|Special Ethical Issues in Intrusive Programming
|Tuesday, May 31, 2016
|4:00 PM–4:50 PM
|Columbus Hall CD, Hyatt Regency, Gold East
|Area: PRA/DDA; Domain: Translational
|Chair: Bruce Linder (Pryor, Linder & Associates/Safe Management Group Inc.)
|CE Instructor: Bruce Linder, Ph.D.
|Abstract: This symposium presents three special ethical issues in intrusive programming. First, the importance of insuring a meaningful stimulating environment will be discussed that focuses on Daily Activity Scheduling (DAS). Six years of research of six groups homes serving adults with acquired brain injury will be presented that gives the results of a House Manager DAS Training Program to improve the quality and implementation consistency of DAS. Second, the importance of adequate Crisis Intervention Training (CIT) will be discussed that focuses on Safe Management Group’s Program which meets several important criteria of CIT for intrusive programming – individualization, documentation, and specification. Staff training outcome data for initial and refresher training that focuses on knowledge and performance competency assessment will be presented and will highlight the special techniques of teaching and maintaining effective preventative verbal de-escalation skills. And third, the necessity of “hands-on” assessment by supervising clinicians of non-intrusive and intrusive programming will be discussed. A “One-Day” programming assessment protocol will be presented with outcome data for 10 adults with developmental disabilities that shows the assessment of “Safe Extinction” in treating severe aggressive escape behaviour.
|Keyword(s): Behavior Assessment, Ethics, Intrusive Programming, Staff Training
The Effectiveness of Manager Training in Programming and Monitoring Activity Schedules for Residential Group Homes
|JACKLYN NOBRE PERES (Pryor, Linder & Associates), Bruce Linder (Pryor, Linder & Associates)
Despite studies demonstrating that predictable activity schedules improves challenging behavioural among developmentally disabled children under experimental conditions, very little is known about the level of consistency with which residential staff provide daily activity schedules (DAS) in naturalistic adult group home settings and how to improve such consistency. Four years of research will be summarized. Study 1 of 6 group home settings servicing 35 adults with acquired brain injuries found, using six 2-week probes over three years, that written DASs were implemented on average only 37% of the time. A second intervention study in two of the group homes over a 12 month period found that DAS implementation could be substantially improved to 80% or higher with a 47% reduction in group home negative behavioural incidents with a DAS training program that focused on supervisor training in on-the-floor DAS supervision. In addition, the positive preventative components of Behaviour Support Plans were implemented significantly more consistently than in 5 comparison group homes which had not received DAS training. Study 3 demonstrated that DAS training conducted for 4 different agencies servicing adults with developmental disabilities improved quality and implementation of DASs, and quality of life. Implications for quality of care will be discussed.
The Effectiveness of Safe Management Group's Crisis Intervention Training for Staff Serving Adults With Acquired Brain Injury or Developmental Disabilities
|BRUCE LINDER (Pryor, Linder & Associates/Safe Management Group Inc.)
Despite the importance of crisis intervention training (CIT) for insuring staff and client safety, no peer-reviewed published data are available for the effectiveness of CIT on performance competencies. Safe Management Groups CIT will be described especially in relation to proposed standards for intrusive programming including Individualization of techniques for client and staff; written Documentation for accountability; and Specification and approval of technique in Behaviour Support Plans supervised by behavior analysts. Knowledge and Performance Competency outcome data for 2-day initial training and 1-day refresher training will be presented that shows greater success and retention in teaching physical intervention skills than verbal de-escalation skills. The outcome of a specialized enriched verbal de-escalation program will be presented which illustrates the need for specialized CIT.
An Assessment Protocol and Outcome Data for "Safe Extinction" With Adults With Severe Behavioural Disorder and Developmental Disabilities
|JOANNE SALAMEH (Pryor, Linder & Associates), Bruce Linder (Pryor, Linder & Associates)
A substantial research literature has established the prevalence of escape-motivated aggressive behaviour in children, adolescents and adults with developmental disabilities. A small subgroup of adults, perhaps about 3-5 percent, can be defined as severe, in that there is substantial daily risk with limited effectiveness of so-called positive programming only and psychopharmacologic treatments. This talk will introduce a form of escape-extinction called safe extinction (SE) in which contingent physical interventions and preventative mechanical restraints are used in combination with typical differential reinforcement of alternative and incompatible behaviour to produce substantial reductions in aggressive behaviour and increases in complaint and productive behaviour. A one-day assessment protocol will be presented that enables rapid and efficient assessment of the effectiveness of SE, a critical feature of intrusive programming. Data for ten adult cases of 1-day SE will be presented illustrating the extinction and generalization process.