Planning, Applying, and Evaluating a Treatment Program

1. Planning, Applying, and Evaluating a Treatment Program Chapter 24

2. A Problem Has Been Referred: Should You Design A Program? • Questions to answer: • Was the problem referred primarily for the benefit of the client? • Can the problem and the goal be specified such that you are dealing with a specific behavior or set of behaviors that can be counted, timed, or measured in some way? • Is the problem important to the client or to others? • Have you eliminated the possibility that there are complications involved in this problem that would necessitate referring it to another specialist? • Is the problem one that would appear to be easily manageable? • If the goal is reached, might it be easily generalized and maintained? • Can you identify significant individuals in the client’s natural environment who might help to record observations and manage controlling stimuli and reinforcers? • If there are individuals who might hinder the program, can you identify ways of minimizing their potential interference? • On the basis of your tentative answers to these eight questions, do your training qualifications, daily schedule, and available time seem adequate for you to participate in the program?

3. Selecting and Implementing and Assessment Procedure • For reliable baselining, define the handicap in precise behavioral terms. • Select an appropriate baselining procedure that will enable you to: • monitor the problem behavior • identify its current stimulus control • identify the maintaining consequences of the problem behavior • monitor relevant medical/health/personal variables • identify an alternative desirable behavior • Design recording procedures that will enable you to log the amount of time devoted to the project by the professionals working on it • Ensure that the observers have received appropriate training in identifying critical aspects of the behavior, applying the recording procedures, and graphing data • If the baseline is likely to be prolonged, select a procedure for increasing and maintaining the strength of the record-keeping behavior of the data recorders • Select a procedure for ensuring the reliability of the baseline observations • After beginning to collect baseline data, analyze those data carefully to select an appropriate intervention strategy and decide when to terminate the baseline phase and begin intervention

4. Considerations for Assessment Procedures • What daily times can the mediator(s) schedule this project? • Will others in the situation help or hinder your data collection? • Will the surroundings help or hinder your assessment? • What is the frequency of the existing behavior? • How rapidly should the behavior change?

5. Strategies for Program Design and Implementation • Define the goal, identify the target behaviors and their desired amount and stimulus control • Identify individuals who might help to manage controlling stimuli and reinforcers. Also identify those who might hinder the program • Examine the possibility of capitalizing on antecedent control. Can you use: • Rules? • Goal setting? • Modeling? • Physical guidance? • Situational inducement? • Motivating operations? • If you are developing a new behavior, will you use shaping, fading, or chaining? What motivation establishing operation will you use?

6. Strategies for Program Design and Implementation • If you are changing the stimulus control of an existing behavior, can you select the controlling SDs such that they: • are different from other stimuli on more than one dimension? • are encountered mainly in situations in which the desired stimulus control should occur? • evoke attending behavior? • do not evoke undesirable behavior?

7. Strategies for Program Design and Implementation • If you are decreasing behavioral excess: • Can you remove SDs from the problem behavior? • Can you withhold reinforcers that are maintaining the problem behavior, or present motivation abolishing operations for those reinforcers? • Can you apply DRL? • Can you apply DRO, DRI, or DRA? • Should punishment be used? • Specify the details of the reinforcement system: • How will reinforcers be selected? • What reinforcers will be used? • How will reinforcer effectiveness be continually monitored, and by whom? • How will reinforcers be stored and dispensed, and by whom? • If a token system is used, what are the details of its implementation?

8. Strategies for Program Design and Implementation • Specify the training setting. • Describe how you will program generality of behavior change by: • Programming stimulus generalization. Can you: • Train in the test situation? • Vary the training conditions? • Program common stimuli? • Train sufficient stimulus exemplars? • Establish a stimulus equivalence class? • Programming response generalization. Can you: • Train sufficient exemplars? • Vary the acceptable responses during training? • Use behavioral momentum to increase low probability responses within a response class? • Programming behavior maintenance. Can you: • Use natural contingencies of reinforcement? • Train people in the natural environment? • Use schedules of reinforcement in the training environment? • Give the control to the individual?

9. Strategies for Program Design and Implementation • Specify the details of the daily recording and graphing procedures • Collect the necessary materials • Make checklists of rules and responsibilities for all participants in the program • Specify the dates for data and program reviews and identify those who will attend • Identify some contingencies that will reinforce the behavior modifiers and mediator • Review the potential cost of the program as designed and judge its merit against cost; reprogram as necessary • Sign a behavioral contract • Implement the program

10. Program Maintenance and Evaluation • Monitor your data to determine whether the recorded behaviors are changing in the desired direction • Consult the people who must deal with the behavioral handicap, and determine whether they are satisfied with the progress • Consult other sources to determine if your results are reasonable in terms of the amount of behavior change during the period the program has been in effect • If 1, 2, 3 are satisfactory, proceed to step 8 • If 1, 2, 3, are unsatisfactory, answer the following questions: • Have the reinforcers hat are being used lost their appeal? • Are competing responses being reinforced? • Are the procedures being applied incorrectly? • Is there outside interference that is disrupting the program? • Are there any subjective variables that might be adversely affecting the program? • If none of the answers to questions are yes, check if additional programming steps need to be added or removed • If the results are now satisfactory, proceed to guideline 8; otherwise consult with a colleague, or consider changing a major aspect of program, or redoing functional analysis

11. Program Maintenance and Evaluation • Decide how you will provide appropriate program maintenance until the behavioral objective is reached • Following attainment of the behavioral goal, outline an appropriate arrangement for assessing performance during follow-up observations and assessing social validity • After successful follow-up observations have been obtained, determine the costs for the behavioral changes that occurred • Where possible and appropriate, analyze your data and communicate your procedures and results to other behavior modifiers and interested professionals

12. Token Economies Chapter 25

13. Some Definitions • Conditioned Reinforcers • Not originally reinforcing but becomes reinforcer after being paired with other reinforcers • Tokens • Conditioned reinforcers that endure, can be accumulated and exchanged for backup reinforcers • Token Economy • Behavior Modification program that uses tokens

14. Advantages of Token Economies • Can be given immediately • Paired with many different backup reinforcers • Can be administered to large diverse groups

15. Setting up a Token Economy • Decide on target behavior • Define behaviors so that all involved can identify instances of appropriate and inappropriate behavior • Take baselines • Baseline data important to know what is needed • Data can help with selecting backup reinforcers • Select backup reinforcers • Identify backup consequences through direct and indirect assessment • Use wide variety of backup reinforcers • Can use response-cost procedures to punish inappropriate behavior

16. Setting up a Token Economy • Select the type of tokens to use • Can take many forms, but should be: • Durable • Easy to handle • Difficult to steal • Difficult to counterfeit • Can have graded value for tokens • Can associate different types of tokens with different behaviors

17. Setting up a Token Economy • Identify available help • Depending on the situation, different people may need to help • Ex: teachers, volunteers, behaviorally advanced peers, etc. • Choose the locations • Some locations are better than others, but often do not have a choice of location • Managing Consequences • Ensure backup reinforcers are on hand • Clearly describe criteria for earning and exchanging tokens • Award tokens as immediately as possible • Use reinforcers such as praise with tokens • Keep accurate records • Provide bonuses for high-level performance • Train those administering tokens

18. Specific Implementation Procedures • Must decide on procedures for: • Keeping data • What kinds of sheets? • Who will record the data? • When will recording take place? • The reinforcing agent • Who will administer the reinforcement and for what behaviors? • Number or frequency of tokens to Pay • More tokens to start • Gradually decrease number of tokens • Less pleasant activities might earn more

19. Specific Implementation Procedures Continued: • Managing the Backup Reinforcers • How frequently will backup reinforcers be made available? • Frequency high in the beginning • How much will each reinforcer cost? • Should be related to monetary cost • High demand items should cost more • Low cost for backup reinforcers that have therapeutic value • Possible Punishment Contingencies • Can use tokens to administer punishment through fines • May need to teach clients how to accept fines in a nonaggressive, relatively nonemotional way

20. Specific Implementation Procedures Continued: • Supervision of Staff • Duties must be clearly spelled out • Staff must be monitored closely • Reinforcement must be offered for appropriate behavior • Handling Potential Problems • Problems must be planned for in advance • Likely problems: • Confusion • Staff shortages • Attempts by clients to get tokens they have not earned or backup reinforcers for which they do not have enough tokens • Clients playing with tokens in distracting ways • Failure to purchase backup reinforcers

21. Preparing a Manual • Token Economy Manual • Written set of rules describing exactly how the economy is to run • Includes: • Definite procedures for evaluating whether or not the rules are being followed adequately and procedures for ensuring that they are • Methods for arbitrating disputes about rules • Should be detailed • Should be given to all staff members

22. Programming Generality to the Natural Environment • Token economy should be designed so that social reinforcement gradually replaces tokens • Weaning from tokens: • Eliminate tokens gradually • Gradually make the schedule of token delivery more and more intermittent • Decrease token value gradually • Gradually decrease amount of backup reinforcement that a token can purchase • Or, gradually increase the delay between getting tokens and purchase of backup reinforcements • Gradually transfer control to the clients

23. Ethical Considerations Must take precusions to avoid abuse Making the system completely open to public scrutiny may ensure that no abuse happens

24. Ethical Issues Chapter 30

25. Historical Implications Cultural history and personal experiences with others abusing power, taught people to react negatively to behavior modification This term evokes many negative feelings

26. Behavioral View of Ethics Ethics – standards of behavior developed by culture to promote the survival of that culture Ethical guidelines are an important source of behavioral control when immediate reinforcers influence individual to behave in a way that leads to aversive stimuli for others When members of the same culture learn to follow the same ethical guidelines, the guidelines exert rule-governed control over behavior

27. Arguments Against Deliberately Controlling Behavior • Because of history and experiences, some have argued that all attempts to control behavior are unethical • Goal of any social help profession involve change in behavior and behavior control • It is often necessary to change, manage, influence, or control behavior • It is necessary to ensure that it is done ethically

28. Ethical Guidelines • Organizations that have addressed ethical guidelines involved in behavior modification: • Association for the Advancement of Behavior Therapy (AABT) • American Psychological Association (APA) • Association for Behavior Analysis (ABA)

29. Ethical Guidelines • Based on: • 1977, Behavior Therapy, publication of set of ethical questions to ask • 1978, Stolz & Associates, a comprehensive report on ethical issues involved in behavior modification • 1988, Van Houten et al., The Behavior Analyst, published a statement of clients’ rights • 2002, American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct

30. Ethical Considerations • Qualifications of the Behavior Modifier • Must receive appropriate training – academic and supervised practical training • Procedures being used are the most up-to-date • Steps to ensure countercontrol and accountability: • Supervision by members of ABA, AABT, or both • Various certification programs

31. Ethical Considerations • Definition of Problem and Selection of goals • Target behaviors selected must be most important for client and society • Emphasis on teaching functional, age-appropriate skills • For those with handicaps, focus on teaching skills that promote independent functioning • Goals should be consistent with the basic rights of the client to dignity, privacy, and humane care • Steps to ensure countercontrol and accountability: • Require behavior modifier to clearly specify his or her values relating to client's problems • Client as an active participant in the selection of goals and identification of target behaviors

32. Ethical Considerations • Selection of Treatment Method • Use the most effective, empirically validated methods with the least discomfort and fewest negative side effects • Use least intrusive and restrictive interventions • No agreement on a continuum of intrusiveness or restrictiveness • Interventions based on positive reinforcement considered less intrusive than interventions based on aversive control • Intrusive and restrictive sometimes refer to the extent to which clients are given choices and allowed freedom of movement in a therapeutic environment • Intrusive and restrictive sometimes refer to the extent to which consequences are deliberately managed as opposed to naturally occurring • Steps to ensure countercontrol and accountability • Informed consent • Ethical review committees

33. Ethical Considerations • Record Keeping and Ongoing Evaluation • Maintenance of accurate data throughout the program • Behavioral assessment before the program • Ongoing monitoring of target behavior • Possible side-effects • Appropriate follow-up evaluation after treatment • Confidentiality to be respected at all times • Steps to ensure countercontrol and accountability: • Client access to records • Frequent discussions with client about progress in the program • Periodic peer evaluation of data