/22/2022<br>
slide64. © 2016 IABA 3/22/2022<br>
slide65. Breaking the Barriers to Social & Community Integration:A Non-linear ABA Framework for Research, Support and Training DEPENDENT VARIABLES ASSESSMENT FOCUSED SUPPORT SITUATIONAL MANAGEMENT POSITIVE PROGRAMMING ECOLOGICAL STRATEGIES PROACTIVE STRATEGIES REACTIVE SERVICE DESIGN SUPPORT PLAN MEDIATION SPEED &
DEGREE OF
EFFECTS SIDE EFFECTS SOCIAL
VALIDITY CLINICAL/
EDUCATIONAL
VALIDITY GENERALIZATION OF EFFECTS DURABILITY OF EFFECTS TRAINING SOCIAL
CHANGE AGENTS COMPLIANCE
NATURAL SPECIFIC GENERAL PROFESSIONAL SPECIALIZED INDEPENDENT VARIABLES OVER
TIME EPISODIC
SEVERITY © 2016 IABA 3/22/2022<br>
slide66. © 2016 IABA Focused Support Strategies 3/22/2022<br>
slide67. © 2016 IABA Focused Support Strategies To reduce, and if possible, eliminate, the need for a reactive strategy. 3/22/2022<br>
slide68. © 2016 IABA Time-Based Schedules Increase the density of time-based delivery of preferred events. 3/22/2022<br>
slide69. © 2016 IABA Differential Schedules 3/22/2022<br>
slide70. © 2016 IABA DRO - Differential Reinforcement of Other Behavior Reinforcement after a specified period of no undesired responding 3/22/2022<br>
slide71. © 2016 IABA DRO 3/22/2022<br>
slide72. © 2016 IABA DRO - Variations DRO - Reset Schedules
DRO - Fixed Interval Schedules
DRO - Progressive Schedules 3/22/2022<br>
slide73. © 2016 IABA DRO - Variations A DROP schedule of reinforcement involves the progressive increase of reinforcement available for each consecutive interval during which target behavior does not occur up to a specified maximum 3/22/2022<br>
slide74. © 2016 IABA DRO Variations Momentary DRO Schedules
Trial by Trail -Omission Training
DRO Escalating (Increasing Interval) Schedules 3/22/2022<br>
slide75. © 2016 IABA DRO-Implementation Selection of target behavior
Selection of DRO variation
Selection of time interval
Goldilocks Rule
Fixed interval: 50% of the average time between responses before intervention 3/22/2022<br>
slide76. © 2016 IABA DRO-Implementation Selection of reinforcers
The Free Access Rule: The maximum amount of positive reinforcement available during intervention must be less than the person would seek given free access
General considerations 3/22/2022<br>
slide77. © 2016 IABA DRO-Implementation Fading of reinforcers
Positive programming 3/22/2022<br>
slide78. © 2016 IABA DRL - Differential Reinforcement of Low Rates of Responding The reinforcement of the undesired response, if more than a specified period of time has elapsed since the last response, or if fewer than a specified number of responses occurred during a preceding interval of time. 3/22/2022<br>
slide79. © 2016 IABA DRL - Variations IRT Method
Low Rates Method 3/22/2022<br>
slide80. © 2016 IABA DRL Low
Rate
Behavior High Rate

Behavior 3/22/2022<br>
slide81. © 2016 IABA DRL-Implementation Response rate
Learner ability
Interval size & reinforcement criteria
Changing criteria
Reinforcement magnitude 3/22/2022<br>
slide82. © 2016 IABA DRL Advantages Success with high rate behaviors
Flexible interval size
Ease of implementation
Reinforcement frequency
Tangible feedback
Speed of effects
Potential for group contingencies
Potential for completely eliminating behaviors 3/22/2022<br>
slide83. Potential for Group Contingencies & Systems © 2016 IABA 3/22/2022<br>
slide84. © 2016 IABA DRL - Cautions Non-constructive
Concerns regarding social validity
Minimize potential for aversive component
Student controlled
Matter-of-fact
Non-exchangeable
Non-interruptive
Link failure with opportunity 3/22/2022<br>
slide85. © 2016 IABA ALT-R Differential Reinforcementof Alternative Responses The reinforcement of specified behaviors that are topographically different from the undesired response. 3/22/2022<br>
slide86. © 2016 IABA ALT-R Variations DRA
DRI
100% 3/22/2022<br>
slide87. © 2016 IABA THE 100% RULE The target behavior and the alternative response, taken together, must represent the universe of possibilities. 3/22/2022<br>
slide88. © 2016 IABA ALT-R Variations The 100% Rule: The target behavior and the alternate response, taken together, must represent the universe of possibilities. 3/22/2022<br>
slide89. © 2016 IABA ALT-R Implementation 1. Meet 100% rule or approximate
2. Specify reinforcement schedule
a. Free access rule
b. Mediating systems
3. Natural contingencies 3/22/2022<br>
slide90. © 2016 IABA ALT-R Advantages 1. Lasting effects
2. Constructive
3. Social validity 3/22/2022<br>
slide91. © 2016 IABA ALT-R Concerns Delayed effect
Complexity and mixed evidence
Recovery and rebound 3/22/2022<br>