Module 5-Evidence Bases Practices and ABA, PDF

MODULE 5: EVIDENCE BASED-PRACTICES AND PRINCIPLES OF ABA READINGS: CHAPTERS 3 & 4 What will we cover today? ◦ Quiz 4 Review ◦ Evidence Based practices ◦ Laws guiding practice ◦ IEPs and IFSPs ◦ Brief overview of Principles of Applied Behavior Analysis ◦ Key concepts of ABA ◦ Functional Analysis an...

MODULE 5: EVIDENCE BASED-PRACTICES AND PRINCIPLES OF ABA READINGS: CHAPTERS 3 & 4 What will we cover today? ◦ Quiz 4 Review ◦ Evidence Based practices ◦ Laws guiding practice ◦ IEPs and IFSPs ◦ Brief overview of Principles of Applied Behavior Analysis ◦ Key concepts of ABA ◦ Functional Analysis and Functional Behavioral Assessments EVIDENCE BASED PRACTICES Evidence Based Practices (EBP) ◦ What are they and why is it important to consider them? ◦ Evidence based strategies are those strategies and/or interventions that are supported via research (multiple studies conduced with various agencies and educational institutions and published within scientific peer-reviewed journals) ◦ They are important for the following reasons: ◦ Effectiveness and efficiency is established in objective manners ◦ Educational policies, ethical guidelines, and legislations and laws surrounding education, psychological and medical practices require evidence based practices to be implemented ◦ Funding: Funding sources like government aid for educational programs, grant programs, medical insurances that cover individualized or special education services or therapy require use of evidencebased practices to approve funding Laws Guiding Practice ◦ Some of the most influential laws guiding the practice of special education and therapeutic services for individuals with ASD are: ◦ 1975: The Education for all Handicapped Children Act: first instituted the idea of Free and Appropriate Public Education (FAPE) for all children regardless of disability/diagnosis. This law was later amended and renamed in 1986, 1991 and 1997 as IDEA (Individuals with Disabilities Education Act) law ◦ 1990: Americans with Disabilities Act: Included a bill of rights for individuals with special needs ◦ 2001: No Child Left Behind Act: Posited that each child has the right and must obtain free, fair, equal and significant opportunity to achieve at least the minimum state standards for Academic and Educational competency levels and assessments. Accountability for lack of progress and lack of effectiveness is required. This law also requires special education teachers to be specifically “highly qualified” with having at least a BA agree and passing a state competency test on subject matter ◦ 2004: Individuals with disabilities Education and Improvement Act (IDEIA) Reauthorized the IDEA law from 1997 ◦ It is the school districts responsibility to ensure that their student has access to the education/services/accommodations to reach their maximum potential ◦ If a school district is not able to provide the services needed with th resources they have to determine whether a referral to another school within the district or another school district is needed, more training for staff and teachers is needed, whether there is a need for hiring more staff or professionals 2015: Every Student Succeeds Act: This law reemphasized the need for setting specific standards, assessments and qualification of teachers and prohibits federal influencers (Hall, 2018) Individuals with Disabilities Improvement Act (IDEIA) ◦ Highlights importance of having observable and measurable goals ◦ If there is lack of progress, stagnant progress, or slow progress is observed, school teams must consider: ◦ Changing instructional strategies. This including consulting with another professional (like BCBA, SLP, OT, school psychologist, etc.) about other strategies that may be effective ◦ Updating goals to either target a smaller goal/step of a skill set such that they are achievable ◦ Changing goals to prioritize skills that would allow the student to be able to reach other goals IDEIA also requires in-service training and professional development of support staff to help them support their students to achieve their academic goals. This includs training in evidence based practices, strategies and tools. IEP AND IFSP Individualized Education Program (IEP) ◦ Free and Appropriate Public Education is implemented via IEP for an individual with special needs or individual with special needs ◦ IEP is composed with the consultation of an IEP team composed of: Parents, all teachers that will or currently work with the student, other professionals (SLP, BCBAs, OTs, PTs), Local Education Agency(LEA) staff (usually a school principle/vice principle or administrator), and IDEA requires IEP to involve the student themselves whenever possible ◦ IEP is instated after a psychoeducational assessment is conducted and the student is found to be eligible for special education services. Parents have the right to request this assessment by the school free of charge and paid for by the school district and the student does not need to have a prior diagnosis ◦ Once IEP is established, IEP team meets every year to discuss progress and propose new goals ◦ All members of the team must agree with the components of the IEP and formally sign the IEP document before it can be implemented ◦ Often parents take time to evaluate whether they are in agreement with the IEP goals ◦ They have the right to take the IEP document home and make a decision and do not have to sign during the IEP meeting Structure of IEPs ◦ Structure of IEPs ◦ Present levels of functioning- written in paragraph form for academic areas (reading, writing, math, English, Behavior/social emotional development, self-help/independence, as well as if there is a presence of any medical concern (as discerned by the school nurse and/or reported by the parent(s)) ◦ Eligibility and/or plan for participation in state standardized assessments ◦ Goals* Goals are objective, observable and measurable Divided into short term objectives and yearly/long term goals Current goals and their progress is listed and discussed with the team first New goals are written next and proposed ◦ IEP team can discuss and make changes to the current or future goals during the meeting Accommodations and modifications that help the student achieve their goals Offer of FAPE: includes which special education services will be provided to the student (SLP, OT, 1:1 aide, special education class, PT, etc.) and how many hours/week or year of each service will be provided ◦ ◦ ◦ ◦ ◦ ◦ *parents must receive progress notes on IEP goals every 9 weeks and an IEP meeting is held at least once per year Parents have the right to call an IEP at any time during the year Individualized Family Service Plan (IFSP) ◦ For children 3-5 year old. Like an IEP is an individualized plan for the child with ASD or a developmental disability/disorder ◦ Composed of a team of professionals as well parents ◦ Has specific goals for the client to be successful in their natural setting. ◦ Natural setting is an environment that the child has the most exposure to in daily routines. E.g. the client home, school, community outings (parks), daycares etc. ◦ Difference between IEP and IFSP: IEPs are only implemented in the school settings. IFSP include services outside of the school. Depending on the child’s need, they can either have an IEP or an IFSP or they have both ◦ IFSPs also include observable and measurable goals and progress on those goals is tracked on an annual bases. Identification of Evidence Based PRACTICES (EBP)/Strategies ◦ How are EBPs identified? ◦ Research, literature reviews, and peer-reviews of journal research ◦ National Autism Center in 2009 initiated the National Standards project which evaluated the effectiveness of 14 various strategies for working with individuals with ASD ◦ National Professional Development Center (NPDC) also conduced a review. This identified 27 evidence based practices to have strong efficiency and effectiveness with ASD population ◦ See Figure 3-1 in the textbook on page 57 for a full list of the EBP strategies and their brief descriptions ◦ Autism Focused Intervention Resources and Modules (AFIRM) is a website that includes training videos of all 27 EBP strategies for autism divided into Modules. The teaching material includes videos ◦ All 27 EBP strategies fall within Applied Behavior Analysis which further supported that effectiveness of ABA as a therapeutic approach for individuals with Autism APPLIED BEHAVIOR ANALYSIS (ABA) What does ABA mean? ◦ Applied: It is implemented in natural setting(s) Schools, homes, community locations, daycares, group homes, etc. and the goals are socially significant for the client. “Socially significant” means the goals that are created in the treatment match the need of the client and help them become as independent as possible by helping them access their social and educational environment(s). Socially significant goals also consider the client’s cultural and traditional background and age ◦ Behavior: The targeted skill that is observable and measurable ◦ Analysis: The progress on the goals are evaluated and the treatment effectiveness is determined based on its success at teaching the targeted skill and helping the client achieve higher levels of independence ◦ ABA is a part of science of behavior. Science of behavior has 3 focuses: philosophical/theoretical science of behavior, experimental analysis of behavior, and Applied Behavior Analysis Theoretical Basis of ABA ◦ Charles Darwin’s work related human and animal behavior and formed the basis of the understanding that similar principles govern human and animal behavior ◦ John Watson posited the relationship between environmental events (stimulus) and responses (behavior) ◦ B.F. Skinner considered the founder of ABA expanded on Watson’s worked and stated that there are two categories of behavior: Respondent behavior (unlearned behavior) and Learned Behavior. ◦ Skinner posited that Learned behavior is influenced by: ◦ Antecedents: what happens immediately before the behavior ◦ Consequences: What happens immediately after the behavior ◦ According to Skinner, behavior is maintained due to consequences (i.e. if the behavior continues to be observed across time, it is because a consequence reinforced it) KEY CONCEPTS OF ABA 3 Term Contingency ◦ ABC’s of Behavior ◦ Main ABA principle is that behavior is governed by events that immediately precede and follow a behavior ◦ A=Antecedent- an event, stimulus, social attention, sign, emotion, thought, or action that occurs immediately before the behavior ◦ B=Behavior- the objective description of a behavior ◦ C=Consequence- an event, stimulus, social attention, sign, or action that occurs immediately after a behavior Motivating Operations (MO) ◦ Remember our discussion on Pivotal response treatment and incidental teaching? Both approaches considered client motivation ◦ Motivation is shown to play a strong role in whether or not a behavior will be emitted (shown) ◦ Motivating operations alter the effectiveness of a potential reward/reinforcement such that it can increase the likelihood that the behavior occurs or decreases the likelihood of the behavior from occurring as well as alter the frequency/duration of the behavior and any behaviors that lead to the behavior ◦ If an event increases the likelihood of a behavior, it is called establishing operation ◦ If an event decreases the likelihood of a behavior, it is called abolishing operation ◦ Let’s consider some examples: ◦ Hunger/Eating ◦ Upcoming wedding/wedding has passed ◦ Do you have examples? Reinforcement and Punishment Reinforcement and punishment are “consequences” Behavior increases in the future Behavior decreases in the future Something Added (+) Positive reinforcement Positive Punishment Something taken away (-) Negative Reinforcement Negative Punishment Preference assessments ◦ ABA has strong emphasis on reinforcement. A consequence cannot be reinforcing if the student/client does not like what was offered ◦ To determine what a client “likes” or finds reinforcing therapists can conduct preference assessments. Preference assessments can be formal or informal ◦ Informal preference assessments include offering choices- “do you want x or y?” “what would you like to work for?”. This assessment is most frequently used ◦ Formal preference assessments include: ◦ Paired preference assessment ◦ Multiple stimuli with replacement ◦ Multiple stimuli without replacement Stimulus Control ◦ Stimulus control is established when the presence of an antecedent alters the rate or frequency of a response due to learning history with the antecedent stimulus ◦ This antecedent is called discriminative stimulus ◦ Let’s consider some examples Consequence-based Strategies: Prompting ◦ Prompting: teaching any skill starts with prompting, meaning showing the client how to do the skill via physical guidance (physical prompting), modeling (showing the child how to do the skill by themselves having parents to do it, via videos, or having siblings do it), speaking to them (vocal teaching/prompting) ◦ Important to fade prompting so clients do not develop prompt dependency ◦ Hierarchy of prompting: full physical, partial physical, gestural, model, vocal prompting, partial vocal prompting, and natural antecedent (discriminative stimulus, natural event) Consequence based Strategies: Extinction and Differential Reinforcement ◦ Extinction: Extinction procedure involves withholding reinforcement for a behavior that has previously received reinforcement in order to decrease the frequency of the behavior ◦ Do not use extinction on its own. Instead use: ◦ Differential reinforcement (DR): when a reinforcement is withheld for a behavior we want to decrease, an alternative, incompatible behavior is prompted and reinforcement is provided for an socially appropriate response instead ◦ (We will learn various types of DR procedures in Module 6 next week and rest of your ABA classes will have more details on this) How about behaviors we want to decrease? ◦ Review: Why do behaviors occur in the first place? ◦ ABA posits that all behavior is a type of communication and every behavior has a reason “function” ◦ 4 functions of behavior (remember the acronym SEAT) ◦ Sensory ◦ Escape/Avoidance ◦ Attention (or also called “access to attention) ◦ Tangible FUNCTIONAL ANALYSIS AND FUNCTIONAL BEHAVIORAL ASSESSMENTS Functional Behavioral Assessments (FBA) ◦ FBAs are conducted to determine a hypothesis of the function of a behavior ◦ Main way to determine function of a behavior is via an ABC analysis ◦ ABA data is collected via numerous ways: ◦ Parent reports ◦ BCBA/teacher/MA level professional or another trained professional completing ABA data via direct observations at home/school/daycare/community or combination of settings ◦ Results of the FBA state a hypothesis of the function of the behavior Functional Analysis (FA) ◦ Most schools and private practice BCBAs often base their intervention plans on the hypothesized function of the behavior ◦ However, hypotheses can be tested via a more experimental approach that involves setting up contrived situations and manipulating events in the environment to determine which situation has the most instances of the behavior ◦ FAs require setting up situations or trials: 4 conditions for each function and one control condition ◦ Demand condition: introduces an non-preferred task demand to determine if the function is escape/avoidance ◦ Alone Condition: has the client engage independently with toy(s) or materials to see if the function is sensory ◦ Tangible condition: has examiner remove preferred item(s) or activities from the client to see if the function was access ◦ Access condition: Has the examiner or a preferred individual be present with the client but not engage with the client or make eye contact with him/her, or speak to the client, to see if the behavior occurs due to access ◦ In the Brief Functional Analysis, functions of multiple behaviors and multiple clients can be tested at the same time ◦ Based on the FBA or FA, a behavior intervention plan can be designed Behavior Intervention Plans (BIP) ◦ In order to target a behavior for reduction, it is important to have a clear, concise, objective and measurable definition ◦ This is because challenging behaviors like tantrums or aggression can look different between different individuals as well as change across time ◦ Because each behavior has a function even when it is a challenging/maladaptive behavior, BIPs must include a suggestion for replacement behavior(s) i.e. what can the client do instead that is safer, more socially appropriate, and would help the client access his social and learning environments ◦ This is referred to as “functionally equivalence” Questions?