Module 6 Program Creation.pdf

Module 6: Program Creation and using Evidence Based Practices Module 6 Reading: Chapter 5 What will we cover today? *Review Module 5 Quiz *Behavior Reduction * FBAs Some of the Most Common Evidence Based ABA Strategies: ´ Discrete Trial Training ´ Discrimination Training ´ Errorless learning...

Module 6: Program Creation and using Evidence Based Practices Module 6 Reading: Chapter 5 What will we cover today? *Review Module 5 Quiz *Behavior Reduction * FBAs Some of the Most Common Evidence Based ABA Strategies: ´ Discrete Trial Training ´ Discrimination Training ´ Errorless learning and Graduated Guidance ´ Incidental Teaching ´ Pivotal Response treatment ´ Use of Schedules of reinforcement ´ Token Economy systems ´ Functional Communication Training (FCT) ´ Self-management Systems ´ Behavioral contracts Reducing Challenging Behaviors Strategies for Preventing and Decreasing Challenging Behavior(s) ´ In Module 5 we learned about Behavior Intervention Plans (BIPs) ´ BIPs include: objective definitions of the target behavior, function of the behavior, state what behaviors will be taught to replace the behavior, and included information about interventions ´ Interventions for reducing challenging behaviors can be divided into proactive interventions and reactive interventions: ´ A) Antecedent-Based interventions (proactive interventions): strategies that can be used prior a behavior occurring such that the behavior is less likely to occur ´ B) Consequence-Based interventions (reactive Interventions): strategies that can be used after a behavior occurs such that the behavior is less likely to occur in the future Ethical and Legal Considerations ´ All school districts and therapeutic services are required by law as well as ethical guidelines to use positive behavior supports (using and prioritizing antecedent based interventions as well as reinforcement based interventions) ´ And/or using least restrictive approach and alternatives (providing less intrusive methods and teaching and prompting strategies first and then considering more intrusive prompts and supports, if the initial strategies do not work Antecedent Based interventions ´ Most important antecedent based strategy is building rapport with the client and providing a fun and engaging environment for learning ´ Giving choices ´ Changing tasks/modifying length of tasks ´ Providing support and assistance to complete difficult/non-preferred tasks ´ Presenting a sequence of preferred/ “easy”/ mastered tasks prior to presenting a novel/nonpreferred task ´ Giving attention sporadically across the day/activities when challenging behavior is not occurring ´ Priming: giving a heads-up about changes in routine and/or upcoming changes like ending a preferred activity and moving a non-preferred activity. ´ Can be done via implementation of visual schedules (written or pictural list of upcoming activities) ´ Timers ´ Verbal reminders ´ Verbal/picture/written rules for expected behaviors placed on a student’s desk Consequence-Based Interventions ´ Review: what are consequences? ´ Reinforcement must always be prioritized. According to ethical guidelines we must not use punishment based procedures unless we have tried all of the reinforcement based strategies. 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, Differential Reinforcement, and Punishment ´ 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 ´ Punishment procedures: Presentation of a non-preferred or aversive consequence (positive punishment) or taking away of a preferred reinforcer contingent on display of a challenging behavior (negative punishment) such that the future frequency of the behavior reduces ´ TIME OUT ´ CONTINGENT EXERCISE Types of Differential Reinforcement ´ Differential Reinforcement of Alternative Behaviors (DRA): When reinforcement is withheld for challenging behavior and reinforcement is instead presented for a socially appropriate alternative behavior ´ Differential Reinforcement of Incompatible Behaviors (DRI): When When reinforcement is withheld for challenging behavior and reinforcement is instead presented for a socially appropriate incompatible behavior. Incompatible behavior is a behavior that cannot be done at the same time as the target behavior. E.g. the target behavior for reduction is hitting someone to get their attention. Incompatible behavior would be to ask for and give a high five. ´ Differential Reinforcement of Other Behavior (DRO): Reinforcer is provided when the target behavior is omitted or absent during a specific time interval. ´ Non-contingent Reinforcement: Rewards are provided on a fixed or variable schedule rather being presented when the target behavior is seen. By providing regular reinforcement, it is less likely that a target challenging behavior would occur 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 “functional equivalence” Components of a BIP ´ Operational definition of the behavior ´ Function of the behavior ´ Behavior Reduction Goal to decrease the behavior: observable and measurable goal statement. Make sure to include a goal mastery date ´ Proactive/Antecedent Based Strategies: What strategies will the clinicians use to reduce the likelihood that the behavior would take place ´ Reactive/Consequence Based Strategies: What strategies will the clinician use when the target behavior does occur so that the target behavior is less likely to occur in the future ´ Replacement Behavior(s): A list of behavior(s) that the clinician will teach the client that match the function of the target behavior but are more socially appropriate Common Evidence-Based Practices Discrete Trial Teaching (DTT) ´ Has a clear three term contingency: Instruction (antecedent), Client response (behavior), Consequence (reward or a prompt for correct response) ´ Most often done as a structured task and often done at a table but can be conducted naturally when a task is presented an practiced across various trials e.g. teaching a client to sort his/her laundry ´ Typically used when teaching a new skill ´ Requires data collection after each trial and that is why DTT often results in greater amount of data compared to other strategies due to need for multiple trials to practice skill Discrimination Training ´ Involves teaching clients to respond to certain stimuli and not to other selected stimuli, e.g. teaching different color, teaching them to identify a picture of their mom by saying “mom” and not respond with “mom” when a picture of a another woman is presented ´ Matching-to-sample is a way to teach discrimination or conditional discrimination. E.g. if a client is learning colors, you can present red, yellow, and green and give a red card to the client. The instruction “put with red” can be given and corrective prompt given if the client does not match correctly. This way, not only can the instructor can teach the client to discriminate between red, yellow and green colors but also teach conditional discrimination. Conditional discrimination teaches the client to respond under specific circumstances and not under others: for our example: the client learns that putting the red card with the other red card is only accurate under the condition that the instruction is “put with red” Errorless teaching/Learning and Graduated Guidance ´ Errorless learning involves running teaching trials in a way that client experiences success in responding with the correct response ´ When teaching a new skill, therapists can use errorless teaching by giving an instruction and immediately guiding the client to make the correct response. E.g. if you have a client who is learning to discriminate red color from green and yellow, by presenting the three cards giving the client the red card and giving instruction “put with red”. Then providing the prompt immediate to the red card by pointing to it ´ Important: Client could become prompt dependent ´ Therefore, it is important to have a prompt fading plan ´ One way to fade prompts is graduated guidance: do least-to-most prompting. Once the client learns the skill, decrease prompt level by going from physical prompt to partial physical prompt, then to vocal prompt, and then gestural prompt Incidental Teaching ´ Client led activities as well as client’s motivation are used to teach skills from client treatment plan ´ Uses naturally available activities and can be used to teach any skill including: turn taking, sharing, requesting (manding), Labeling (tacting), putting dishes away after a favorite meal etc. ´ E.g. putting a preferred item/activity out of reach of the client and waiting for them to request (mand) for the item ´ Using Wait, ask, say, show, and do ´ Once the child does the task, provide praise Pivotal Response Treatment (PRT) ´ Related to and similar to incidental teaching because the skills are taught using child’s motivation ´ Similar skills can be taught with both strategies but PRT is different because PRT uses a more structured application: ´ 1) follow child’s lead, 2) provide the child choice of activities (at least one is preferred by client), 3)intersperce maintainance trials (skills that the client already has mastered), 4) reinforce correct responding/attempts with a natural consequence ´ Also, PRT requires that the skill be a pivotal skill being taught under the protocol. Pivotal skills are those skills, if learned, could help the client either learn other skills or can help the client access his or her learning/educational environment ´ E.g. of skills being taught flexibility (e.g. in playing preferred games by the rules), sharing/turn taking, manding, tacting, waiting, etc. Video Modeling ´ Video modeling is where a client observes another person completing a skill and imitates it ´ Everydayspeech.com is a great resource for video modeling across various skills from various domains ´ Can be used to teach social skills, play skills, self-help skills (like toileting, folding clothes, etc.), community skills (e.g. crossing the street), self-regulation skills, conversations, social problem solving skills Using Schedules of Reinforcement ´ Reinforcement schedules define how frequently and how far apart reinforcers are delivered ´ When teaching a new skill, we always use Continuous schedule of reinforcement (each instance of appropriate response results in a reinforcer being provided) ´ Overtime as the client makes progress on the goal, we move to natural schedules of reinforcement which is variable schedule of reinforcement (i.e. it is not predictable when the reinforcer will be provided by the client’s perspective. Variable trials are delivered before reinforcer is delivered in a session) ´ E.g. of variable schedules of reinforcement in natural situations: ´ slot machines, ´ sometimes when we ask for something we get it, and sometimes we don’t, ´ sometimes when we do something nice for another person, they say “thank you” and sometimes they don’t Waiting for reinforcers is also an essential skill that can be taught. Token Economy Systems ´ Use of predetermined set of physical items or written tally system (these are “tokens”) that needs to be earned before the “tokens” can be traded for a back-up reinforcer ´ Tokens can be stickers/Velcro icons with pictures of favorite characters ´ Most of the time, because of conditioning, the tokens can become reinforcers themselves and we don’t need a back up reinforcer but token economy’s require the use of a back-up reinforcer which can be traded when the tokens are earned (E.g. it can be a toy/activity/attention/alone time, etc.) ´ E.g Some strategies for Higher Functioning Individuals with ASD Behavior Contracts ´ For higher functioning clients with ASD who have language and capacity to understand complicated concepts. ´ A behavior contract is established between: either the client and the parent, and/or client and the teacher/support staff, and/or the parent/caregiver and the BCBA ´ Behavior contract structure includes: ´ Information on target behavior to increase or decrease ´ The goal that is to be attained written in measurable/observable terms ´ Who will monitor the progress on the goal ´ What are the reward(s) attained based on meeting the guidelines of the contract Self-Management System ´ Self- Management of Contingencies involves the client setting their own goal(s) to track, self-monitoring/data collection on self, self-instruction and self-reinforcement ´ Therapist or BCBA provide support with creating goals for the client and teaching them strategies to know exactly what behavior they are to work toward, strategies to reach the goal, collect data, and provide self-reinforcement ´ Can be used with behaviors to increase or decrease Any Questions?