|Extreme Makeover: The Sustained Outplacement of a Chronically Institutionalized Individual—What Is Making It Work?
|Monday, May 31, 2010
|9:00 AM–10:20 AM
|Area: AUT; Domain: Service Delivery
|Chair: Deena Holmes (ASAP-Autism and Support Programs)
|Discussant: Catherine A. Demis Gill (Behavioral Consulting, Inc.)
|CE Instructor: Catherine Demis Gill, M.A.
|Abstract: This presentation will focus on the necessary components in providing effective treatment in a community based setting for individuals who have been previously institutionalized. This clinical case study will provide an overview of a nineteen year old man diagnosed with autism who has been institutionalized since the age of ten due to severe and chronic self-injury. Safety had only previously been maintained by the use of habituated mechanical restraint which greatly limits his range of motion and hence his ability to engage in meaningful activities. Procedures that have effectively lowered maladaptive behaviors combine a number of interventions including functional communication training, DRO and limiting use of physical restraint while fading the highly desired and sought after mechanical restraint. In addition, components affecting successful treatment in group home settings will be discussed. These will include values, philosophy, treatment fidelity, coordination of services and durability of trouble shooting. Data indicate a decrease of self-injurious behavior with a simultaneous increase of time free of mechanical restraint. The development of reinforcement assessment methods and rationale for the use of that method may reduce future use of mechanical restraints will aslo be presented. Additional data will be collected and presented.
|A Mother's Eye: A Review of the Social Validity of Programming Across the Years
|JUDY CLARK (ASAP-Autism and Support Programs), Catherine A. Demis Gill (Behavioral Consulting, Inc.), Ruth M. Hurst (University of North Carolina, Wilmington)
|Abstract: This presentation is important because the social validation of programs used by behavior analysts is rarely formally assessed. The parent will provide an overview of her reactions to the types of programs that have been used over the years for a nineteen year old young man with mental retardation and autism who engages in severe self injurious behavior and aggression. This discussion will encompass programs used during and after institutional placement. The parent’s perspective on behavioral program content and effectiveness will be discussed in light of family values and long term goals for the client. There will be a particular emphasis on the severity of the problem behaviors emitted by the young man and the high degree of restrictiveness (continual mechanical restraint) of programming procedures that he has undergone over the last eight years. The effects of this client’s behavior and programs on the emotional health and wellbeing of the client’s family will be shared. The parent will provide summary statements about the degree of social validity perceived to be present in his behavioral programming over the course of treatment.
|A Behavioral Package for a Recently Deinstitutionalized Man With Autism for the Treatment of Self-Injurious Behavior
|CATHERINE A. DEMIS GILL (Behavioral Consulting, Inc.), Ruth M. Hurst (University of North Carolina, Wilmington), Deena Holmes (ASAP-Autism and Support Programs), Chris Mitchell (ASAP-Autism and Support Programs), Emily L. Baxter (University of North Carolina, Wilmington), Janeal Guy (ASAP-Autism and Support Programs)
|Abstract: This clinical case study will provide an overview of a 19-year-old man diagnosed with autism who was institutionalized between ages 10 and 18 due to severe, chronic self-injury and who now requires continual mechanical restraint for protection from self-injurious behavior (SIB). The focus of this presentation will be on behavioral programming since deinstitutionalization. The use of restraint was begun at the institution following an episode of high rate SIB which resulted in severe and multiple hematomas to the face and head. Following this episode, safety began to be maintained by the continual use of mechanical restraint which not only limited his range of motion but also limited his ability to engage in meaningful activities. Further, less severe forms of SIB continued to occur even when restrained. The restraint became a highly valued and sought after stimulus and remains so. In the client’s new setting, continual restraint persists. However, a combination of functional communication training, schedules, schedules of reinforcement for appropriate behavior and DRO have effectively lowered the rate of self-injurious behavior, and these data will be presented. Data to be collected will demonstrate the continued effects of this behavioral package and modifications to it, including possible fading of restraint.
|Restraint Versus Reese’s: Strengthening Reinforcer Assessment by Assessing response strength
|EMILY L. BAXTER (University of North Carolina, Wilmington), Ruth M. Hurst (University of North Carolina, Wilmington)
|Abstract: This talk will provide the rationale for development of a new reinforcer assessment method and its relevance to a 19-year-old deinstitutionalized male with mental retardation and autism who engages in self injurious behavior (SIB) managed with constantly worn mechanical restraint. The development of this assessment may be particularly important in general and helpful in this case where there is a long standing history of severe SIB accompanied by an apparent high preference for restraint and a historic use of restraint contingent on SIB. The assessment is being designed so that it will include procedures compatible with those used in the assessment of behavioral momentum. This will include assessing reinforcer preference and choice under schedules of reinforcement as well as behavioral strength under behavioral challenges such as extinction and satiation. The proposed assessment methods will be presented and discussed with special attention to how they may be implemented and useful in cases such as the one described above. Hypothetical outcomes will also be discussed along with how they might influence programming decisions that could lead to a reduction in restraint use.