Archives for December 2015

Can control be a function of behavior? – A follow up

In an earlier post, I described a scenario consisting of a client’s engagement in problem behavior in the presence of activities previously identified as high preferred and discussed why control could not be the function of the problem behavior. I also explored how standard functions of behavior (i.e., escape from or access to stimuli), in addition to the presence of various motivation operations (MOs) might offer more adequate behavioral explanations. Relevant MOs and their potential contribution to problem behavior were listed as follows.

  • During a task interruption, the occurrence of a simultaneous, ongoing activity might reduce the client’s preference for the practitioner requested activity.
  • There may be a functional relation between the client’s preference for an activity and the time of day.
  • The client’s history with aversive task presentations from others may have generalized to all requests, effectively reducing the client’s preference for any activity initiated by others.

Child pupil with parent or teacher reading a book in public library.

The purpose of the current post is to discuss potential strategies to address these problems. Hagopian, Bruzek, Bowman, and Jennett (2007) evaluated a demand fading intervention to address problem behavior occasioned by activity interruption. During the intervention, clients were exposed with altered presentations of two discriminative stimulus cards. One card indicated clients could engage in uninterrupted play. The other card indicated compliance with interruptive demands would be reinforced, client demands would not be reinforced, and preferred activities were restricted. Over the course of the intervention, the amount of time spent in uninterrupted play was gradually reduced while the time spent in the interruption condition was increased.
When instability in client preferences are a problem, one might address these preference shifts by conducting multiple and frequent preference assessments to identify the events most likely to be effective reinforcers at that point in time (DeLeon, Graff, Frank-Crawford, Rooker, & Bullock, 2014). One may also provide clients with opportunities to choose between potential reinforcers. Instead of selecting activities for the client, the practitioner could arrange the provision of choice selections prior to or following an instruction or task.

McLaughlin and Carr (2005) discussed how poor rapport might contribute to problem behavior exhibited by clients following task demands. Poor rapport might be due to a history of negative interactions between the client and practitioner, such as the practitioner’s high rates of aversive nonpreferred stimulus presentations. When this happens, the presence of the practitioner might become related with upcoming aversive events. McLaughlin and Carr (2005) implemented an intervention to improve rapport between clients with disabilities and staff members. In this case, the clients engaged in problem behavior with some staff members and not with others, suggesting a problem with client – staff member rapport. An intervention to improve rapport focused on establishing staff members as generalized reinforcers by conditioning them with a wide array of social, activity, and tangible reinforcers. That is, staff members were trained to noncontingently present preferred stimuli. Staff members were trained to identify and respond appropriately to the client’s verbal and nonverbal communicative attempts (i.e., the function of various client behaviors and how to respond with a functionally equivalent consequence). Staff members were also trained to strengthen reciprocity (e.g., turn-taking) by participating in activities of shared interest with the client. Activities of shared interests were identified with client-staff member dyads and staff members were trained how to initiate and include equal participation in these activities with the client. Following the intervention, compliance with task demands improved and problem behavior decreased.

A scenario that was not mentioned in the previous post, but is also relevant to this discussion includes problem behavior occasioned by noncompliance with client mands. That is, the client tends to engage in problem behavior when she makes a request and others do not comply with the request. Bowman, Fisher, Thompson, and Piazza (1997) systematically evaluated the environmental variables contributing to problem behavior occasioned by noncompliance with a variety of client demands. Because the specific demands varied within and across sessions (e.g., consisted of mands for the onset or offset of attention and tangibles, as well as the dictation of others’ activities), standard functional analysis procedures (where one type of reinforcer is tested at a time) could not adequately assess the behavioral function. Modifications to the standard functional analysis methodology were necessary. The results of the modified functional analysis suggested that problem behavior was maintained by compliance (or an increased likelihood of compliance) with mands. Following the completion of the functional analysis, the investigators implemented functional communication training (FCT) to reduce problem behavior.

During the FCT procedure implemented by Bowmen et al. (1997), appropriate mands were reinforced according to an FR1 schedule. Maintaining treatment integrity with dense schedules, such as the FR1, might be difficult in typical applied settings. O’Conner et al (2003) implemented an intervention to address problem behavior maintained by compliance with client mands that might be more practical for applied settings. Their intervention consisted of a three-tier level system. At level 3, a discriminative stimulus in the form of a card indicated the client could play his way and the therapist complied with all reasonable demands. The therapist also delivered continuous attention and provided access to high preference items. If the client engaged in moderate intensity problem behavior, he was moved to level 2. At level 2, lower preferred items and minimum levels of attention were provided. Therapists did not comply with demands. The client remained at level 2 until 15 min had progressed without problem behavior. Engagement in severe problem behavior resulted in the client moving to level 1. At level 1, the client was place in an exclusionary time-out. Once 10 min had passed without problem behavior, the client was moved to level 2. During scheduled academic activities, compliance with work demands were reinforced with breaks. The level system was incorporated into the break intervals, based on the presence or absence of moderate and severe problem behavior.

Throughout this post, we discussed several interventions to address problem behavior occasioned by very specific environmental events. The practitioners’ design and implementation of these effective procedures was enabled by their ability to identify the relevant contributing environmental events related to the problem behavior. Identification of the environmental events maintaining problem behavior is key to effective treatment. The use of ambiguous terms such as ‘control’ in functional statements do not assist in the development of function based procedures. Without this information, use of the most effective procedures is not possible.

References

Bowman, L. G., Fisher, W. W., Thompson, R. H., & Piazza, C. C. (1997). On the relation of mands and the function of destructive behavior. Journal of Applied Behavior Analysis, 30, 251-265.

DeLeon, I. G., Graff, R. B., Frank-Crawford, M. A., Rooker, G. W., & Bullock, C. E. (2014). Reinforcement arrangements for learners with autism spectrum disorder. In J. Tarbox, D. R. Dixon, P. Sturmey, & J. L. Matson (Eds.), Handbook of Early Intervention for Autism Spectrum Disorders (pp. 205-228). Springer New York.

Hagopian, L. P., Bruzek, J. L., Bowman, L. G., & Jennett, H. K. (2007). Assessment and treatment of problem behavior occasioned by interruption of free-operant behavior. Journal of Applied Behavior Analysis, 40, 89-103.

McLaughlin, D. M. & Carr, E. G. (2005). Quality of Rapport as a Setting Event for Problem Behavior: Assessment and Intervention. Journal of Positive Behavior Interventions, 7, 68-91.

Strategies to facilitate successful collaborations with caregivers

Businesspeople shaking hands in office with coworkers and staff sitting at the table with them

Collaborating with caregivers and other stakeholders is a necessary component of behavior analytic service provision.  Stakeholders are typically responsible for seeking out and funding services provided to the client.  Stakeholders close to the client, such as parents or teachers, may also function as primary behavior change agents.  It is apparent from the various stakeholder roles that the establishment and maintenance of good rapport with stakeholders is essential to the efficacy of behavior analytic services.

How does one arrange for successful collaborations throughout the provision of services?

You can start by engaging in activities similar to those conducted during initial direct client sessions.  That is, start with rapport building.  Establishing rapport is typically recommended as the first step in the provision of behavior analytic services.  The goal is to establish yourself as a reinforcer for the purpose of facilitating program efficacy.  Of course establishing rapport with stakeholders will not consist of the same behaviors as rapport building with direct clients.  During initial sessions with stakeholders, you should focus on smiling, making eye contact, and listening to stakeholders (Bailey & Burch, 2010).  Listening activities might include acknowledging stakeholders’ concerns by paraphrasing what they have previously said.

Once you are ready to implement the intervention, set stakeholders up for small successes.  You can do this by assisting them with minor environmental arrangements that are likely to be quickly reinforced.  Keep in mind these activities do not have to be directly related to the client.  For example, I once taught a caregiver how to put appointments and set reminders in the calendar on her phone.  She had difficulty keeping track of appointments and often double booked herself.  The few minutes I spent with her on the activity prevented future double bookings and the associated missed appointments.  The activity also functioned as a rapport builder for me.  By assisting stakeholders with procedures that are both easily implemented and likely to produce quick results, you work to promote the stakeholders’ confidence in your abilities.  During the later stages of service provision, stakeholders may demonstrate patience with procedures yielding delayed results as they begin to trust your recommendations.  Rapport building activities should continue throughout the course of service provision.  In addition to the previously stated activities, one should deliver praise and positive feedback for stakeholder contributions, strengths, and successes.

Rapport building is only one set of behaviors involved in fostering successful collaborations. Setting expectations and relevant goals during the initiation of services will also facilitate positive stakeholder relations. When setting expectations, you can briefly explain the nature of behavior analytic services by describing how you will provide services to the client.  You should discuss your expectations of relevant stakeholders throughout the provision of services, as well as what they should expect from you.  Adherence to our standard of social significance requires that program goals correspond with clients’ and/or stakeholders’ goals (Wolf, 1978).  Be sure to consider stakeholders’ values when setting goals.  Prioritize treatment goals by considering how much time is allotted for the provision of services, as you will not be able to address every need at once.  When service hours are limited, you may only be able to effectively target a small number of behavioral concerns.  Stakeholders may request that you address much more than is possible during the allocated service time.  Rather than prioritizing treatment goals on you own, you can include stakeholders in the process by asking them to choose from a list of priorities.

After you have set goals and reviewed expectations, additional actions to promote positive collaborations should occur throughout the intervention phase.  Relevant stakeholders should be made aware of and approve of procedures involved in all aspects of the intervention.  Consider the stakeholders’ ability to implement procedural recommendations.  Be careful not to overwhelm them by suggesting too many changes at one time.  When recommending multicomponent interventions, you can set stakeholders up to successfully follow-through by gradually assigning more intervention components as stakeholders proficiently execute them.  Further into the intervention phase, the practitioner who has established and maintained good rapport with stakeholders and has demonstrated successes with the client might be asked to address additional behavioral concerns.  In cases where the practitioner is unable to accommodate additional targets, the practitioner may continue to facilitate collaborations by orienting stakeholders back to previously agreed upon goals.  At this time, it may be necessary to reevaluate program goals and relevant stakeholders might be asked to restate their priorities.

The development and maintenance of successful stakeholder collaborations is a process that occurs throughout one’s provision of behavior analytic services.  Activities such as rapport building, setting expectations and goals, and offering choices can facilitate positive collaborations and assist in the delivery of effective services.   What activities have contributed to your successful collaborations?  Comment below and continue following BAM Network!

References

Bailey, J. S., & Burch, M. R. (2010). 25 essential skills & strategies for the professional behavior analyst: Expert tips for maximizing consulting effectiveness. New York, NY: Routledge Taylor & Francis Group.

Wolf, M. M. (1978). Social validity: The case for subjective measurement or How applied behavior analysis is finding its heart. Journal of Applied Behavior Analysis, 11, 203-214.