The Development and Acceptability of a Comprehensive Crisis Prevention Program for Implementation in Health Care Settings.

INTRODUCTION: Behavioral crises are increasingly prevalent in health care settings. Existing programs, however, include procedures that lack adaptability, omit critical components, and deviate from clinical best-practice recommendations. Health care employees also continue to report lacking confidence for safely managing behavioral crises. AIMS: We described the development and acceptability of a comprehensive crisis prevention program and its modification for a large pediatric health care system to help remediate the limitations of existing programs. METHOD: Chi-square analyses evaluated the acceptability of the crisis prevention program pre- versus post-training and at 3- and 6-month follow-up times. For insignificant outcomes, logistical regressions identify whether responses differed between emergency-department and nonemergency-department employees. RESULTS: Chi-square analyses were significant for 10 of 15 questions suggesting that employees were more confident in managing and communicating during behavioral crises post-training, and that this confidence was maintained. Logistic regressions found that emergency-department employees differed in some responses to the acceptability questionnaire than nonemergency-department employees over time. CONCLUSION: The present crisis prevention program is adaptable to various settings and patients, and it is well received overall by employees. The safety of patients and employees is integral to the delivery of quality care and improving patient-provider relations.

Interpersonal and Group Contingencies.

Responding by individuals in groups has been a prominent interest of the field of psychology. Experimental analyses of human behavior have provided some unique findings of the role that the environment, including both social and nonsocial stimuli, may have on individual responding. Cooperative and competitive contingencies, previously evaluated in animal and human operant research, provide unique insight into applied interventions, in particular group contingencies. The current manuscript attempts to bridge these two literatures to foster the development of more effective technologies and lines of experimental or translational research that may better inform interventions in the applied realm.

Effects of Magnitude on the Displacement of Leisure Items by Edible Items During Preference Assessments.

Studies on preference assessments have shown that when both edible and leisure items are compared, edible items tend to displace leisure items in preference hierarchies. However, the mechanisms behind this process are currently unclear. One possibility is that displacement may be a product of the relatively brief periods of access to leisure items typically used in preference assessments. The purpose of the current investigation was to examine whether the duration of access to leisure items affects displacement. In this study, participants chose between preferred leisure items and the edible items that had previously been shown to displace those leisure items in a preference hierarchy. Duration of access to the leisure item was systematically increased across series to identify the magnitude at which leisure items became more preferred than edible items. Results indicate that as the duration of access to leisure items increases, displacement decreases.

An evaluation of delay to reinforcement and mand variability during functional communication training.

Children with autism spectrum disorder and other developmental disabilities often exhibit invariant responding (i.e., restricted behavioral repertoires), deficits in communication, and challenging behavior. Approaches demonstrated in the basic and applied literature to increase response variability include extinction, lag schedules of reinforcement, and percentile schedules of reinforcement. Results of basic studies have also indicated that delays to reinforcement often produce increases in response variability. The purpose of the current study was to evaluate the effects of a delay to reinforcement on the variability of communication responses during functional communication training with individuals with developmental disabilities and histories of engaging in challenging behavior. Results indicated that delays to reinforcement increased mand variability with all four participants with variable effects on challenging behavior across participants.

Using caregiver report on the impact of challenging behavior exhibited by children with autism spectrum disorder to guide treatment development and outcomes.

Objectives: Evaluations of treatments using applied behavior analysis (ABA) for challenging behavior have relied mostly on direct behavioral observation. While observation is crucial, qualitative information can also be beneficial. In this study, we describe methods for using qualitative information in ABA treatments for challenging behavior. Method: Three participants were undergoing treatment for challenging behavior. Information was collected through caregiver interviews at the start and end of the admission. Directed content analysis identified themes in the interviews and we compared treatment outcomes using qualitative and quantitative measures. Results: Three themes emerged: description, frequency, and impact of the behavior. Quantitative and qualitative measures both suggested successful interventions for two participants. For the third, direct observation suggested treatment was effective while caregiver report did not. Conclusion: Incorporation of qualitative information into outcomes allowed for a more comprehensive view of treatment success and guided assessment and treatment decisions. Treatments based on applied behavior analysis (ABA) are commonly studied for the treatment of challenging behavior, but these studies rely mostly on direct behavioral observation. While observation is crucial, qualitative information is also useful in ensuring meaningful results. In this study, we describe a method of collecting, analyzing, and using qualitative information collected from caregivers and compare qualitative to quantitative outcomes.

Lag Schedules and Functional Communication Training: Persistence of Mands and Relapse of Problem Behavior.

We evaluated the effects of lag schedules of reinforcement and functional communication training (FCT) on mand variability and problem behavior in two children with autism spectrum disorder. Specifically, we implemented FCT with increasing lag schedules and compared its effects on problem behavior with baseline conditions. The results showed that both participants exhibited low rates of problem behavior during treatment relative to baseline during and following schedule thinning (up to a Lag 5 schedule arrangement). Variable and total mands remained high during schedule thinning. With one participant, variable manding persisted when the value of the lag schedule was reduced to zero. The current results are discussed in terms of implications for training multiple mand topographies during FCT for the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

An Evaluation of Lag Schedules of Reinforcement During Functional Communication Training: Effects on Varied Mand Responding and Challenging Behavior.

We evaluated the effects of lag schedules of reinforcement during functional communication training (FCT) on the varied use of mands and challenging behavior by two individuals diagnosed with autism. Specifically, we compared the effects of Lag 0 and Lag 1 schedules of reinforcement during FCT. The results showed that each participant exhibited increases in varied mand responding during FCT with the Lag 1 schedule of reinforcement relative to Lag 0; challenging behavior remained low during both FCT lag conditions relative to baseline. Results are discussed in terms of treatment implications relating to FCT and the potential prevention and/or mitigation of clinical relapse during challenges to treatment.

The Effects of Conducting a Functional Analysis on Problem Behavior in Other Settings: A Descriptive Study on Potential Interaction Effects.

It has been suggested that reinforcing problem behavior during functional analyses (FAs) may raise ethical questions, such as resulting in an increase in problem behavior outside of FA sessions. The current translational study assessed whether conducting an FA resulted in increases in problem behavior outside of the FA setting for six participants using a nonconcurrent multiple baseline across participants design. The rate of problem behavior was measured outside the FA setting prior to and during an FA. Idiosyncratic results suggest that problem behavior outside of the FA setting may increase, decrease, or be unaffected by conducting an FA.

Correspondence between the results of functional analyses and brief functional analyses.

PURPOSE: This study sought to examine the correspondence between brief functional analyses and more thorough functional analyses as described in the model of functional assessment proposed by Vollmer et al.1 Methods: A panel of trained clinicians indicated the presence/absence of specific functions of problem behavior based on graphic results from brief functional analyses and functional analyses conducted with 19 participants. These conclusions were compared across assessments. RESULTS: The functions identified by the panel based on results of brief functional analyses had low correspondence with those of the more thorough functional analysis conducted with the same participants. CONCLUSIONS: Although brief-functional analyses appear regularly in clinical practice and the literature, findings from this study suggest that results may differ from those of more thorough functional analyses. Additional study is necessary to determine the cause of discrepant results between these two methodologies.

Further evaluation of latency-based brief functional analysis methods: An evaluation of treatment utility.

OBJECTIVE: Objectives were to evaluate latency-based brief functional analysis (BFA) model for identifying functions of aberrant behavior and treatments generated based on the results of the latency-based brief functional analysis. METHODS: We conducted latency-based BFA, including contingency reversals, and function-based treatment evaluations, including non-contingent reinforcement (NCR) and differential reinforcement of alternative behavior (DRA) with three individuals with autism using single subject design methodology. RESULTS: Socially-mediated functions (attention; tangible) were indicated for two participants and an automatic function was identified for one participant. The treatments generated based on results of the BFA were effective at reducing aberrant behavior for all participants. CONCLUSIONS: Results provide additional support that latency-based BFA model has utility in (a) the identification of functions of aberrant behavior and (b) the generation of function-based treatments. These results suggest clinicians who encounter setting and client-specific constraints (e.g. time; severity of aberrant behavior) have additional flexibility in choosing assessment tools.

Effects of the Good Behavior Game on classwide off-task behavior in a high school basic algebra resource classroom.

This study investigated the effects of the Good Behavior Game (GBG) on classwide off-task behavior in two ninth-grade basic algebra resource classes. Ten students with a variety of disabilities, in two classrooms, and their special education resource teacher participated in this study. A reversal design was employed, in which the special education teacher implemented GBG compared to typical practice-algebra readiness instruction. Results showed that classwide off-task behavior decreased in the GBG conditions compared to the baseline and reversal conditions. Fidelity measures indicated that the teacher implemented GBG with fidelity. Students and the teacher rated GBG favorably. Overall findings support the use of GBG for reducing classwide off-task behavior. Implications for practice and future research directions are presented.

Further evaluations of functional communication training and chained schedules of reinforcement to treat multiple functions of challenging behavior.

We evaluated functional communication training (FCT) combined with a chained schedule of reinforcement procedure for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism. Following functional analyses that suggested that challenging behavior served multiple functions for both participants, we implemented FCT in which mands for a discriminative stimulus (S(D); wristband) were reinforced with access to the S(D) and all three functional reinforcers. Next, we modified the procedure by incorporating delays to increase ease of implementation and promote toleration of delays to reinforcement. Last, we made additional modifications to the procedure by incorporating a chained schedule of reinforcement such that (a) mands for the wristband were reinforced with access to the wristband and (b) specific mands for respective functional reinforcers were reinforced in the presence of the wristband. The results showed that the procedure successfully treated challenging behavior with multiple functions. Future directions in the evaluation and development of treatments that simultaneously address multiple functions are discussed.

Functional communication training and chained schedules of reinforcement to treat challenging behavior maintained by terminations of activity interruptions.

In this article, the authors evaluated functional communication training (FCT) and a chained schedule of reinforcement for the treatment of challenging behavior exhibited by two individuals diagnosed with Asperger syndrome and autism, respectively. Following a functional analysis with undifferentiated results, the authors demonstrated that challenging behavior was occasioned by interruptions of ongoing activities and maintained by terminations of interruptions. Next, they demonstrated the effectiveness of a treatment consisting of FCT with a chained schedule of reinforcement. Last, they modified the chained schedule procedure to increase ease of implementation and promote toleration of activity interruptions, and academic tasks were incorporated into the treatment.