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
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
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)
ID services,
1940s & before
Institutions
1980s
↓
↓
social policy,
and ABA
Segregation
ABA started 1940s
custodial care
↓
↓
training
↓
↓
“behaviour mod”
Deinstitutionalisation
Normalisation
(punishment & lollies)
↓
↓
↓
now unpopular
Science out,
values-based fads
popular
↓
1990s
Community and
communities
2000s
↓
↓
2008 on
?
↓
↓
↓
Evidencebased
services?
Alternatives researched
↓
↓
Alternatives found for
most individuals
↓
ABA re-adopted?
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
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
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)
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
Background
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Client – Goal
Support – Equipment
Task Analysis
Baseline
Training
Prompting
Reinforcement
Staff
Independence
Maintenance
Task analysis for forward chaining
radio use.
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1
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5
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Go to bedroom
Close bedroom door
Go to stereo
Touch top left hand corner of stereo
Push 'on/off' button
Feel for & push 'radio/turner' button
Listen to radio
Push 'on/off' button
Figure 1. Percentage of steps completed independently, across sessions for
radio use.
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
Increasing Independent
Engagement with Household
Chores
I-Chen Sharon Ho, MSc, PGDipAppPsych
ABA Graduate 2007
Now at IDEA and Blomfield School, Whangarei
Background
• Client: Wyatt
• Goal: To increase client’s independence when
engaging in chores.
• Goal rationale
Programme
• Behavioural Momentum
• What is it?
• Can we make the strategy more efficient?
Figure 1. Time spent vacuuming independently across sessions for
compliant task-related behaviour as a function of changing
criterions.
Increasing Meaningful
Engagement in Adults with
Intellectual Disabilities
Sheree Adams, MA, PGDipAppPsych
ABA Graduate 2007
Now at Centre for Autism & Related Disorders
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
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 .
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
Baseline
Phase II
Phase I
F/U
Intervention B
DO
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A
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O
F
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V
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Staff
Level of
engagement
Intervention A
DT
DM
Prompting +
Reinforcement
PN
sessions
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.
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)
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 . . . .
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?
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
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
Programme
• 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
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.
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
Communication Training and
Decreasing Food Stealing
I-Chen Sharon Ho, MSc, PGDipAppPsych
ABA Graduate 2007
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)
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
Figure 1. Percentage of independent correct responses across
sessions as a function of picture exchange communication systems
training.
Figure 2. Frequency of stealing attempts across sessions as a
function of extinction.
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
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 is complex
– 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
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
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
"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
Website address for presentation
http://www.psych.auckland.ac.nz/postgraduateprogramme/ABA.htm
Includes references, Fisher & Piazza flyer, and
further examples
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.
More examples from University of
Auckland ABA students’ and
graduates’ work for ID services
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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
More examples continued
Decreasing problems:
• Reduce aggression
• Reduce tantrumous outbursts
• Reduce self-injury: e.g., regurgitation, headhitting, pica
• Reduce property destruction
• Reduce restraints
• Eliminate fear of open spaces, thus increasing
social activity
• Monitor effects of medications on behaviours