Gentle Teaching Evaluation Network
G-TEN
International Alliance to Produce Evidence – Simple Yet Scientific
James W. Conroy, Ph.D.
The Center for Outcome Analysis
www.eoutcome.org
2COA September 2007
Outline Purpose
Why Measure and Measure What? Paradigms and Resistance
The Scientific Literature – Paradigm War Things are Changing, Especially in the Americas Now is a Very Good Time to Seek Evidence in a
Cooperative International Venture Dimensions We Must Measure
– Interactions, Qualities of Life (including feeling safe and loved), Behavior, Person-Centeredness
How to Move Forward: Pilot Studies, Home, Funding, Nations, Studies
COA September 2007 3
Purpose
Today – to share our thinking about how to get new, reliable, valid scientific evidence
Aiming toward publishing studies And obtaining serious funding from USA
organizations – government and foundations
GTEN – what is our best strategy toward production of good evidence across our nations?
COA September 2007 4
Why Seek Evidence?
We have a common belief in Gentle Teaching We all hope that it will spread, and negative
approaches and aversives will end We will need more evidence to bring the skeptics
and the “undecideds” along Yet we must overcome powerful past rejection by
behavioral scientists GTEN – is there hope of achieving this?
COA September 2007 5
The Controversy in the “Scientific” Literature, 1980s and 1990s
Why all the resistance, skepticism? Because GT threatens established thinking
and funding? Look at this title from one of the critics: Bailey, J.S. (1992) Gentle teaching: trying
to win friends and influence people with euphemism, metaphor, smoke, and mirrors. J Appl Behav Anal. 1992 Winter; 25(4): 879–883.
COA September 2007 6
The Controversy in the “Scientific” Literature, 1980s and 1990s
McGee, J. J., Menolascino, F. J., Hobbs, D. C., & Menousek, P. E. (1987). Gentle teaching: A non-aversive approach to helping persons with mental retardation. New York: Human Sciences Press.
McGee, J. J., & Gonzalez, L. (1990). Gentle teaching and the practice of human interdependence: A preliminary group study of 15 persons with severe behavioral disorders and their caregivers. In A. C. Repp & N. N. Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 237-254). Sycamore, IL: Sycamore.– Caregiver’s Interactional Observation System (CIOS) and the
Person’s Interactional Observation System (PIOS)
COA September 2007 7
1989 JABA
J Jordan, N N Singh, and A C Repp (1989). An evaluation of gentle teaching and visual screening in the reduction of stereotypy. J Appl Behav Anal. 1989 Spring; 22(1): 9–22.
Extremely complex behavioral research design with just 3 “subjects”
“…gentle teaching was found to be more effective than task training for 2 subjects but less effective for the 3rd “
Published anyway – because their Discussion conclusions were negative about GT
Footnote on Singh – Therapy Malls in big institutions and DOJ witness history
COA September 2007 8
1992 Review of the Controversy
A J Cuvo (1992). Gentle teaching: on the one hand ... but on the other hand. J Appl Behav Anal. 1992 Winter; 25(4): 873–877.
Perhaps the most balanced review of the early controversy.
This would be worthwhile reading because it explains the harshness of the attacks on GT.
COA September 2007 9
Most Recently, 2003:
Polirstok, Susan Rovet EdD; Dana, Lawrence PhD; Buono, Serafino Dot.; Mongelli, Vita Dottssa.; Trubia, Grazia Dottssa. Improving Functional Communication Skills in Adolescents and Young Adults with Severe Autism Using Gentle Teaching and Positive Approaches. Topics in Language Disorders. 23(2):146-153, April/May/June 2003.
Described positive findings, both for individuals and workers.
Working with 18 young people in Sicily.
COA September 2007 10
More Recent Rigorous Study in England Cullen C. & Mappin R. (1998). An examination of the effects of
gentle teaching on people with complex learning disabilities and challenging behaviour. Br J Clin Psychol. 1998 May;37 ( Pt 2):199-211.
13 students, 7 staff observed 13 weeks “pre” and 23 weeks “post” 45 hours direct observational data on handheld computers, 75
hours of video “Wherever there were differences between gentle teaching and IEP
these were in favour of gentle teaching, although they were generally relatively minor in terms of clinical (rather than statistical) significance.” NOTE the disclaimer
Conclusions: all effects of GT unimportant, may be “useful adjunct” But who did the training, and how was it reinforced?
COA September 2007 11
Scientific Revolutions
Thomas Kuhn’s “The Structure of Scientific Revolution” 1963
The source of the phrase “Paradigm Shift” When the prevailing “model” or “paradigm” fails
to explain something – an anomaly Sometimes a new worldview is required But there will be powerful resistance The thinking which was the cause of our success
in the past often becomes the reason for our failure in the future.” - Einstein
COA September 2007 12
1. Current paradigm does not “work” for some observations – anomaly and crisis. Not all in the community will care about anomaly – too comfortable
2. The proponents of the “new” are reviled, criticized, distrusted – Threat!
3. Competing camps form
a. One camp seeks to defend the old institutional constellation.
b. One (or more) camps seek to institute a new paradigm
4. Polarization: civil scientific discourse fails – Demonization, stridency, desperate defense – paradigm wars
5. Circular arguments - Each group uses its own paradigm to defend its paradigm – circular discussions
6. Finally, the new does replace the old, and the guardians of the old “suddenly” embrace the new as though they had thought of it themselves
7. Gentle Teaching has been immersed in a paradigm war
8. But this paradigm shows every sign of success – allies have sprung up – we will live to see it become the established belief system
9. To speed this up, evidence developed within the scientific method will help
13COA September 2007
Is the Paradigm Changing At Last?
There’s reason to believe so Look at the insurgencies into the bastions of
resistance Look at the organizations that have embraced
positive approaches (not the same thing but emerged from GT thinking) e.g. Herb Lovett
Look at the rise of aversive regulations, concerns, surveys, government requirements
COA September 2007 14
Even the ABA (Association for Behavioral Analysis)….. Now has a Special Interest Group, the PBS ABA International Newsletter
– Volume 29 | 2006 | Number 2 Positive Behavior Supports
– The Positive Behavior Support (PBS) SIG addresses the interests of members engaged in experimental and applied analyses of behavior who are proponents of positive behavior support. Established in January 2005, the goals of the SIG are to promote and disseminate positive behavior support within ABA, and to ensure that PBS is aligned with the science of behavior.
COA September 2007 15
PBS - SIG
The PBS SIG currently has approximately 40 formal members….electronic listserv with over 70 recipients, many of whom belong to both ABA and the Association for Positive Behavior Support (APBS).
Goals of the PBS SIG are to: – Increase the number and visibility of PBS presentations at the ABA
convention – Disseminate accurate information about PBS to ABA’s
membership – Promote methodologically sound, data-based PBS research – Encourage open dialogue among behavior analysts and proponents
of PBS www.pbsaba.org www.pbsaba.org/newsletter
COA September 2007 16
Association for Positive Behavioral Support, APBS.org http://www.apbs.org/main.htm Affiliated with TASH TASH has 20 years of commitment to
positive approaches Should GTI interact with the new emerging
groups with similar values? Or should GTI simply be aware that the
world is changing toward our values?
COA September 2007 17
USA – Nationwide AwarenessIs Finally Emerging Aversives Survey3.pdf
COA September 2007 18
Old Paradigm, New Paradigm
Old – Behaviorism– Mechanistic
– Ghost in the machine
– We can shape any person’s behavior
– All means are fair, if justified by ends
New – GT & Positive– Humanistic
– Presumes humanity
– We can make a real connection with any person
– The process is often as important, sometimes more important, than the outcomes
COA September 2007 19
Dual Dimensions of MeasurementIndividual Caregiver
Feeling Safe Protecting – Confidence in Ability to Offer Safety While Avoiding Negatives
Feeling Loved Assisting Warmly – Feeling of Offering Unconditional Love
Enjoying Interactions Enjoying Job
Self-Control (less challenge) Feeling of Success in Job
Self-Control (choicemaking) Pride in Sharing Power
Self-Actualization – Becoming More Authentic Human
Self-Actualization – Becoming More Authentic Human
COA September 2007 20
Simple Rating Scale:The Person Being Supported
Very Cold,
Negative
Neutral Very Warm, Positive
Response to Caregivers' Presence Response to Caregivers’ Words Response to Touch Response to Food, Drink Acceptance of Doing Things with Caregivers Acceptance of Doing Things with Peers Self-Esteem
?
COA September 2007 21
Simple Rating Scale:The Caregivers
Close Distant
Warm Cold
Heart Head
Warm Protection Restraint
Engagement Disengagement
Colleague/Friend “Boss”
Unconditional Love Conditional Rewards
New Memories Old Memories
COA September 2007 22
Input, Process, and Outcomes
InputEffort, Resources, Time, Emotional Investment, Hope
ProcessSafe, Loving,
Positive, Supportive,
Persistent, Patient
OutcomesRelationships,
Qualities of Life, Behavior Change
Measure GT Here?
Feedback After Success/Failure
(Or is GT Here?)
COA September 2007 23
We Have Good Measures for the Collateral Outcomes
Control of one’s own life (DCI) Person-centered planning (EPP) Qualities of life (QOL Then & Now) Family perceptions of quality life and service Qualities of work life for the caregivers (QOWL) If we can get decent measures of Safe and Loved
from both perspectives, these other outcomes will make a very strong case.
COA September 2007 24
Paradigm Shift – What It’s Like
What Animal is This?
Duck? Or Rabbit? The switch is what a Paradigm Shift feels like.
COA September 2007 25
I’ve Already Seen…. Two and a half paradigm shifts I came in at the end of the Medical Model in 1970 I witnessed and studied the decline of belief in a need for
segregation – deinstitutionalization I took part in the self-determination movement from its
inception, studying and demonstrating And now the largest system of grants ever given from
the USA’s major funding source, “Money Follows the Person,” $500 million, is aimed at individual control of resources (SD) in community settings.
I believe that the time of GT’s ascension is coming fast.
COA September 2007 26
We Are Going to Live to See it Happen
The signs are clear Our task is to gently develop and offer the
evidence People have begun to want to believe Gentle nudges and good solid science are
all that’s needed Our international cooperation via GTEN
will be very important – and FUN!
COA September 2007 27
We Need Partners
This idea is now a year old We’ve been studying and thinking Siddhartha’s motto:
– I can think, I can wait, I can fast I think the time is right to move forward
with real data, real pilot studies, and plans for large-scale evaluative research.
Cross-nations: GTEN
COA September 2007 28
Comments and Ideas
All ideas welcome Testers of these instruments needed Critiques needed
Thank you for your attention and for the honor of appearing before
you at this conference
COA September 2007 29
COA September 2007 30
Perceived Qualities of Life:“Before S-D and Now”
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5
Safety (NS)
Relationship with family
Health
Health care
Food
Relationship with friends
Overall quality of life
What he/she does all day
Getting out/getting around
Comfort
Treatment by staff
Happiness
Privacy
Running own life
Then
Now
COA September 2007 31
How “Person-Centered” is the Planning Process?
4.43 Are meetings held as needed? 4.29 Emphasis on cooperation in meetings?
4.20Are meetings comfortable for focus person?
4.06Does respondent consider plan to be Person-Centered?
4.02Does process allow and deal with conflicts?
4.02Is the planing process flexible, trying other ways?
3.86Strong efforts to understand person's hopes and dreams?
3.78Does process emphasis creativity, new ideas?
3.75Are the person's relationships considered?
3.71Does the person have ultimate authority in disagreements?
3.65Is process governed by formal rules and regulations?
3.63Does the planning process take money into consideration?
3.35Does group have control over money supporting the person?
3.11Do the unpaid group members have the real power?
3.07Are community and informal support networks emphasized?
COA September 2007 32
How Many Friends?
11
22
4
1
2
11
4
2
4
3
5
10
8
6
3
4
2
# OF FRIENDS
904530252018151312109876543210
Cou
nt
12
10
8
6
4
2
0
COA September 2007 33
Who Are YourClosest Friends?
47
45
43
43
35
29
23
16
0 5 10 15 20 25 30 35 40 45 50
CO-WORKER ORSCHOOLMATE
OTHER
RELATIVE
STAFF OF HOME
STAFF OF DAYPROGRAM
HOUSEMATE
OTHER PAID
NEIGHBOR
c
34COA September 2007
One Wish in 1994 One Wish in 1996
None More contact with familyNone Meet Garth Brooks, go to Disney world, walkNone Enjoy better healthNone FriendsNone HairNone To go on a plane to FL to see sister, make more $None To always be happy and grow into independenceHam sandwich More friendsTo be finished work MotorcycleTo be sleeping Ride a bike, go to Disney with SteveBill Clinton To be healthy, to be safe and aliveGet out of house and go to Keene (Accomplished)Go to Disney World (Accomplished)To go to California Would like to visit FL + CATo live near my parents Go horseback ridingVacation in Florida Good healthHave a brain Want to have a little boy babyGet away from Keene housing authority To meet celebrities, to live in warm climateNot to have a roommate To live like royalty, a queen with loyal subjectsA friend Go visit Maine someday, maybe have more moneyThat my father was still alive I'd like to see Richard CTo be married To have Keene fully accessible, live in dream house
Top Related