BEH 5049 Unit 9 Slides

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Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 1 BEH 5049 Unit 9 Interdisciplinary Assessment and Treatment of Problem Behavior: Working With Other Health Professionals Iser G. DeLeon, Ph.D., BCBA-D 1 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 2 Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior B. Working With Medical Professionals C. Working With Speech, Hearing, and Language Professionals D. Working With Occupational Therapists E. Summary Comments on Collaborating on Problem Behavior 3 Section Outline A. Introductory Comments on Working With Non-Behavior Analysis Professionals on Problem Behavior 1. BA and Interdisciplinary Settings 2. Range of Interdisciplinary Efforts in ASD 3. BACB Ethics Code on Collaboration and its Practical Implications 4 Tasks q H-9: Collaborate with others who support and/or provide services to clients. q H-8: Make data-based decisions about the need for ongoing services. (BACB ® , 2017) 5 Objective q Interdisciplinary setting a. Define b. Identify examples and non- examples 6

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 2 Interdisciplinary Settings q Professionals representing “multiple disciplines collaborate to improve outcomes of individuals” (Brodhead, 2015, p. 70). q Current focus = interdisciplinary collaborations most relevant to assessment and treatment of PBx 7 BA & Interdisciplinary Settings q Behavior analysts often work as part of an interdisciplinary team, sometimes converging upon the same behavior targets q Different team members may prescribe different intervention elements for a client q Ideally, all team members are aware of every intervention and how interventions may potentially interact 8 ASR ❑ Define an ”interdisciplinary setting”: 9 ASR ❑ Yuri is a BCBA ® who works in an interdisciplinary setting. When talking with an occupational therapist, Yuri is provided several OT interventions. It is important that Yuri review these interventions to determine how they may interact with his own proposed interventions. a. True b. False 10 ASR q Which of the following is an example of a behavior analyst working in an interdisciplinary setting? a. Allison meets with the team at the gymnasium where her client takes classes. She reviews with them the new intervention for self-injurious behavior and ensures they can implement the plan accurately b. Axel is working with children with severe eating disorders. He hosts a group meeting monthly with the parents of his clients to discuss challenges that they face and to provide general recommendations and support for the families ( ASR continues next slide ) 11 ASR (continued) a. Amanda works as a BCBA in a pediatric hospital setting. She meets with the OT to review assessment results for a client with significant eating difficulties. Together the OT and Amanda determine appropriate goals for the client to improve chewing and swallowing and increase the variety of foods accepted b. Austin is a BCBA who supervises six RBTs. He meets with them monthly as a group to review research articles and discuss client applications of the procedures in the research articles 12

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 3 Benefits of Collaboration q Effective interdisciplinary planning promotes: § Frequent updates of progress across professionals § Joint problem-solving § Collective progress evaluation (LaFrance et al., 2019) 13 Benefits of Collaboration (continued) q “[Enhanced outcomes] can be achieved with a foundation of shared ethics and mission, combined with a respect for the unique expertise each discipline offers” (LaFrance et al., 2019, p. 710). 14 Primary Areas of Professional Emphasis (BACB, n.d.) 15 (Green et al., 2006, p. 76) Number of Concurrent Treatments for ASD 16 Common ASD Treatments: ABA Behavior analysis • 5 of top 25 (Green et al., 2006, p. 76) 17 Common ASD Treatments: Pharmacological and Dietary Pharmacotherapy Biological therapy Dietary interventions • 12 of top 25 • 35 other medications (clonidine, Prozac, etc.) listed in top 108 (Green et al., 2006, p. 76) 18

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 4 Common ASD Treatments: Speech and Language Speech & language • 3 of top 25 (Green et al., 2006, p. 76) 19 Common ASD Treatments: Occupational Therapy Occupational therapy • 2 of top 25 (Green et al., 2006, p. 76) 20 Common ASD Treatments q 21 of 25 most common treatments come from: § Applied behavior analysis § Medication; supplements; diet § Speech and language pathology § Occupational therapy (Green et al., 2006) 21 ASR ❑ Which of the following disciplines were identified as providing the most common ASD treatments? ❑ Occupational therapy ❑ Applied behavior analysis ❑ Speech and language pathology ❑ Chiropractic ❑ Medication, supplements, and diet 22 ASR ❑ Treatments for ASD are most commonly used: a. In isolation b. In combination with other treatments 23 Objective q Given a scenario, identify the best course of action for a behavior analyst to take when collaborating with other professionals 24

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 5 BACB Ethics of Collaboration q What are BACB ethical obligations concerning interdisciplinary collaboration? q What are practical implications? § Putting ethics into practice 25 BACB Ethics Standard 2.10 q Collaborating with Colleagues § Prioritize the best interests of the client § Compromise when possible, but prioritize the client’s welfare (BACB, 2020) 26 BACB Ethics Standard 3.01 q Responsibility to Clients § Support client rights § Do no harm § Act in their best interest (BACB, 2020) 27 Practical Implications of Supporting Client’s Interests q Prioritizing the client’s best interest can mean: § Demonstrate respect for the knowledge and skills that others bring to a case § Gain an understanding of nonbehavioral interventions § Offer your expertise in systematically evaluating interventions (sometimes unproven) promoted by other professionals 28 ASR ❑ Which of the following statements are true regarding the BACB ethics code and interdisciplinary settings? ❑ ABA should always be placed first as a potential treatment ❑ We do not coerce people to use the treatment we select ❑ We have an obligation to support the client’s best interests ❑ One of our main priorities should be to disprove nonbehavioral approaches 29 Collaboration Example: Lerman at al. (2008) q “Appraisal could be extended to an experimental analysis when caregivers are not dissuaded from employing unproven therapies. A behavior analyst could offer his or her expertise in the measurement and analysis of behavior to help evaluate therapeutic outcomes” (p. 50). 30

Rev 07/18/23 CMV Copyright © ABA Technologies, Inc. 2021 BEH 5049 Unit 9 Slides p. 6 Unproven Therapy Example in Lerman et al. (2008) q Hyperbaric oxygen therapy (HBOT): Inhalation of concentrated oxygen inside pressurized chamber q Promotes dissolution of oxygen into the blood; enhancing reparation of damaged tissue q Relevance to ASD: “by reversing neurological abnormalities that might be associated with this disorder” thereby proving effects “beneficial for children with autism” (p. 51) “ HyperBaric Oxygen Therapy Chamber 2008.jpg ”, by James Heilman, MD , CC BY-SA 3.0 31 Evaluation Example in Lerman et al. (2008) q Evaluated task engagement and problem behavior during 10-minute instructional sessions at a therapy center: § Baseline: Before HBOT intervention § During HBOT: 60-minute HBOT sessions on the same day § Post-HBOT: After termination of HBOT intervention 32 Data From Lerman et al. (2008) (p. 55) 33 Lerman et al. (2008) Conclusions q HBOT provided little benefit, if any q Helped inform caregivers to make an informed decision regarding treatments q Demonstrates a model to evaluate interventions proposed by other disciplines 34 ASR q The Lerman et al. (2008) study evaluated the effectiveness of HBOT by measuring task _____ and problem behavior, across individuals with _____ start dates, through a _____ _____ design. 35 ASR ❑ The Lerman et al. (2008) study explicitly set out to disprove HBOT effectiveness because it could potentially be dangerous for individuals who receive it. a. True b. False 36

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