Association for Behavior Analysis International

Shifting organizational practice to be more comprehensive, compassionate, and effective is a necessary undertaking that requires grit, determination, passion, and convincing data. The literature supporting the use of Practical Functional Analysis and Skills-Based Treatment (PFA/SBT) to treat severe problem behavior shows it can be effective and generalizable. Client Zero was the first client within our region and agency to access the efficacy of PFA/SBT. His outcomes sparked the initiatives which fundamentally shifted our organization and therefore our region. Client Zero began his treatment in October 2019 in his school placement and November 2019 in his home environment. The utilization of the SBT process opened pathways previously thought to be inaccessible to this client due to the severity and complexity of his behavioral profile. We will demonstrate the overall outcomes from his treatment plus maintenance and generalization data spanning 18 months across multiple contexts and people who support him. The demonstrated outcomes influenced agency-wide implementation as well as the consultation models utilized to support local school districts. This model of behavioral intervention has increased successful outcomes across a vast array of contexts and implementers in our region. Client Zero paved the way for this shift to occur regionally.

Maintaining client and staff safety when working with clients who exhibit severe problem behavior has remained a paramount concern in the field of Applied Behavior Analysis. Literature has identified that the Practical Functional Assessment and Skills Based Treatment (PFA/SBT) approaches are effective in significantly reducing rates of problem behavior. This presentation sought to evaluate the relative frequency of aggression toward staff, restraint, and isolation before and after implementing Skills Based Treatment on an organizational level where clinically indicated. A review of company-wide Critical Incident Report data was conducted to determine the frequency of these incidents during the year prior to the organizational shift to SBT, as well as in the year following the shift to SBT. The presenters hypothesized that there would be a considerable decrease in the frequency of aggression, restraint, and isolation following the implementation of SBT with clients exhibiting severe problem behaviors. Preliminary data analysis supported this hypothesis.

This case study will examine a client who's services began approximately one year into the organization implementation of Skills Based Treatment. Given the severity of his behavioral profile and his lack compliance with virtually all adult directions his program initially consisted of full sessions of Skills Based Treatment. However, the client continued to have frequent episodes of extended non-compliance and tantrums. During a session in which the client was completing an assessment it was observed that his behavior appeared be decreased when he had increased periods of structure. As such, it was hypothesized that increasing periods of structure would contribute to the client's ability to remain happy, relaxed and engaged. A shift was then made in his programming to intersperse structured activities with periods of Skills Based Treatment trials. In doing so, not only did progress improve for the Skills Based Treatment branches that were implemented, but there was also a significant decrease in problematic behaviors.