Behavioral Assessments Module 5

What is evidence based practice?

The process of conscientious, explicit, judicious use of current best evidence based decision about the care of the individuals.

• This does not account for client values or practitioner’s professional background when making treatment decisions.

What was Stauss, Glaszious, RIchardson, and Haynes' elaboration of evidence-based medicine?

That it requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.

What does the three-legged stool analogy signify?

Evidence, expertise, and client context

What is self-determination?

The ability of a person to consider options and make appropriate choices regarding residential life, work, and leisure time.

Why should we teach self-determination skills?

Quality of life, everyone can choose, essential for positive long-term outcomes.

What are three areas for determining if there should be less choice or more choice?

Source of input, degree of risk, degree to which input is binding.

How can you identify a client’s potential for making safe choices?

Interviewing others, client interviews and responses, direct observations

How do we provide just enough prompting to get appropriate choices?

1. Identify the choice situation

2. Provide any restrictions that must be accounted for in their choice.

3. Provide time for them to make the choice, if not choice is made, provide an unrestrictive prompt

4. Provide additional time to make the choice, if not choice is made, provide a restrictive prompt.

5. Provide additional time to make the choice. If no choice is made, make the choice on their behalf.

6. If the choice made results in a high-risk situation, negate the choice and provide restrictions.

What is counter control?

Behavior that occurs in order to escape aversive control contingencies placed by others.

What types of things do we have control over when we work with our clients?

• Goals

• Settings

• Schedules

• Access to reinforcement

• Others

What is habilitation?

Teaching the skills necessary for clients to live as independently as possible.

What was Wyatt V. Stickney (1971, 1972, 1975)?

n 1970, Alabama decided to cut its cigarette tax, but that tax was earmarked to support the state’s mental health services.

• One mental health hospital, Bryce State, laid off over 100 staff members because of the cuts, including 20 of their psychologists,

• This left a 1:1,700 ratio of psychiatrists to clients.

• Caused a massive decrease in the quality of services, prompted a lawsuit, filed on behalf of 15-year-old Ricky Wyatt as the primary plaintiff.

What were the three goals of Wyatt v. Stickney?

Establish a right to treatment Establish a right to habilitation Set a minimum standards for safety, education, training, medication, nutrition, ratios, and individual treatment.

What were the results of Wyatt v. Stickney?

35 standards of adequate treatment required for institutions Standards for sterilization and electroshock in Alabama Several community-based developmental service centers, advocacy programs,, as well as the closure of problematic centers Fair housing act Included consumers at all levels of development and longest running mental health lawsuit dismissed in 2003, 33 years later.

What are the arguments against a client's right to choose?

May make bad choices Might fail May not engage in skills often enough to sustain skills for living. May not acquire skills necessary to live independently.

What is informed consent?

Giving explicit permission before any assessment or treatment takes place.

• Must have the capacity to decide, have the ability to make choices and ability to make decisions

Capacity is a legal determination, in the absence of one, how can you obtain consent?

Surrogate consent: typically close family members or friends but cannot override active refusals for client Guardian consent: court- appointed legal custodian, laws very state by state.

What are clinician co-requisites for empowering clients?

Time, collaboration skills, adaptability,

What is social validity?

Clinicians must determine the acceptability of the services they provide.

• Are the goals important to the client?

• Are they happy with the procedures?

• Are they happy with the outcome?

How can you create situations where clients are happy, relaxed, and engaged (HRE)?

A client who is happy, relaxed, and engaged is more likely to be contacting adequate reinforcement for the activities they are engaging with, have paired appropriately with staff members, and otherwise are open  to learning.

What are some discussion to have with clients or caregivers to ensure HRE?

Topography, tangibles, social, environment, communication, cessation

How can you assess risk?

Nature of the behavior Are staff appropriately trained? Is the setting appropriate for treatment? Is the BCBA experienced? Is there risk to others? Is there buy-in? Is there liability to the BCBA?

How can you assess benefits?

Direct benefits to client Indirect benefits to setting  Benefits to caregivers and other professionals Benefits to peers Decreases to liability Benefits to the BCBA Benefits to field and consumer relations

Behavior analysts are more likely to breach confidentiality when they have what?

A history of breaching it in small ways.

How can you assess efficacious contexts ? (Fawcett)

Gather samples of goals, procedures, and outcomes Select consumer judges for acceptability Decide dimensions and develop rating scale Provide unbiased instructions and ensure confidentiality.

What were the takeaways from Self Determination for Persons with Disabilities (Schloss)?

Special education graduates often fail to make successful transitions to adult life Many remain underemployed due to a lack of decision-making skills. Developed decision-making model