Positive behavior support and applied behavior analysis

Evaluating the effectiveness of the Complex Behaviour Forum-A multisystem approach to supporting people with complex challenging behaviour

BACKGROUND

This study assessed the effectiveness of a cross-departmental case review panel-the Multicap Complex Behaviour Forum (CBF)-in reducing challenging behaviour exhibited by people with intellectual disabilities.

METHODS

Thirty participants (15 CBF participants and 15 matched-control participants) took part in the study. Behavioural data was collected for each CBF participant (and their matched control) for the three-month period before entering the CBF, during their time in the CBF, and the 3 months after exiting the CBF.

RESULTS

There was a significant interaction of group and time observed, with the CBF participants showing more change in behavioural incidents across time. Associated with this change was a noticeable reduction in staff injury costs related to the challenging behaviour of the CBF participants.

CONCLUSIONS

This study demonstrates that positive behavioural and organisational outcomes are enhanced by fostering collaboration across multiple organisational systems when it comes to supporting people who exhibit challenging behaviours.

A Discussion of Positive Behavior Support and Applied Behavior Analysis in the Context of Autism Spectrum Disorder in the UK and Ireland

This article addresses the relationship between applied behavior analysis (ABA) and the emergence of positive behavior support (PBS) in context of autism spectrum disorder (ASD) in the UK and Ireland. Two overarching issues that are salient in this discussion are professional training and certification. To date, there has been a lack of standardized training or statutory requirements to practice PBS despite proponents insisting that its practice should be grounded in behavior analytic principles. Furthermore, there is an undercurrent of anti-ABA bias fueled by misinterpretation and unsubstantiated anecdotal claims used to promote an alternative "value based" approach to managing behavior.

The Evolution of the Conceptually Systematic Dimension and Its Current Functions in Applied Behavior Analysis

What does it mean to be conceptually systematic in contemporary applied behavior analysis (ABA) research and practice? To answer this question, the present study conducted a historical analysis of ABA scholars' interpretations of the conceptually systematic dimension of ABA over the last 55 years. The present article found the current characteristics of the conceptually systematic dimension are indeed sufficient to suggest ABA's conceptual independence from the experimental analysis of behavior or any other subdisciplines of behavior analysis. Based on this finding, this article addresses the challenges in contemporary ABA field such as ABA's own basic and applied continuum, translational research, and its relationship with other disciplines' research and practice.

Putting the power of behavior analysis in the hands of nonbehavioral professionals: Toward a blueprint for dissemination†

Behavior analysts have much to offer nonbehavioral professionals who work with the communities that we serve. Successful dissemination of behavior-analytic technologies to these professionals could potentially improve their practice. Although the literature contains some exemplary examples of successful dissemination, our discipline would benefit from a blueprint for conducting this important work. In this article, I share our experiences disseminating behavioral technologies to educators, law enforcement officers, and health care providers who engage with neurodiverse individuals. These experiences form the basis of a recommended blueprint for dissemination, which awaits empirical support. After describing this tentative blueprint, I provide suggestions for future research on how best to disseminate our technologies to nonbehavioral professionals, the ideal content of those dissemination activities, and the conditions under which professionals may be more likely to embed our technologies into their best practices.

Latent Class Analysis on Types of Challenging Behavior in Persons with Developmental Disabilities: Focusing on Factors Affecting the Types of Challenging Behavior

This study sought to analyze the latent classes of challenging behaviors among persons with developmental disabilities and examine the effects of related variables. To this end, the Korea Employment Agency for Persons with Disabilities collected data from the Survey on the Work and Life of Persons with Developmental Disabilities from 3000 households that included at least one family member with a developmental disability aged ≥15 years, surveying the persons themselves as well as their caregivers. As a result of the analysis, four latent classes were derived based on the types of challenging behavior and named as follows: overall challenging behavior, aggressive behavior, socially inappropriate behavior, and no challenging behavior. The main disability, disability grade, presence of multiple disabilities, disability status, activities of daily living, reading skills, writing skills, and situational awareness were significant factors affecting each latent class in the type of challenging behavior. Significant factors differed among the groups. This study identified the types of challenging behaviors and their influencing factors in a large sample of individuals with developmental disabilities and analyzed the correlation between their challenging behaviors and activities of daily living.

Barriers and facilitators to practitioners' implementation of positive behavior support practice in social care organizations in Ireland

In Ireland, the provision of behavior support services has developed following the introduction of Health Information and Quality Authority (2013) standards and the regulation of Positive Behavior Support (PBS) under the Health Act (2007). The purpose of this study was to explore what factors facilitate and act as barriers to implementation of behavioral recommendations in Intellectual Disability organizations from the practitioner's perspective. Twelve interviews were carried out, audio recorded, transcribed and analysed using Braun and Clarke's (2006) Thematic Analysis. One superordinate theme (administrator support), four themes (values, resources, relationships and implementation of consequences) and five sub-themes (staff turnover and burnout, training and knowledge, time and physical contact, relationships between practitioners and staff and staff and service users) were identified, all interconnected in the implementation process. A common thread reflected throughout the themes, was the practitioner's acknowledgment of barriers overpowering facilitation which resulted in a less than optimum implementation of PBS.

Revealing underlying factors of absenteeism: A machine learning approach

INTRODUCTION

The basis of support is understanding. In machine learning, understanding happens through assimilated knowledge and is centered on six pillars: big data, data volume, value, variety, velocity, and veracity. This study analyzes school attendance problems (SAP), which encompasses its legal statutes, school codes, students' attendance behaviors, and interventions in a school environment. The support pillars include attention to the physical classroom, school climate, and personal underlying factors impeding engagement, from which socio-emotional factors are often the primary drivers.

METHODS

This study asked the following research question: What can we learn about specific underlying factors of absenteeism using machine learning approaches? Data were retrieved from one school system available through the proprietary Building Dreams (BD) platform, owned by the Fight for Life Foundation (FFLF), whose mission is to support youth in underserved communities. The BD platform, licensed to K-12 schools, collects student-level data reported by educators on core values associated with in-class participation (a reported-negative or positive-behavior relative to the core values) based on Social-Emotional Learning (SEL) principles. We used a multi-phased approach leveraging several machine learning techniques (clustering, qualitative analysis, classification, and refinement of supervised and unsupervised learning). Unsupervised technique was employed to explore strong boundaries separating students using unlabeled data.

RESULTS

From over 20,000 recorded behaviors, we were able to train a classifier with 90.2% accuracy and uncovered a major underlying factor directly affecting absenteeism: the importance of peer relationships. This is an important finding and provides data-driven support for the fundamental idea that peer relationships are a critical factor affecting absenteeism.

DISCUSSION

The reported results provide a clear evidence that implementing socio-emotional learning components within a curriculum can improve absenteeism by targeting a root cause. Such knowledge can drive impactful policy and programming changes necessary for supporting the youth in communities overwhelmed with adversities.

"I've never been positive … I am now": Participant perspectives of a Positive Behaviour Support intervention (PBS + PLUS) for community-living individuals with ABI and their close others

Challenging behaviours are common following moderate to severe acquired brain injury (ABI). These behaviours cause relationship and community participation difficulties and are a significant source of stress for many individuals with ABI and their close others (COs). A Positive Behaviour Support intervention, PBS + PLUS, was implemented to assist individuals with ABI to collaboratively build meaningful lives and self-regulate their behaviour. This study explored the perspectives of individuals with ABI and COs (family members, friends, and carers) who had completed an individualized 12-month PBS + PLUS intervention. Fifty-two individuals participated in semi-structured interviews, and a thematic analysis of interview transcripts identified the interrelated themes of Openness to Change, Embeddedness, Clinician Connection, and Preparedness for the Future. Participant perceptions of, and engagement with, PBS + PLUS were influenced by an attitude of openness to new ideas and by the intervention itself. Achieving contextual relevance allowed the intervention to become embedded in participants' lives, and the client-clinician relationship was central to participants' positive experiences. While most participants felt better equipped to cope with the future, some experienced difficulties transitioning to post-intervention life. These results suggest PBS + PLUS may assist individuals with ABI to lead meaningful lives and more confidently overcome behavioural challenges, while encouraging supportive and empowered COs.

Behavioral Artistry: Examining the Relationship Between the Interpersonal Skills and Effective Practice Repertoires of Applied Behavior Analysis Practitioners

This study investigated interpersonal skills associated with the concept of behavioral artistry (BA), a repertoire of practitioner behaviors including care, attentiveness, and creativity, among others, associated with the effective delivery of applied behavior analysis (ABA) treatment. Survey results indicated parents of children with autism preferred BA descriptors for ABA therapists over non-BA descriptors. A separate survey of 212 university students on a standardized personality assessment revealed students majoring and/or working in the field of ABA had lower levels of BA than those in other human services professions. Practitioners with higher BA scores were observed and rated more positively in their delivery of ABA for children with autism. Implications for training/supervising effective ABA practitioners within a BA model are discussed.

Brain injury, behaviour support, and family involvement: putting the pieces together and looking forward

Purpose: (1) to provide insight into the family's experience and support needs following acquired brain injury (ABI) specific to behavioural changes; (2) to provide an overview of empirically-based behaviour support approaches for individuals with ABI; and (3), to examine family involvement in implementing behavioural interventions.Methods: Review of the literature.Results: Family members experience significant distress resulting from neurobehavioural changes in relatives with ABI, and report unmet informational and practical support needs regarding this issue. The importance of utilising family expertise within the rehabilitation process is widely acknowledged, with the increasing involvement of family members being promoted. There is growing evidence supporting the use of positive behaviour support approaches for individuals with ABI in community settings, and evidence supporting the involvement of family within behavioural interventions.Conclusions: This review suggests the need to develop alternative support models that shift the focus towards building competence in everyday support people rather than dependency on the service system. A bottom-up approach is recommended, with the aim of addressing unmet support needs and increasing the competence of family members in supporting behaviour change in individuals with ABI. Recommendations are provided in informing an optimal community-based neurobehavioural support model. Implications for RehabilitationPositive behaviour support is recommended in supporting behavioural changes following brain injury, with family expertise utilised in this process.Evidence suggests that family members can be effectively trained in developing and implementing behaviour support strategies.Family involvement in behavioural interventions may address unmet support needs and increasing the competence of family members in supporting behavioural changes following brain injury.

Challenges for Behavioral Assessment in Brazilian Schools

Abstract In this article we begin by providing an overview of the need to increase the frequency with which behavioral assessment is used in Brazilian schools. We then describe various methods of behavioral assessment. Next, we discuss various purposes for assessing behavior in school settings. We then discuss general challenges that impact the assessment of behavior. Finally, we conclude by discussing the importance of identifying psychological and social concerns early in childhood and call for the development of additional evidence-based assessment tools that are appropriate for use in Brazilian schools.

Hibiscus rosa sinensis mediate anxiolytic effect via modulation of ionotropic GABA-A receptors: possible mechanism of action

The current study was designed with the aim to investigate anti-anxiety potential of Hibiscus rosa sinensis roots and its possible mechanism of action. For this purpose hole board test, elevated plus maze test and light/dark exploration test were employed. The ethanol extract of plant was administered orally at two different doses i.e. 100 and 500 mg/kg for consecutive 14 days. The results of present investigation indicate that plant extract significantly (p < 0.05) increased the number of head dips and rearings as compared to control on respective days of observation. The extract increased the time of permanence in open arms and the number of head dips in elevated plus maze. In light/dark test, our study indicate that Hibiscus rosa sinensis significantly (p < 0.05) increased the time spent in light compartment and number of entries as compared to control. In addition the anxiolytic effects of HRS at highest tested dose were blocked by flumazenil, a GABA-A receptor antagonist that indicate that Hibiscus rosa sinensis potentiated the GABAergic actions. The results propose that the ethanol extract of Hibiscus rosa sinensis has prospective anxiolytic effect in mice via inhibition of ionotropic GABA receptors, using different behavioral paradigms.

Schooling and Children's Mental Health: Realigning Resources to Reduce Disparities and Advance Public Health

Schools have long been the primary setting for children's mental health services but have neither the resources nor the expertise to manage these services independently. The critical importance of school success for children's adjustment provides a strong rationale for schooling as an essential component of children's mental health services. In this article, we review evidence for how schooling and mental health coalesce, suggesting an alignment of school and community mental health resources that prioritizes successful schooling as a key mental health outcome. We describe collaborative principles and ecological practices that advance a public health focus on children's mental health while also reducing the burden on schools to maintain mental health services. We close with a model of mental health services illustrating these principles and practices in high-poverty urban schools and propose future directions for research and practice to promote positive mental health for all children and youth.

PBIS May Not Qualify as Classical Applied Behavior Analysis. So What?

Some disagreement exists over whether Positive Behavior Interventions and Supports (PBIS) embodies the features of Applied Behavior Analysis (ABA) as described in a classic 1968 paper by Baer, Wolf, and Risley. When it comes to disseminating interventions at a societal level, a more compelling issue is whether ABA should become more like PBIS.

A Critique of Sociocultural Values in PBIS

Horner and Sugai provide lessons learned from their work with disseminating the Positive Behavioral Interventions and Support (PBIS) model. While PBIS represents an empirical school-wide approach for maladaptive student behaviors, the model appears to have limitations regarding sociocultural values and behavioral data collection practices. The current paper provides an overview of three identified areas for improvement and outlines how administrators using PBIS can incorporate acceptance and mindfulness-based intervention procedures to address the discussed limitations.

Beyond the impasse? Systemic consultation and understanding complex cases

BACKGROUND

Systemic consultation provides an opportunity for clinicians working with complex cases and behaviours of concern to reflect on interpersonal dynamics that may be inhibiting change. This approach to case review is drawn from systemic family therapy, a model that is gaining some acceptance within the field of intellectual disability.

METHOD

Thematic analysis was used to explore the experience of eleven clinicians attending systemic consultation. Clinicians were experienced in behaviour support, had no prior experience in family therapy and presented with complex cases described as 'stuck'.

RESULTS

Consultations were seen to have many benefits, including a heightened awareness of the interpersonal needs of both clients and carers and the development of a facilitative position and skills to apply to cases. Less experienced clinicians were more likely to feel overwhelmed by this less structured, more relationally oriented focus.

CONCLUSIONS

Systemic consultation has the potential to augment behaviour support, enabling clinicians to understand and negotiate problematic interpersonal dynamics when responding to behavioural difficulties. Less experienced clinicians may require additional training and support in the systemic approach.

The content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII) and its potential application in accommodation and day-support services for adults with intellectual disability

BACKGROUND

The quality of support provided to people with disability who show challenging behaviour could be influenced by the quality of the behaviour support plans (BSPs) on which staff rely for direction. This study investigated the content validity of the Behaviour Support Plan Quality Evaluation tool (BSP-QEII), originally developed to guide the development of BSPs for children in school settings, and evaluated its application for use in accommodation and day-support services for adults with intellectual disability.

METHOD

A three-round Delphi study involving a purposive sample of experienced behaviour support practitioners (n = 30) was conducted over an 8-week period. The analyses included deductive content analysis and descriptive statistics.

RESULTS

The 12 quality domains of the BSP-QEII were affirmed as valid for application in adult accommodation and day-support service settings. Two additional quality domains were suggested, relating to the provision of detailed background on the client and the need for plans to reflect contemporary service philosophy. Furthermore, the results suggest that some issues previously identified in the literature as being important for inclusion in BSPs might not currently be a priority for practitioners. These included: the importance of specifying replacement or alternative behaviours to be taught, descriptions of teaching strategies to be used, reinforcers, and the specification of objective goals against which to evaluate the success of the intervention programme.

CONCLUSIONS

The BSP-QEII provides a potentially useful framework to guide and evaluate the development of BSPs in services for adults with intellectual disability. Further research is warranted to investigate why practitioners are potentially giving greater attention to some areas of intervention practice than others, even where research has demonstrated these others areas of practice could be important to achieving quality outcomes.

Rehabilitation Approaches to the Management of Aggressive Behaviour Disorders after Acquired Brain Injury

Symptoms of neurobehavioural disability acquired through brain injury, especially aggression, are associated with severe social handicap. Differences in terminology have resulted in varying estimates, but aggressive behaviour disorder appears to be characteristic of survivors at some point in their recovery journey. This paper provides a brief review regarding the prevalence, development and causes of aggression associated with acquired brain injury (ABI), and what can be done to help manage them. The advantages of using standardised measures conceptualised for ABI in the assessment and formulation of aggressive behaviour disorders are especially highlighted. A range of treatment methods and the evidence base relating to these are described. The contribution of pharmacological therapies, cognitive behavioural therapy and behavioural interventions are explored. It is argued that the strongest evidence base is associated with behaviour therapy, especially when carried out in the context of neurobehavioural rehabilitation, and two case studies are described to illustrate the clinical advantages of interventions derived from operant theory. Comparative lack of ABI experts trained in the management of post-acute behaviour disorders remains a limiting factor.

What is evidence-based behavior analysis?

Although applied behavior analysts often say they engage in evidence-based practice, they express differing views on what constitutes "evidence" and "practice." This article describes a practice as a service offered by a provider to help solve a problem presented by a consumer. Solving most problems (e.g., increasing or decreasing a behavior and maintaining this change) requires multiple intervention procedures (i.e., a package). Single-subject studies are invaluable in investigating individual procedures, but researchers still need to integrate the procedures into a package. The package must be standardized enough for independent providers to replicate yet flexible enough to allow individualization; intervention manuals are the primary technology for achieving this balance. To test whether the package is effective in solving consumers' problems, researchers must evaluate outcomes of the package as a whole, usually in group studies such as randomized controlled trials. From this perspective, establishing an evidence-based practice involves more than analyzing the effects of discrete intervention procedures on behavior; it requires synthesizing information so as to offer thorough solutions to problems. Recognizing the need for synthesis offers behavior analysts many promising opportunities to build on their existing research to increase the quality and quantity of evidence-based practices.

The efficacy of positive behavioural support with the most challenging behaviour: the evidence and its implications

BACKGROUND

Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. Questions have been raised as to PBS effectiveness, costs, and accessibility.

METHOD

Outcome studies meeting specified criteria for PBS were selected for review. All told, 12 outcome studies encompassing 423 cases were included.

RESULTS

This review showed that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community.

CONCLUSIONS

The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment.

Why reinvent the wheel? A behaviour analyst's reflections on pedagogy for inclusion for students with intellectual and developmental disability

The number of children identified as having intellectual or developmental disability is rising worldwide and their education has been found wanting. It has been said that "they simply need better teaching." At the same time, there is an increasing evidence base that pedagogy that is based on the discipline of behaviour analysis offers the best prospect for individuals diagnosed with autism spectrum disorders. On the basis of this evidence, it is proposed that behaviour analysis should be applied more broadly to improve teaching for all children with intellectual or developmental disability.

Crucial issues in the applied analysis of verbal behavior: reflections on crucial conversations: tools for talking when the stakes are high

A popular-press self-help manual is reviewed with an eye toward two issues. First, the popularity of such books documents the existence of considerable demand for technologies that address the everyday problems (in the present case, troublesome conversations) of nondisordered individuals. Second, many ideas invoked in popular-press books may be interpretable within an analysis of verbal behavior, although much more than casual translation is required to develop technologies that outperform self-help manuals. I discuss several challenges relevant to research, theory refinement, technology development, and dissemination, and conclude that behavioral alternatives to existing popular-press resources may not emerge anytime soon.

Behavioural interventions for children and adults with behaviour disorders after TBI: A systematic review of the evidence

OBJECTIVE

To systematically review the evidence for the effectiveness of behavioural interventions for children and adults with behaviour disorders after TBI.

DESIGN

Using a variety of search procedures, 65 studies were identified. This literature was reviewed using a set of questions about participants, interventions, outcomes and research methods.

PARTICIPANTS

The 65 studies included 172 experimental participants, including children and adults.

INTERVENTIONS

A number of specific intervention procedures were used, falling into three general categories: traditional contingency management, positive behaviour interventions and supports and combined.

RESULTS

All of the studies reported improvements in behavioural functioning.

CONCLUSIONS

Behavioural intervention, not otherwise specified, can be considered a treatment guideline for children and adults with behaviour disorders after TBI. Both traditional contingency management procedures and positive behaviour support procedures can be said to be evidence-based treatment options. However, a variety of methodological concerns block stronger conclusions.

Applied behavior analysis treatment of autism: the state of the art

The treatment of individuals with autism is associated with fad, controversial, unsupported, disproven, and unvalidated treatments. Eclecticism is not the best approach for treating and educating children and adolescents who have autism. Applied behavior analysis (ABA) uses methods derived from scientifically established principles of behavior and incorporates all of the factors identified by the US National Research Council as characteristic of effective interventions in educational and treatment programs for children who have autism. ABA is a primary method of treating aberrant behavior in individuals who have autism. The only interventions that have been shown to produce comprehensive, lasting results in autism have been based on the principles of ABA.

Positive Behavior Support and Applied Behavior Analysis

Positive behavior support (PBS) emerged in the mid-1980s as an approach for understanding and addressing problem behaviors. PBS was derived primarily from applied behavior analysis (ABA). Over time, however, PBS research and practice has incorporated evaluative methods, assessment and intervention procedures, and conceptual perspectives associated with a number of additional disciplines. Recently, there has been some confusion regarding the definition of PBS and, in particular, its relationship to ABA. In this article, it was noted that the practice of PBS and ABA, in some instances, can be indistinguishable but that important differences in definitions and emphases mandate an explicit distinction. The purpose of this article is to address some of the key points of confusion, identify areas of overlap and distinction, and facilitate a constructive and collegial dialog between proponents of the PBS and ABA perspectives.