|Systematic Fading of Restrictive Programming|
|Saturday, May 28, 2022|
|10:00 AM–11:50 AM |
|Meeting Level 2; Room 257B|
|Area: AUT/DDA; Domain: Applied Research|
|Chair: Haley Steinhauser (Melmark New England; Regis College)|
|Discussant: Patrick Romani (University of Colorado, Anschutz Medical Campus)|
|CE Instructor: Haley Steinhauser, Ph.D.|
|Abstract: The aim of behavior analytic practice and interdisciplinary collaboration is to use the least restrictive and most effective programming. At times, the least restrictive and effective option will involve restrictive procedures such as protective equipment, medication, and physical restraint to ensure the safety and well-being of the individuals receiving services. Restrictive procedures require both data-driven implementation following unsuccessful alternatives and systematic fading and modifications, with the consistent objective of utilizing the least restrictive procedures that promote best outcomes. The four presentations in this symposium address this topic from various angles, including (1) a behavioral-pharmacological intervention corresponding with an increase in successful transitions and decrease in aggression-contingent restraints, (2) an interdisciplinary review team (IRT) approach to medication management, (3) long-term effects of behavioral interventions and electroconvulsive therapy (ECT) in a man with catatonia, life-threatening self-injury, and autism spectrum disorder (ASD), and (4) organizational clinical systems on restrictive programming.|
|Instruction Level: Intermediate|
|Keyword(s): medication reduction, protective equipment, restraint reduction, restrictive programming|
|Target Audience: The target audience should have experience or familiarity with severe forms of challenging behavior (e.g., self-injury, aggression).|
|Learning Objectives: (1) Identify for systematically fading restrictive programming.
(2) Describe the utility of interdisciplinary collaboration in the context of medication management.
(3) Outline several organizational clinical system options for managing and fading restrictive programming.|
|Clinical Safety in Treating Severe Aggression: Evaluation of Behavioral-Pharmacological Intervention|
|JAIME ALYSSA SCIBELLI (Melmark New England), Frederick Scibelli (Melmark New England), Julia Hrdina (Melmark New England), Kelly Anglin (Melmark New England), Silva Orchanian (Melmark New England), James Luiselli (Melmark New England; William James College)|
|Abstract: This case study concerned clinical safety and behavioral-pharmacological intervention with an 18-year-old man who had autism spectrum disorder and high-frequency aggression towards care providers at a specialized school. A multicomponent behavior support plan included antecedent, differential reinforcement, environmental modification, and physical management procedures subsequently combined with neuroleptic medication (aripiprazole). The behavioral-pharmacological intervention eliminated care provider implementation of aggression-contingent physical restraint and was associated with increased transition compliance during the school day. Clinical safety components emphasized comprehensive care provider training, continuous supervision, function-based treatment, and prevention-focused strategies. Intervention effects were long-standing and care providers rated their training, implementation fidelity, and therapeutic outcome favorably.|
Interdisciplinary Review Team Approach for Medication Management With Individuals With Autism Spectrum Disorder
|FRANK L. BIRD (Melmark New England), Jill Harper (Melmark New England), Andrew Shlesinger (Melmark New England), James Luiselli (Melmark New England; William James College)|
The use of psychotropic drugs for individuals with developmental disabilities is common practice. Jobski, Hofer, Hoffman, and Bachmann (2016) documented an overall median use of psychotropic drugs in 45.7% of individuals with autism spectrum disorder (ASD). Wink et al., (2018) documented that psychotropic medication usage can be over 90% for youth with ASD admitted to inpatient units. A related concern is the number of psychotropic medications utilized at one time, referred to as polypharmacy (see Masnoon et al., 2017). The interdisciplinary review team (IRT) model was created to establish a continuum of medication management for individuals with complex needs. Core features of the model are multi-disciplinary team members, data-driven decision-making, and high-level administrative support. The objectives of each IRT meeting are: 1) state the current clinical status of the individual; 2) state current clinical needs; 3) foster team discussion; 4) advocate for medication change that maximizes benefit for the individual; 5) minimize multiple treatment changes at once; and 6) minimize risk associated with chosen treatments. Data will be presented across multiple individuals demonstrating the effectiveness of this approach in making clinically informed decisions regarding medication. Care providers, and family members rated the utility of this model favorably and implementation fidelity will be demonstrated.
Long-Term Effects of Behavioral Intervention and Electroconvulsive Therapy in a Man With Catatonia, Life-Threatening Self-Injury, and Autism
|Frank L. Bird (Melmark New England), RUCHI SHAH (Melmark New England), James Luiselli (Melmark New England; William James College)|
Catatonia is a psychiatric condition characterized by the presence of immobility, mutism, body posturing, stereotypy, and unresponsiveness to external stimulation, among other symptoms (American Psychiatric Association, 2013). Several population-based studies have reported catatonia in 12-20% of children, adolescents, and young adults with autism spectrum disorder (Luiselli, Bird, & Wachtel, 2021). A key diagnostic finding in many of these cases was the presence of motor stereotypy and self-injury in persons who went many years without such problems and co-occurred with loss of self-care, daily living, communication, social and other adaptive skills. This multi-phase case study evaluated treatment effects from behavioral intervention and electroconvulsive therapy (ECT) in a man with ASD and diagnosis of catatonia who displayed life-threatening self-injury towards care providers. Recommendation for ECT followed a protracted period of pronounced skill and behavior deterioration the man demonstrated in a residential care setting and subsequent to self-inflicted tissue damage that required hospitalization. Long-term outcome data will report the immediate and long-term effects from self-injury, aggression, the fading of protective equipment and activity engagement as well as parametric analysis of treatment responsiveness to a varied schedule of ECT sessions.
|Restrictive Procedures: An Organizational Approach to Monitoring and Reduction|
|SHAWN P. QUIGLEY (Melmark), Brad Stevenson (Melmark), Jill Harper (Melmark New England), Frank L. Bird (Melmark New England), Helena L. Maguire (Melmark New England)|
|Abstract: The application of behavior analysis varies by population (e.g., child, adult, employee), setting (e.g., community, clinic, home), and need (e.g., social skills, challenging behavior, safety). The differences in application create a context for differential application of behavioral principles, strategies, and technologies. For example, a safety application might involve behavioral skills training, performance rewards (e.g., enhanced pay for following safety practices), and utilization of technology to reduce risk (e.g., motorized lift as opposed to manual lift). Practitioners that serve individuals with complex behavioral challenges must also consider differential application of principles, strategies, and technologies to improve safety for the individuals, family members, and employees. Dependent upon local, regional, and governmental regulations, some applications might be considered restrictive, therefore requiring additional oversight. The purpose of this presentation is a brief review of restrictive procedures, examples of restrictive procedures, and an organizational approach to monitoring and reducing the need for restrictive procedures.|