|
| Optimizing Applied Behavior Analysis Services |
| Monday, May 26, 2008 |
| 10:30 AM–11:50 AM |
| Boulevard A |
| Area: CBM/CSE; Domain: Service Delivery |
| Chair: Ralph L. Olson (Pathways Community Mental Health) |
| CE Instructor: Ralph L. Olson, Ph.D. |
| Abstract: This symposium describes a rural, four-county, community mental health authoritys efforts to expand and upgrade its applied behavior analysis services in the context of clinical, administrative, financial, and geographic challenges. The agencys baseline situation is discussed with respect to each of these issues. Key data-based indicators related to clinical practice, staff training costs, and general and consumer-specific levels of physical intervention use are presented. The goals, structure, and various benefits of a significant reorganization resulting in a team-based agency solution are presented. Several major challenges and their unique solutions at the system and clinical practice level are discussed in detail. The objective achievements of the new model are compared to baseline indicators, several additional practical lessons and continuing challenges are highlighted, and future directions are discussed. The overall agency experience offers a model for organizing and delivering more efficient and effective applied behavior analysis services that is supported by some outcome data, while also identifying persistent issues and the need for continued development. |
| |
| There’s Got to Be a Better Way: One Agency’s Self-Assessment of Applied Behavior Analysis Services. |
| RALPH L. OLSON (Pathways Community Mental Health), Louis A. Bersine (Pathways Community Mental Health), Jeffrey C. Brittain (Pathways Community Mental Health), Denise Clark (Pathways Community Mental Health), Laurel R. Kniskern (Pathways Community Mental Health) |
| Abstract: In the authors’ experience, many public mental health agencies are organized to include to varying extents, but not fully realize the benefits of applied behavior analysis services. Rural settings create unique challenges posed by geography and limited staffing, compounding typical public-sector problems related to finances and administrative complexities. Pathways Community Mental Health’s baseline situation relative to clinical and administrative indicators is outlined. The agency’s uncommonly large service area and traditional community mental health center approach to applied behavioral services created multiple challenges which are discussed in detail. Particular attention is devoted to key administrative and clinical practice data which is referenced in subsequent presentations. This presentation, in our experience and opinion, summarizes common dilemmas associated with providing applied behavior analysis services within rural public mental health agencies. |
| |
| Pathways’ Behavioral Psychology Services: Conceptual Foundations and Practical Implementation. |
| LOUIS A. BERSINE (Pathways Community Mental Health), Ralph L. Olson (Pathways Community Mental Health), Jeffrey C. Brittain (Pathways Community Mental Health), Denise Clark (Pathways Community Mental Health), Laurel R. Kniskern (Pathways Community Mental Health) |
| Abstract: Based on an evaluation of the agency situation depicted in the opening presentation, Pathways created a Behavioral Psychology Services (BSP) program, an effort that required comprehensive clinical and administrative reorganization. The clinical core of this program involves a team which includes behavior analysts, psychologists (working toward board certification), paraprofessional staff, and clinical case managers assigned to the team. The BPS team provides applied behavioral services agency-wide under centralized and significantly streamlined administrative leadership. The BSP’s major conceptual goals aimed at clinical, financial, and risk management are discussed in connection with specific problems identified during the agency’s self-evaluation. The range of typical team activities and the practice-level implementation of these goals are presented in detail. This presentation describes a practical agency approach to significantly increasing the efficiency and potency of applied behavior analysis services. |
| |
| Collaborative Problem Solving at the Practice and Systems Levels – Building a Training Wheel. |
| DENISE CLARK (Pathways Community Mental Health), Ralph L. Olson (Pathways Community Mental Health), Louis A. Bersine (Pathways Community Mental Health), Jeffrey C. Brittain (Pathways Community Mental Health), Laurel R. Kniskern (Pathways Community Mental Health) |
| Abstract: Early on in the implementation of the Behavioral Psychology Services (BPS) program, several key problems were encountered which required creativity and collaboration. At a systems level, Pathways recognized the need to ensure consistency, quality, and cost savings for its contract agency employees receiving Professional Crisis Management (PCM) training. PCM training provides direct care staff with detailed, competency-based instruction related to understanding, preventing, and responding to serious aggression and self-injury. PCM training, selected for its applied behavior analysis conceptual base and many additional features, represented an important direct care staff training segment. This training, however, was practically and financially ponderous for small contractor agencies to provide independently. A collaborative training model and its clinical and economical benefits were developed to address this. At the practice level, implementing the BPS program involved several shifts in communication, team work, and service delivery, particularly related to direct care staff training. The collaborative training model and specific practice strategies offer readily generalizable examples of service delivery problem solving. |
| |
| Several Years Into the Adventure: Progress, Perspective and Prognosis. |
| JEFFREY C. BRITTAIN (Pathways Community Mental Health), Ralph L. Olson (Pathways Community Mental Health), Louis A. Bersine (Pathways Community Mental Health), Denise Clark (Pathways Community Mental Health), Laurel R. Kniskern (Pathways Community Mental Health) |
| Abstract: In the final presentation of this symposium, the authors present current Behavioral Psychology Service (BPS) program data in comparison to baseline data detailed in the initial presentation. These data describe BPS clinician caseloads, on-site clinician presence, serious behavior episodes, costs and numbers of placements in state facilities, and comparisons of organizational structure. As a result of implementing the BPS program, caseloads and geographic challenges are more manageable and clinician contacts in direct care settings have become more regular and frequent. Serious behavior episode data are encouraging and state facility placements/costs dramatically reduced. Beyond the encouraging data-based picture, a number of more subjective, but equally important, observations and insights have been accumulated. Thoughts on the BPS implementation process, strategies for providing the most effective services home-by-home, staffing and management variables that impact effectiveness, additional direct care staff training needs, pursuing behavior analyst board certification while on the job are discussed. Considered from empirical and qualitative perspectives, the BPS program has produced compelling conceptual and practical benefits and represents an important example of improving applied behavior analysis service delivery. |
|
| |