Association for Behavior Analysis International

Alcanzando is a not for profit organization that provides educational services based on the principles of applied behavior analysis to children with autism around the Spanish speaking world. This Symposium is meant to share the data from their services over the last 7 years.

This presentation will discuss the Ethical and Cultural considerations that should be in place when providing early intervention behavioral services to children with autism in various Spanish speaking countries.

Play and Social Skills are key necessary components to lead successful adult lives. This presentation will provide information regarding strategies that were found to be successful in teaching these skills to young children diagnosed in the Autism Spectrum in Peru.

In the age of the internet, organizations and business rely on a web presence for advertising. Companies post information on their websites including the type of services provided, the credentials of their owner and employees, and their contact information. Behavior analytic organizations are no different than any other business utilizing websites and social media websites (e.g., Facebook, Twitter, Instagram, blogs), in an effort to boost referrals. There is no harm in behavior analytic organizations and business in maintaining websites for advertising purposes unless the rights of consumers are violated with regards to confidentiality, disclosures, and a misrepresentation of practice. The Behavior Analysis Certification Board (BACB), the American Psychological Association (APA), and HIPPA all have codes of conduct and/or regulations for professional behavior; however, many behavior analytic websites are in violation of these codes. Crucial changes in social media content are required in order for the consumers of behavior analysis to be protected. This symposium reviews the regulation from the BACB, APA, & HIPPA related to confidentiality and social media. A review of behavior analytic websites is discussed with regards to ethical violations based on the BACBs Professional and Ethical Compliance Code for Behavior Analysis, followed by recommendations for avoiding future violations on behavior analytic websites.

It is essential for behavior analyst to understand the regulations that guide our profession and ethical practices with regards to social media including organizational and business websites, Facebook and Twitter accounts, and blogs. Many businesses and organizations use social media as a means to increase advertising for client referrals through the use of testimonials. A major concern with the use of testimonials is the lack of confidentiality related to testimonials. The Behavior Analysis Certification Board (BACB), the American Psychological Association (APA), and HIPPA all have codes of conduct and/or regulations for professional behavior. While many of the regulations are comparable, subtle variations across each exist. This presentation compares and contrasts the regulations of BACB, APA, and HIPPA regarding professional behavior and the use of social media, as well as examines our obligation to follow such codes of conduct. A review of confidentiality standards is included, particularly around the use of written and video testimonials on websites.

The Brain Injury Association of America has reported CDC estimates of 2.4 million Traumatic Brain Injuries (TBI) each year. Of those injuries 3-5% will result in chronic impairments of mood, function and cognition. ABA offers a significant addition to neurorehabilitation in terms of accountability, quantification and effectiveness. This panel will cover some of the more frequently encountered challenges and demonstrate the effectiveness of the behavioral approach within a multidisciplinary team. This panel will review effective treatment procedures and strategies that increase an individual's quality of life and reduce the burden for caregivers. The panelists will cover topics including: bowel and bladder training using an auditory cue vs. scheduled toileting, anger management utilizing massed practice of relaxation using cue card training, and timely intervention for adjustment problems including depression and anxiety that lead to improved participation and engagement in rehabilitation, which allow individuals to better accept their "new normal."

Programs prioritizing ?motivating Behavior Change? frequently fail to generate sustained engagement: over 80% of employees who attempt to create new, healthy behaviors still fail at continuing their training after just the first 30 days, and corporate lifestyle management programs return only $0.50 for every $1 invested (RAND, 2015). The CDC attributes 80% of chronic conditions to this inability to form successful wellbeing habits, resulting in almost $1 Trillion in lost productivity alone (CDC, 2009). The problem is not that people resist change, but they resist being changed. While health promotion can motivate employees to make episodic, temporary changes, when it comes to creating lasting results, learning the skill of creating new habits is what is vital for long-term Behavior Change. The reason: While motivation may get you started, habit keeps you going. Developed by licensed, clinical psychologists from Yale and the University of Washington, this session covers best practices in the design of sustainable Behavior Change systems that have led to the successful training of unconscious, daily habits, derived from more than eight years of clinical testing of evidence-based research from over 100 behavioral researchers. Habit Design has trained more than 500 companies and 100,000 employees - from UnitedHealthcare, Humana, Aetna, Kaiser Permanente, Stanford Medical School, Boeing, Google, The White House, and many others.

Rural behavior analysts face many issues. This panel will bring together three practitioner-researchers who are working within the scope of these issues. Panelists will present issues pertinent to ethical practice in small communities, reviewing telehealth and telepractice constraints, and issues related to remote supervision of behavior analysts, assistants, students, and RBTs.

The Behavior Analyst Certification Board (BACB) has recently announced a change in the ethical guidelines for credentialed behavior analysts. Specifically, a new enforceable compliance code (i.e., Professional and Ethical Compliance Code for Behavior Analysts) was developed and will take effect in January 2016. The new Code is intended to more clearly present ethical expectations and expand the range of professional conduct (BACB, 2014). Given the new Code and its intent for creation, it seems reasonable that the new Code would affect pre-service training of behavior analysts to ensure newly credentialed behavior analysts have the prerequisite skills to understand and follow the Code. The purpose of this symposium is to provide an overview of four different training programs and how each program is providing pre-service training specific to the new Code. Presenters are from varied training programs that provide training on campus, online, hybrid (online and on campus) and within community-based practicums.

The BACB's New Ethical and Professional Compliance Code for Behavior Analysts is the standard for the professional behavior of behavior analysts. It is also our compass- the main source for information about navigating ethical challenges and inculcating the values of the profession into students and trainees. Information on how this can be approached from a teaching/training perspective will be shared. In particular, strategies for teaching ethical decision-making will be described. Specific strategies for helping young professionals to adhere to the code and to reduce their risk of noncompliance will be discussed. The need for signal detection skills and resource management skills will be highlighted. In addition, considerations for the promotion of ethical behavior will be discussed at both the individual and organization levels.

Training programs for pre-service behavior analysts, and common arrangements of clinical practices, too often result in ABA being siloed from other disciplines. If we are to succeed with our mission of facilitating change globally, in all meaningful domains of our lives and environments, we must successfully integrate services and research with those in different fields. Behavior analysts might also have an ethical obligation to shed light on how we might design and re-design our "contextual fit" to meet our cultural standards. Presenters from multiple disciplines: academia, linguistics, special education, and neurology, will explore how they introduce ABA into new cultures, teach pre-service professionals to program for research and collaboration with non-behavioral providers, expand their own interdisciplinary relations, and are changed personally and professionally by the experience. Panelists will also discuss their research and efforts to integrate ABA with art therapy, ceremonial and cultural participation, and religious studies while giving consideration to scientific as well as ethical dimensions that define the field of behavior analysis. We invite professionals working in medicine, psychology, business, ecology, anthropology, religious and cultural studies, sociology, and more to share their challenges and strategies. How are you creating interdisciplinary connections, opportunities, and collaboration that strengthen relationships and result in behavior analysis being integrated in larger initiatives and with other fields?

Behavior analysts recognize the importance of incorporating motivation and reinforcement within service delivery. Additionally, behavior analytic treatment programs incorporate effective function based procedures to increase compliance with demands and decrease escape maintained challenging behavior. These procedures often include forced physical prompting and paced prompts that may increase the occurrence of challenging behavior or reduce acceptance of the procedures by caregivers and staff. This symposium explores potential ethical alternatives to traditional escape extinction using 7 Steps to Earning Instructional Control, wait-outs, and conditioning work as a reinforcer that address the problems behavior analysts face with traditional escape extinction procedures in discrete trial programming.

Behavior analytic intervention programs frequently include the use of forced prompting to earn compliance with demands and reduce escape maintained challenging behavior. This approach is effective but can result in an increase in challenging behavior if the challenging behavior is also maintained by attention or can be difficult to implement with clients who are larger in size. Additionally, caregivers and staff may not accept the use of forced prompting and may not implement the procedure during the naturally occurring routine, which also reduces the effectiveness of the procedure. The purpose of this presentation is to explore ethical considerations regarding the use of forced prompting by drawing from the BACB Guidelines for Responsible Conduct and Van Houten et al. (1988). Additionally, the presentation will explore how the 7 Steps to Earning Instructional Control addresses these ethical considerations and whether research in the basic or applied areas supports alternatives to forced prompting such as the 7 Steps as viable options for reducing escape maintained challenging behavior.

Escape-avoidance behavior is a common impediment to skill acquisition and a frequent maintaining variable for a variety of behavioral excesses. While a great number of antecedent interventions (e.g., demand fading, student choice, errorless teaching) can decrease problem behavior levels, escape- avoidance behaviors do not immediately drop to zero levels, and reactive measures invariably account for some part of the behavior intervention plan. Among potential reactive treatments, escape extinction has the greatest empirical support and is typically recommended. This presentation will demonstrate the efficacy of an alternative to escape extinction in 3 studies across 5 participants. In this procedure, task resistance is followed by a temporary withdrawal of that task and a substantial limit upon student options until the task has been completed. Though counter-intuitive (because escape-maintained behavior produces temporary escape), this procedure, colloquially known as a wait out, tends to not only decrease escape-maintained behavior, but also to improve a number of qualities of student participation. Participants will learn the rationales behind the use of wait and will see examples of how to implement the procedure.

Requests for the regulation of the practice of behavior analysis is ever increasing with the adoption of insurance coverage for ABA services. Developing licensure for practitioners of behavior analysis might be possible and could produce benefits for consumers as well as practitioners. In certain cases however, pursuing licensure can be a risky undertaking. This panel consists of individuals from three states in the US, that have recently adopted Licensure laws. Our panelists will describe the pitfalls and pivotal moments along the way. Finally, the panelists will discuss and suggest strategies that may be helpful for other states also seeking to regulate (or redefine) behavior analytic practices.

Behavior analysis has grown in popularity over the past 20 years, to the point of being a high-demand service in the area of autism and developmental disabilities. Our field has an ethical code that governs our professional behavior. However, there are an increasing number of incidents of behavior analysts behaving in ways that are in conflict with ethics and best practice. Section 7 of the BACB Professional and Ethical Compliance Code obligates behavior analysts to approach behaviorists who are drifting from our ethical code, in an attempt to rectify potentially unethical situations. The panel members will start this session by briefly describing some cases where behavior analysts were engaging in ethically questionable practices and how they were resolved. The bulk of this session will provide opportunities for dialog between the audience and panel members to discuss questions of practice by audience members, and strategies to resolve these potential ethical situations. Participants will be given decision-making strategies and role-play various scenarios to better prepare them for improving the behavior of behavior analysts who may be drifting from ethical practice.

In general, when we as Applied Behavior Analysts carry out behavioral interventions, we must look carefully to address or eliminate potential ethical concerns. When working with sexual behaviors in particular, potential ethical concerns abound, especially when those we work with have intellectual or developmental disabilities. There are also legal implications of which we must be cognizant when working in the delicate domain of sexual behavior. Using research and clinical case examples to illustrate their points, members of this panel will address some of the legal and ethical concerns and themes that commonly arise when clinicians are called upon to address issues related to sexual behavior in applied settings. Panelists will also discuss reasons why behaviors that are sexual in nature may warrant targeted behavior change efforts through empirically verified sex education curricula and behavior reduction programming, as well as situations in which it would be unethical to target such behaviors.

The funding and monitoring sources for behavior analysts have changed over the last five with the introduction of behavior analyst licensure and health care coverage for families affected by ASD. Additionally, the number of BACB certificants continues to grow nationally. Due to the high number of new BACB certificants, new licensing laws, and increased health-care funding sources for ABA treatment, behavior analysts must be responsive to pertinent field based ethical issues associated with the practice of behavior analysis in homes and communities. This discussion will introduce the topic of applied ethics as to identify the common ethical issues encountered by practicing proving home/communizing based ABA services. Furthermore, the discussion will address cross reference these identified ethical concerns with the BACB compliance code and behavior analysts licensing regulations across the country. Finally, the presenter will recommend the best course of action based on established case law when behavior analysts encounter these ethical dilemmas.

Effective January of 2016, the Professional and Ethical Compliance Code for Behavior Analysts (the Code) outlines the expectations of professional and ethical behavior for individuals practicing in the field of behavior analysis. Despite its intentions, behavior analysts are likely to encounter ethical dilemmas that may not be fully resolved with application of the Code. For example, based upon the Code, behavior analysts are obligated to tailor behavior-change programs to the uniquegoals of each client. However, with nonverbal adult patients there is a unique challenge in determining their goals. New, but similarly complex ethical dilemmas are likely to develop as a result of changes to the landscape of fee-for-service models. For example, accountable care organizations, which have been established under the auspices of the Affordable Care Act, employ a pay-for-performance reimbursement model that may compel behavior analysts to develop performance metrics for behavioral interventions. This talk explores ethical questions for behavior analysts that may challenge the Code and provides a breakdown of such questions from the perspective of an ethicist and a practicing behavior analyst.

BCSNA currently offers services based on Applied Behavior Analysis (ABA) principles including: skill acquisition for young children with ASD and other neurological disabilities and disorders, functional behavior assessments and analyses for individuals demonstrating challenging behavior, parent training, school consultation, supervision services, etc. One of the recent services requested of BCSNA by the state of Arizona (motivated by cost containment issues) includes a Placement Stability Package (PSP) to assess, treat/stabilize children and adults in their home settings prior to transferring them to an inpatient facility in another state. The PSP is a program where parent and care provider training is vital to keeping the individual stable and abate the need to send them out of state. As licensed Behavior Analysts in Arizona (under the Board of Psychological Examiners), BCBAs are held to both the APA and BACB ethical guidelines. Issues and challenges surrounding how services are provided to rural culturally and linguistically diverse minority health populations will be discussed.

Achieving the best outcomes for individuals with intellectual and developmental disabilities in adulthood begins with an early interdisciplinary teamwork including multiple types of activities related to transition. Practical and ethical considerations should include who should be involved, what skills should be taught, where these services should be offered, when they should be delivered, how services should be delivered, and why they should be taught. This symposium will address ethical considerations involving interagency collaboration across the lifespan, creating a balance in teaching academic, functional, and self-determination skills, the need to consider community settings and programming for generalization across settings, and how technology can facilitate skill acquisition across settings. There is a need for practitioners to consider these areas when working with children as they transition through various services with a mindful approach about factors related to adult outcomes including quality of life, sustainability of naturally occurring contingencies, resources allocated, and both individual and societal benefits. The symposium will present the various ethical considerations associated with selecting skills that are most relevant to long-term goals, precursory skills, and environmental factors related to the utilization of those skills.

There is increasing use of antecedent-based treatments in the treatment of pediatric feeding disorders, but limited reporting of systematic assessment of antecedent manipulations. In the current study, we developed an experimental assessment method to evaluate the effects of varied antecedent manipulations (e.g., changes to liquid or food properties) on acceptance or mealtime problem behaviour. Conditions showing the most improvement are matched to an individualized treatment protocol for each child. This study is conducted in family homes in New Zealand, with children that are dependent on some degree of tube feeding to meet their nutritional needs. Preliminary results from five participants have shown that this assessment may identify effective treatment protocols to increase oral nutrition in the absence of escape extinction.

Psychopharmacological and behavioral interventions are used to treat challenging behaviors in individuals with intellectual disability (ID), often in combination. However, little is known about the interaction between medication pharmacodynamics and behavior function. A better understanding of these mechanisms could serve as the conceptual foundation for combined interventions. We conducted extended functional analyses to assess the impact on behavior function of various dosages of primarily antipsychotic medications. We explored the relation between the changes in medication (i.e., new prescription, dosage change in an existing prescription) and problem behavior by conducted a very long series of functional analysis sessions. Four individuals with ID and challenging behavior who were also receiving psychotropic medications participated. Behavior function remain the same after a change in medication in 14 out of the 21 medication manipulations examined.

Evidence-based practice (EBP) is a multi-component process in which practitioners select, refine and deliver clinical services based on a) the best available scientific evidence, b) unique client and contextual features and c) ongoing clinical progress monitoring and decision making. Developed initially in medicine, EBP has been extended to the delivery of applied behavior analysis (ABA) services and is considered an essential feature of ethical and high quality (ABA) service delivery. This symposium reviews the defining features of EBP as applied to ABA service delivery and provides a synopsis of the challenges encountered in implementing the EBP process in ABA. This symposium will offer practical advice for ABA practitioners and supervisors who are interested in improving the quality and accountability of ABA and clinical behavior analysis service delivery. Additionally, it will offer guidance for instructors and researchers who are interested in the dissemination of ABA technology and quality assurance.

As Applied Behavior Analysis principles and procedures have been shown to be effective, many ABA practices have become standardized with non-individualized procedures. The idiosyncratic practices of some of these standardized programs' have eroded their ABA scientific foundations. These practices often ignore the research supported principles and application procedures of ABA creating possible ethical violations. This symposium will present examples of ABA practices which have possibly eroded and compromised the efficacy of ABA. We will also discuss the possible ethical implications of these trends.

Applied behavior analysis (ABA) has typically evaluated its outcomes using reliable and valid observational data of increases in adaptive behavior, decreases in maladaptive behavior, generalization, maintenance and social validity and more recently systematic reviews and meta-analysis. Despite the evidence for effectiveness, wide spread adoption, beyond adoption of simple contingency management has been scarce. Once important and neglected aspect of evidence-based practice is economic evaluation. This paper highlights opportunities for promoting ABA by demonstrating economic benefit of ABA.

Sometimes the best-intentioned practitioners implement ABA interventions that fail to produce behavior change of sufficient magnitude, generality and durability to resolve the presenting problem. This presentation will review the ethical obligation to incorporate clinical benchmarks and clinical progress monitoring in a manner that allows for early detection of treatment failures and shortcomings. It also reviews seven practical strategies for troubleshooting treatment failures.

The field of Applied Behavior Analysis continues to expand its reach to many around the world. With 41 non-US chapters, the Association for Behavior Analysis International illustrates the geographical reach of our science. The advent of technology has assisted professionals in connecting across vast distances which previously were impenetrable. With this international reach, many behavior analysis products, therapists and consultants find themselves working across significant distances and with colleagues, clients and customers who do not share the same cultural norms and life experience, often with people whom theyve never had the benefit meeting in-person. Providing applied behavior analytic service internationally is rewarding, yet challenges unique to cross-cultural service delivery often present themselves. Technology provides new opportunities for some countries whom quality ABA service and supports were previously unavailable. This panel presentation, includes professionals using technology to provide services in multiple countries across four continents. Learn about the challenges faced in providing quality and ethical services across multiple geographic regions through technology. Success stories achieved will be shared as well as challenges that continue to exist.

Adults and children with intellectual disabilities and problematic sexual behavior (IDPSB) can pose serious risks to themselves, as well as to others. While results from studies vary, the general consensus is that individuals with IDPSB are over-represented in the criminal justice system. In addition, specialized treatment options in the community are often limited. This symposium focuses on community-based treatment strategies designed to reduce problematic sexual behavior. The first study evaluates a multi-component residential treatment program for children who have engaged in sexually harmful behavior. The second and third presentations both provide case examples of longer-term treatment for adults with forensic involvement, and specific, individualized treatment strategies are presented. Challenges related to treatment provision in real world settings with this high risk population will be discussed. The importance of individualized treatment and probes to measure success were identified as critical factors in all three presentations.

A multi-component behavioral intervention (MCBI) was associated with a reduction in harmful sexual behaviour in children attending a residential program. The MCBI was comprised of a points and levels system, sex and relationships education, cognitive behaviour therapy, counselling and behavior contracts. Successful adherence to the program (e.g., safe and respectful behaviour, attendance in school, compliance with the therapy program etc.) earned the children access to high tariff activities and access to the internet and social media contingent on achieving the relevant level. Those who earned high level status attended college and work experience with staff support. Staff support was systematically faded out for those young people who graduated from the program. Inadvertent probes demonstrated that harmful sexual behaviour relapsed in a number of children.

Human Development Center (HDC), inc., is a non-profit organization that provides behavior analytic treatment to consumers with intellectual disabilities in a variety of community-based settings. HDC specializes in assessing and treating behaviors that interfere with the consumers ability to live successfully and safely in the community. Assessment involves extensive reviews of records and data on target and replacement behaviors, along with ongoing interviews, observations, and probes. The treatment approach includes the design and implementation of individualized behavior plans with skill programs designed to increase pro-social behaviors and decrease challenging behaviors, and an emphasis on teaching societal rules for sexual behavior, increasing appropriate avoidance behaviors and strengthening coping skills. Behavior analysts work closely with each consumer to develop a rapport and build a collaborative relationship in order to help each person achieve his identified goals. Ongoing assessment, twenty-four support, open communication, probes and data-based program changes along the way are designed to contribute to success. While highlighting one individuals successful journey from intensive residential supports to his own home, this presentation will provide a customized overview of a treatment package for an individual with forensic involvement as a result of sexual offending behavior.

Ethical considerations require that all interventions include plans to fade out treatment once intermediate goals are achieved. This is particularly challenging when the target behaviors are related to problematic sexual behavior or illegal practices. Our agency provides services to adult males diagnosed with intellectual disabilities with forensic involvement, including registered sexual offenders, predators, or consumers that have been referred to residential treatment as part of their parole agreement. A summary of assessment, long term individualized interventions and results for an individual with a substance abuse history and forensic involvement as a result of sexual offending behavior will be presented. Specific instruction will be provided regarding using consequence avoidance strategies to help treat behaviors that occur or are observed less frequently, and how to conduct probes to evaluate the use of skills in situ. This individual was able to successfully transition from intensive residential habilitation to supported living, maintain success while living independently, and achieve major life goals, such as getting married.

A conceptual analysis of punishment will be presented. A brief history of the word punishment (both in vernacular usage, and in clinical usage) is presented. Writings from B.F. Skinner, Jack Michael and Murray Sidman are reviewed, summarized, and compared. Given the significant departure that these writings take from traditional descriptions of the effects of punishment on behavior, two competing analyses of punishment are presented. These two analyses, punishment as a direct procedure and punishment as an indirect procedure, are explained and directly compared. Data from previously published studies supporting both conclusions will be presented and analyzed. In addition, the effects of reinforcement and motivating operations on punishment and learning are explored. Finally, recommendations are made to refine how aversive control procedures are conceptualized, researched, trained, and implemented. Recommendations are made regarding how behavior analysts talk about punishment, how they describe procedures, and how to better understand a seemingly simple, yet ultimately complex phenomenon.

The use of aversive consequences has resulted in several instances of questionable ethical behavior that has severely affected the field of applied behavior analysis throughout its relatively short history. This component of the symposium will provide a review of the role of behavioral principles in the implementation of punishment procedures in the development and perpetuation of unethical and abusive behavior demonstrated by clinicians and staff in programs such as Willowbrook, Sunland Developmental Center, Behavior Modification Units in prison settings, etc.. Survey data provided by Behavior Analysts on abuse investigations, conclusions, and recommendations will be presented with the purpose of validating or invalidating the purported commonalities among the conditions present at the programs reviewed above. Recommendations and considerations will be provided on how to better prevent such missteps from occurring in the future. It is imperative to remember the past ethical issues in order to progress as a field and not repeat history.

On a gradient, the majority of individuals consider themselves to be sexual beings. Individuals with developmental disabilities are no exception. Socio-sexual behavior includes responses characteristic of sexual acts as well as social behaviors associated with gender identity, romantic relationships and perspective taking. As behavior analysts, we are well aware of the power of behavior analytic principles on the shaping of behavior. Through behavior analysis we can increase socially significant behavior to address behavioral deficits while decreasing behavioral excesses that lead to social and developmental problems. Although they are potentially sensitive, target behaviors included within the realm of sexuality should be no exception. In this presentation, the author will discuss common issues encountered when behavior analysts target socio-sexual behaviors with individuals diagnosed on the autism spectrum. Topics covered will include practical issues such as where and when to provide instruction; professional issues such as how to assess behavioral needs and select behavior analytic teaching techniques; ethical issues such as how to effectively work alongside guardians while respecting the desires of the individual; and legal issues such as consent laws. Issues will be discussed through a review of the literature along with experience gained through real life case studies.

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.

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.

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.