Applied Behaviour Analysis: Contributions to Best-Practice Residential Services

1. Applied Behaviour Analysis: Contributions to Best-Practice Residential Services Oliver Mudford, I-Chen Sharon Ho, Kylie Jeffrey, Sheree Adams, & Katrina Phillips University of Auckland ABA Programme Staff and Graduates National Residential Intellectual Disability Conference: Auckland. February 14th 2008

2. Outline What is Applied Behaviour Analysis? ID residential services, social policy and ABA: Brief history ABA approach to skill teaching Examples of increasing skills ABA approach to problems in 21st Century Examples of decreasing problems Encouraging evidence-based practices in ID services

3. What is ABA? A science that . . . applies procedures derived from the principles of behaviour . . . (especially, reinforcement) systematically . . . (not randomly) to improve socially significant behaviour . . . (important for person) to a meaningful degree . . . (that is, improves lifestyle) and to show that the procedures used were responsible for the improvement. (. . . that is, provides evidence)

4. ID services, social policy, and ABA

5. What happened to ABA in 1990s? • ID services de-professionalised • “Teaching people skills for living will occur naturally by contact with community” (. . . not true for many) • “Problem behaviours would not occur with good values and community living” (. . . not supported by evidence) • Training courses to provide skills to staff ended • Psychologists (some were ABA) “not needed” • ABA psychologists moved to other populations • Clinical Psychology lost interest in ID (and ABA) • ABA teaching in NZ universities declined - No new ABA specialists trained

6. Meanwhile, ABA advances from late-1980s to present • Research on individualising reinforcers for increasing behaviours and teaching new skills: preference and reinforcer assessment • More research on individualising interventions for problem behaviours almost eliminating need for 1970s treatments that fail services’ “values check”: e.gs., functional analysis, NCR, FCT • ABA practitioner credentials established internationally: Behavior Analyst Certification Board (BACB) from 2000 • University courses specialising in ABA re-established - from 2003 in NZ

7. ABA approach to skill teaching Examples of increasing skills Teaching and training conducted for clients and staff of residential services in Auckland Further examples on website (address at end)

8. Teaching a Man with ID and Vision Impairment to Use His Radio Kylie Jeffery, MSc, PGDipAppPsych ABA Graduate 2007 Now at Essdee Behaviour Specialists, Taupiri

9. Background Client – Goal Support – Equipment Task Analysis Baseline Training Prompting Reinforcement Staff Independence Maintenance

10. Task analysis for forward chaining radio use. 1 Go to bedroom 2 Close bedroom door 3 Go to stereo 4 Touch top left hand corner of stereo 5 Push 'on/off' button 6 Feel for & push 'radio/turner' button 7 Listen to radio  8 Push 'on/off' button

12. Figure 1. Percentage of steps completed independently, across sessions for radio use.

13. Conclusion • Task analysis successful with other goals • Success verified with client, family and staff • 26 sessions over 1 ½ months to teach a skill that leads to a lifetime of independent activity

14. Increasing Independent Engagement with Household Chores I-Chen Sharon Ho, MSc, PGDipAppPsych ABA Graduate 2007 Now at IDEA and Blomfield School, Whangarei

15. Background • Client: Wyatt • Goal: To increase client’sindependence when engaging in chores. • Goal rationale

16. Programme • Behavioural Momentum • What is it? • Can we make the strategy more efficient?

17. Figure 1. Time spent vacuuming independently across sessions for compliant task-related behaviour as a function of changing criterions.

18. Increasing Meaningful Engagement in Adults with Intellectual Disabilities Sheree Adams, MA, PGDipAppPsych ABA Graduate 2007 Now at Centre for Autism & Related Disorders

19. Introduction • I compared two methods to increase engagement levels of four men with developmental disabilities who live in staffed residential care. • “Engagement” in worthwhile leisure and domestic activities

20. Method • Participants were four men aged 25-35 and six staff aged 28-55 • The study consisted of four phases, baseline, alternating treatments, single treatment and follow-up. • Both resident (levels of engagement) and staff behaviour (interactions with residents) were recorded during all observations • The interventions were administered in an alternating fashion, on the same day. One in the morning and in the afternoon .

21. Two Interventions • In Treatment A the staff were told “there is not enough activity going on, would you do something to increase it please?” • In Treatment B staff were told the above and given a written list of over 50 suggested activities and asked to approach clients and offer a choice of activity. The list was removed at the end of the observation. • Staff were thanked regardless of the level of subsequent activity

22. Phase II Baseline Phase I F/U Intervention B DO Staff DT DM Prompting + Reinforcement PN sessions PERCENTAGE OF INTERVAL Intervention A Level of engagement Figure 1: Percentage of session spent engaged for all individuals. Lines represent level of engagement across all conditions. Bars represent the percentage of intervals staff spent attempting to engage individuals and prompting them to maintain engagement, for all staff, across baseline, treatment and follow up phases. F/U is follow-up. 26

23. Conclusion • Baseline levels of client engagement were very low across all individuals • Intervention B (provision of a list) was more effective, therefore it is necessary to give staff a written list of suggested activities and to offer the individuals a choice of activities to obtain a stable increase in engagement levels • Prompting and reinforcement was necessary to increase engagement levels with one individual (PN)

25. Goals for residents guided by: • Discussion, prioritising, and agreement with resident, staff, and family • Active participation – busy • high activity = highly reinforcing living environment • Teach and maintain functional skills • Increasing signs of happiness cont . . . .

26. Guiding principles for goals (cont) • Minimise disruptive behaviours • Replace with functional skills • Minimise restrictions • Encourage and teach choice • Create and maintain a stable environment • not chaotic, for residents and staff • Maximise safety • from own or others’ behaviour ABA in practice is not really a values-free activity – is it?

27. ABA approaches to reducing problems Examples of decreasing behaviours Note that these rely on changes in reinforcement – not punishment Teaching and training conducted for clients and staff of residential services in Auckland

28. Comparison of Interventions to Decrease Grabbing by a Man with Intellectual Disabilities Katrina Phillips, MSc, PGDipAppPsych, BCBA ABA Graduate 2007 Now at Rescare Homes Trust and UoA

29. Function of behaviour Social Positive Reinforcement Decreasing problem behaviour over two time periods using NCR (non-contingent reinforcement) Activity engagement Extinction (i.e., ceasing to reinforce) Combinations of the above Programme

30. Figure 1. Frequency of BN’s grabbing during the morning shift (90 mins). Graph shows four different interventions: baseline (no intervention), task engagement and extinction, task engagement, extinction and NCR, or extinction and NCR.

31. Conclusion Grabbing of other residents reduced to zero with a combination of providing engaging activities for BN, non-contingent attention systematically every 5 minutes, and attending minimally to instances of grabbing

32. Communication Training and Decreasing Food Stealing I-Chen Sharon Ho, MSc, PGDipAppPsych ABA Graduate 2007

33. Background • Client: Alf • Goal: To increase Alf’s ability to request for food using a picture card • Goal rationale and function of challenging behaviour (food stealing)

34. Programme • Picture Exchange Communication • Extinction, i.e., stopping food stealing • Block Alf’s reach for others’ food • Teach others to move their food out of Alf’s reach

35. Figure 1. Percentage of independent correct responses across sessions as a function of picture exchange communication systems training.

36. Figure 2. Frequency of stealing attempts across sessions as a function of extinction.

37. Before behavioural reinforcement procedures were widely used with individuals with severe or profound intellectual disabilities, those individuals were frequently medically sedated and warehoused – living zombies . . . But once systematic reinforcement programmes began to be used, these individuals could be taught many important skills, independent eating, dressing, and hygiene behaviours and vocational and recreational behaviour of which they were previously thought to be incapable. Consequently their freedom increased – now they could dress themselves, and decide what to wear; now they could feed themselves and decide what to eat. Systematic reinforcement procedures . . . increased their freedom. Stephen Flora (2007) in Taking America Off Drugs

38. How do staff become trained to use systematic procedures in 2008 in NZ? • Well, perhaps they don’t • Why not? The design of modern individually tailored systematic reinforcement procedures iscomplex • Too sophisticated to be learned in a 1, 2, or 3 day workshop which produce superficial (or mis-) understanding • Application of the individualised procedures is not so complex, and staff can be trained to do them • ID services need to employ qualified individuals to train others to implement behaviour change procedures effectively

39. ABA provides evidence-based practices [EBP] for services for people with ID ID sub-groups, e.g., MoH/MoEd ASD EBP guidelines 100s of research articles showing benefits Applications of ABA for ID overall: 1000s of research articles This evidence is not well-known to ID services maybe too complex to interpret or perhaps known, but ignored or denigrated by those recommending alternatives that have no sound evidence base

40. Encouraging evidence-based practices [EBP] in ID services • Recognise that ABA has changed since the 1980s “behaviour mod” days • ID services should consider committing to using EBPs, such as ABA • Encourage, nurture & support training to develop NZ expertise with EBPs • Recruit ABA expertise to educate management (and MoH, NASCs, etc.) and to train residents and staff • Reward staff who use EBPs effectively • NRID? – lobby MoH on these issues • Like Queensland Government have adopted EBP for ID

41. "Current Internationally-Accepted Best Practices for Helping People with Intellectual and Other Developmental Disabilities" Professors Wayne Fisher and Cathleen Piazza (University of Nebraska Medical Center and Munroe-Meyer Institute) July 24th and 25th, 2008 at the University of Auckland Tamaki Campus

42. Website address for presentation http://www.psych.auckland.ac.nz/postgraduate-programme/ABA.htm Includes references, Fisher & Piazza flyer, and further examples

43. References Behavior Analyst Certification Board – www.BACB.com Bailey, J., & Burch, M. (2006). How to think like a behavior analyst: Understanding the science that can change your life. Mahwah, NJ: Lawrence Erlbaum. Favell, J. E., & McGimsey, J. F. (1993). Defining an acceptable treatment environment. In, R. Van Houten & S. Axelrod (Eds.), Behavior analysis and treatment (pp. 25-45). New York: Plenum Press. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied Behavior Analysis (2nd ed.). Upper Saddle River, NJ: Pearson. Flora, S. R. (2007). Taking America off drugs. State University of New York Press Jacobson, J. W., Foxx, R. M., & Mulick, J. A. (Eds.) (2005). Controversial therapies for developmental disabilities: Fads, Fashion, and Science in Professional Practice. Mahwah, NJ: Lawrence Erlbaum Associates.

44. More examples from University of Auckland ABA students’ and graduates’ work for ID services Increasing skills: • Residents clean own rooms, • Make cups of tea for self and visitors, • Increase range and persistence with leisure activities • Improve compliance with reasonable requests from teachers, parents, and staff • Independent bus riding • Money identification • Knowledge and compliance with rules for playing 8-ball pool • Using CD player • Increase exercise • Increase walking • Shoelaces tying • Teaching computer use • Making sandwiches, baking cakes, • Hand washing • Teeth brushing • Communication training, e.g., PECS, signs • Increase activities in vocational training groups • Using washing machines • Loading dishwashers • Find and assess reinforcers for profound ID • Staff training in ABA procedures

45. More examples continued Decreasing problems: • Reduce aggression • Reduce tantrumous outbursts • Reduce self-injury: e.g., regurgitation, head-hitting, pica • Reduce property destruction • Reduce restraints • Eliminate fear of open spaces, thus increasing social activity • Monitor effects of medications on behaviours