Association for Behavior Analysis International

Starting with the Olmstead decision of 1999, and accelerated by the nationwide transition to Managed Care, mental health institutions across the country are shuttering. States are under increasing pressure to move individuals out of such institutions and into community-based settings. If an individual engages in severe challenging behavior, executing this transition can be prohibitively difficult and dangerous. In 2014, one New York City agency was awarded a federal grant to integrate advanced care coordination and ABA-based practices into adult residential services. The agency applied this grant to assist the state of New York in the closure of a large mental health institution. Board Certified Behavior Analysts and Registered Behavioral Technicians were tapped to support the work of a newly-assigned interdisciplinary clinical team. In many cases, results were immediate; Challenging behaviors that had persisted for decades under the mental institution's previous auspices were drastically reduced in both frequency and intensity. Over the course of the next 15 months, the individuals in this facility were gradually moved to community-based housing. The discussants will reflect on the strengths and pitfalls of this approach to transition, as well as the overall potential for generalizing these results to other treatment settings.