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![Page 1: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/1.jpg)
Evidence-Based Intervention Selection & PlanningUtah Behavior Support ClinicDr. Sellers, BCBA-DOctober, 2015
Idaho Partnerships Conference on
Human Services
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IMPORTANCE OF FUNCTION-BASED INTERVENTIONS
1
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“Why” the behavior is occurring
What is the individual trying
to get/accomplish?
“Function”?
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Functions of BehaviorAttention
Escape
Tangible
Automatic
Multiple or Combination
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Escape 38%
Automatic 26%
Attention 23%
Multiple5%
Tangible 3%
Undifferentiated 5%
• 152 children with developmental disabilities
• Self Injurious Behavior
Iwata et al. (1994)
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• ~500 individuals with developmental disabilities
• SIB, aggression, disruption, etc.
Hanley et al. (2003)
Escape 33%
Attention 24%
Auto-matic 15%
Multiple14%
Tangible 10%
Undifferentiated 4%
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Geiger, Carr, & LeBlanc (2010)
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Function-Matched InterventionsBest 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
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BASICS of EVIDENCE-BASED INTERVENTIONS
2
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Teach Problem Behavior No
Longer Results in Desired Reinforcer
• Extinction• Differential
Reinforcement of 0 Rates/Occurrences of Problem Behavior (DRO)
Reduce Motivation to
Engage in Problem Behavior
• Environmental Engineering/Restructuring (revising curriculum/instruction, 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
![Page 12: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/12.jpg)
Ante
cedent-
Base
d:
Non-Contingent Reinforcement (NCR)
Environmental/Curricular Restructuring:
Increased Choice Opportunities
Demand Fading
Common Function-Based Treatments
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Conse
quence
-Base
d:
Extinction
Differential Reinforcement of Other (DRO)
Differential Reinforcement of Alternative (DRA)
Functional Communication Training (FCT)
Common Function-Based Treatments
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EVIDENCE-BASED INTERVENTION SELECTION
3
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Evidence-Based Practice
Effective Client Outcomes
Client Context
& Values
Best Availabl
e Evidenc
e
Clinical Expertise
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Cri
tica
l C
on
sid
era
tion
s
Individual
Level of Independence/Quality of Life
Safety
Individual’s deficits/nee
ds
Individual’s strengths/preferences
Contextual Fit
(resources, acceptability)
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Intervention Selection-Published Guides
Escape Maintained Problem Behavior
Geiger, Carr,
LeBlanc (2010)
Attention Maintained Problem Behavior
-Appropriate for Tangibly Maintained
Grow, Carr, & LeBlanc (2009)
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• 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
Environment
Escape Function-Very common function (most or second most, depending on source)
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Intervention Descriptions
Table with Strengths & Limitations
Decision-Making Flow
Chart
Description of
Intervention Selection
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Consider Intervention
Options
Identify
Problem Bx
Functional
Assessment
Fx = Escape
Curricular or
Instructional
Revision
Demand
Fading
Extinction
Noncontingent Escape
Activity Choice
DNRA / FCT DNRO
ESCAPE-MATCHED INTERVENTION OPTIONS
Tx Selection –Escape Maintained
Geiger, Carr, LeBlanc (2010)
Antecedent-Based Consequence-Based
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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
![Page 24: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/24.jpg)
Using the Intervention Selection Guide
Tx Selection –Escape Maintained
Geiger, Carr, LeBlanc (2010)
CA
UTIO
N
REV
ISIT
FLEX
IBIL
ITY-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
![Page 25: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/25.jpg)
• 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
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TREATMENT SELECTION for ESCAPE MAINTAINED BEHAVIOR EXAMPLE
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• Male• 10yrs Old (but very
large)• Autism• Referred for: Severe
Aggression
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Attention Function-A Thought
Attention Tangible
SOCIAL POSITIVE
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Intervention Descriptions
Description of
Intervention Selection
Case Example
Using Flow Chart
Decision-Making Flow
Chart
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Identify
Problem Bx
Functional
Assessment
Fx = Attention
Consider Intervention
Options
NCR Classroom Restructuring CWPT Extinctio
n FCT DRA
ATTENTION-MATCHED INTERVENTION OPTIONS
Antecedent-Based Consequence-BasedTx Selection –Attention
MaintainedGrow, Carr, LeBlanc (2009)
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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
![Page 35: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/35.jpg)
Using the Intervention Selection Guide
Tx Selection –Escape Maintained
Geiger, Carr, LeBlanc (2010)
CA
UTIO
N
REV
ISIT
FLEX
IBIL
ITY-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
![Page 36: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/36.jpg)
TREATMENT SELECTION for ATTENTION MAINTAINED BEHAVIOR EXAMPLE
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• Male• 13yrs Old (but very
small for age due to pre-mature birth)
• Multiple Dx• CP• Visual • Impairments
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TREATMENT –Functional Communication Training
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TREATMENT SELECTION for TANGIBLY MAINTAINED BEHAVIOR EXAMPLE-Using Attention Intervention Selection Guide
![Page 41: Evidence-Based Intervention Selection & Planning Utah Behavior Support Clinic Dr. Sellers, BCBA-D October, 2015 Idaho Partnerships Conference on Human.](https://reader034.fdocuments.us/reader034/viewer/2022051621/5697bfbf1a28abf838ca3562/html5/thumbnails/41.jpg)
MaNo 5 Anxiety, ADHD,
potential Autism Referred for
noncompliance: yelling/noncompliance, aggression (tantrums)
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TREATMENT –Functional Communication Training
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INTERVENTION PLANNING
4
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REVIEW STEPS
FUNCTION of PROBLEM
BEHAVIOR?
INTERVENTION SELECTED?
IMPLEMENTATION
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Implementation
OPTION 1 JUST DO IT –The “Hand Off”
OPTION 3
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Implementation Components
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PlanningAssess 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)
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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
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Telling instead of Teaching
Trial & error implementationDevelopment of bad/incorrect habits/practices
No opportunity to see skill being used
No opportunity to practice/demonstrate mastery
No systematic feedback, or poor feedback
LEADS TO:
ImplementingC
OM
MO
N E
RR
OR
S IN
TR
AIN
ING
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Parsons et al. 2012
Implementing-Behavioral Skills
Training (BST)
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Instructions
Modeling
Rehearsal
Feedback
Continue until Mastery –You know the individual is done when s/he demonstrates the skill!
Implementing -Components
of BST
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SupportingCheck-Ins-In Person
-Email-Text
-Phone-Notes
Treatment Fidelity and IOA Checks
Praise, Praise, Praise
Retraining (if
needed)
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Evaluate effects of intervention• D
esired reduction of problem behavior
• Desired increase of appropriate behavior
• Desired generalization
• Desired maintenance
Evaluate Need for Additional or Advanced Staff Training
Reviewing
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Implementation Components
Risk of not completing
Continued Prob. Bx or Increase
Loss of Time
Risk of Injury
Potential to Increase
Resistance to Future
Interventions
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RESOURCES
5
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RESOURCES
Reviews/Summaries
Best-Practice Guidelines
Practice Recommendations
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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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Next Class
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Practitioner Resources for Applied Behavior Analysts
http://wmich.edu/autism/resources
Western Michigan UniversityAutism Center of Excellence