Towards a Practical Functional Assessment and Skill-Based Treatment Process Addressing Severe Problem Behavior- Part 2

Mahshid Ghaemmaghami Author

04/13/2022 Added

13 Plays

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Conference 2022

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[00:00:00.100]Obsessed with coffee and Starbucks.
[00:00:02.900]You might go to Starbucks.
[00:00:05.160]Some signals are there, right?
[00:00:06.710]So whether the Starbucks is open or closed,
[00:00:09.601]that one's pretty clear.
[00:00:10.640]But even if it's open,
[00:00:11.620]you might walk in,
[00:00:13.230]and even though you go to that Starbucks every day
[00:00:16.270]at that particular time,
[00:00:17.620]today, you walk in, and seven teenagers,
[00:00:20.400]because apparently kids now go to Starbucks,
[00:00:23.420]walked in before you, and they're in line.
[00:00:26.110]And you can't go straight to the barista
[00:00:29.340]and get your coffee,
[00:00:30.460]and you need to tolerate that.
[00:00:32.140]And they're taking their time
[00:00:33.630]and, you know, so there's a lot of interruptions
[00:00:36.260]and delays and things that happen.
[00:00:38.550]And then you get to the cash register and you're like,
[00:00:40.477]"Alright, finally!
[00:00:42.010]Need that latte!"
[00:00:43.320]And she's like, "Oh,"
[00:00:44.950]and she walks off because she needs to do something.
[00:00:47.070]They're really busy, they just had seven orders.
[00:00:48.770]She's not taking your order yet.
[00:00:50.780]Most of us would probably keep our cool and wait.
[00:00:55.940]Now, that wait will be a lot more tolerable
[00:01:00.400]if your phone is with you and you can get busy on Instagram
[00:01:03.590]or Facebook or something, right,
[00:01:05.530]if you're with a friend and you can talk to your friend,
[00:01:08.390]if there isn't, you know,
[00:01:09.580]if you didn't leave your kids in the car,
[00:01:11.270]like a good mother,
[00:01:13.050]you will be more patient, more patient.
[00:01:17.630]But there are a lot of factors that determine
[00:01:21.620]how well you're going to tolerate that unexpected delay
[00:01:26.500]that just happened.
[00:01:29.640]And that's what we want our kids to get used to,
[00:01:34.640]that things happen and they're unpredictable,
[00:01:37.320]and sometimes they're unfair.
[00:01:39.620]And for the most part,
[00:01:41.110]I want us to create healthy environments,
[00:01:44.100]healthy contingencies, pleasant learning environments.
[00:01:48.750]But we do have to have some toleration
[00:01:52.680]and some exposure to these difficult situations as well.
[00:01:58.790]So this is where the teaching needs to happen of the skills.
[00:02:01.810]And this is how we ultimate empower the client.
[00:02:05.980]You gotta move beyond your trauma.
[00:02:07.870]And to move beyond your trauma,
[00:02:09.930]it's not just enough to avoid it.
[00:02:12.220]You actually have to have some coping skills,
[00:02:15.260]some ways of mitigating some of those effects,
[00:02:17.570]problem-solving, have some social skills.
[00:02:20.539]And then, ultimately, to be involved in the community,
[00:02:23.930]you need some skills,
[00:02:24.840]so some prerequisite skills that need to be taught
[00:02:27.160]in an educational setting,
[00:02:28.740]some vocational skills that need to be taught,
[00:02:30.660]so you can maybe have a job and have more fulfilling life.
[00:02:35.150]And any fun place you can think of, even Disneyland, right,
[00:02:38.210]there's a lot of annoying things about it.
[00:02:39.850]There's lines and, you know, just things that happen.
[00:02:42.500]Life is just full of the good and the bad.
[00:02:49.850]So the skill-based treatment,
[00:02:53.000]which kinda gives the main point away,
[00:02:55.830]you need skills,
[00:02:59.050]is really for talking about teaching
[00:03:01.990]very specific replacement skills
[00:03:05.150]for those same problem behaviors
[00:03:07.170]that were occurring previously,
[00:03:11.040]but doing so in a safe, dignified,
[00:03:13.230]and, again, a trauma assumed approach.
[00:03:16.470]We're gonna continue keeping our commitments
[00:03:18.820]and our values throughout.
[00:03:20.150]We're still gonna teach from joy.
[00:03:22.370]We're still gonna build trust through our teaching.
[00:03:25.540]Trust comes also from some very clear boundaries.
[00:03:31.840]You know that if you've ever been with kids,
[00:03:33.840]or even just people,
[00:03:34.760]you know, sometimes too much is too much.
[00:03:38.320]Like, you want to know that there is a boundary.
[00:03:41.160]We just wanna make sure that that boundary is fair,
[00:03:44.730]that it's not too tight,
[00:03:45.700]there aren't too many restrictions and redirections,
[00:03:49.140]and hard nos,
[00:03:49.973]there are times where you have more freedom.
[00:03:53.050]And, ultimately, though,
[00:03:55.700]through those very clear consequences,
[00:03:58.600]and letting a child experience those different consequences,
[00:04:00.940]you are going to build more trust.
[00:04:04.100]We see these relationships maintain,
[00:04:06.130]even though we ask kids to do some hard things.
[00:04:08.480]And we tell them, right?
[00:04:09.830]So sometimes in the later stages of the treatment,
[00:04:11.850]you might say, "Hey, buddy,
[00:04:13.530]today, the toughest thing I'm gonna ask you to do
[00:04:16.880]is to do some work when it's really loud in here,
[00:04:19.330]and I know how you hate loud noises."
[00:04:21.810]And I might just say that to a kid.
[00:04:22.927]"You ready to come and do this with me?
[00:04:24.510]I think you can do it."
[00:04:25.990]And again, he opts in.
[00:04:27.810]He gets to decide, he's opting in,
[00:04:29.540]and we celebrate the tough things that he's tolerating,
[00:04:33.840]and we talk about how difficult that was,
[00:04:36.930]and what he's achieving.
[00:04:42.140]And, really, I want us to start thinking about cooperation
[00:04:46.950]in shared experiences, rather than compliance.
[00:04:53.830]I think our emphasis on compliance and compliance training
[00:04:58.080]has gotten us in trouble.
[00:04:59.510]I always struggled with this a little bit,
[00:05:01.180]even when I was a compliance person.
[00:05:05.380]So I'm a woman and I come from a background
[00:05:10.020]of a pretty traditional culture.
[00:05:11.770]I come from Iran.
[00:05:13.310]I grew up in Iran, actually,
[00:05:15.430]for the first 15 years of my life.
[00:05:18.470]And I've broken a lotta rules in my life.
[00:05:21.990]A lot.
[00:05:22.910]If you knew me personally you'd know
[00:05:24.760]that I'm a pretty non-compliant person, generally speaking.
[00:05:28.090]I break all sorts of deadlines.
[00:05:30.560]As I'm sure Annette would tell you,
[00:05:34.850]I didn't send my slides in time.
[00:05:37.870]All sorts of rules are broken.
[00:05:39.620]If you know Dr Hanley, who's my mentor,
[00:05:42.710]he's a pretty non-compliant guy.
[00:05:45.470]And I struggled with this quite a bit early on,
[00:05:49.210]because I was like, "How do we do this?
[00:05:51.430]How do we teach kids to be compliant,
[00:05:53.871]and go for compliance and compliance
[00:05:56.050]and compliance and compliance,
[00:05:57.080]and then at some point we don't want them to be compliant?"
[00:05:59.830]And even when they're little,
[00:06:00.880]there are situations we don't want them to be compliant.
[00:06:04.729]And I had enough sense
[00:06:06.730]to never want hundred percent compliance,
[00:06:09.290]because I knew that there is a problem
[00:06:10.940]with hundred percent compliance, right?
[00:06:14.060]Even from a very young age,
[00:06:15.670]you want kids sometimes to say no,
[00:06:17.240]because the adults might be asking them to do things
[00:06:20.010]that you don't want them to comply with.
[00:06:22.120]And so compliance was always a little bit hard for me,
[00:06:26.870]to really understand how do you then teach
[00:06:29.310]that discrimination later on,
[00:06:30.820]that there are times you can be non-compliant?
[00:06:34.290]And the way I saw us use compliance,
[00:06:37.710]really, what we were working on was obedience, right,
[00:06:42.260]in the way we did compliance training.
[00:06:43.820]Now, when I used the word obedience,
[00:06:46.200]it's a little more uncomfortable, isn't it?
[00:06:48.460]Like, "You're doing obedience training."
[00:06:50.040]Do you really wanna live in a society
[00:06:51.850]that we're doing obedience training?
[00:06:54.150]That's what three-step prompting was doing.
[00:06:55.930]It was teaching obedience.
[00:06:58.640]So, you know, you asked me, how did I come about that shift?
[00:07:02.790]And it was a slow process,
[00:07:04.630]because there was things that I was uncomfortable with
[00:07:07.610]for a while.
[00:07:08.443]I was sitting with them for a while
[00:07:09.970]before I realized I don't like it.
[00:07:11.817]And it did coincide ultimately
[00:07:13.550]with my own journey into motherhood.
[00:07:17.190]And I have two daughters,
[00:07:19.390]and I sure as hell want them to be super non-compliant
[00:07:21.980]with a lot of society's rules.
[00:07:24.080]And so that was also very important to me,
[00:07:26.910]that I gotta teach them.
[00:07:28.690]Now, the thing with non-compliance is, though,
[00:07:32.880]there are obviously differential consequences.
[00:07:34.990]You know that every rule you break,
[00:07:36.730]there are some consequences.
[00:07:38.060]It's just that there is that freedom
[00:07:39.720]and there's that option.
[00:07:40.810]There's that choice to make that decision
[00:07:43.800]to break it or not.
[00:07:46.560]I know all choice is a little bit limited,
[00:07:49.600]but there are sometimes more valid choices than others.
[00:07:56.170]And I want us to, as much as possible,
[00:07:58.970]increase the opportunities for valid choices, fair choices.
[00:08:02.830]There's truly two consequences,
[00:08:04.500]and it's not that one of them is so bad
[00:08:06.800]that you won't make that choice.
[00:08:09.620]There is still a difference,
[00:08:12.470]but there is a true choice happening.
[00:08:14.210]And that's what I mean by cooperation.
[00:08:16.580]You all cooperate on a day-to-day basis.
[00:08:19.780]There are some instances of obedience.
[00:08:23.510]Like I am very obedient when I'm crossing the border
[00:08:25.940]and coming into the United States
[00:08:27.560]where it says I was born in Iran.
[00:08:29.660]Especially the last 10 years,
[00:08:30.740]I've been very, very, very obedient.
[00:08:32.930]I answer all the questions
[00:08:34.130]and I don't have any smartass answers coming outta my mouth.
[00:08:37.190]I just come straight, follow the rules, no questions asked.
[00:08:40.580]Same thing with if the cops pull you over,
[00:08:42.530]maybe you find yourself acting the same way.
[00:08:44.830]But even as a society, we realize that compliance
[00:08:47.880]and just status quo is not necessarily where we wanna go.
[00:08:50.970]So this growth and this change that's happening,
[00:08:53.770]that we're inviting you to make,
[00:08:55.400]is happening on a grand scale as well.
[00:09:00.060]And so cooperation I like.
[00:09:03.360]And cooperation and shared experiences,
[00:09:05.270]especially working with older kids, older adults,
[00:09:09.080]young adults that you are serving, is also really important.
[00:09:13.380]You know, we talked a little bit
[00:09:14.890]at the end of the last session about how weird it is
[00:09:17.500]to stand on top of a teenager or an adult and say,
[00:09:21.527]"Okay, fold this.
[00:09:22.610]Fold it like this.
[00:09:23.470]Now like this.
[00:09:24.303]Now domp it out again.
[00:09:25.136]Do it again."
[00:09:26.080]We wanna really move away
[00:09:27.350]from these silly demand situations.
[00:09:29.390]We wanna make them meaningful,
[00:09:31.170]and we wanna be a partner in that.
[00:09:34.310]Be a partner in their joy when they're in HRE,
[00:09:36.830]but also be a partner in the demand situation
[00:09:39.630]that you're presenting,
[00:09:40.820]and create those contexts as much as possible.
[00:09:43.770]It's subtle shifts sometimes.
[00:09:45.240]It's simply you having your own set of materials
[00:09:47.310]and doing the exact same thing.
[00:09:49.860]But, you know, I think about,
[00:09:51.230]okay, if I'm a mom, and I have older kids,
[00:09:54.170]and let's say it's time to do chores,
[00:09:57.030]I'm likely also doing something, right?
[00:09:59.070]Maybe I'm doing the dishes and they're doing something else,
[00:10:03.240]but maybe as a family on a Saturday morning,
[00:10:05.560]we're kinda like cleaning the house a little bit together.
[00:10:09.286]I probably don't have my feet up
[00:10:11.680]and ordering the kids to do things.
[00:10:14.130]And so we don't wanna create that kind of a context
[00:10:17.940]in our teaching either.
[00:10:26.030]Now, there's been a lot of applications of this process,
[00:10:29.030]which is really exciting and really nice.
[00:10:32.130]And, again, you guys will have these references,
[00:10:34.950]if you're interested in reading the papers,
[00:10:36.650]but the process has shown very strong treatment utility,
[00:10:40.570]the assessment and the skill-based treatment
[00:10:44.590]that I'm talking about.
[00:10:47.120]So behavior analysis has had many procedures
[00:10:50.817]and many assessments that have been very powerful
[00:10:55.510]in the sense that the changes in behavior
[00:10:59.920]are very much possible.
[00:11:02.590]Like I said, we have a lot of data
[00:11:04.820]on the efficacy of our interventions,
[00:11:08.380]meaning, in an ideal situations,
[00:11:10.520]we have some really powerful processes,
[00:11:13.240]including those punishment and extinction procedures
[00:11:15.480]that I talked about.
[00:11:16.960]But the second question of how probable is it,
[00:11:20.430]like, if you did it yourself at home, will it work or not?
[00:11:23.650]That's the second piece.
[00:11:25.270]That one's been a little bit more shaky.
[00:11:27.060]And with this process,
[00:11:28.210]especially over the last two years,
[00:11:30.350]with COVID and all the challenges that came about with that,
[00:11:34.000]we've had some really nice success.
[00:11:36.180]And now I can confidently say that not only is it possible,
[00:11:40.390]but it's also probable.
[00:11:42.410]It is slower.
[00:11:45.480]It takes a little bit longer.
[00:11:48.565]Gave you a simple example this morning about toothbrushing.
[00:11:51.330]Three-step prompting would get me through
[00:11:52.820]that tooth brushing in five minutes with my daughter.
[00:11:56.590]Sometimes when we're doing it her way,
[00:11:58.900]it takes half an hour.
[00:12:00.450]Now, you can obviously imagine that
[00:12:02.830]in some of the work we gotta do with our students,
[00:12:06.480]but I also have a lot of students
[00:12:10.450]that I knew when they were four and five,
[00:12:13.080]and now they're 17, 18, 19, 20,
[00:12:16.030]and even though we did that compliance training early on,
[00:12:19.070]we're back to square one at 19 and 20,
[00:12:21.730]because they're now bigger, stronger,
[00:12:24.280]and they know they can fight that three-step prompt
[00:12:27.530]if you try it.
[00:12:29.500]And so the fact that we got through some things fast
[00:12:32.810]doesn't mean that we actually were any further along,
[00:12:36.587]and I want us to go slow
[00:12:38.750]and hopefully have some lasting change.
[00:12:45.480]And what's even more beautiful,
[00:12:48.450]here's the thing.
[00:12:49.283]I know I'm criticizing us a lot.
[00:12:53.300]Our heart was always in the right place, right?
[00:12:55.500]Most of us that are working in this field
[00:12:57.247]didn't get into this field because we wanna get rich.
[00:13:00.910]We did it because we believed in what we're doing,
[00:13:04.330]we wanted to make a difference,
[00:13:05.990]we were focusing on overall improving the quality of life
[00:13:12.370]for the kiddos that we were working with.
[00:13:14.660]But maybe I think we were emphasizing or focusing too much
[00:13:19.070]on the end goal and the intention,
[00:13:22.420]and less so on the process by which you get there.
[00:13:26.510]And what I've learned now is the end doesn't matter
[00:13:29.550]if the procedures are so bad nobody wants to use them,
[00:13:32.710]if they feel awful to get there.
[00:13:35.090]So socially valid outcomes are irrelevant
[00:13:38.810]if we don't have socially valid procedures.
[00:13:41.870]And so now when we ask people about the social validity
[00:13:47.000]of this process,
[00:13:47.940]we ask them whether the treatment is also acceptable.
[00:13:51.310]So of course we still care about,
[00:13:53.777]"Hey, were you happy with the improvements
[00:13:56.050]and problem behavior?"
[00:13:57.020]That still matters,
[00:13:58.850]because you can have a very nice sounding,
[00:14:01.240]super fun thing to do.
[00:14:04.270]Maybe you like music,
[00:14:05.810]maybe you like horse therapy.
[00:14:08.020]It's enjoyable to do those things,
[00:14:09.660]but if they don't make a difference
[00:14:11.290]in the actual problem you're trying to solve,
[00:14:13.810]that also is problematic.
[00:14:16.230]But they both matter.
[00:14:17.610]How does it feel to go through this process?
[00:14:21.790]And then is the outcome also valid?
[00:14:23.950]And so we have some really nice data.
[00:14:26.490]Jesso and colleagues published this in 2018,
[00:14:29.630]showing sixes and sevens from parents
[00:14:33.510]on the acceptability of the treatment,
[00:14:36.820]as well as the actual outcome
[00:14:39.670]on problem behavior and communication.
[00:14:42.420]Those were the skills.
[00:14:51.050]So what does the treatment entail,
[00:14:52.490]other than intermittent and unpredictable reinforcement?
[00:14:57.720]We kinda have a relatively consistent process
[00:15:03.240]at the beginning,
[00:15:04.370]where, like I mentioned, we start with communication.
[00:15:07.740]So if you think about it as a tree, right,
[00:15:12.380]this repertoire we're trying to build,
[00:15:16.260]so that you can access the sun, right?
[00:15:19.590]Those are all the reinforcers,
[00:15:20.890]those are all the good things.
[00:15:22.700]You first need a pretty solid trunk.
[00:15:26.250]And that solid trunk starts with communication.
[00:15:30.220]Really good communication.
[00:15:31.820]And this is probably a life-long goal.
[00:15:35.290]But for a lot of these goals to be realized,
[00:15:39.490]for the individual to actually tolerate some
[00:15:42.570]of these teaching contexts that they would need to tolerate
[00:15:45.420]in order to learn those skills,
[00:15:47.320]we also need to really work
[00:15:49.210]on some toleration and relinquishing.
[00:15:51.820]So those are the other aspects of the trunk.
[00:15:56.450]So as I mentioned this morning,
[00:15:58.710]we need you to communicate,
[00:15:59.950]then we need you to give your stuff up.
[00:16:01.500]We need you to tolerate coming with us
[00:16:03.900]and cooperating with some skills.
[00:16:05.490]And then what those branches look like,
[00:16:07.440]you know, what are the skills,
[00:16:08.470]what are the actual specific repertoires
[00:16:12.280]you're gonna work on,
[00:16:13.310]specific behavioral changes you're gonna work on,
[00:16:15.990]are very specific to each learner.
[00:16:18.780]That's when it really becomes individualized.
[00:16:21.080]And you might, for example, have some language goals.
[00:16:23.930]You might have some leisure goals.
[00:16:27.030]You might have some exercise goals.
[00:16:30.410]You might have some social skills goals.
[00:16:33.180]Really, every situation that you describe
[00:16:35.780]that's challenging right now,
[00:16:37.090]like, you know, "Hey, Jimmy,
[00:16:39.140]Jimmy likes to talk,
[00:16:40.570]but he only likes to talk about his topics."
[00:16:44.050]So you might be like, "Well, you need
[00:16:45.630]to sometimes tolerate other people's topics."
[00:16:47.850]That can be a branch right here.
[00:16:50.400]First, you need to teach Jimmy to ask nicely
[00:16:53.690]to go back to his topic.
[00:16:55.370]Then you need to teach him to stop talking about
[00:16:57.440]the things he wants to talk about
[00:16:58.830]and actually switch gears to another topic,
[00:17:01.720]at least tolerate listening to other people,
[00:17:03.930]talk about those things,
[00:17:04.880]and then potentially also participate in those topics,
[00:17:08.980]even though it's not his favorite.
[00:17:11.090]By contrast, Sarah might need to exercise more.
[00:17:15.010]She might need to walk around
[00:17:16.720]and add some steps to her day.
[00:17:19.740]So these could be health goals,
[00:17:20.900]social goals, academic goals.
[00:17:23.800]These could be vocational goals.
[00:17:25.110]These could be goals that the client identifies.
[00:17:27.230]They want to participate in a particular context
[00:17:30.650]or activity, and they need some prerequisite skills.
[00:17:47.399]What we have found.
[00:17:48.232]Here's the take home points
[00:17:49.500]if you wanna achieve this beautiful tree for your clients.
[00:17:54.300]The first thing you need
[00:17:57.470]is personalize and synthesize reinforcement context.
[00:18:01.130]That assessment we talked about this morning really matters.
[00:18:03.630]That HRE context really matters.
[00:18:06.260]And this is why you can have one little reinforcer in there.
[00:18:10.080]Look at what you're trying to teach here.
[00:18:11.490]Look at this tree, right?
[00:18:15.480]Sometimes this means going along
[00:18:18.610]with someone's expectations for 45 minutes,
[00:18:22.040]doing some tough things
[00:18:23.310]in light of some really strong triggers.
[00:18:27.410]The thing you're working towards,
[00:18:28.670]the thing you're gonna get at the end of that,
[00:18:30.050]needs to be pretty powerful.
[00:18:35.490]The synthesis really makes this not only powerful,
[00:18:41.380]but more ecologically valid.
[00:18:42.930]As I mentioned this morning,
[00:18:44.310]most of us don't escape a particular task
[00:18:48.260]to just sit there and stare at nothing.
[00:18:53.560]We do something else.
[00:18:55.470]We escape from X to Y.
[00:19:01.280]So, at the very least,
[00:19:02.113]we have the positive and negative reinforcement combined.
[00:19:07.090]And then most of us need some form of attention.
[00:19:09.390]At the very least, we need a person
[00:19:11.040]that can help us problem-solve,
[00:19:13.210]that can help us resolve and get some things right.
[00:19:16.400]Who wouldn't want a little person as a helper?
[00:19:19.430]I do, all day.
[00:19:21.140]So that that's always good.
[00:19:28.140]And what's nice about having this synthesized contingency,
[00:19:31.000]and really relying on the power of having it all,
[00:19:36.420]means that while you're doing this process,
[00:19:38.880]you also don't have to make everybody else's life difficult.
[00:19:42.640]You don't have to be like, "Hey, we really need the iPad
[00:19:45.860]for these sessions we're doing.
[00:19:48.210]So, Mom, the rest of the time,
[00:19:50.090]you don't get to use the iPad."
[00:19:52.000]I would wanna kill you.
[00:19:53.470]I'd be like, "Erm, no.
[00:19:55.060]I can't do the weekend without the iPad, so no."
[00:19:58.910]How many of us have that had that fight before,
[00:20:01.240]where we're like, maybe for toilet training or whatever,
[00:20:03.120]you're like, "I gotta keep these reinforcers just for this."
[00:20:07.570]And then everybody else hates you,
[00:20:09.500]because now the kid's really upset.
[00:20:12.980]By contrast, now it's like, "Well, no,
[00:20:16.740]he can have the iPad all day."
[00:20:19.040]Because in my session, when I'm doing this,
[00:20:21.570]it's so much more than just the iPad.
[00:20:24.050]He also has my undivided attention.
[00:20:26.190]He also has all these other things.
[00:20:27.660]He might also have that iPad broadcasted
[00:20:31.110]onto this huge screen.
[00:20:34.080]So I always think about enhancing it in your session,
[00:20:36.950]as opposed to restricting things outside of your session,
[00:20:40.210]'cause you gotta realize that this stuff takes time.
[00:20:43.890]What you're doing is really awesome,
[00:20:46.330]and it's gonna make some significant improvements
[00:20:49.360]to that family's life, but not for a while.
[00:20:53.410]They still need to survive for a while.
[00:20:55.500]They still need to be able to keep the peace
[00:20:59.050]and keep everybody safe.
[00:21:09.090]I talked a little bit about this,
[00:21:10.390]how we spend so much time identifying singular reinforcers
[00:21:15.300]only to add them back in in treatment.
[00:21:17.300]And Slaton and colleagues actually looked at
[00:21:20.810]what happens when we do treatment
[00:21:22.720]with just singular reinforcers,
[00:21:24.820]versus those synthesized reinforcers.
[00:21:28.640]And here's kinda the pattern she found.
[00:21:31.000]So, one, she had nine clients,
[00:21:34.540]one, she replicated the data we already know.
[00:21:39.930]Five out of the nine that did standard analysis,
[00:21:43.120]trying to isolate the variables,
[00:21:44.790]she didn't have an answer.
[00:21:46.720]There was no differentiation in the analysis.
[00:21:49.880]With the others that she did have a finding
[00:21:53.810]with the standard analysis, and a finding with the PFA,
[00:22:01.040]she went ahead and implemented treatment,
[00:22:03.650]based on the assessment results.
[00:22:05.450]So if, for example, the standard said escape alone,
[00:22:10.110]she just did a functional communication training treatment
[00:22:13.670]for just escape.
[00:22:14.900]So the response was a break.
[00:22:17.450]And the child would say, "Break,"
[00:22:18.610]and just get a break, with nothing.
[00:22:20.730]By contrast, if the HSCA had said,
[00:22:23.477]"Well, it's escape from demands to YouTube,"
[00:22:26.530]that's what the child would get,
[00:22:27.820]30 seconds of a break from their work to YouTube.
[00:22:32.090]Now, for some clients,
[00:22:34.610]for one client, I believe, both worked.
[00:22:40.320]But then when they went to preference,
[00:22:42.580]asking the kid, "Which treatment do you prefer?"
[00:22:45.990]he liked the synthesis.
[00:22:47.550]Who wouldn't?
[00:22:51.130]With two other kids, this is the pattern she got.
[00:22:53.660]So baseline is from the analysis,
[00:22:56.820]and the circles are problem behavior.
[00:22:59.740]And then you have the line, and the treatment starts.
[00:23:03.110]And when the treatment starts,
[00:23:04.360]technically problem behavior is on extinction here,
[00:23:07.370]and the communication response is supposed to be reinforced
[00:23:12.100]and contact the same reinforcers.
[00:23:14.870]Now, the ones on the left are from the HSCA,
[00:23:24.260]so it's escape, two tangibles and attention,
[00:23:26.760]and escape, two tangibles for Jeff.
[00:23:30.410]You see immediately problem behavior goes away,
[00:23:34.120]and that communication response is being emitted.
[00:23:37.500]That's the open squares.
[00:23:40.670]By contrast, when it was isolated for the same clients,
[00:23:46.160]so now Jeff is in a session,
[00:23:48.470]and it's isolated because the standard said,
[00:23:51.357]"It's just attention," or, "It's just escape," for Emily.
[00:23:55.240]What we see is, technically,
[00:23:57.650]those are the functional reinforcers.
[00:23:59.080]That's what the standards show us,
[00:24:00.430]and the standard tells us that that is the truth.
[00:24:04.650]What we see actually is problem behavior persists
[00:24:09.620]and that request is not being emitted.
[00:24:14.210]I believe Emily was the one with the hair brushing,
[00:24:17.400]that was basically like, "No, no, no.
[00:24:18.680]I don't want you to remove the hairbrush
[00:24:20.200]and turn away from me.
[00:24:21.033]That's not what I want.
[00:24:21.950]I want you to stay.
[00:24:22.940]Give it back to me.
[00:24:23.773]I wanna do it my way."
[00:24:25.250]How do you even isolate that?
[00:24:27.000]It's such a contextual thing.
[00:24:30.050]And that's what we found.
[00:24:32.930]And then when we look at the literature too,
[00:24:34.980]as I mentioned this morning,
[00:24:36.170]there is some data for those of you that are interested,
[00:24:38.810]don't wanna just go by my assertions.
[00:24:40.940]Slaton and Hanley also published a review in 2018
[00:24:44.630]that showed across all treatment data
[00:24:50.090]that, usually in treatment, we end up synthesizing.
[00:24:53.780]And when we synthesize, then treatment is effective.
[00:24:57.560]So even if you isolated an assessment,
[00:24:59.570]you end up putting these things together, because you know
[00:25:02.840]that's a more powerful reinforcement context
[00:25:04.730]if you're trying to teach skills.
[00:25:06.670]So how about we don't waste time?
[00:25:08.720]We start with the HRE context.
[00:25:10.450]We give everything, we enhance it.
[00:25:12.010]We make it so awesome
[00:25:13.200]the kid's scratching your eyes out to get into that session.
[00:25:16.600]Your problem should be that's all they wanna do.
[00:25:20.000]Not the reverse,
[00:25:21.840]of trying to convince them to come with you.
[00:25:30.930]And then, finally,
[00:25:36.720]I want you to keep those values as the forefront
[00:25:40.830]of that's what you do in any given moment
[00:25:44.340]that you're working with your kiddo
[00:25:46.360]and you're trying to teach these skills,
[00:25:48.217]regardless of what step you're on.
[00:25:53.080]If you need to reinforce problem behavior
[00:25:54.740]to keep things safe, you do that.
[00:25:58.450]If you need to reinforce problem behavior
[00:26:01.040]to keep your relationship, you do that.
[00:26:06.273]And then we'll come back and we'll talk about
[00:26:08.190]what you could do differently.
[00:26:21.070]When we do this, we can meet these expectations.
[00:26:24.020]Now, it's not just the child
[00:26:26.220]that's empowered through this process,
[00:26:28.428]the implementers are as well.
[00:26:31.500]Initially, especially with really severe behavior,
[00:26:33.880]what we see is there's a lot of fear.
[00:26:36.500]There's a lot of fear to present these challenging contexts,
[00:26:41.140]these demands, these triggers, right?
[00:26:43.450]Your behavior's been punished.
[00:26:44.800]Mom's behavior's been punished.
[00:26:46.100]Dad's behavior's been punished.
[00:26:47.270]You avoid a lot of these contexts.
[00:26:49.360]And then when you're forced
[00:26:50.810]to present some of these demands,
[00:26:52.820]we see people are very anxious,
[00:26:54.780]because obviously you're thinking about what could go wrong.
[00:26:57.860]And as you continue with this process,
[00:27:01.010]and having that, I guess, security blanket of,
[00:27:07.377]"If he gets upset, I can just reinforce it.
[00:27:10.100]I don't have to wait for an escalation,"
[00:27:11.810]really makes everybody relax,
[00:27:16.250]and now present some of those demands without that fear.
[00:27:20.090]And we all know kids kinda feed off of our fear, right?
[00:27:24.200]When you're super-anxious and you're like,
[00:27:26.387]"Alright, I really need you to take a shower," right,
[00:27:31.790]the whole thing is tense,
[00:27:33.470]versus if you know you can present those demands,
[00:27:35.460]and if you need to back off,
[00:27:37.640]and you need to give some time,
[00:27:38.820]and you need to say, "It doesn't look
[00:27:40.070]like you really wanna shower today,"
[00:27:43.040]then it's not such a big deal to present it.
[00:27:45.900]So we see teaching happening without fear,
[00:27:49.180]because you know you can turn it off,
[00:27:50.990]turn problem behavior off, before it gets worse.
[00:27:56.350]And by acknowledging this, right,
[00:27:58.290]starting with happy, relaxed and engaged,
[00:27:59.954]and then every time a problem behavior happens,
[00:28:01.466]you don't ignore that at all,
[00:28:04.650]you acknowledge it,
[00:28:05.770]what you're communicating to your students
[00:28:08.550]and to your child is that, "I see you.
[00:28:11.130]I'm here for you, even though this is hard."
[00:28:14.350]Like I said, try and talk to a friend when they're upset,
[00:28:19.110]they're telling you what's going on in their life,
[00:28:23.030]and you just pretend like
[00:28:23.920]they didn't just tell you horrible things about their life.
[00:28:26.695]That friend isn't gonna really be your friend for long.
[00:28:30.900]We offer a lot of empathy,
[00:28:32.550]even when our friends are telling us things
[00:28:35.530]that we don't really agree with.
[00:28:37.370]How many of you have friends kinda complain about things
[00:28:39.680]that you're like, "Well, you know,
[00:28:40.700]there's things you can do to change that."
[00:28:42.387]But we listen, we listen patiently.
[00:28:45.370]We offer empathy.
[00:28:48.860]We agree that they're having a hard time,
[00:28:51.610]that this is difficult for them,
[00:28:52.890]even if we don't agree with their life choices.
[00:28:57.840]And we should really extend the same courtesy
[00:28:59.780]to the kids that we work with,
[00:29:02.080]that you may not understand why it's so difficult
[00:29:05.180]to do this, but it is difficult for that child.
[00:29:07.240]You are agreeing with that, that this is hard for you.
[00:29:16.730]So what I'm suggesting is that function-based is not enough,
[00:29:21.520]but that this process is still function-based,
[00:29:24.680]because remember, we were able
[00:29:26.570]to turn problem behavior on and off.
[00:29:30.980]If you're really concerned about the function,
[00:29:33.340]it's in there,
[00:29:34.670]you showed it through the analysis.
[00:29:38.300]All you're doing is really making it
[00:29:40.204]a more ecologically valid treatment.
[00:29:51.750]For some of our learners,
[00:29:53.220]the hardest thing is relinquishing and transitioning.
[00:30:00.400]That's where you're gonna spend a great deal of time.
[00:30:02.950]And you might have to even break that down
[00:30:09.420]into smaller steps to get past it.
[00:30:13.727]Remember, there's a history, perhaps,
[00:30:15.110]of every time an adult has said,
[00:30:16.507]"Hey, time to put your tablet away,"
[00:30:18.620]it's gone away for a long time.
[00:30:21.560]And everything else that that adult has asked you to do
[00:30:25.770]has been really difficult.
[00:30:27.600]So now there's this sort of impulsive, emotional response
[00:30:31.570]to saying, "Put your stuff away.
[00:30:34.610]We gotta do something else."
[00:30:35.620]So we gotta take it super slow.
[00:30:39.950]One thing that has really eliminated some of the fire for us
[00:30:44.740]is not touching their stuff.
[00:30:49.180]Get in the habit of not touching kids' stuff.
[00:30:54.110]A simple, simple change of, "Give me your computer,"
[00:31:01.380]versus, "Put your computer in this basket beside you."
[00:31:06.170]They both achieve the same goal, right?
[00:31:08.600]You want the kiddo to stop watching YouTube
[00:31:10.450]and attend to what you're gonna tell 'em.
[00:31:12.770]One is, "Put it in this basket.
[00:31:14.320]It's safe over here.
[00:31:15.160]We'll leave it right here."
[00:31:16.750]The other one is, "Give it to me."
[00:31:19.750]I honestly have seen such a difference to that response,
[00:31:24.120]but that may not even be where you can start
[00:31:26.030]with that relinquish, right?
[00:31:30.030]You might have to start with, first,
[00:31:31.890]a child momentarily taking their eyes off
[00:31:34.900]of their YouTube video and look at you.
[00:31:37.630]So you might, for the relinquishing, simply start with,
[00:31:40.827]"Hey, look at me for a second.
[00:31:42.740]Thanks so much.
[00:31:43.573]You can go back to playing."
[00:31:45.460]Can we get that without problem behavior?
[00:31:49.970]The next step might be,
[00:31:51.177]"Hey, can you put that down just a little,"
[00:31:53.680]like if you've got your iPad, it's right here,
[00:31:55.367]"Can you put it down?
[00:31:56.480]Can you lower it just a little bit?"
[00:31:59.660]So whatever the step is that you're getting stuck on,
[00:32:03.420]I can guarantee you, I can break it down.
[00:32:08.420]Again, it's fine if you have to reinforce it one time.
[00:32:13.330]Probably if it happened you're like,
[00:32:14.487]"Alright, sounds like you don't wanna do it."
[00:32:16.400]You can't get stuck there.
[00:32:18.470]Problem behavior and this step you actually
[00:32:21.250]are trying to get to
[00:32:23.290]can't both always result in the same reinforcement.
[00:32:26.300]Then you're not getting anywhere.
[00:32:28.160]So while I'm saying extinction is not driving the bus,
[00:32:33.750]I also also want to dispel this myth that exists,
[00:32:38.520]that this process is without extinction.
[00:32:41.170]That's not true.
[00:32:42.040]There is extinction.
[00:32:44.650]We do want to have at least some differences
[00:32:48.800]between one set of behaviors versus another,
[00:32:51.240]so we have that change happen,
[00:32:53.560]and we have the behaviors we want to teach occur.
[00:32:57.960]But most of us have days where we're just not great.
[00:33:04.730]You get up.
[00:33:05.830]You were doing awesome yesterday.
[00:33:07.220]You're like, "Man, Superwoman!"
[00:33:09.550]And then today it's like, (heavy sigh)
[00:33:10.421]"Drinking my coffee is the only accomplishment
[00:33:13.470]I can have today."
[00:33:15.570]And most of us, especially in higher level positions,
[00:33:20.680]have the luxury of goofing off sometimes.
[00:33:24.200]You show up to work and you pretend to do your work,
[00:33:26.430]and you're really not.
[00:33:28.240]The next day, you're gonna have to make up for that
[00:33:30.010]a little bit, right?
[00:33:30.970]So we're not always great.
[00:33:32.550]Can we all agree?
[00:33:34.600]Okay.
[00:33:35.700]Our kids are not always great either.
[00:33:37.890]They show up, and yesterday they were rocking it.
[00:33:41.010]Giving up their stuff was easy.
[00:33:42.560]They put it away.
[00:33:43.393]They came with you.
[00:33:44.226]They even did some work.
[00:33:45.140]And today, today, oh my,
[00:33:49.350]telling them to stop and pause that video
[00:33:51.410]is like hot, hot, hot, hot.
[00:33:54.640]It's okay.
[00:33:56.730]Every single day that you start working with your kiddo,
[00:33:58.970]I want you to think about this.
[00:34:00.220]First things first, FTF.
[00:34:02.790]That's where I work.
[00:34:03.670]First things first.
[00:34:05.400]One, can you get HRE?
[00:34:08.310]Sometimes our kids come in,
[00:34:09.910]especially if you're a school staff,
[00:34:13.100]you don't know what happened that morning,
[00:34:14.570]you don't know what the night was like,
[00:34:15.800]you don't know what breakfast was like,
[00:34:17.090]you don't know what the ride was like.
[00:34:19.100]And that kid comes in hot.
[00:34:21.160]Hot, hot, hot.
[00:34:22.760]Do you jump right into your teaching?
[00:34:24.200]No, you start with HRE.
[00:34:25.790]If you can't get HRE, then that's where you're at that day.
[00:34:30.450]You're just gonna try and see,
[00:34:31.830]despite all of the things
[00:34:33.670]that's happening in that kiddo's life
[00:34:35.100]that you maybe can't control.
[00:34:36.500]And some of our kids have some tough situations
[00:34:38.430]they're living in, right?
[00:34:39.760]Lots of triggers outside of your session
[00:34:41.400]that you can't yet fix,
[00:34:42.890]and they don't have the skills to tolerate.
[00:34:44.980]So they're coming in already pretty upset.
[00:34:48.290]So if that day you can simply get them to be more calm
[00:34:52.280]and more happy, that's a win.
[00:34:56.820]That's the safe place.
[00:34:58.470]And you can acknowledge that they look a little upset.
[00:35:05.020]Alright, let's see what's up.
[00:35:06.640]Let's see what we can do.
[00:35:09.610]If you can get happy, relax, engage,
[00:35:11.310]but you can't get them to manned,
[00:35:12.840]as soon as you come to present the EO they're upset
[00:35:15.620]and you're getting problem behavior,
[00:35:16.590]well, heck, that's where you're at.
[00:35:18.720]We just gotta get the FCR.
[00:35:21.080]So I really want you to be flexible
[00:35:23.810]on a day-to-day basis as well.
[00:35:26.040]And if it was just an odd day,
[00:35:27.260]then we don't need to change anything.
[00:35:29.000]But if it keeps happening, then we've gotta break it down.
[00:35:31.730]And that's what I mean by you gotta keep going back
[00:35:34.720]and looking at, "Okay, what are the trials
[00:35:37.480]that are triggering these behaviors?
[00:35:39.010]What's happening?
[00:35:40.200]What can I do?"
[00:35:52.600]This is where a lot of our branches too,
[00:35:54.530]we can incorporate IEP goals,
[00:35:56.160]because one of the criticisms that you might get initially
[00:36:01.610]is we're not doing anything.
[00:36:05.184]He's supposed to be in school.
[00:36:06.760]He's supposed to be in the ABA clinic,
[00:36:08.530]and we're not doing anything.
[00:36:09.370]We're just playing.
[00:36:11.880]And I think a tool that you might find helpful,
[00:36:16.200]and we have this on our website,
[00:36:18.380]is we've taken these steps
[00:36:19.830]and we've translated them into IEP goals,
[00:36:24.070]starting with even the HRE context.
[00:36:26.690]So even if that's where you're at,
[00:36:29.060]you could probably take a look at writing some goals
[00:36:32.390]in language that all stakeholders can understand.
[00:36:37.600]Because if you just say, "We were in reinforcement
[00:36:40.850]for five weeks,"
[00:36:43.590]we're like, "Hmm."
[00:36:45.090]But if you talk about, you know, with young learners,
[00:36:48.107]"Hey, we now have more initiation.
[00:36:50.130]We now have more eye contact.
[00:36:52.130]We now have some joint attention.
[00:36:55.650]We now have some approach responses.
[00:36:57.830]We now, through play, through shared experience,
[00:37:00.810]have some observational learning happening
[00:37:02.517]and some modeling happening of play."
[00:37:05.840]You're not placing any demands,
[00:37:07.130]but the child is kinda finding it fun to hang out with you
[00:37:09.735]and copy what you're doing.
[00:37:11.840]Those are amazing goals.
[00:37:13.150]Those are tough goals to teach.
[00:37:14.900]If you wanted to target them,
[00:37:16.190]they would be very challenging.
[00:37:18.110]And you might just have to add those as IEP goals.
[00:37:23.020]We have a learner right now who's older,
[00:37:26.590]who's in his twenties.
[00:37:28.500]And when we first started this process
[00:37:31.710]and I was explaining it to these ladies in the front,
[00:37:34.790]the challenge was that he was constantly trying
[00:37:39.520]to figure out, "What is it that you want me to do?
[00:37:42.240]Let me do that."
[00:37:44.130]Hated the stuff we were suggesting for him to do,
[00:37:46.620]but it was still sort of the routine, right?
[00:37:49.790]Like, "Oh, I can't possibly be playing the Wii,
[00:37:52.840]because at 10 o'clock in the morning,
[00:37:54.720]I'm not supposed to play the Wii,
[00:37:56.340]I'm supposed to be doing these other things.
[00:37:57.960]I hate those other things,
[00:37:58.950]and I engage in problem behavior every day,
[00:38:00.930]but I also think it has to be on my schedule."
[00:38:05.960]Now, what we've done with him for the past month
[00:38:08.810]is we don't make the schedule anymore.
[00:38:13.070]We've written everything out in little strips,
[00:38:17.410]and the staff are showing up,
[00:38:19.570]they're sitting down and they're saying,
[00:38:22.297]"We can do whatever you want, buddy.
[00:38:24.280]You tell us."
[00:38:25.890]He makes any kind of choices, they follow.
[00:38:29.000]That's all they do.
[00:38:30.370]And what they've done in the past month
[00:38:33.630]is simply have this young man,
[00:38:37.890]have this 20-year old,
[00:38:39.040]come out of his shell and realize,
[00:38:41.147]"Dude, you're in your twenties.
[00:38:42.450]If you wanna play Wii at nine in the morning, you can."
[00:38:45.990]And that's a win.
[00:38:48.690]That's a win for this team,
[00:38:49.910]because the agency really matters.
[00:38:53.130]There are so many triggers in his every day,
[00:38:56.030]that we don't need to rush too quickly
[00:38:58.240]to present those triggers.
[00:39:00.040]What we gotta start with first is him realizing
[00:39:03.644]that he can just choose.
[00:39:05.850]Because right now, to be honest,
[00:39:07.230]if I tried to do this process too quickly,
[00:39:09.470]I don't even know how to return him back to reinforcement,
[00:39:14.800]'cause he doesn't even know what he wants.
[00:39:17.660]So you might have a learner like that.
[00:39:19.020]Whereas you might have other learners
[00:39:20.270]that are very, very specific about what they want.
[00:39:23.860]And you might have to pick your battles a little bit
[00:39:26.560]at the beginning.
[00:39:27.660]For example, we have here, "Hey, relinquish."
[00:39:32.220]Please don't translate that into cleanup.
[00:39:36.663]Say you have a kiddo that's playing with the trains,
[00:39:39.550]and they've meticulously set that up, and it's awesome.
[00:39:44.190]And you come in and you're like,
[00:39:45.437]"Alright, time to do some math.
[00:39:47.250]Let's first clean up the trains and put 'em all in the bin."
[00:39:50.430]That is too, too hot.
[00:39:53.470]It also signals, "Wow, I don't get to play with the trains
[00:39:57.270]for a really long time then.
[00:39:58.930]I hate this."
[00:40:00.560]As opposed to, "All I want you to do,
[00:40:02.920]if you have one train in your hand,
[00:40:05.070]just put that one down and come with me.
[00:40:07.370]And we'll keep this here, protected.
[00:40:09.570]I'll make sure your little brother
[00:40:10.720]doesn't destroy it either."
[00:40:12.840]Initially in your sessions, when you're teaching this,
[00:40:14.860]you do want to have an environment
[00:40:17.960]that you have as much control over as possible,
[00:40:20.420]because you want this to be a very gradual process.
[00:40:23.580]It's too much for that kiddo to learn to give up the trains,
[00:40:27.810]put 'em away,
[00:40:28.860]have his brother play with it and mess with it.
[00:40:31.420]Like, that's just too much.
[00:40:33.230]He would cross that emotional borderline so quickly
[00:40:37.050]you can't get anything done.
[00:40:39.340]All you gotta do right now is just teach him
[00:40:42.060]that he can let go of that one piece of train
[00:40:44.660]and the world isn't gonna end,
[00:40:46.090]and he can go back to his trains very quickly.
[00:40:48.270]So you want this increase in the expectations
[00:40:51.330]to be so gentle and so slow,
[00:40:54.620]the shaping to be so gradual,
[00:40:56.740]that when you raise the bar,
[00:40:59.410]it's a no-brainer.
[00:41:00.280]It's so easy the kid will do it.
[00:41:01.820]They're coming along with you.
[00:41:03.650]The relationship is great.
[00:41:04.910]The joy is great.
[00:41:06.540]The trust is there.
[00:41:08.110]And what you're asking them to do,
[00:41:09.290]the next step, is super easy.
[00:41:12.920]If the child realizes,
[00:41:14.120]if you make a step and the child's like,
[00:41:15.857]"This is so hard," drop down.
[00:41:19.540]Listen, and drop it down.
[00:41:22.290]So, relinquishing is not cleaning up.
[00:41:25.360]Sometimes I'm working with kids on giving up control.
[00:41:29.090]Now, everything is control, right?
[00:41:30.810]We're giving up control.
[00:41:31.643]They're giving up control.
[00:41:33.590]But some kids are very specific
[00:41:35.550]in the way that they like to play or paint.
[00:41:38.970]Painting is a good example.
[00:41:40.760]Let's say you're trying to teach a kiddo
[00:41:42.540]to tolerate painting differently,
[00:41:44.820]and there's ecological validity to it,
[00:41:46.550]because, you know, there's art class
[00:41:48.010]and there's some stuff that happens at school,
[00:41:50.360]and sometimes you gotta follow the instructions.
[00:41:52.540]It's not free painting day,
[00:41:56.050]but sometimes it is.
[00:41:58.030]Now, with that kiddo,
[00:41:59.540]again, you gotta be pretty strategic with
[00:42:01.290]the type of materials that you select
[00:42:03.420]and how you initially start.
[00:42:06.140]Initially, for the first little while,
[00:42:09.350]while you build this toleration and cooperation
[00:42:12.430]with your demands,
[00:42:13.263]you probably need two sets of paintings.
[00:42:16.260]You need a tree that's his tree,
[00:42:17.640]that you're not gonna mess with,
[00:42:19.370]and you need a tree that you're messing with.
[00:42:21.400]'Cause when he tolerates putting,
[00:42:24.460]I don't know, pink flowers on the tree, even though
[00:42:28.120]he doesn't really think pink flowers belong there,
[00:42:31.160]you want to be able to go back to reinforcement
[00:42:34.370]to something that doesn't have pink flowers on it,
[00:42:37.040]something that you've kept and you can restore
[00:42:40.270]that reinforcing context.
[00:42:41.620]It's not until much, much, much later
[00:42:44.630]that maybe he needs to learn
[00:42:46.920]that sometimes it's the same painting
[00:42:49.250]and someone else had the idea
[00:42:50.530]of putting pink flowers on there,
[00:42:51.777]and it is what it is and it stays, right?
[00:42:55.700]So the gradual increase of expectations
[00:43:00.100]is really, really important.
[00:43:05.470]And this is what we call contextually appropriate behaviors,
[00:43:12.840]or CABs.
[00:43:26.820]The other thing that it's important here
[00:43:29.000]is that intermittent and unpredictable reinforcement.
[00:43:33.310]We're trying to emulate life, right?
[00:43:37.170]We're trying to emulate that, in everyday life,
[00:43:40.310]sometimes you ask for things and you get it right away,
[00:43:43.420]and sometimes you ask for things
[00:43:45.790]and you get it after a little bit of work, or a lot of work.
[00:43:50.690]Sometimes Mom just needs a minute to send this email,
[00:43:53.300]and then she can come and give you
[00:43:54.650]whatever it is you're asking for.
[00:43:55.960]Other times she's busy, and it's a longer business call.
[00:44:03.230]And sometimes we can give you information.
[00:44:06.340]Sometimes we can say, "Hey, I've got a 30-minute phone call.
[00:44:09.660]I gotta deal with this."
[00:44:10.770]Other times, Mom doesn't even know how long she's gonna be.
[00:44:13.890]She can't give you an answer.
[00:44:15.420]You just have things that you gotta keep yourself busy.
[00:44:19.880]I would say there are two general context that every person,
[00:44:24.380]every student I've ever worked with needs to learn.
[00:44:27.370]Now, these two general contexts can be broken into
[00:44:30.150]a lot of CABs and lot of branches, okay?
[00:44:32.300]But they're two general context.
[00:44:35.690]Sometimes you can't do what you wanna do,
[00:44:37.760]you can't have the things you wanna do,
[00:44:40.970]and you gotta do something very specific.
[00:44:43.430]Like you're in math class
[00:44:44.530]and you gotta follow these instructions
[00:44:45.930]and you gotta do exactly
[00:44:47.080]what this teacher's telling you to do.
[00:44:49.700]That's one general context.
[00:44:51.320]You can't have what you want
[00:44:53.180]and you gotta follow very specific expectations.
[00:44:56.910]Then there is another context,
[00:44:58.210]where you really can't have the thing that you want.
[00:45:02.510]You gotta figure out something else to do.
[00:45:05.200]And it's not very specific.
[00:45:06.670]It's just that's more like independent leisure skills.
[00:45:10.880]Maybe your tablet has died.
[00:45:12.900]Mom's busy, she can't fix it right now.
[00:45:15.600]And you just gotta look around
[00:45:17.170]and figure out another activity, occupy your time.
[00:45:21.210]Because waiting is doing.
[00:45:24.380]It's a skill.
[00:45:25.213]It's things you do while you wait that make it tolerable.
[00:45:28.920]And, as all parents know,
[00:45:32.470]I have a kid who has a full room of toys,
[00:45:36.030]and yet this is a skill we had to teach, right?
[00:45:38.140]Like if whatever she's got her mind set on
[00:45:41.710]is not available, and I'm not available,
[00:45:43.530]and I just say, "Do something else,"
[00:45:46.320]she's like, "There's nothing to do."
[00:45:48.500]There's tons of things to do, but that's a skill.
[00:45:50.690]That's a skill we had to teach directly.
[00:45:53.360]And so what I'm suggesting here
[00:45:54.720]is all of the students we work with are all individuals.
[00:45:58.360]And, hey, COVID taught us that about all of us, right?
[00:46:01.140]We needed some alternative fun activities to do
[00:46:04.740]when things we really wanna do are not available.
[00:46:09.800]Now, what's different here than some of the other ways
[00:46:15.510]we try to teach this toleration and waiting
[00:46:19.040]is also in the fact that there is no delay here.
[00:46:22.690]There's no gap, in the sense that
[00:46:26.590]if you look at these ways that reinforcement is delivered,
[00:46:30.160]reinforcements are always delivered following
[00:46:32.670]a very specific chain of responding.
[00:46:37.190]So in this model of treatment,
[00:46:40.590]sometimes all the way to the end,
[00:46:43.160]when a child communicates,
[00:46:44.530]their communication is immediately reinforced.
[00:46:48.550]You could be at the step
[00:46:49.640]where they can tolerate 45 minutes of work,
[00:46:52.700]but that's not every single time that they ask to not do it.
[00:46:58.950]Sometimes when they ask they get it right away,
[00:47:00.450]so there's immediate reinforcement.
[00:47:03.520]Sometimes, though, they gotta do a little bit more.
[00:47:05.870]So you always see there's sort of a chain.
[00:47:08.060]If you were to follow the EO all the way
[00:47:10.040]to the denial Q and Go,
[00:47:12.410]you see that we have very specific expectations laid out.
[00:47:16.690]Even if it's like figure out
[00:47:18.200]an independent leisure activity to do,
[00:47:21.310]it is still looking at a response
[00:47:23.950]that looks like some sort of leisure activity
[00:47:26.060]that they're doing independently.
[00:47:27.130]You're still looking at a response requirement.
[00:47:29.960]And this is important,
[00:47:30.980]because if we were to simply impose a delay,
[00:47:35.070]like a child said, "I want this,"
[00:47:36.490]and we said, "Not right now,"
[00:47:39.290]and then instructed nothing else,
[00:47:43.091]now you have that gap where...
[00:47:45.930]We used to do this.
[00:47:47.390]There is some old data on this where we just say,
[00:47:49.747]"Okay, wait."
[00:47:52.500]Now it's time.
[00:47:53.590]And you gradually extend that time.
[00:47:56.240]Thirty seconds, one minute, five minutes, 10 minutes.
[00:48:02.040]Here's what happens with extinction.
[00:48:04.420]That's extinction right there, right?
[00:48:06.020]And as you increase the gap,
[00:48:10.690]you basically have extinction induced variability.
[00:48:15.290]I know it's a technical term,
[00:48:16.520]but what it means is whatever you wanted,
[00:48:20.450]you said, "I want this thing," is not available.
[00:48:22.890]No one's telling you what else to do.
[00:48:24.590]Now you get a bunch of other behaviors happening.
[00:48:27.740]You get a lot of other responses happening.
[00:48:29.680]Now, extinction induced variability sometimes is great.
[00:48:33.960]Sometimes it results in some creative behaviors that happen.
[00:48:39.610]Sometimes you discover other ways of getting things,
[00:48:42.130]like imagine going to maybe a vending machine
[00:48:48.370]and you put your coin in and the drink doesn't come out,
[00:48:52.720]and then you start shaking it,
[00:48:54.970]and then three things fall out.
[00:48:56.527]And you're like, "Whoo, that was good," right?
[00:49:01.130]We use extinction induced variability sometimes
[00:49:03.480]in the arts,
[00:49:05.310]sometimes when we want things to be creative.
[00:49:09.050]But in order for it to be good,
[00:49:11.380]you need some prerequisites skills.
[00:49:13.140]You need a repertoire of skills that are functional,
[00:49:19.900]that are appropriate, that are desirable.
[00:49:21.840]And you just are trying to get a kid
[00:49:24.010]to kinda do something different.
[00:49:26.520]But a lot of the kids we work with have a skill deficit,
[00:49:30.920]a significant skill deficit.
[00:49:34.150]When you put that communication response on extinction
[00:49:37.500]and don't instruct and don't directly teach something else,
[00:49:41.400]extinction induced variability results
[00:49:43.420]in another form of problem behavior to occur.
[00:49:50.111]You don't get appropriate behavior.
[00:49:51.397]You're probably not gonna
[00:49:52.720]get appropriate play behavior, really.
[00:49:55.170]You might get that with a typically developing kid
[00:49:56.950]that has a strong player repertoire.
[00:50:00.400]But here, what I'm suggesting
[00:50:02.070]is let's not leave it to chance.
[00:50:04.560]Let's really specifically teach what the child should do
[00:50:09.760]when they cannot have what it is that they want.
[00:50:14.340]You're there, you're spending the time,
[00:50:17.560]and we're really good at teaching skills.
[00:50:19.870]And that's what I mean by this is skill-based treatment.
[00:50:23.010]So if you've been in the field
[00:50:25.130]and you've done DROs, for example,
[00:50:28.010]DROs are not good, because all a DRO says
[00:50:31.810]is as long as you don't engage in the problem behavior,
[00:50:35.960]you get X,
[00:50:37.640]and then you have extended intervals of that.
[00:50:42.060]But DROs show repeatedly that, in fact,
[00:50:45.090]what ends up happening
[00:50:45.960]is newer forms of problem behavior emerge during that time,
[00:50:50.690]'cause DROs don't teach, DRAs do,
[00:50:53.800]and this is a DRA.
[00:50:55.870]And you can choose,
[00:50:57.410]again, based on the goals for that individual
[00:51:00.110]that they've identified or their parents have identified,
[00:51:02.760]or their teachers have identified,
[00:51:04.180]or the context dictates what these skills should be.
[00:51:08.300]And you specifically teach them,
[00:51:09.670]even if it's independent skills,
[00:51:13.450]there is some prerequisites for that.
[00:51:15.430]So my daughter, for example,
[00:51:16.960]needed to learn to, one, relinquish,
[00:51:21.240]walk away from the tablet that's dead.
[00:51:24.190]Stop asking me to end my call.
[00:51:27.210]She needed to transition to the playroom that exist,
[00:51:30.320]and she needed to scan and maybe pull out some of the bins
[00:51:34.500]and check out what's inside them so that she could choose.
[00:51:36.780]Those are all behaviors you can teach
[00:51:39.710]that our learners might not have in their repertoire.
[00:51:42.290]Are they independently scanning the environment
[00:51:44.220]and seeing what else is available?
[00:51:46.200]And you might have to specifically instruct those skills.
[00:52:00.770]So in summary, then, when you get into this treatment,
[00:52:05.290]the first place to start is by teaching that relinquish,
[00:52:09.130]get instructional control over that,
[00:52:12.840]then get transitioning to happen,
[00:52:15.840]and then very gradually increase the amount of behavior
[00:52:20.240]and the type of behavior we require.
[00:52:22.840]The variability is really important here.
[00:52:26.270]If you're working with a kid for an hour or two,
[00:52:28.710]you probably wanna have multiple branches, right?
[00:52:30.910]You don't wanna be working on language or on math
[00:52:33.900]the entire time,
[00:52:35.530]especially if that's a very difficult task for that kid.
[00:52:39.330]So, generally speaking, I say,
[00:52:40.447]"Hey, let's choose three branches that we're gonna work on
[00:52:43.820]so that you can alternate between them."
[00:52:45.860]And maybe one of those branches is a little easier.
[00:52:47.910]So we might have a play branch and a language branch
[00:52:50.930]and a math branch,
[00:52:52.360]and within that you have some activities,
[00:52:54.230]so that every time you interrupt and you say,
[00:52:56.107]"Okay, come on with me.
[00:52:57.160]We're gonna do some work,"
[00:52:58.870]it's not the most difficult work that kid has to do.
[00:53:03.530]And then, not only that,
[00:53:04.550]I talked to you guys about expect various amounts of work.
[00:53:09.260]You gradually increase the amount of work you want,
[00:53:11.810]but you keep that variability always.
[00:53:14.750]Until the very end,
[00:53:15.740]sometimes just communication works.
[00:53:17.760]Until the very end,
[00:53:18.660]sometimes they come over to do math,
[00:53:20.330]and all they do is pick up their pencil to get started,
[00:53:23.410]and you say, "Thanks so much.
[00:53:25.200]I love that you were willing to do some math.
[00:53:27.220]You know what?
[00:53:28.053]Go back and play."
[00:53:29.350]Sometimes they just do two problems,
[00:53:30.840]even though you gave them a huge stack of worksheets,
[00:53:33.400]and you're like, "That's all I needed.
[00:53:35.150]Thank you."
[00:53:36.400]Sometimes they do five worksheets,
[00:53:39.420]and you kind of increase that thing.
[00:53:41.010]The hope remains alive.
[00:53:44.010]At any given point I might say, "Thank you.
[00:53:45.980]That was awesome."
[00:53:48.540]And if you think about your own behavior too,
[00:53:51.100]I don't know if you guys have any kind of,
[00:53:52.820]maybe I'm the only one, but I have,
[00:53:54.170]I download a lotta time management programs for myself.
[00:53:59.850]And one of my weaknesses is writing.
[00:54:02.430]I love to talk, but I don't like to write.
[00:54:04.869]So I have papers I gotta write or edit.
[00:54:08.710]And especially when it's like a long paper,
[00:54:11.490]and I know I gotta do it,
[00:54:13.040]there's this huge pause that happens
[00:54:16.510]before I even get started,
[00:54:17.930]because it's a tedious, long task.
[00:54:21.040]So laundry gets done, the kitchen's spotless,
[00:54:25.530]I make homemade food for my 10-month old.
[00:54:28.600]Like, everything is great.
[00:54:30.380]And I still haven't started my paper.
[00:54:32.550]One of the strategies that's super effective
[00:54:35.050]is there's an app that you can download,
[00:54:38.170]and it's basically like random intervals,
[00:54:41.320]and it says, "Alright, for this interval,
[00:54:43.730]you're just gonna start working.
[00:54:45.370]You're gonna start your a paper."
[00:54:47.530]And this buzzer goes off.
[00:54:49.890]And whenever it goes off,
[00:54:51.300]you get to get up and you get to do something else.
[00:54:52.777]You get to check Facebook,
[00:54:54.260]you get have to have another coffee,
[00:54:55.707]whatever it is you wanna do.
[00:54:57.970]And it's random.
[00:54:59.060]So I play it.
[00:55:01.300]I start working.
[00:55:02.590]I might write a paragraph and it buzzes.
[00:55:04.580]I might write three pages and it buzzes.
[00:55:06.320]It's random interval.
[00:55:07.670]And the longest interval might be like a half-an-hour.
[00:55:11.160]But the shortest one might be two minutes.
[00:55:13.120]Do you know how much work I get done because of that?
[00:55:16.670]I know it sounds a little gamey, but there's a lot of data,
[00:55:20.500]we have it in basic arrangements,
[00:55:25.140]we have it with humans,
[00:55:26.460]we have it with non-humans,
[00:55:28.360]that shows if you know that there's a long delay
[00:55:32.220]to your reinforcement,
[00:55:33.410]there's a lot of pausing in problem behavior,
[00:55:35.270]and, basically, procrastination that happens.
[00:55:37.880]And for our kiddos, that could look like problem behavior,
[00:55:40.930]because you just signaled,
[00:55:42.707]"Look at the stack of worksheets I need you to do,"
[00:55:45.532]and they're like, "Heck no."
[00:55:48.670]So you can do two things.
[00:55:50.110]You can always have the stack of worksheets available,
[00:55:55.110]but the kid doesn't know.
[00:55:56.020]They might come and just orient towards the worksheet
[00:55:58.240]and that's all you needed.
[00:55:59.400]They might come and do two problems.
[00:56:01.680]They might come and do seven.
[00:56:03.270]Now, with some kids, because of the history,
[00:56:05.710]seeing that stack of worksheets is already too hot,
[00:56:08.440]so you might wanna put it away,
[00:56:10.290]and you might only bring out the work that they need to do.
[00:56:12.520]So you can adjust these types of signals and things
[00:56:15.140]for your learner and make it something that works.
[00:56:18.260]Figure out where the triggers are, remove it,
[00:56:20.820]and then gradually bring it back out.
[00:56:23.480]Maybe you do in a regular classroom need to tolerate
[00:56:26.040]that there are signals of work.
[00:56:29.000]That's something you need to get used to.
[00:56:30.530]The teacher has those things out.
[00:56:32.510]But you can slowly work towards that.
[00:56:34.600]But just know that there's nothing unique here.
[00:56:36.650]We are the same, right?
[00:56:38.550]We just have figured out problem behavior
[00:56:41.900]that looks a little bit better.
[00:56:44.060]Like my problem behavior is doing laundry,
[00:56:47.230]but it's still problem behavior,
[00:56:48.370]in the sense that I'm not getting the paper done.
[00:57:00.770]Final thoughts I'd like you to leave here with
[00:57:03.620]is focus on cooperation, not compliance.
[00:57:07.830]Focus on cooperation, not accuracy.
[00:57:10.929]It's okay if a child errs and you need to correct that.
[00:57:13.690]All you're looking for here
[00:57:15.720]is cooperation with the teaching context.
[00:57:18.769]And that teaching context can include error correction
[00:57:21.620]and prompting and whatnot.
[00:57:24.280]Focus on cooperation, not speed.
[00:57:31.030]And as you challenge your learners,
[00:57:33.440]introduce one challenge at a time,
[00:57:35.960]build the skills for that challenge
[00:57:37.670]before you start stacking those challenges up,
[00:57:41.000]and always maintain the joy, safety,
[00:57:44.890]televisability and trust.
[00:57:50.400]Thanks, guys.
[00:57:51.879](delegates applauding)
[00:58:00.630]What was the intervention reinforcement
[00:58:02.767]that you referred to?
[00:58:05.010]I have one that's called the Pomodoro.
[00:58:09.120]That one though is set.
[00:58:10.480]And I found myself like,
[00:58:12.320]even though it was only 25 minutes,
[00:58:13.970]I was like, "Twenty-five minutes, I don't wanna do it,"
[00:58:15.537]and I would turn it off.
[00:58:17.144]And I think the next one I have is,
[00:58:20.200]it's just a random interval generator.
[00:58:24.790]It works, yeah.
[00:58:25.623]And you can have it for kids too.
[00:58:27.840]And I think there's one too that you can like spin.
[00:58:30.750]You can make a game for kids and you spin it.
[00:58:38.137]And I sometimes hide it.
[00:58:38.970]I say, "Well, I spun it, and it's gonna ring.
[00:58:41.060]You just dunno what it is."
[00:58:43.180]PBIS has an app called
[00:58:45.826](speaking off mike)
[00:58:57.540]Yeah, so you could probably use that.
[00:58:59.130]And I would use the variable one.
[00:59:00.730]And it's free. Nice.
[00:59:03.000]Thank you.
[00:59:07.150]Be Positive is the app.
[00:59:15.304]Yes.
[00:59:19.393](speaking off mike) Thank you very much.
[00:59:21.256]Thank you.
[00:59:22.405](speaking off mike)
[00:59:28.824]That's good.
[00:59:29.657]Give us a chance again. (laughing)
[00:59:31.104]It's what's I wanna stay.
[00:59:32.935]This has really helped me understand
[00:59:34.234](speaking off mike)
[01:00:15.471]Nice.
[01:00:16.589]You know, I think, again, I know I criticize us a lot,
[01:00:20.090]but we have some really awesome teaching procedures
[01:00:23.920]to offer, and it's really ultimately the way
[01:00:25.960]that I think we all learn.
[01:00:27.830]It's not unique to one population or another,
[01:00:32.300]but we also have to adjust some of those procedures.
[01:00:35.930]Yes.
[01:00:37.275](speaking off mike)
[01:00:39.010]Yeah.
[01:00:40.881](speaking off mike)
[01:00:43.840]Sure.
[01:00:46.580](muffled speech)
[01:00:56.330]Alright.
[01:00:57.163]So the question is about buy-in in the school system.
[01:01:01.460]We work with a lot of school system across the US.
[01:01:04.940]And I would say that there's a mix
[01:01:07.030]of who is actually implementing this.
[01:01:10.560]With some schools, depending on,
[01:01:12.600]I guess, the funding and the resources available,
[01:01:14.890]It is BCBAs and RBTs,
[01:01:17.750]or people that are more behaviorally trained
[01:01:19.890]that are doing it,
[01:01:21.087]but we've done it successfully with the paraprofessionals
[01:01:26.437]in the classroom, as well as the teachers.
[01:01:29.310]Usually, teachers can't devote in the initial stages
[01:01:33.100]the sort of on-one-time required,
[01:01:34.830]so the paraprofessionals end up doing it.
[01:01:36.910]And on our website, we have two types of training.
[01:01:39.300]We have one that's for BCBAs that are looking for CEUs,
[01:01:42.540]and it's a more conceptual training,
[01:01:45.670]and then we have another one
[01:01:46.630]that's geared towards paraprofessionals and parents.
[01:01:50.050]And that one gets more into the micro-teaching tactics,
[01:01:54.210]prompting, differential reinforcement and how to do that,
[01:01:57.200]and so that's what I would recommend.
[01:01:59.260]But, really, all we need is somebody who's willing
[01:02:03.350]to do this process initially with a child
[01:02:06.100]and kind of be the hero of that team.
[01:02:09.050]And then, as far as extending it to others,
[01:02:11.820]once we see success with one person,
[01:02:13.920]more people get on board.
[01:02:16.180]And if you're a school system that's considering this,
[01:02:18.210]or a school team that's considering,
[01:02:20.540]my recommendation would be to start small,
[01:02:23.390]but start with multiple examplers.
[01:02:25.070]So get a team together
[01:02:26.310]and just have like three cases go through this,
[01:02:29.800]and have everybody else watch what's happening.
[01:02:32.840]And through you doing it, you'll get a lot more buy-in.
[01:02:37.610]I was gonna add that we have here
[01:02:39.460]in Nebraska some of those school teams
[01:02:41.260]that are going through this process with FTF.
[01:02:43.600]We have weekly collaborations through this process.
[01:02:46.080]We some (faintly speaking) in the room.
[01:02:48.760]So if your school is interested in this process,
[01:02:51.820]our state board (faintly speaking) specialists
[01:02:54.010]are working toward this,
[01:02:55.885]and we've definitely (faintly speaking)
[01:02:57.447]and had licenses (coughing drowns out speech)
[01:02:59.280]that will help point (faintly speaking)
[01:03:01.039]in the right direction.
[01:03:02.039](faintly speaking)
[01:03:03.820]Awesome.
[01:03:04.653]Yeah, you guys have role models here that can help.
[01:03:08.958](speaking off mike)
[01:03:17.000]Yeah, I believe it's on
[01:03:18.520]the Practical Functional Assessment website.
[01:03:23.566]I don't know that I can show you you right now,
[01:03:26.110]but what I can do is I can send it to Annette
[01:03:31.060]and have her put it as one of the supplementary materials,
[01:03:34.410]if that helps.
[01:03:36.060]Okay.
[01:03:36.893]Along with these slides as well.
[01:03:45.740]Alright, well, you hung in there.
[01:03:47.470]Thanks, guys.
[01:03:49.036](delegates applauding)
[01:04:04.080]Oh, thank you.

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Towards a Practical Functional Assessment and Skill-Based Treatment Process Addressing Severe Problem Behavior- Part 2

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