Association for Behavior Analysis International

School-wide Positive Behavior Support, a data based multi-tiered framework has been shown to be effective in schools in improving behavior support (Sugai & Horner, 2009). The use of data based decision making incorporating applied behavior analysis/evidenced based practices at the universal, secondary and intensive level has not been implemented in large organizations serving adults with autism spectrum disorder and developmental disabilities. A critical feature of an effective multi-tiered data based decision approach is to have efficient and effective data systems that allow teams to make timely data based decisions at each tier. Secondly, it is a challenge of large organizations to install data-based organizational wide systems to support effective applied behavior analytic practices implemented with treatment integrity. The symposium will present data from a large behavior analytic organizations in how to implement a multi-tiered system of support to improve staff performance as well as clinical outcomes for individuals with ASD and/or IDD. The presentations will review how to efficiently use staff resources to maximize clinical effectiveness.

This presentation will review the implementation of universal behavior support interventions across a large behavior analytical organization serving over 2,000 individuals with IDD and/or autism across 100 programs. The hallmark of any effective multi-tiered system of support using behavior analytical/evidenced based practices is timely data based decision making by representative data teams at each tier. The use of paper based systems and the timely and efficient conversion of this information into representative visual presentations using excel/and or other graphing programs to allow teams to make data based decisions is consumes significant staff resources. Secondly, the use of functional assessment information to ascertain system interventions particularly in these programs is often lacking. The development of an efficient electronic data collection system for universal data (incident reports) and automatic visual presentation of these data was a high priority to help universal teams analyze their information and build program-wide behavior support plans. Data will be presented on the analysis of data, treatment integrity and reductions in problem behavior.

This data based presentation demonstrates the development and implementation of data based decision making teams for those individuals with developmental disabilities with high risk behavior within a multi-tiered system of behavior support. Within a multi-tiered system of support universal interventions are implemented across all individuals with the organization. Secondary or targeted interventions are implemented for those individuals who are not responsive to the universal interventions. At the intensive level are those individuals who exhibit problem behavior who either are not responsive to targeted/secondary interventions or engage in high risk behaviors. This presentation will review the implementation of intensive behavior support interventions across a large behavior analytical organization serving over 2,000 individuals with IDD and/or autism across 100 programs. Intensive data based teams were formed to review on a monthly basis progress monitoring data on the most challenging behaviors of these individuals. All individuals had behavior support plans in place. Based on the responsiveness of the individuals to their behavior support plans these teams make suggestions to improve intervention effectiveness. Treatment integrity of the system implementation was taken and showed improvements over the course of nine months. Improvements were seen in the effectiveness of the behavior support plans in 19 of the 20 individuals involved in the intervention. Overall reductions were seen in the amount of restraints used during the intervention as compared to preintervention.

In 2013, the Massachusetts Department of Developmental Services (DDS) began a process of mandating the adoption of a positive behavior support (PBS) approach, in lieu of applied behavior analysis, as the model for clinical service delivery for the currently 32,000 adults served through DDS and its contracted vendors. A seminal article by Horner et al. (1990) began with the statement that, "In recent years, a broad-based movement has emerged in support of non-aversive behavior management" (p. 125). Unfortunately, while there is a plethora of data supporting the use of a PBS approach within school based systems, as noted by Johnson, Foxx, and Mulick (2004), little such evidence exists within adult populations. The purpose of the research described within this symposium is to evaluate the implementation of a PBS model within a large-scale adult service system utilizing a within-subject experimental design. While the primary Independent Variable in the study is a system-wide PBS approach, the research design was structured to focus on the impact of the effect of the Reid and Parsons (2007) Positive Behavior Support Training Curriculum, 2nd Ed. The results of this evaluation along with a discussion of the cost-benefit implications for service providers will be discussed. The PBS training was implemented in a Multiple Baseline Design across three cohorts of 18 DDS funded adult group homes, serving 5+/- individuals each. A pre-Training Baseline was followed sequentially by Training alone and Training combined with feedback. Inter-Observer reliability was collected across all conditions and settings, with an overall mean of >85%. Results indicated that Training alone was insufficient to produce clinically significant results. However, Training plus Feedback did produce clinically significant results in staff behavior. Indirect measures of client behavior, such as the level of restrictive practices employed and the frequency of emergency physical restraints also showed positive changes as a result of the Training plus Feedback condition. Additionally, maintenance data on the long-term impact of this approach will be reported.