|Current Evidence for the Efficacy of Synthesized Contingencies in Assessment and Treatment|
|Sunday, September 29, 2019|
|11:30 AM–12:20 PM |
|Stockholm Waterfront Congress Centre, Level 6, A3/A4|
|Area: DDA/AUT; Domain: Applied Research|
|Chair: John E. Staubitz (Vanderbilt University Medical Center, TRIAD)|
|CE Instructor: John E. Staubitz, M.Ed.|
Five years ago, Hanley and colleagues (2014) introduced the Interview-Informed Synthesized Contingency Analysis (IISCA) and the accompanying skill-based treatment (SBT) process as a means to improve the efficiency, safety, and social validity of the functional assessment and treatment of severe problem behavior. Since then, a number of applications of IISCA and SBT have been published as demonstrations of a practical functional assessment process. This symposium includes a review of the literature in which state-of-the-art methods for evaluating single case research were applied to evaluate the evidence base for IISCA and SBT for reducing problem behavior and supporting skill acquisition. The symposium also includes two consecutive case series in which the efficacy of variations on the IISCA and SBT approach were evaluated. Specifically, the focus of one case series was an application of the IISCA in which 3-minute sessions were used and total analysis time to inform treatment was as little as 15 minutes. In the second case series, experimenters evaluated the efficacy of SBT in the absence of physical intervention and in the context of an enhanced choice model intended to mitigate the collateral effects of extinction.
|Instruction Level: Intermediate|
|Keyword(s): functional assessment, IISCA, skill-based treatment, synthesized contingencies|
|Target Audience: |
Researchers, practicing behavior analysts and graduate students
A Systematic Review and Meta-Analysis of the IISCA and FCT-TT
|BØRGE STRØMGREN (Oslo Metropolitan University), Oda Vister (Oslo Metropolitan University), Sigmund Eldevik (Oslo Metropolitan University)|
Functional analyses (FAs) are frequently being used in treatment of problem behavior. Thus, there is a need to review whether FAs represent an evidence-based practice and should be recommended. We performed a systematic review of a special application of FA, the Interview-Informed Synthesized Contingency Analysis (IISCA) resulting with Functional Communication Training and Tolerance Training (FCT-TT). A systematic search strategy was performed in relevant data bases for those peer-reviewed articles published between 2014 and 2018 in English or a Scandinavian language, employing a single-case experimental design in which treatment was a combination of IISCA and FCT-TT, the dependent variable was problem behavior, and a line-graph showing results was included. Studies were appraised and results were synthesized through the following methods: Descriptives, methodological quality and evidence base, were assessed. The synthesis included extracting the BC-SMC effect size (equal to Cohen’s d), and Meta-Analysis yielding a combined effect size and forest plot. The methodological quality was low across studies, so IISCA/FCT-TT cannot yet be regarded as an evidence-based practice. The combined ES was -2.82 (95 % CI: -6.98–1.34), (PI: -10.16–4.52). The results were quite heterogenous (I2 = .95), leaving the meta-analysis results largely uninterpretable.
|Improving Analytic Efficiency: A Consecutive Case Series Evaluation of a Practical Functional Assessment Model|
|JOSHUA JESSEL (Queens College), Sophia Ma (Queens College), Debra Rosenthal (Queens College), Alisa Dean-McCabe (Queens College), Andrew Ng (Queens College)|
|Abstract: The functional analysis is an empirically validated tool used to identify environmental variables contributing to problem behavior to improve treatment outcomes. Unfortunately, clinicians overwhelmingly report the sparse use of the functional analysis because of time constraints and safety concerns. The interview-informed synthesized contingency analysis (IISCA) was developed in 2014 as a practical functional assessment model with the intention of addressing the reported concerns from clinicians. We conducted this study with, currently, four consecutive cases of individuals diagnosed with autism who were admitted to our clinic for their severe problem behavior. The IISCA was conducted with each participant using 3-min sessions to determine if the entire analysis could be as brief as 15 min. All IISCAs were differentiated and successfully informed the subsequent skill-based treatments that eliminated problem behavior. These results suggest that analytic efficiency can be improved by using the practical functional assessment model with sessions as brief as 3 min.|
A Replication of the Enhanced-Choice Model of Skill-Based Treatment Within a Public School Setting
|JOHANNA STAUBITZ (Vanderbilt University), John E. Staubitz (Vanderbilt University Medical Center, TRIAD), Michelle Hopton (Vanderbilt University Medical Center- TRIAD), Marney Squires Pollack (Vanderbilt University), Rachel Haws (Vanderbilt University), Caroline Goerke (Vanderbilt University)|
Skill-Based Treatment (SBT) uses synthesized contingencies to teach alternative responses that will compete with problem behavior (Hanley et al., 2014). When manual guidance is prohibited, unsafe, or non-preferred by caregivers, the Enhanced Choice Model of SBT (ECM-SBT; Rajaraman et al., 2018) may be employed to mitigate collateral effects of extinction. Within ECM-SBT, trained responses (e.g., functional communicative responses [FCR]) and two additional alternatives to problem behavior operate concurrently. These two alternatives include (a) entering a ‘hangout’ area, in which evocative conditions are suspended and the client may access all preferred items and activities as well as low-quality attention from the therapist and (b) leaving the session entirely. We replicated ECM-SBT procedures with three elementary students in a public special day school for children who engage in severe and persistent problem behavior, in which manual guidance by non-district personnel was prohibited. We present procedures, including methodological deviations from the Rajaraman study, results of Interview-informed Synthesized Contingency Analyses, SBT, and generalization protocols, as well as client response allocation among alternatives within the ECM-SBT model.