Needed independent and dependent variables in multi-element behavior support plans addressing severe behavior problems.

Ethically , behavior analysts are required to use the least aversive and restrictive procedures capable of managing behaviors of concern. This article introduces and discusses a multi-element paradigm for devising support plans that include ecological, positive programming, and focused-support proactive strategies for reducing the frequency of problem behavior occurrence. It also includes reactive strategies, i.e., separate independent variables. In this paradigm, reactive strategies are aimed solely at getting rapid, safe control over the incident, thereby reducing measured and quantified episodic severity. Behavior analysts who publish in mainstream behavioral journals do not always make it explicit how they, in fact, successfully employed non-aversive reactive procedures to achieve rapid/safe control over the severity of a behavioral incident. Three examples of published studies in the behavioral literature which successfully, though only implicitly, used non-aversive reactive strategies (NARS) to reduce the severity of the behaviors of concern are described. The multi-element paradigm discussed in the present article is illustrated by the support plans that address the challenging behavior of three children in a pre-school setting, using both proactive and reactive strategies. Reactive strategies were used for the purpose of reducing episodic severity (ES) and proactive strategies were aimed at reducing the frequency of occurrence. Following a comprehensive functional analysis and assessment (CFA) and the implementation of a multi-element behavior support (MEBS) plan, results show successful outcomes without the need for any aversive or restrictive procedures. When addressing severe behaviors of concern, in addition to reducing behavioral occurrence, safety should also be improved by reducing ES as a measured outcome and as a function of the reactive strategies employed, including in many cases, the use of strategic capitulation, i.e., providing the identified reinforcer for the target behavior.

The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications.

BACKGROUND: Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. Questions have been raised as to PBS effectiveness, costs, and accessibility. METHOD: Outcome studies meeting specified criteria for PBS were selected for review. All told, 12 outcome studies encompassing 423 cases were included. RESULTS: This review showed that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community. CONCLUSIONS: The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment.

Developing behavioural services to meet defined standards within a national system of specialist education services.

In response to increasing demand for more accountability and improved outcomes in the provision of behavioural services, Specialist Education Services (SES) in New Zealand employed the trainer of trainers programme developed by the Institute for Applied Behaviour Analysis (IABA). The goal was to develop a national training team capable of training SES staff to carry out assessments and develop support plans that could meet defined standards. The purpose of this study was to evaluate the outcomes of this trainer of trainers project. The primary methods of evaluation included the pre-post training comparisons of trainees' functional assessments and positive behaviour support plans, against 140 defined criteria. The results of this project indicated that the SES national training team was able to train SES staff to meet the same standards of service delivery as the external IABA trainers. Further, a Periodic Service Review (PSR) system was implemented to insure that service standards could be maintained at a high level. A major conclusion reached in this study was that a trainer of trainer approach appears to be effective in preparing large numbers of educational personnel to meet the increasing demands by schools for professionals to meet a high standard of service delivery.

The safe management of physical aggression using multi-element positive practices in community settings.

BACKGROUND: Behavioral strategies often are used with people with acquired brain injury. Most involve the application of contingent reinforcement and punishment for selected behaviors or teaching important skills to overcome the challenging behaviors. However, consequential intervention and other strategies that depend on new learning may be precluded when working with individuals with significant short-term memory impairment. MAIN OUTCOME MEASURES: The present case study reports the results of non-consequential strategies based on a positive, multi-element model to address physical aggression and other related problems for such an individual. RESULTS: Support did not involve the use of aversive consequences for challenging behaviors nor the use of physical management/restraint. The identified problems were effectively and safely addressed and community living in close proximity to his family was maintained. CONCLUSIONS: The implications of this approach for the support of people who face similar challenges are discussed, including the ability to address serious problems such as physical aggression without resorting to aversive procedures.

Rehab rounds: training professionals in use of positive methods for community integration of persons with developmental disabilities.

Mainstream psychiatry has all but ignored the clinical needs of persons with developmental disabilities. With some notable exceptions, individuals in this group have been served in the community by behaviorally oriented psychologists or relegated to long-term institutional care. However, effective interventions are available, beginning with a functional analysis of the antecedents and consequences of targeted problem behaviors. Procedures for building adaptive coping and functional skills or compensating for their deficiency have been developed that are based on skills training, wraparound supports for employment and community living, stimulus control, and contingencies of reinforcement. Applied behavior analysis using task analysis, stimulus control, and contingencies of reinforcement also spawned some of the first techniques--including the token economy--shown to improve functioning and reduce psychopathology among persons with schizophrenia. One of the premier organizations to have documented the efficacy of person-centered, behavior-analytic, and community-based wraparound support services for persons with developmental disabilities is the Institute for Applied Behavior Analysis in Los Angeles. The institute was founded 20 years ago and has served more than 1,000 children, adolescents, and adults with developmental disabilities. Its staff have designed and empirically validated nonaversive techniques for modifying the behaviors that place their clients or others at risk of harm or injury and that often lead to the clients' ejection or isolation from community life. In this Rehab Rounds column the authors describe and evaluate the institute's training and consultation activities.