Towards a Practical Functional Assessment and Skill-Based Treatment Process Addressing Severe Problem Behavior (Part 1)

Mahshid Ghaemmaghami Author

04/14/2022 Added

50 Plays

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Conference 2022

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[00:00:00.972]All right, you guys are continuing with me.
[00:00:03.070]That's a good sign.
[00:00:05.940]Okay, so we're gonna get into a little bit more details
[00:00:14.630]than what we talked about earlier.
[00:00:20.170]Was everybody, was anybody not in the keynote?
[00:00:26.260]Okay, good.
[00:00:27.100]Because I just had some reminders,
[00:00:29.190]but we can skip through those quickly.
[00:00:35.651]And basically just remind everybody.
[00:00:37.520]So we're gonna go now and discuss the actual assessment
[00:00:40.610]in more detail, and keeping in mind the commitments
[00:00:44.770]and the values that we reviewed previously.
[00:00:51.000]And so the name that you'll become familiar with is PFA,
[00:00:57.060]Practical Functional Assessment.
[00:00:58.800]Just trying to kind of make it stand out
[00:01:03.100]from behavioral functional assessments that maybe you've
[00:01:06.529]done in the past or you have witnessed
[00:01:10.470]and highlight the value of practicality
[00:01:14.120]and something that we've really worked
[00:01:16.222]and continue to work hard to achieve.
[00:01:19.020]And this practicality is really getting us closer to, again,
[00:01:21.890]those constructs of effectiveness,
[00:01:24.550]which includes not just the end, the goal,
[00:01:28.270]and whether you got it or not, but how did you get there?
[00:01:31.730]What was the experience like?
[00:01:33.500]Do people wanna do this again, right?
[00:01:35.520]Social validity.
[00:01:36.970]And then, of course, whether those effects
[00:01:38.920]maintain over time with different people,
[00:01:41.590]not just the experts, and not just in certain settings,
[00:01:44.590]but really in the relevant settings with relevant people.
[00:01:48.610]So the practical functional assessment
[00:01:50.370]and the follow up to it, skill-based treatment,
[00:01:55.737]has been shown to produce socially-meaningful outcomes.
[00:02:01.000]It's been socially validated
[00:02:02.610]and generally an applicable process.
[00:02:05.650]We've done this with kids, with adults, with adolescents,
[00:02:09.310]with individuals with or without developmental disabilities,
[00:02:12.680]with or without vocal verbal language.
[00:02:14.440]Sometimes there's sort of a misunderstanding
[00:02:16.550]that this is good for young kids only.
[00:02:19.780]This is good for kids that have language.
[00:02:22.544]Those are misconceptions.
[00:02:25.370]There's been a lot of generality of this process
[00:02:28.980]that's been demonstrated through the populations
[00:02:31.410]that we've served.
[00:02:33.600]And certainly the largest population we've served
[00:02:37.450]has been individuals with ASD.
[00:02:40.480]I think that's because, mostly because that's
[00:02:43.690]when the services are available,
[00:02:45.120]when you have that diagnosis, right?
[00:02:46.660]But certainly even with kids without a diagnosis,
[00:02:49.210]this process has been shown to work.
[00:02:53.160]And our focus really, especially over the past two years,
[00:02:55.980]has been gaining the same outcomes when we start
[00:03:01.620]and finish this process in home and in schools, right?
[00:03:05.130]So no longer in sort of specialized session rooms
[00:03:10.870]and universities, but really just in the actual environment
[00:03:14.110]that this is happening.
[00:03:17.500]And it starts with first gaining and understanding.
[00:03:21.880]Do you guys hear like a little bit of a background
[00:03:24.020]every time I speak, how do I avoid that?
[00:03:27.340]If I move a little further away, is that bad?
[00:03:29.940]Do you still hear me?
[00:03:31.610]Okay, maybe we'll do that.
[00:03:34.450]So understanding problem behavior is our first step,
[00:03:38.690]but we're saying let's do that through a safe, dignified,
[00:03:42.610]and trauma-informed and trauma-assumed analysis.
[00:03:46.530]Now, has anyone here done a standard functional analysis
[00:03:51.720]or witnessed one ever?
[00:03:54.210]Okay.
[00:03:55.570]I've, that's where I started as well,
[00:03:57.980]as a behavioral analyst.
[00:03:59.390]There were some standard analyses I did.
[00:04:01.238]And I did that before I went back for my PhD,
[00:04:05.270]when I was a practitioner and working
[00:04:08.510]with mostly really young kids on the spectrum.
[00:04:11.910]So still a lot of the problem behavior
[00:04:14.750]was relatively manageable in the setting that I was in,
[00:04:17.640]but I can assure you that, one,
[00:04:19.790]it took a lot of convincing to get permission
[00:04:24.030]to do it in my setting.
[00:04:26.990]And then the experience for me was very disappointing
[00:04:32.150]because I did not have a good outcome.
[00:04:34.840]It was not a good experience.
[00:04:37.070]And even with the ones that I had an outcome or a finding,
[00:04:41.400]okay, intention maintained,
[00:04:43.640]then treatments that were designed based on that finding
[00:04:49.660]did not actually work or had limited utility.
[00:04:55.120]And so, and these findings or this experience that I had
[00:04:59.747]has actually been captured quite a bit
[00:05:02.760]in the literature as well.
[00:05:04.260]If you look at the standard functional analysis
[00:05:06.470]and the data on it, more than 50% of the time.
[00:05:10.360]Now keep in mind, these are published studies, okay.
[00:05:14.640]By experts.
[00:05:15.700]More than 50% of the time, when you do a standard analysis
[00:05:19.020]where you're trying to tease apart, is it attention,
[00:05:21.100]escape, tangible, right?
[00:05:22.420]The standard Iwata analysis,
[00:05:24.480]you end up with undifferentiated analyses,
[00:05:26.880]meaning you end up with no answer.
[00:05:29.510]More than 50% of the time, and that's done by experts.
[00:05:33.400]And that's not even including
[00:05:36.650]the data that's not even published.
[00:05:38.340]Every researcher knows that there's a file drawer
[00:05:41.110]of data that just never went anywhere, okay.
[00:05:46.410]And so we have an assessment.
[00:05:48.150]We had an assessment for years, that we knew what sort of,
[00:05:51.611]if it worked, if it gave us an understanding.
[00:05:54.455]It was the best, but not surprising
[00:05:58.300]that a lot of practitioners were not using it
[00:06:00.920]because imagine going through all the
[00:06:02.300]administrative red tape, getting permission to do it,
[00:06:05.240]do it, and it looks ugly when you do it.
[00:06:08.620]And I'll tell you guys why in a second.
[00:06:10.730]And then also not having an answer.
[00:06:13.870]And then try and get that permission again next time
[00:06:15.990]for another kid, right?
[00:06:18.170]So I often say, if an individual,
[00:06:20.530]or if you know the population at large
[00:06:22.201]is not doing something, we gotta think about that.
[00:06:25.340]The fact that the organism is not wrong.
[00:06:27.270]We're behavior analysts here.
[00:06:28.730]We gotta look at, well,
[00:06:29.900]clearly the contingencies are supporting
[00:06:32.370]many behavior analysts avoiding an analysis.
[00:06:34.650]And that is what we find in the descriptive interviews
[00:06:36.877]that have been done with behavior analysts.
[00:06:38.716]When we ask them, what kind of assessment do you do?
[00:06:41.150]Most of them would say, you know, I do ABC assessments.
[00:06:44.260]I do observations, I don't do analysis.
[00:06:46.730]And when we would ask them,
[00:06:47.708]"well, do you know that those other assessments
[00:06:49.697]"are not as good as analysis?"
[00:06:50.960]They would say, "Yeah, I know," right?
[00:06:53.370]So it's not a lack of education.
[00:06:54.950]It's not a lack of knowledge.
[00:06:56.190]It was a lack of utility.
[00:06:57.910]It was not helpful.
[00:06:59.050]If you're not using it, it's because it's not helping you.
[00:07:01.240]It's not helping your clients.
[00:07:02.340]And we have to recognize that.
[00:07:03.530]And so the birth of the practical functional assessment
[00:07:06.505]comes from that.
[00:07:07.700]Comes from data that basically
[00:07:09.320]told us this process was not helpful.
[00:07:12.870]It was not leading to effective treatments,
[00:07:16.160]to meaningful outcomes.
[00:07:18.130]Because we're applied behavior analysts.
[00:07:20.410]We are clinicians.
[00:07:21.530]We are people that are working.
[00:07:23.620]We've had a referral for a problem.
[00:07:26.600]Our job is to fix it.
[00:07:27.710]It's not about a scientific curiosity.
[00:07:29.860]We can get into a conceptual debate about
[00:07:31.746]what the standard analysis teaches us.
[00:07:33.695]You know, do we ever wanna know what this variable is,
[00:07:36.463]does the function of behavior matter or not.
[00:07:38.533]I'm talking to you today from the perspective
[00:07:42.510]of a clinician, with a family in front of you,
[00:07:44.940]with a kid in front of you,
[00:07:45.900]with a person in front of you that you need to help.
[00:07:49.160]So for me, the main purpose of the assessment
[00:07:51.650]is to figure out a treatment.
[00:07:54.100]And the purpose of treatment is
[00:07:55.249]to have a meaningful outcome.
[00:07:57.240]And really the purpose is for me to not work
[00:07:59.180]with that family forever, to be able to say goodbye,
[00:08:02.130]and for them to say, "Thank you very much.
[00:08:03.577]"Our problem is solved."
[00:08:05.500]So if we keep those goals in mind,
[00:08:07.540]that's the kind of assessment I'm talking about here,
[00:08:09.599]with respect to practical functional assessment,
[00:08:11.850]and whether it's the one that you should use.
[00:08:17.140]So the aim of traditional functional assessment
[00:08:19.690]was really to identify function.
[00:08:21.390]We've talked for years about the importance of this.
[00:08:23.990]We need to know what the function is.
[00:08:29.270]But, again, it was a good place to go.
[00:08:33.060]Remember we came from behavior modification.
[00:08:35.320]Actually we came from, as a society, as a field,
[00:08:38.380]we came from, people engage in problem behavior,
[00:08:40.430]self-injury in particular, and we said
[00:08:42.129]nobody could possibly explain why this is.
[00:08:44.840]There is no cause for it.
[00:08:46.130]That was the start, right?
[00:08:47.990]Let's just put these individuals in restraints.
[00:08:50.820]Let's put them, segregate them from society.
[00:08:53.380]And let's forget about it.
[00:08:55.100]That's where we came from.
[00:08:56.450]Then came behavior modification,
[00:08:58.310]which showed, hey, with some arbitrary reinforcers
[00:09:01.749]and punishers, we can actually stop the self-injury.
[00:09:04.720]We can teach some skills.
[00:09:05.810]So, you know, that's good.
[00:09:07.730]That's the next step.
[00:09:09.180]Saying, no, no, these are operant behaviors
[00:09:11.820]that we can change.
[00:09:15.170]Of course, that wasn't good either
[00:09:16.370]because we weren't understanding the reason.
[00:09:18.240]So it wasn't a place to stop.
[00:09:19.610]So the next stop was let's understand it.
[00:09:23.799]But what we're suggesting is, that was over 30 years ago.
[00:09:27.690]Every science is growing.
[00:09:28.900]Every understanding is growing.
[00:09:30.220]As a society, we're learning more and more.
[00:09:31.890]So this is really the next step.
[00:09:33.700]We learned a lot.
[00:09:35.650]The traditional analysis gave us a lot of information,
[00:09:38.850]but it also highlighted maybe some other problems,
[00:09:41.770]and we need to recognize those things.
[00:09:43.750]And ultimately we don't yet
[00:09:46.380]have meaningful treatment outcomes at large.
[00:09:49.510]So let's see what the next step is.
[00:09:53.660]And so the aim of the practical functional assessment,
[00:09:56.330]you know, sometimes I get into mostly friendly debates
[00:09:59.570]with other behavior analysts, especially researchers.
[00:10:02.410]Some of them are good friends.
[00:10:04.490]About ISCA versus the standard analysis,
[00:10:09.370]and what this teaches us and what that teaches us.
[00:10:12.030]And I finally have come to the thing to say, you know what?
[00:10:14.765]You're right, I don't know the function.
[00:10:17.330]I don't know the function, and I don't care.
[00:10:21.250]It doesn't matter, okay?
[00:10:24.610]So move away from those debates.
[00:10:26.066]If you're working with other professionals,
[00:10:27.970]and that's the kind of debate you're getting into,
[00:10:30.290]highlight the fact that let's talk about treatment utility.
[00:10:34.023]That's the question here.
[00:10:35.720]Because here's the thing.
[00:10:37.010]We still are doing an analysis with the ISCA.
[00:10:39.790]You're still, when you do a practical functional assessment,
[00:10:41.840]you're still,
[00:10:42.770]you're not just doing the script of assessments.
[00:10:44.620]You're doing an analysis, you have an understanding,
[00:10:47.070]The difference is you are identifying a context
[00:10:51.000]in which problem behavior happens.
[00:10:53.240]The relevant variable that standard people
[00:10:55.741]are really fond of is in there.
[00:10:58.770]You might just have some additional things around it.
[00:11:01.320]You might say, you know, it's not about just attention.
[00:11:03.640]It's about attention in light of what, right?
[00:11:08.217]And you might have some tangibles,
[00:11:09.960]and you might have some escape included in there.
[00:11:12.760]And the standard people might say,
[00:11:14.337]"Those things don't matter."
[00:11:16.353]And I'm saying, all right, let's exercise.
[00:11:19.189]Let's do a little exercise here and say,
[00:11:22.260]let's assume for a moment that I have some additional
[00:11:25.480]positive things in there that should not be in there.
[00:11:28.780]So let's assume I have a false positive.
[00:11:30.890]That's what people talk about.
[00:11:32.008]You have some irrelevant variables in there.
[00:11:34.890]I added attention, even though it really doesn't matter.
[00:11:37.800]I added the iPad, even though it really doesn't matter.
[00:11:40.110]I added, you know,
[00:11:42.760]the trampoline and that's not really the factor.
[00:11:46.525]That's a risk with my assessment.
[00:11:48.054]The risk with your assessment,
[00:11:49.319]you might have a false negative.
[00:11:51.253]You might not be including attention,
[00:11:53.504]even though it matters.
[00:11:55.080]You might not be including the tablet,
[00:11:57.115]even though it matters.
[00:11:59.814]And now we go to treatment.
[00:12:02.670]The additional stuff I've added, what has it done?
[00:12:05.790]It has enriched the environment.
[00:12:08.360]It's made it a little bit more cumbersome.
[00:12:10.180]No problem, I admit that.
[00:12:12.120]Yeah, it makes it a little more hard.
[00:12:13.240]Now I'm saying, "Hey Mom,
[00:12:14.567]"you need to provide really high quality attention
[00:12:16.657]"and all the stuff."
[00:12:17.567]You know, if you guys have done PFAs,
[00:12:19.720]you know that you set up that context of HRE,
[00:12:22.130]and it's very rich.
[00:12:23.240]It takes you time to set it up and time to take it down.
[00:12:28.330]But you really turn problem behavior off.
[00:12:31.780]By contrast, if you have a false negative,
[00:12:34.031]if you fail to include something that matters,
[00:12:37.240]what's the risk there?
[00:12:41.010]It's danger.
[00:12:42.058]It's lack of safety.
[00:12:44.150]And when we look at rate of problem behavior
[00:12:46.930]in a lot of published literature,
[00:12:50.120]we actually do see elevated rates of problem behavior.
[00:12:53.110]More than it was necessary.
[00:12:56.460]Especially in something like escape conditions, right?
[00:12:59.620]So imagine this.
[00:13:01.550]In a standard analysis, problem behavior happens.
[00:13:06.040]You're given 30 seconds of a break from task, right?
[00:13:11.020]That's how the session run, it runs, in a standard analysis.
[00:13:14.030]So you engage in self-injury.
[00:13:16.870]You get a 30-second break from your tasks.
[00:13:19.020]Things are removed.
[00:13:19.980]Nothing else is provided.
[00:13:20.990]There's no attention, there's no tangible.
[00:13:22.600]We're isolating, we really need to know the variable.
[00:13:25.890]After 30 seconds, the task is presented again.
[00:13:28.910]You engage in self-injury, the task is removed again.
[00:13:31.610]What you should have is two instances
[00:13:34.560]of problem behavior, right?
[00:13:37.830]Because you do this, you get it.
[00:13:39.910]You do this, you get it.
[00:13:41.212]If we look at the second by second data
[00:13:44.020]of a lot of these analyses,
[00:13:45.850]you'll see that in the 30 seconds of break,
[00:13:49.430]that self-injury did not stop.
[00:13:52.040]Sometimes you have as many as 500 instances
[00:13:54.482]of self-injury in a standard analysis.
[00:13:59.080]My question, remember I talked about the immediate effect
[00:14:03.270]of reinforcement is it turns problem behavior off.
[00:14:06.170]If escape was the variable and now you have 30 seconds
[00:14:09.840]of escape, why is this persisting?
[00:14:13.970]Because most kids don't escape alone, right?
[00:14:18.150]So the risk of false negative,
[00:14:19.930]the risk of not including relevant variables,
[00:14:22.730]contextually relevant variables,
[00:14:25.240]ecologically valid variables that do exist.
[00:14:28.140]Again, we're not adding things that kids don't experience
[00:14:30.300]on a day to day basis.
[00:14:31.340]This information's coming from their homes
[00:14:33.650]and their schools.
[00:14:35.350]The risk of you not including it is that you might
[00:14:37.770]have way higher rate of problem behavior.
[00:14:40.070]We talked about trauma, that comes with that.
[00:14:42.997]And when we look at the treatment data, this already exists.
[00:14:46.280]This isn't my data or my colleague's data.
[00:14:49.200]These data already exist.
[00:14:50.890]When you go to treatment, what we've ended up doing,
[00:14:54.600]we spend all this time figuring out the variable.
[00:14:57.330]Then we go to treatment.
[00:14:59.111]We add the other variables in.
[00:15:02.750]We add tangibles.
[00:15:04.220]We add tangibles and attention, and we call it...
[00:15:07.752]We needed some arbitrary, additional reinforcers
[00:15:10.430]to teach the skills, right?
[00:15:13.540]So when you go to treatment,
[00:15:14.547]and you're trying to teach these skills,
[00:15:16.050]escape alone isn't working, isn't getting you what you need.
[00:15:19.040]And you end up adding these other variables.
[00:15:20.870]But you're saying those were not the functional reinforcers.
[00:15:23.845]We're just adding them in because we needed
[00:15:25.380]to motivate the child better.
[00:15:26.910]And it's just funny to me, to be honest.
[00:15:29.118]I mean, in a sad way,
[00:15:31.181]that we spent so much time isolating a variable,
[00:15:33.770]exposing that child to this high rate
[00:15:35.360]of problem behavior happening in our assessment.
[00:15:38.270]And that's just in the 49% of assessments
[00:15:42.760]that actually give us an answer.
[00:15:44.613]And then at the end of it, it didn't even matter anyway.
[00:15:47.900]We added the other variables in.
[00:15:50.535]By contrast, the context I'm asking you
[00:15:52.960]to identify through your practical functional assessment
[00:15:56.320]doesn't need things to be added later.
[00:15:58.550]You already have 'em in there, all the way to the end
[00:16:00.788]of the repertoires you're trying to teach.
[00:16:03.510]You're trying to find a very
[00:16:06.890]exceptionally motivating context.
[00:16:11.180]Remember, the door is open and the kid doesn't wanna leave.
[00:16:15.230]When my teams tell me, "So the problem now is he wants
[00:16:18.707]"to do practice all the time."
[00:16:19.980]I say, "Good."
[00:16:21.250]That's a good problem to have.
[00:16:23.410]He's like coming to you and saying, "Can we do this?
[00:16:25.093]"Can we do SBT?"
[00:16:27.860]Now we've kept some things, some of the assumptions
[00:16:29.940]of functional assessment and functional analysis.
[00:16:32.820]And mainly we're still behavior analysts.
[00:16:37.114]Some of my colleagues might disagree with that,
[00:16:38.830]but I am still a behavior analyst,
[00:16:41.670]and I still have the working assumption
[00:16:45.440]of if problem behavior's occurring with regularity,
[00:16:49.120]it is reinforced.
[00:16:50.020]It is still an operant.
[00:16:53.000]And we're still talking about the ABCs.
[00:16:55.230]The antecedents, what was happening before the behavior,
[00:16:58.337]the behavior, and then the consequence, right?
[00:17:03.500]Not everybody here is a behavior analyst or, better yet.
[00:17:08.960]Do you guys know what EOs and SRs
[00:17:11.160]are when I use those terms?
[00:17:14.650]You don't.
[00:17:15.483]Okay, let's go over that.
[00:17:16.570]Some of you do.
[00:17:17.940]So I want you to think about any behavior.
[00:17:22.530]Most of us are sitting here right now,
[00:17:24.330]and there are thousands of responses in your repertoire.
[00:17:30.340]You're a human with maybe millions of responses.
[00:17:33.140]You could be doing anything right now, right?
[00:17:36.760]And these are operant behaviors, meaning they're voluntary.
[00:17:39.570]They're not, we're not talking about reflexes, right?
[00:17:41.460]We're not talking about you blinking
[00:17:43.150]because something's coming towards your eye.
[00:17:44.680]That's a respondent.
[00:17:46.000]We're talking about operant behavior.
[00:17:47.250]I could be sitting.
[00:17:48.800]I could be standing up.
[00:17:49.730]I could be talking.
[00:17:50.563]I could be asking for ice cream, right?
[00:17:53.080]There are lots of things that are in your repertoire.
[00:17:56.820]Which one do you engage in in this moment
[00:17:59.400]depends on two things.
[00:18:01.370]One, the need.
[00:18:04.140]So in lay terms, is there something you want, right?
[00:18:08.560]Ice cream.
[00:18:09.800]I want ice cream all the time, okay.
[00:18:12.080]So there's a need.
[00:18:14.295]I haven't had ice cream, sadly, today.
[00:18:18.630]I don't have a bowl of ice cream in front of me.
[00:18:22.730]So the need for ice cream is there,
[00:18:24.870]and I am actually kinda hungry.
[00:18:26.140]So I'm hungry, I haven't had ice cream.
[00:18:28.770]There's no ice cream in front of me.
[00:18:30.960]There is stuff in the environment.
[00:18:33.500]These are things, environmental events we talk about,
[00:18:36.130]that establish the value of ice cream as a reinforcer.
[00:18:41.690]The things I just described.
[00:18:43.060]There is no ice cream, I don't have it.
[00:18:45.710]I'm hungry, I haven't had food for a while.
[00:18:47.470]All of those things, those contextual variables,
[00:18:51.160]environmental variables,
[00:18:53.240]have increased the value of ice cream.
[00:18:57.770]They continue to increase the value of ice cream.
[00:19:02.720]But I'm not asking you for ice cream, am I?
[00:19:06.020]So it's not just about these variables
[00:19:09.850]that increase its value.
[00:19:11.100]The value, these things are EOs, establishing operations.
[00:19:15.460]They establish the value of a reinforcer.
[00:19:20.530]But that's not enough.
[00:19:22.190]The other reason, the other thing that matters
[00:19:26.780]as to whether I will ask you for ice cream or not
[00:19:29.180]is some sort of contextual cue that tells me there's a
[00:19:33.570]probability of you actually giving me ice cream, right?
[00:19:37.920]There's cues in this environment right now
[00:19:39.860]that tell me it's probably not going to be reinforced.
[00:19:42.810]It might even be punished or ridiculed, right?
[00:19:45.730]If I said, "Hey, can I get some ice cream?"
[00:19:47.730]The answer's likely no.
[00:19:48.790]And that's based on a historical learning
[00:19:51.210]that has happened, right?
[00:19:52.540]There are cues in the environment that tell me
[00:19:54.930]what potential reinforcers are available right now.
[00:19:59.440]And so that's what helps you.
[00:20:01.660]The cues are called SDs.
[00:20:05.690]The things that increase the value
[00:20:07.090]of a reinforcer are called EOs, and then a response occurs.
[00:20:12.240]And then the reinforcer is the SR.
[00:20:14.070]Those are the things that maintain it.
[00:20:15.410]So let's say somebody walked by,
[00:20:18.100]and they looked like an ice cream guy.
[00:20:19.560]And they had like a thing they were pushing.
[00:20:21.130]And I was like, "Ooh, can I have some ice cream?"
[00:20:23.770]And the guy gave me the ice cream.
[00:20:25.020]I would eat that ice cream.
[00:20:25.853]And that would be the reinforcer,
[00:20:27.790]for me asking for it, right?
[00:20:29.420]And so these are important.
[00:20:30.870]The EOs are important, very important.
[00:20:33.360]And in fact, in the assessment,
[00:20:35.150]we mostly rely on the EOs, but SDs are important too.
[00:20:40.340]SDs can be things like you standing up and coming over,
[00:20:44.310]hovering over a child.
[00:20:45.417]That's a cue for you're about to do something.
[00:20:48.780]SDs can be the actual demands that you present.
[00:20:52.150]SDs can be, there's a tablet, but I have it high up.
[00:20:55.370]So the tablet is visible but not accessible.
[00:20:58.470]So the child kind of knows, oh, that that thing is available
[00:21:01.518]if I engage in problem behavior.
[00:21:03.039]SDs can be Mom versus Dad versus your brother, right?
[00:21:08.550]Let's say there was some ice cream in the fridge,
[00:21:10.350]and I was sitting on the couch.
[00:21:12.790]And my brother walked into the living room.
[00:21:14.910]The likelihood of me asking,
[00:21:16.377]"Hey bro, can I have some ice cream?"
[00:21:18.710]And him getting it for me is like next to zero.
[00:21:21.810]The likelihood of my mother getting it however is very high.
[00:21:25.430]So my mom is a different SD than my brother.
[00:21:28.440]And you do see this actually, right?
[00:21:30.070]So you might, for example, hear about kids engaging
[00:21:32.620]in certain behaviors with certain people, but not others.
[00:21:36.490]And that's based on a history
[00:21:37.501]of reinforcement that's happened.
[00:21:39.349]So I am gonna be talking about EOs.
[00:21:41.910]I'm gonna be talking about SRs,
[00:21:43.280]and I'm gonna be talking about SDs.
[00:21:45.440]Are we good?
[00:21:47.210]This language makes sense now?
[00:21:49.780]Okay, cool.
[00:21:50.613]So those things we've kept.
[00:21:51.460]We're still behavior analysts.
[00:21:52.570]We still think these are operants.
[00:21:53.987]And we still think we gotta figure out the EOs
[00:21:56.460]and the SDs and the reinforcers.
[00:22:01.360]And these things, even though there might be some
[00:22:04.260]underlying biological, neurological and medical causes
[00:22:08.560]for some of these behaviors
[00:22:09.870]and why perhaps certain difficulties have risen,
[00:22:15.790]these operants still seem to exist and matter,
[00:22:20.020]this operant contingency I'm describing,
[00:22:21.980]still seems to be something we can control and change.
[00:22:24.680]Despite the fact that an individual
[00:22:26.990]might be born a certain way, right?
[00:22:30.120]So we work with different obviously
[00:22:33.370]genetic dispositions and whatnot,
[00:22:35.170]whether as a result of diagnosis or just differences
[00:22:39.810]in our genomes, and these operants still work.
[00:22:44.950]The difference might be that one population might require
[00:22:48.900]more experience with these contingencies than others.
[00:22:56.520]But there are some new assumptions.
[00:22:57.910]And this is what I alluded to.
[00:22:59.150]And an assumption in PFA and SBT is we really believe
[00:23:03.260]that reinforcement is actually synthesized.
[00:23:06.690]That multiple events co-occur together
[00:23:10.120]to maintain problem behavior, to maintain any behavior.
[00:23:14.230]That there is no such a thing as isolated variables,
[00:23:18.240]that it's actually sort of a scientific thing we've
[00:23:21.580]identified, but from an ecological perspective.
[00:23:24.380]Meaning in the regular world, things co-occur.
[00:23:28.030]There is no isolated variable that really matters.
[00:23:31.397]And that is an assumption we've used and we rely on now.
[00:23:35.920]And so in my questions, in my interview with caregivers,
[00:23:39.640]I'm not really asking them to identify,
[00:23:42.039]was it escape, was it tangible, was it attention?
[00:23:44.820]I'm asking them to describe to me context.
[00:23:46.790]And in fact, I'm combining everything together, right?
[00:23:50.630]So if it's sometimes a tablet and sometimes my attention,
[00:23:53.490]and sometimes he wants to play with water, I add it all in.
[00:23:58.030]'Cause, again, you're trying to kind of create a context
[00:24:00.330]that is so awesome the kid doesn't wanna leave.
[00:24:03.750]So I call it Disneyland on steroids.
[00:24:07.650]That's your context, that's your reinforcement context.
[00:24:11.307]The other thing we have learned, and there's some data,
[00:24:13.750]and for those of you that are geeks
[00:24:15.590]like me and want the papers,
[00:24:17.010]you can look at the two papers here.
[00:24:19.330]These slides will also be available
[00:24:20.740]for you guys after this talk, okay?
[00:24:22.992]But we've shown over and over again.
[00:24:25.570]And others, other researchers have shown over and over again
[00:24:28.160]that a lot of times response classes
[00:24:30.730]include both mild and severe problem behavior.
[00:24:35.450]And you don't need to see the severe form
[00:24:38.210]of behavior to treat it.
[00:24:40.980]You can actually introduce your intervention
[00:24:44.560]at the mild turn away, push away,
[00:24:48.767]and still treat severe aggression and injury
[00:24:51.248]and never see it.
[00:24:53.100]It is a bit of an inference, right?
[00:24:55.710]Because we're doing assessment.
[00:24:57.080]We're reinforcing mild behaviors.
[00:24:59.260]We're saying keep your contingency class open.
[00:25:03.500]Again, think about it from a risk perspective.
[00:25:07.550]Let's say, saying, "I don't really want to,"
[00:25:11.090]and kind of trying to pull away,
[00:25:13.219]and self-injury are all in the same response class,
[00:25:16.850]which we've shown repeatedly.
[00:25:19.060]And you decide in the name of science that you're only,
[00:25:22.310]because you wanna be very accurate.
[00:25:23.730]And that was one of the suggestions people have made,
[00:25:26.220]which I think is a dangerous, dangerous recommendation.
[00:25:29.790]That one way to resolve the issue
[00:25:32.100]of undifferentiated analyses and multiple control
[00:25:35.000]that we find with standard analysis is because we're
[00:25:37.620]combining different typographies of problem behavior.
[00:25:39.957]And we need to isolate the typographies.
[00:25:42.590]Now think about that.
[00:25:43.520]So now I'm gonna do an analysis on just SIB.
[00:25:48.490]So now I'm gonna get all these other behaviors
[00:25:51.500]before I get SIB.
[00:25:52.610]You're gonna get a lot more behaviors.
[00:25:54.730]That session's gonna look really ugly.
[00:25:57.710]The child has to every single time escalate
[00:26:00.780]all the way to the most serious behavior.
[00:26:03.240]And that's what Christine Warner's study showed,
[00:26:07.796]that if we in fact close the contingency,
[00:26:12.220]we see a much higher rate of behaviors overall.
[00:26:15.022]And yeah, we will get the most serious one,
[00:26:17.160]but at what cost?
[00:26:18.980]Again, think about trauma.
[00:26:20.840]So what we're suggesting is let's make an inference.
[00:26:23.940]You reinforce mild behaviors in your assessment.
[00:26:27.210]You do make an inferential leap.
[00:26:32.760]You take an inferential leap and say,
[00:26:34.227]"I think these are all the same response class."
[00:26:37.070]So I'm gonna go ahead and treat behavior based
[00:26:39.830]on the responses that I did see.
[00:26:42.690]If by the end of that treatment,
[00:26:44.170]you're able to put the child in the context
[00:26:48.980]that were reported as problematic, right?
[00:26:52.810]You now can do math.
[00:26:54.090]You now can go to the grocery store.
[00:26:56.040]You now can ask the child to stop their tablet,
[00:26:58.810]stop their activity, come with you and do things.
[00:27:01.040]They're doing all that stuff.
[00:27:02.100]And they're not engaging in severe behavior.
[00:27:04.180]What we're saying is you treated it.
[00:27:06.170]I know you never saw it, but we treated it 'cause, again,
[00:27:10.330]at the beginning, we're identifying,
[00:27:11.602]so what are the problematic contexts?
[00:27:14.570]What are the expectations?
[00:27:15.770]What are the goals for this individual?
[00:27:17.190]Let's imagine that problem behavior was not a barrier,
[00:27:20.890]was not a concern, what would you want your student to do?
[00:27:24.960]What would you want your child to do?
[00:27:27.520]We identify that terminal goal.
[00:27:30.944]And then we get there.
[00:27:32.900]And we sometimes never see the most severe behaviors
[00:27:36.755]and tantrums that were reported to happen.
[00:27:40.390]And I kind of have to sometimes prepare parents for that.
[00:27:44.000]Some parents are very happy.
[00:27:45.970]They're like, "I don't wanna see it.
[00:27:47.139]"It's traumatizing for me to see it as well."
[00:27:49.810]But some other parents are like kind of disappointed.
[00:27:53.690]They're like this wasn't the worst they can get.
[00:27:56.810]And I think, you know, there's just,
[00:27:59.160]not that they're, obviously they don't
[00:28:01.500]want their child to experience that.
[00:28:03.090]But they want us to really understand, right?
[00:28:06.420]They're thinking, "You didn't see how bad this can get.
[00:28:08.917]"I'm not making this up, this can get really bad."
[00:28:11.150]So I think it's important.
[00:28:12.450]And I now prep my parents and my consultees
[00:28:15.100]that I probably am not gonna see what you experience,
[00:28:18.740]and that's by design.
[00:28:20.840]I'm trying to avoid it, and it's okay.
[00:28:22.720]I can still get the right understanding,
[00:28:24.977]and I can still get you the outcome you need
[00:28:27.330]without seeing that, so that they're not disappointed
[00:28:30.850]or worried that I didn't really get to the real question.
[00:28:37.030]Do we know why this has happened with the other screen?
[00:28:41.710]Okay, thank you.
[00:28:43.210]You guys okay If I continue?
[00:28:45.550]Okay, now there are 12 tactics for how we do this
[00:28:48.300]and keep the safety and dignity
[00:28:49.840]in the trauma-informed care in place.
[00:28:53.720]And the tactics are listed here.
[00:28:56.100]We're gonna go over them together.
[00:28:59.450]One of the first things is obviously we start with
[00:29:01.370]that open-ended interview to make sure we
[00:29:03.960]understand the context really well.
[00:29:05.740]We synthesize everything together.
[00:29:08.060]The goal of the open-ended interview, again,
[00:29:10.100]is for us to be taught by the experts
[00:29:15.780]on that client's behavior what's happening.
[00:29:18.720]What's the most concerning problem behavior?
[00:29:21.430]When do they occur?
[00:29:23.050]What I really wanna get out of this open-ended interview
[00:29:25.520]is the mild precursors.
[00:29:28.911]People, here's the thing.
[00:29:30.810]Severe behavior is easy to see and to recognize, right?
[00:29:34.450]Aggression, self-injury, severe tantrums.
[00:29:36.679]You don't need a lot of information
[00:29:39.640]to see it when it happens.
[00:29:41.330]By contrast, I spend a great deal of time
[00:29:43.700]in my open-ended interview trying to figure out
[00:29:46.140]from Mom or the teachers, when do you get nervous?
[00:29:50.770]There are signs that they know, right?
[00:29:54.510]They might talk about, well,
[00:29:55.470]when he tenses his shoulders and they go up, I know.
[00:29:59.486]I know that something bad is about to happen.
[00:30:02.330]So moms and dads and teachers and caregivers
[00:30:05.840]have a lot of signs that they recognize,
[00:30:09.670]that they know of before that severe behavior happens.
[00:30:12.148]And I wanna get that information out
[00:30:14.490]and have that information.
[00:30:16.090]What we wanna reinforce is those things.
[00:30:19.250]And then, of course, I wanna know
[00:30:20.557]what makes the child happy, relaxed, and engaged.
[00:30:26.070]And then what parents do to turn it off
[00:30:28.109]when problem behavior does happen.
[00:30:29.830]Those also tell us a little bit about what the child likes.
[00:30:35.360]And then the other thing that's not really listed here,
[00:30:38.130]but I spend, more recently,
[00:30:39.900]I spend a lot of time getting to is those end goals.
[00:30:44.410]And sometimes that takes a little bit of digging
[00:30:47.350]because, again, parents and teachers sometimes
[00:30:50.670]are a little bit paralyzed with problem behavior, right?
[00:30:55.180]It's been such a concern, such a barrier,
[00:30:58.420]that they're not even thinking
[00:30:59.670]about the possibilities of what could be, you know?
[00:31:03.600]And so sometimes it gets stuck at Mom might say,
[00:31:07.188]"I want him not to engage in self-injury
[00:31:09.557]"when I take his tablet away."
[00:31:12.690]That's the first step.
[00:31:13.620]Okay, all right, you took his tablet away.
[00:31:16.070]Why, what should you do?
[00:31:17.440]What do you want him to do?
[00:31:18.906]And sometimes parents and teachers are kind of like,
[00:31:22.757]"Oh, well he never tolerates that.
[00:31:24.387]"So I never take it away.
[00:31:25.257]"So I don't even know what I want after that."
[00:31:27.720]Right, and it takes a little bit
[00:31:28.709]of digging and conversations
[00:31:30.284]and sometimes really looking at maybe some age appropriate,
[00:31:34.100]developmentally appropriate goals and expectations.
[00:31:37.700]Look at the IEP, look at what do we want her to do?
[00:31:44.640]Because you need to know that
[00:31:46.690]before you go into your assessment.
[00:31:48.380]Here's the thing.
[00:31:50.070]The goal of the assessment is not to see
[00:31:52.550]whether I can get you to engage in problem behavior.
[00:31:55.350]The answer to that question is yes.
[00:31:58.570]Every one of you guys, every one of us,
[00:32:01.710]can be put in a context and pushed to the point
[00:32:06.330]where you will punch somebody.
[00:32:08.670]If that's the challenge, accept it.
[00:32:11.600]You will all engage in that behavior.
[00:32:13.790]That's not the goal.
[00:32:14.730]When we go into the assessment,
[00:32:16.050]and we don't know our terminal expectation,
[00:32:18.950]we get into weirdness,
[00:32:21.050]or we don't have a full understanding.
[00:32:23.621]People are shocked because when you create that HRE context,
[00:32:28.340]and it's beautiful and the kid really experiences it,
[00:32:31.820]sometimes we get a lot of cooperation initially.
[00:32:34.630]So parents and teachers are shocked.
[00:32:38.530]They're like, "Oh, you told him to put his tablet away,
[00:32:40.607]"and he did, and he's coming with you."
[00:32:42.560]I've been in analysis before where we're like,
[00:32:44.417]"Okay, come on, let's go.
[00:32:45.337]"We're gonna do something."
[00:32:46.560]And then the kid comes, and everybody's like,
[00:32:49.857]"We don't have the next step
[00:32:51.257]"because we never thought we would get here."
[00:32:55.710]And two things happen.
[00:32:56.543]Either we say, "Okay, thank you.
[00:32:57.817]"You can have your stuff back."
[00:32:58.950]And we didn't really get to the challenging context.
[00:33:03.140]We don't have a good end goal
[00:33:05.440]to really say problem behavior's not a concern, right?
[00:33:08.810]So we do want to have a reasonable expectation
[00:33:12.030]for that child.
[00:33:14.640]The other weird thing that might happen is
[00:33:16.990]people start to just the piss kid off.
[00:33:20.630]Like we're not just trying to be mean.
[00:33:22.240]We're not like, you know, if, for example,
[00:33:24.733]if you took the tablet away and then Mom's like,
[00:33:26.817]"Well, I'm gonna start playing with his game now."
[00:33:29.057]I'm like, "Well, does that ever happen?"
[00:33:31.600]Like is that ever a context
[00:33:32.829]that this child needs to tolerate?
[00:33:34.490]Would you ever take, you know, his Wii
[00:33:37.611]and lose his level for him?
[00:33:41.850]Now, they might say,
[00:33:42.807]"Well, yeah, because he has a sibling.
[00:33:44.637]"He has his brother and his brother sometimes
[00:33:47.597]"has to play that game while he needs to
[00:33:50.517]"get dressed and wash his teeth.
[00:33:52.537]"And he can't tolerate anybody else playing the game.
[00:33:55.367]"And you know, this is a shared device we all have,
[00:33:57.987]"and he does need to tolerate that."
[00:33:59.433]Then I would say, "Okay, no problem."
[00:34:01.100]That's an ecologically valid goal.
[00:34:04.090]Sometimes not only are you not able to play on your tablet
[00:34:07.880]or watch YouTube, but your brother is,
[00:34:10.340]and he's playing poorly, okay?
[00:34:13.080]That's hard for some kids to tolerate.
[00:34:14.890]But it's not just about us being jerks, okay?
[00:34:17.240]It's not like, "Oh, I'm gonna take it.
[00:34:18.337]"I'm gonna be like teasing you to see
[00:34:20.437]"if you will get upset or not."
[00:34:22.250]And so it is important in the interview for us to figure out
[00:34:25.419]what's the expectation, what's the goal.
[00:34:28.330]What should the child be able to do
[00:34:29.710]if problem behavior was not a concern for you?
[00:34:33.830]We talked about synthesized reinforcers.
[00:34:36.050]The other thing we do in the analysis,
[00:34:37.790]which really increases safety and trust
[00:34:39.950]is we make it super clear.
[00:34:41.620]It's a little bit artificial.
[00:34:43.470]This is a part where we're adding some SDS that maybe,
[00:34:46.230]or exaggerating some SDs to make it super clear
[00:34:48.740]to the kid that we just switched.
[00:34:51.310]We just went from HRE to work, okay
[00:34:56.480]So we work a lot with sort of your posture.
[00:35:00.230]When it's HRE time, when it's the kid's,
[00:35:03.351]in his reinforcement context,
[00:35:05.651]I instruct everybody to sit down, to relax,
[00:35:08.810]to be at their level, right?
[00:35:10.270]Get away from your teacher posture or mom posture,
[00:35:13.160]and just hang out, be a buddy, be a friend.
[00:35:16.500]Remove all signals of you're about
[00:35:18.190]to interrupt or supervise or redirect.
[00:35:21.660]By contrast, when it's time to present the EO,
[00:35:24.410]to present those triggers, right?
[00:35:26.390]And the EO in this situation is
[00:35:29.268]what might cause problem behavior,
[00:35:31.103]basically increase the value of escape,
[00:35:33.910]tangibles and attentions, is you coming over,
[00:35:36.530]telling them to do something different
[00:35:38.080]and taking their stuff away.
[00:35:39.130]That's the EO.
[00:35:42.177]But we don't do that too fast and we make it super clear.
[00:35:46.440]And initially, anyway, I encourage people
[00:35:49.250]to set up two contexts that are super clear.
[00:35:52.530]Like there's a table of high expectations.
[00:35:54.620]That's where the work's gonna be done.
[00:35:56.680]There's an area of reinforcement.
[00:35:59.290]Now with some kids though, they will mess with you.
[00:36:04.400]Some kids are like,
[00:36:06.557]"Oh, you just got me to come over there
[00:36:08.287]"and do some math your way?
[00:36:10.067]"When it's my reinforcement,
[00:36:11.247]"I wanna sit at this table and redo the math my way."
[00:36:15.359]Don't be confused by that either.
[00:36:17.460]It's not about like, once it's their time,
[00:36:20.300]you return back to HRE, it's about who is leading who?
[00:36:24.507]Who makes the decision where to sit?
[00:36:26.440]If the child wants to sit at the table
[00:36:27.880]by expectation and even do the demands, let 'em, right?
[00:36:31.790]It's about, in HRE, it's about we are following your lead.
[00:36:36.290]You're the boss, you get to decide what to do,
[00:36:39.040]even if that includes math.
[00:36:42.280]In fact, we saw that in some of our analysis.
[00:36:45.140]Slaton's paper in 2017, she had a participant who,
[00:36:50.870]when we did the standard analysis with her,
[00:36:52.930]it was about brushing her hair.
[00:36:55.070]So the therapist would come and say,
[00:36:56.817]"Okay, brush your hair this way."
[00:36:59.300]And she would engage in problem behavior.
[00:37:00.960]We'd be like, "Okay, you don't have to."
[00:37:02.210]We would remove the brush and put it away.
[00:37:04.630]And she would engage in a lot of problem behavior,
[00:37:06.600]which didn't make any sense if this is escape maintained.
[00:37:10.110]What we found mattered was in the ISCA, in the PFA,
[00:37:15.729]when we would come in and say, "Brush your hair this way."
[00:37:18.790]And she would engage in problem behavior, we would say,
[00:37:20.167]"Okay, okay, how do you wanna do it?"
[00:37:22.536]And she wanted us to give her the brush
[00:37:26.200]and for us to say the instruction again,
[00:37:28.280]and for her to do it differently,
[00:37:29.610]and for us not to correct it.
[00:37:32.100]So the removal of the brush
[00:37:35.390]was not actually what she wanted.
[00:37:37.890]She wanted to sort of basically do it her away.
[00:37:41.200]We've had a lot of kids that wanna do a task,
[00:37:43.870]but wanna do it their way.
[00:37:45.190]And it's important for them to go back
[00:37:46.500]to the reinforcement context and for you to allow them
[00:37:49.390]to decide what it is they wanna do.
[00:37:52.110]Maybe they're playing with the trains 10 seconds ago,
[00:37:54.470]but they're not into it anymore.
[00:37:56.140]So this analysis also allows you to deal with
[00:38:00.186]what maybe we've referred to in the literature
[00:38:02.780]as fluctuating MOs, right?
[00:38:06.000]Kids that, like the tablet is fun now.
[00:38:08.780]Now the tablet seems to pull up more durability,
[00:38:12.870]but you know, kids that are like right now,
[00:38:14.480]they wanna bounce on the trampoline.
[00:38:15.960]10 seconds later they wanna do this other thing.
[00:38:18.435]30 seconds later, it's another thing.
[00:38:20.820]Sometimes they want you to talk to them.
[00:38:22.040]Sometimes they don't, and that's okay.
[00:38:25.500]With this analysis, they're free to come and go.
[00:38:32.330]The other thing we start with is we really
[00:38:33.995]want the initial contact, the initial start,
[00:38:38.106]to be experiencing things their way.
[00:38:40.900]Really stay there until you have HRE.
[00:38:43.010]Don't move too quickly to presenting those EOs.
[00:38:47.620]You gotta be flexible with your time.
[00:38:50.970]We talked about the open door policy.
[00:38:54.820]The open door has really taught us a lot.
[00:38:58.520]Sometimes kids come in, and they just wanna know
[00:39:01.540]that they can leave.
[00:39:03.208]And they leave, they go out there,
[00:39:05.690]and they're like, "Hmm, it sucks.
[00:39:07.087]"Let's go back to the stuff you had set up for me."
[00:39:08.450]And they come right back.
[00:39:10.510]And if we just chill for a minute, everything's okay, right?
[00:39:14.010]Like you don't need to be so reactive and think,
[00:39:16.017]"Oh no, I have it wrong, it's not happening."
[00:39:18.520]Let 'em just go, and then figure out other things.
[00:39:23.710]I think one kid famously,
[00:39:25.120]in one of the analysis we were doing live coaching with
[00:39:28.610]really wanted to know what's happening
[00:39:31.607]in the women's bathroom, right?
[00:39:35.360]Like he would see his teachers not be so happy,
[00:39:37.600]go into the women's bathroom, come out happier.
[00:39:40.040]And he's like, "Man, what's in there?"
[00:39:41.973](students laugh)
[00:39:42.920]So any analysis, right?
[00:39:46.020]We had to convince the school.
[00:39:47.460]Now this was when school was closed,
[00:39:49.550]but we were in the school.
[00:39:50.530]We had to convince them to, can we just go in there?
[00:39:52.477]Because they were like, no, this is not something,
[00:39:54.900]he's obviously not gonna be allowed to do this.
[00:39:57.640]You know, because we talk about in the analysis,
[00:39:59.770]whatever you give access to,
[00:40:01.410]you're gonna give access to during treatment.
[00:40:03.280]It's a context you are identifying.
[00:40:06.590]He only did it once.
[00:40:07.920]He went in there,
[00:40:08.753]he realized it looks exactly the same as the men's bathroom.
[00:40:11.170]Never went in there again.
[00:40:13.130]Do you know how many behaviors and escalations
[00:40:14.829]and problems they had dealt with precisely related
[00:40:18.490]to him wanting access to the girls' bathroom?
[00:40:22.320]Like we saw that with just one look.
[00:40:25.560]And then he came back into analysis
[00:40:27.060]and everything was okay.
[00:40:28.600]Sometimes kids just wanna go for a walk,
[00:40:30.130]and they come right back.
[00:40:31.740]Sometimes we think we have everything,
[00:40:34.250]and the kid goes and grabs something else.
[00:40:35.760]And we say, "Hey, bring it with you.
[00:40:38.277]"We forgot about something."
[00:40:39.900]Nobody identified it, and they bring it back with them.
[00:40:43.520]So just because a kid leaves your analysis
[00:40:46.150]is not the end of the world.
[00:40:49.400]Sometimes where we start,
[00:40:51.570]especially for kids that have been overly managed
[00:40:54.540]with behavioral interventions is,
[00:40:57.274]as a first step in winning this trust and empowerment,
[00:41:04.120]we just work on the kid opting in.
[00:41:06.700]So initially the kid opts in and out, in, out,
[00:41:10.080]in, out, in, out.
[00:41:11.250]We only spend like 10 minutes of our hour
[00:41:14.820]in the actual room where we're gonna do this.
[00:41:18.820]And it takes us a few weeks for the kid
[00:41:20.530]to spend the majority of their time in that room,
[00:41:23.880]opt in and stay in.
[00:41:25.590]And if I can teach a kid to simply opt out without engaging
[00:41:29.732]in problem behavior, but say, "Hey, I'm all done with this.
[00:41:32.117]"I want out," and not engage in an escalation, that's a win.
[00:41:35.810]That's something to celebrate, right?
[00:41:38.460]That's empowerment and giving control back.
[00:41:40.240]So the open door policy really gives you the best kind
[00:41:45.110]of feedback as to whether you
[00:41:46.390]have the right reinforcement context or not.
[00:41:51.909]We really want someone that knows the child
[00:41:54.260]and preferably really the parents to be there.
[00:41:57.720]Gone are the days where a kid would be dropped off
[00:42:00.780]and the analysis would happen or treatment would happen,
[00:42:04.060]and then the parents would pick the kid up.
[00:42:06.200]For a variety of reasons.
[00:42:07.500]Ultimately, we want the parents to do this.
[00:42:10.640]To know what we're doing, to establish it.
[00:42:12.650]So there's a lot of modeling that can and happen.
[00:42:15.000]But really initially they are the experts that can help us
[00:42:18.380]decide whether we're on the right path or not.
[00:42:24.370]For really young kids,
[00:42:25.450]it really increases the gentleness of this process.
[00:42:27.730]Imagine trying to separate a three year old from his mother
[00:42:30.063]when he has no toleration for that.
[00:42:32.420]That's an end goal for treatment, not right now.
[00:42:34.920]Mom can be there.
[00:42:35.850]She can be part of the reinforcement context.
[00:42:41.730]We talked about this already, the signals.
[00:42:46.880]So, if you see this ever, and you're like,
[00:42:49.387]"Man, what's with all these people doing the..."
[00:42:51.577](hands clap) Okay.
[00:42:53.790]Sorry.
[00:42:55.370]They've been trained by us.
[00:42:57.430]Sometimes it's really loud.
[00:42:58.460]I gotta be like,
[00:42:59.293]"Okay, let's let's not be so loud with our clapping."
[00:43:01.300]And just so you guys know, by the end of treatment,
[00:43:05.670]when you extend this to the relevant context,
[00:43:08.690]you're gonna get rid of these things, okay?
[00:43:11.350]This kiddo is not gonna be like every time somebody claps,
[00:43:14.137]they're like, "Oh, shit, something's about to happen."
[00:43:16.670]Okay, we get rid of the clap.
[00:43:22.750]For most of our kids, this is kind of the progression.
[00:43:25.650]Remember I said there are these nasty videos
[00:43:27.920]of me just coming and removing the tablet.
[00:43:30.430]No more.
[00:43:31.830]Okay, so we stand up.
[00:43:33.960]Some kids are so clear about what's
[00:43:37.420]going on around them, as soon as you stand up,
[00:43:39.670]they're like, "Uh uh.
[00:43:41.300]You're like, "All right, I'll sit down."
[00:43:44.098]So you stand up, you softly clap.
[00:43:47.400]And there's a little pause that you insert
[00:43:48.964]after each of these things.
[00:43:50.700]You want the child to have an opportunity to ideally
[00:43:54.670]engage in one of those mild behaviors
[00:43:57.510]and tell you I don't like where this is going.
[00:44:01.420]So you don't get severe behavior.
[00:44:04.210]And then you get closer.
[00:44:07.120]The first thing you ask them is to stop what they're doing,
[00:44:08.781]put whatever they have in their hand down.
[00:44:12.680]And then you go through the steps, right?
[00:44:14.280]So you might be like,
[00:44:15.317]"All right, time to put your computer away."
[00:44:20.700]And then you're like, "Here's how you do it."
[00:44:22.580]But you know, ever so gently.
[00:44:24.290]You're just not making any fast movements
[00:44:26.130]because you don't wanna get punched in the face.
[00:44:27.950]Nobody does.
[00:44:29.730]And then as you go to guide, again,
[00:44:32.930]remember physical guidance is okay
[00:44:34.746]if there is cooperation with it.
[00:44:37.600]As you go to guide the child, and they either
[00:44:39.700]resist your prompts or try to get away from it
[00:44:42.370]or push away from it,
[00:44:44.320]you immediately say, "Okay, don't worry about it."
[00:44:47.790]Again, this is assessment.
[00:44:48.860]We're just trying to figure it out.
[00:44:51.700]If they don't, however, you keep going.
[00:44:54.570]And this is where I love it
[00:44:56.410]when people get surprised, right?
[00:44:58.754]They're like, "This never happens."
[00:45:01.220]Like what's happening now, where are you going?
[00:45:02.890]Do you know where you're going?
[00:45:04.450]Because if we meet the expectations,
[00:45:06.990]so let's say it's a six year old.
[00:45:10.470]I've been in a lot of design sessions when teachers say,
[00:45:13.367]"Well, math block is 75 minutes."
[00:45:17.220]Like, come on now.
[00:45:18.713]I don't stay on task more than 20 minutes.
[00:45:22.750]I'm usually on Facebook in about 18.
[00:45:26.630]So if we really look at what's going on in math block
[00:45:30.430]and what the other kids are doing,
[00:45:32.660]I would say it's pretty good for like a seven year old
[00:45:35.870]or even a 10 year old to be on task
[00:45:37.920]for 10 minutes or 15 minutes, right?
[00:45:41.620]Then there's usually like a little break,
[00:45:43.800]maybe a change in the activities.
[00:45:45.700]Maybe they'll, talking to your friends or whatever,
[00:45:47.900]but something's happening.
[00:45:48.980]Nobody, no one.
[00:45:51.210]I taught college students.
[00:45:52.700]I knew that with my lecture,
[00:45:54.552]I lost them after about 25 minutes,
[00:45:57.650]unless I told them to do something else.
[00:46:00.210]There was a little break, it was a little fun.
[00:46:02.760]I swear a little bit, they love that.
[00:46:04.330]And I would get them back on track, right?
[00:46:07.890]Because it's hard to stay on task.
[00:46:09.290]So sometimes you gotta tone it down with parents
[00:46:12.960]and teachers and be like, "Let's get real here."
[00:46:15.280]15 minutes is probably really good.
[00:46:18.170]You wanna get to the specifics.
[00:46:19.430]Like, is it one-on-one instruction
[00:46:23.440]or is it you gotta move away?
[00:46:25.090]Like you instruct for maybe a couple of minutes
[00:46:27.400]and then move away.
[00:46:28.233]You're busy with another student.
[00:46:29.420]The child has to wait for help.
[00:46:30.770]So we're getting to really the end goal.
[00:46:33.100]If we're saying, "Hey, math teacher, this kiddo is fine.
[00:46:36.767]"You teach him just the way you teach everybody else."
[00:46:39.550]They need to tolerate all of those things
[00:46:40.620]that happen in the classroom, right?
[00:46:43.280]There's a little bit of lecturing.
[00:46:45.210]There's a little bit of instruction.
[00:46:46.300]The teacher might correct what you just did.
[00:46:48.060]Might ask you to erase it and do it again, write it nicely.
[00:46:51.228]Remember, we're not tiptoeing around things anymore.
[00:46:53.630]So we're looking at what would
[00:46:55.410]that context really look like?
[00:46:58.240]And we expose the child to that context.
[00:47:00.084]And sometimes we find, wow, they can actually do it.
[00:47:04.850]If you gave them a really good reinforcement context
[00:47:06.800]to begin with.
[00:47:07.740]But more often than not,
[00:47:08.830]when we have the end context properly identified
[00:47:12.510]and with enough details,
[00:47:13.725]we see some signs of problem behavior.
[00:47:17.930]At the very least, we see sort of the mild behaviors.
[00:47:21.000]And then we can terminate.
[00:47:22.440]And we can realize, "Okay, this is where we gotta teach."
[00:47:28.310]Here's some examples of the mild behaviors
[00:47:30.430]that we've included.
[00:47:31.263]Again, that open contingency class is important.
[00:47:52.920]And then we very clearly want to communicate
[00:47:55.580]to a child that we hurt them,
[00:47:58.080]if they engage in mild behaviors or severe,
[00:48:01.070]it doesn't matter, it's open, right?
[00:48:02.710]You're hoping for the mild,
[00:48:03.770]but if the severe one happens, you do the same thing.
[00:48:05.640]You immediately get back to reinforcement
[00:48:07.840]and do it as quickly as possible.
[00:48:10.509]You apologize.
[00:48:11.780]You know how much kids love
[00:48:14.000]when parents and teachers apologize?
[00:48:16.540]This is really important in treatment too.
[00:48:17.994]Like we always say, "I'm sorry, I messed up.
[00:48:20.819]"I'm sorry I asked you to do that.
[00:48:23.527]"You're right."
[00:48:25.050]And especially with more vocal verbal kids
[00:48:28.250]that wanna continue and are like
[00:48:30.210]stewing a little bit and wanna tell you, like,
[00:48:32.537]"I already told you the other time not to do this
[00:48:34.947]"and here you are again."
[00:48:36.025]We engage in that conversation and it really turns it off,
[00:48:38.870]turns those emotions off.
[00:48:40.820]And they're just bitching, so acknowledge it.
[00:48:43.187]"Yeah, you're right.
[00:48:45.367]"I, yeah.
[00:48:46.337]"I know, you did tell me, I forgot.
[00:48:48.377]"I goofed up.
[00:48:49.587]"I'm so sorry.
[00:48:51.057]"It does suck.
[00:48:51.890]"I hate it when people ask me to do things I
[00:48:53.437]"don't wanna do as well."
[00:48:54.960]We engage in that conversation.
[00:48:56.290]It really, really helps.
[00:49:05.430]And we really have moved away from any kind
[00:49:07.507]of time-based criteria.
[00:49:09.520]Like when we go back to reinforcement,
[00:49:12.220]we're not in reinforcement for 30 seconds.
[00:49:15.010]Especially if that child is upset and they're stewing,
[00:49:17.243]and they're talking about how that was really unfair.
[00:49:19.830]And why are you acting stupid?
[00:49:21.700]They already said they don't wanna do that.
[00:49:24.350]And you know, 30 seconds has gone by,
[00:49:26.156]that child hasn't even really
[00:49:28.020]consumed their reinforcers yet.
[00:49:29.950]They just spent 30 seconds telling you
[00:49:31.490]how unfair whatever you did was.
[00:49:34.010]So we wait until the child is back in HRE.
[00:49:38.120]There is no time criteria here, other than you might say,
[00:49:41.020]hey, we're not gonna present another EO,
[00:49:43.720]another trigger until the child has been happy,
[00:49:46.485]relaxed, engaged, for one minute,
[00:49:49.700]for two minutes, for five minutes,
[00:49:51.820]depending on the age and whatnot.
[00:49:54.600]And so, and sometimes they increase that.
[00:49:56.650]So if it took 10 minutes for that child
[00:49:59.380]to get back to HRE, I might say,
[00:50:00.947]"Hey, let's just stay in HRE
[00:50:02.167]"for another five minutes, right?"
[00:50:04.300]'Cause the stacking effects of the EO matter as well.
[00:50:07.380]And this also matters in treatment.
[00:50:13.120]So really changing everything we do to performance based.
[00:50:18.470]Values first and then performance based
[00:50:21.140]as opposed to any kind of time based or,
[00:50:23.293]hey, three trials, and then I gotta move on.
[00:50:25.890]Really look at how the child is engaging
[00:50:28.840]and responding to whatever it is you're doing.
[00:50:33.920]I'm gonna give you some examples of this
[00:50:36.520]from the data that we have,
[00:50:39.690]and also show you if you're not familiar
[00:50:40.927]with the way we take data on our analyses,
[00:50:44.240]now we've shifted away from rate,
[00:50:47.960]which is something you were used to, right?
[00:50:49.670]A session, let's say two responses per minute.
[00:50:52.843]We're really getting back to actually
[00:50:54.008]what Skinner was doing, right?
[00:50:55.700]Skinner was looking at moment to moment responses.
[00:51:00.000]And we're saying, "Hey, that really matters.
[00:51:01.627]"We need to see that."
[00:51:02.940]And this is what the graph looks like now
[00:51:05.240]for moment to moment responses.
[00:51:06.730]And I'm gonna take a little bit of time,
[00:51:08.580]and I'm gonna try and be really loud.
[00:51:09.960]Can you guys hear me in the back?
[00:51:11.920]Good, okay.
[00:51:13.240]So one thing that you don't see in the traditional,
[00:51:16.359]and a lot of the data in the literature, including ours,
[00:51:19.196]on this stuff, we're hoping to use these data going forward
[00:51:25.540]is what is the child doing and reinforcing, right?
[00:51:31.550]What you have did on maybe is the rate of reinforcement
[00:51:34.540]or the fact that you gave 30 seconds
[00:51:35.433]of reinforcement or five seconds of reinforcement.
[00:51:38.810]But that is programmed reinforcement, right?
[00:51:41.890]That's talking about what you did.
[00:51:43.856]You said, "Hey, okay, you can have your tablet back."
[00:51:47.550]That doesn't mean the child was actually
[00:51:48.775]using the tablet, consuming the reinforcer.
[00:51:53.120]You have no idea how much
[00:51:55.040]experienced reinforcement really was.
[00:51:58.130]You just have data on--
[00:52:00.730]This area cannot hear you
[00:52:01.862]when you are not on the microphone.
[00:52:03.890]Okay, but they can see the the thing?
[00:52:06.323]Yes. Okay.
[00:52:07.156]So I'll talk about it without pointing to it.
[00:52:11.930]So the first line that you see there, the solid line, okay?
[00:52:17.260]That's the line that again is telling us
[00:52:20.370]what I did as the implementer.
[00:52:22.800]The solid line says I was providing reinforcement.
[00:52:28.950]I was acting the way I thought the child
[00:52:30.950]would want me to act.
[00:52:31.800]I gave them the tablet back.
[00:52:33.040]I sat close to them.
[00:52:34.492]I commented when they initiated.
[00:52:36.720]Whatever the child wants me to do.
[00:52:38.320]I'm trying to deliver reinforcement.
[00:52:40.220]That's what I'm doing.
[00:52:41.053]That's my behavior.
[00:52:42.590]The dotted line above is telling you whether the child
[00:52:46.550]was in fact consuming that reinforcer.
[00:52:49.260]Were they happy, relaxed and engaged.
[00:52:50.940]If it's happening, there's a dotted line there.
[00:52:54.040]Second by second is telling you,
[00:52:55.910]this kid came in and immediately got into their reinforcers
[00:53:00.110]and was HRE.
[00:53:01.780]It was an easy kiddo to work with, okay?
[00:53:04.540]We had five minutes.
[00:53:06.451]Then you see a break.
[00:53:08.840]Those little breaks, they're probably a little hard to see.
[00:53:12.230]But this kiddo was also very fast
[00:53:14.081]to engage in mild behavior.
[00:53:16.590]Okay, that's the moment of like,
[00:53:18.517]"Okay, we're gonna do something else."
[00:53:20.720]You see a tiny bit of interruption
[00:53:23.180]to the lines of reinforcement and the lines of HRE.
[00:53:25.910]You immediately see the open symbol,
[00:53:30.500]which is basically mild behavior.
[00:53:33.780]And we immediately go back to reinforcement,
[00:53:36.270]and the kiddo immediately reengages
[00:53:38.740]in the reinforcement context.
[00:53:39.573]Their happy, relaxed, engaged.
[00:53:41.180]So he was happy to get back to his stuff.
[00:53:44.350]And he was very quick to tell you he
[00:53:46.220]didn't like to deviate from it.
[00:53:47.760]Now this is a beautiful analysis.
[00:53:49.527]This is a hard kiddo to teach because his impulsivity
[00:53:54.509]to problem behavior is so fast.
[00:53:57.180]One of the things that I tell my implementers
[00:53:58.690]is you better be fast with your prompts.
[00:54:00.580]Or we better be, we better tone it down.
[00:54:05.190]Sometimes with kiddos,
[00:54:06.410]if you stand up and clap and say,
[00:54:07.517]"Okay, it's time to do something else,"
[00:54:08.710]they're already engaged in problem behavior.
[00:54:10.570]So what we might do is in treatment,
[00:54:13.100]simply stand up and prompt immediately the response we want.
[00:54:17.010]Because we don't want problem behavior to happen.
[00:54:19.330]We wanna beat the child to any instances
[00:54:21.950]of even mild behavior.
[00:54:23.230]So beautiful, we celebrate this.
[00:54:24.467]And then we say, "Wow, you've got some hard work to do."
[00:54:28.470]By contrast, I want you to take a look at this next graph.
[00:54:33.630]Now with this guy, same thing.
[00:54:37.780]He came in, we delivered reinforcement.
[00:54:41.250]We had engagement immediately, beautiful.
[00:54:43.570]We went to our first instance of the EO,
[00:54:46.890]but we got the mild behavior, the severe behavior, right?
[00:54:50.260]That's the filled circle.
[00:54:51.350]So we had the more serious
[00:54:52.890]problem behavior happen immediately.
[00:54:55.340]Remember, it's an open contingency.
[00:54:56.641]That's important for the safety.
[00:54:58.640]You're not just reinforcing mild behavior.
[00:55:01.080]You're reinforcing either one.
[00:55:03.010]And with this guy, you see that the analysis continued more
[00:55:06.490]because it was important for us to teach him,
[00:55:10.397]"You don't need to engage in severe behavior.
[00:55:12.587]"We will respect your mild behaviors as well."
[00:55:14.850]So it was continued a little bit to empower him
[00:55:18.720]and to deescalate a little bit.
[00:55:21.890]Sometimes we do that.
[00:55:23.080]We also had some carryover.
[00:55:25.120]When we switch back to reinforcement,
[00:55:26.930]you see the two behaviors that happen,
[00:55:29.589]even though we went back to reinforcement.
[00:55:31.700]Now what's nice about it is it was immediate, right?
[00:55:35.480]Like it was like, okay, time to do some work.
[00:55:37.700]He engages in problem behavior.
[00:55:38.533]We were like, "Okay, you don't have to."
[00:55:39.366]He engaged in one more instance of behavior,
[00:55:41.660]but then he didn't, he got back to HRE.
[00:55:43.710]So that's good, it's not persisting.
[00:55:45.779]But it gave us a reason to continue and do more trials.
[00:55:49.050]And by the end, you see the pattern
[00:55:51.220]that's similar to the first guy, right?
[00:55:53.950]We just have one instance of mild behavior.
[00:55:55.890]We go back to reinforcement, everything's good.
[00:55:59.470]Here's a third example.
[00:56:02.230]This is when that initially EO
[00:56:04.390]was not presented for a while.
[00:56:07.050]Because this kiddo came in, was in reinforcement,
[00:56:11.960]was HRE, but still engaged in some behaviors.
[00:56:16.150]And some of this might be avoidance behavior, right?
[00:56:18.500]Like you have kids that have a bit of a history,
[00:56:20.741]and maybe you made a subtle move and they thought,
[00:56:24.737]"Oh, you're about to do something."
[00:56:26.080]So they're like, "Ah, I see you, don't move."
[00:56:29.180]So they're a little bit tense.
[00:56:31.870]They're a little bit too impulsive.
[00:56:33.260]They don't trust you yet.
[00:56:34.610]We stay in HRE longer.
[00:56:35.890]And you see here, we stayed in HRE for 11 minutes.
[00:56:38.705]Sometimes it's much, much longer.
[00:56:41.040]And then when we had it, we went to the first EO.
[00:56:46.440]Then we got back, we stayed in HRE a little bit longer
[00:56:49.370]than all the other examples I showed you.
[00:56:51.000]Again, I wanted this kiddo to relax.
[00:56:54.270]When we went to our second EO,
[00:56:57.980]you see he complied a little bit.
[00:56:59.650]It took a while.
[00:57:02.240]Right, we built a better relationship.
[00:57:03.810]But then we went back to the third and fourth,
[00:57:05.370]and he was like, "Oh, I know this game, okay."
[00:57:07.280]It becomes a business transaction.
[00:57:09.850]That's what we're hoping for, right?
[00:57:12.215]I've gone from a kid trying to stab you with a pencil
[00:57:14.960]to just holding the pencil up and say, "Mm."
[00:57:18.129]You're like, "All right, good, that's good.
[00:57:22.257]"I hear you, I see you."
[00:57:26.260]How much time do I have?
[00:57:28.455](woman whispers indistinctly)
[00:57:29.370]Cool.
[00:57:30.711]So we have a little bit of work to do
[00:57:32.420]as well after the analysis, right?
[00:57:34.270]We really wanna reflect back.
[00:57:35.960]We learned some things.
[00:57:37.570]We sometimes discover new R2s.
[00:57:39.660]These are the mild behaviors we're looking for, right?
[00:57:42.040]So we're in the analysis.
[00:57:43.220]Mom is there with us or the teacher.
[00:57:44.623]And they're like,
[00:57:45.457]"Ooh, ooh, that right there is another one.
[00:57:47.817]"I forgot to tell you.
[00:57:49.799]"When he does that thing with his eyes, he's getting upset."
[00:57:54.540]Sometimes what we see with kids is,
[00:57:58.845]let's say we didn't include vocal stereotypy, right?
[00:58:03.790]And then sometimes even the vocal stereotypy
[00:58:06.730]is automatically maintained.
[00:58:09.320]We see that as we present the EO,
[00:58:11.680]sometimes kids get a little bit faster,
[00:58:14.390]a little bit more elevated,
[00:58:16.650]a little bit more loud with their vocal stereotypy.
[00:58:18.640]It changes in tone and frequency a little bit.
[00:58:24.220]And we're like, "Hmm, that's an R2.
[00:58:25.987]"That just changed from, I'm just having fun,
[00:58:28.797]"hearing myself to I'm trying to keep you away."
[00:58:33.090]So the thing with automatically maintained behaviors
[00:58:36.250]is that a lot of times they are dual controlled.
[00:58:39.730]There's also a social aspect to it
[00:58:41.470]because kids have learned,
[00:58:42.357]"If I just engage in my vocal stereotypy, people stay away."
[00:58:45.860]And there is a change.
[00:58:46.710]And if you can agree on that change, you can add it.
[00:58:49.340]Sometimes kids start asking you questions.
[00:58:51.460]So I've had kids that go,
[00:58:54.048]"Why, why do I have to do that?"
[00:58:56.560]And you know, that's a reasonable,
[00:58:59.140]it's not a problem behavior.
[00:59:00.710]But then as I persist with the EO, they might go,
[00:59:03.397]"Why, why, but why?
[00:59:05.147]"Why do I have to do it?
[00:59:06.090]Now I'm like, "Hey, that's elevated."
[00:59:09.000]That's a mild behavior.
[00:59:11.400]We can reinforce that, we can add that in.
[00:59:13.640]So we add more sort of signs that the child's not happy.
[00:59:18.520]That's one thing we learned in the analysis.
[00:59:20.690]The other thing we learn,
[00:59:23.040]obviously the most important thing, when I wanna say,
[00:59:25.357]"Hey, was this analysis successful or not?"
[00:59:27.540]The most important thing is that everybody was safe.
[00:59:32.120]That everybody thought this was dignified.
[00:59:34.761]And that if problem behavior happened,
[00:59:36.910]we were able to turn it off.
[00:59:39.040]I care more about the fact that we
[00:59:40.269]turn problem behavior off and didn't have it
[00:59:44.750]then how fast we turned it on.
[00:59:46.970]Remember, the first case I showed you.
[00:59:48.720]Yeah, that's great.
[00:59:49.714]But actually that's a hard one to treat.
[00:59:52.410]It's better when kids have a little bit of a toleration
[00:59:54.966]and then problem behavior happens.
[00:59:56.104]That's space where you could teach when you go to treatment.
[00:59:59.007]So I'm not worried about that part.
[01:00:01.910]It's really cool when we see a child get back to HRE.
[01:00:06.190]It's really cool that despite the fact that you
[01:00:07.889]just presented some EOs and some triggers,
[01:00:10.475]the child still likes you.
[01:00:12.410]Has some approaches with you, right?
[01:00:14.860]So a lot of relationship building,
[01:00:16.476]testing of the relationship, giving us an idea of like,
[01:00:19.343]when we go to treatment,
[01:00:20.312]how long should we stay in HRE in between our trials?
[01:00:25.610]How much time does this kid need to kind of recover
[01:00:28.040]from whatever you tried to do two seconds ago?
[01:00:36.470]And so, I also encouraged people to really
[01:00:40.500]look at that HRE time not as wasted time,
[01:00:44.470]not as, "Okay, that's the time I'm not teaching."
[01:00:47.070]But really think about it as a time that you're
[01:00:48.740]actually doing some great teaching.
[01:00:49.956]A lot of spontaneous MANs can happen during that time.
[01:00:54.340]A lot of our kids just need to learn to approach better
[01:00:57.430]and initiate better and recruit attention better.
[01:01:01.420]And that can happen in HRE.
[01:01:03.880]And for our older kids,
[01:01:05.140]it's really a time to repair some of the relationship
[01:01:08.190]and some of the history they've had
[01:01:09.870]in instructional context.
[01:01:12.980]And it's also a time for us to just chill
[01:01:16.200]and learn to share in the experience
[01:01:19.060]with our students and with our kids.
[01:01:23.444]It's not the time for you to take data.
[01:01:27.640]It's not the time for you to check the next trial.
[01:01:31.310]It's the time for you to be there.
[01:01:34.020]Even if the child doesn't want you to talk,
[01:01:36.360]you should still look available,
[01:01:38.420]interested, and a captive audience.
[01:01:41.530]It's about saying, "I'm here for you,
[01:01:43.147]"whatever it is you need.
[01:01:44.177]"If you need me to just be quiet
[01:01:45.437]"and watch you, I'll do that."
[01:01:47.110]But it's not the time where I'm just busy,
[01:01:49.180]and you are doing your reinforcement time, okay?
[01:01:52.200]I want us to be a very active participant,
[01:01:54.830]and, in fact, put away some of those clipboards and clickers
[01:01:57.350]and whatnot, that have sort of signaled to kids that we're
[01:02:01.330]not really interested in what they're interested in/
[01:02:02.990]We just have our own agenda.
[01:02:06.250]All right, hopefully you have an answer
[01:02:08.090]by the end of this analysis,
[01:02:10.530]and you've of course kept these values
[01:02:12.180]and priorities in check.
[01:02:13.310]And then the next session this afternoon,
[01:02:15.477]we're gonna talk about now how do you teach?
[01:02:18.409]And we have some time for questions, I believe.
[01:02:24.190]Yes.
[01:02:26.415](student speaking indistinctly)
[01:02:35.000]Yeah, it looks very similar, but honestly, the difference,
[01:02:38.980]I would say the biggest difference is for adults,
[01:02:42.530]we have had to really work hard
[01:02:45.700]on being more of a peer, acting more like a peer.
[01:02:49.040]So those interactions that you have
[01:02:50.980]with adults really matter.
[01:02:53.460]And the type of demands that we present really matter too.
[01:02:57.554]If, really, I mean, starting from adolescence,
[01:03:00.230]I would say that if you're presenting demands,
[01:03:02.050]even in the EO condition,
[01:03:03.680]really think about it being a shared experience.
[01:03:07.720]So we want, even if you're presenting,
[01:03:09.950]let's say a task that has to do with chores.
[01:03:12.430]Let's say, doing your laundry, for example.
[01:03:16.610]It looks really weird when you're hovering over an adult
[01:03:18.739]and telling them, "Okay, fold these towels.
[01:03:21.197]"Do this, do that."
[01:03:22.920]It looks a lot more ecologically valid
[01:03:24.770]if you're sitting down, you've got your pile
[01:03:26.340]to fold and they've got their pile.
[01:03:28.960]So really thinking about the shared experience,
[01:03:31.770]the ecological validity of the demands.
[01:03:34.580]And then, in the reinforcement context,
[01:03:36.990]kind of move away from, for most adults,
[01:03:40.480]I would say from the bubbly like,
[01:03:42.467]"I'm here to entertain you,"
[01:03:43.690]and just kind of be more responsive to what they want.
[01:03:47.590]And sometimes I've even had implementers, for example,
[01:03:50.980]when an adult is playing their game,
[01:03:53.750]let's say on the Wii,
[01:03:55.360]that you're also playing your game.
[01:03:57.530]And it just looks like two buddies hanging out,
[01:04:00.980]having snacks together, playing a game,
[01:04:03.300]showing each other what's going on
[01:04:04.209]and a lot less supervised.
[01:04:09.920]Yes?
[01:04:11.640]What do you do child if what the child prefers
[01:04:14.457]is actually not positive or ecological behaviors?
[01:04:17.978](student speaking indistinctly)
[01:04:24.375]In that context.
[01:04:25.990]Yeah, so, you know, we try and bring a lot
[01:04:28.905]of behaviors under contextual control.
[01:04:32.140]Meaning, sometimes people talk about rough play housing
[01:04:36.230]and whatnot, so we might have some rules around that.
[01:04:38.980]We might say, "Hey, let's act it out
[01:04:41.637]"with other dinosaurs and whatnot."
[01:04:43.580]We try and limit how much instruction we issue,
[01:04:48.280]but there are definitely some what I would say hard nos,
[01:04:51.670]some boundaries, but a lot of the boundaries
[01:04:54.671]are actually anticipation of what happens.
[01:04:58.550]So for example, you might be like,
[01:05:00.067]"Well, when he does this, then in a few steps,
[01:05:03.747]"he's gonna do this other thing.
[01:05:04.777]"So I'm gonna impose my rule over here."
[01:05:07.160]And I work with my implementers and parents and teachers
[01:05:09.280]to be like let's not anticipate what could happen.
[01:05:11.930]I know you have a history here.
[01:05:13.270]Let's just relax.
[01:05:15.071]Let's remove your supervisory signals.
[01:05:19.190]And actually we see a lot of kids calming down.
[01:05:22.740]They might test you a couple of times.
[01:05:24.350]And then they're like,
[01:05:25.183]"Oh, okay, you're like, kind of cool."
[01:05:27.570]And then we see them move away
[01:05:29.760]from the problematic behaviors.
[01:05:31.012]It happens a lot with stereotypy as well.
[01:05:33.980]Sometimes people say, "Well, he gets really excited,
[01:05:36.047]"and then he goes from excited to self-injury."
[01:05:39.130]But it's actually because, as they get excited,
[01:05:41.560]we become anxious.
[01:05:43.130]We start to kind of like get a little closer,
[01:05:46.410]like give off signals that,
[01:05:47.840]okay, I'm about to like end this activity.
[01:05:49.700]And that's the thing that switches the child away from being
[01:05:53.550]in their fun part to engaging in self-injury or aggressions.
[01:05:57.040]It's actually a way to kind of signal to you,
[01:05:59.097]"I see you, I see you're about to end my fun."
[01:06:02.550]So I think those ones are...
[01:06:05.240](student speaking indistinctly)
[01:06:10.999]And we know that some of your expectations will be good,
[01:06:14.260]and, you know, he gets it.
[01:06:15.836](student speaking indistinctly)
[01:06:17.860]And then, as soon as we leave, it's back.
[01:06:21.650]Yeah, I mean, that sounds to me like
[01:06:23.390]really what we have in that situation
[01:06:24.703]is we don't have true toleration and cooperation
[01:06:28.339]of basically these long delays, right?
[01:06:32.570]Because leaving a room probably means going
[01:06:34.890]to the business as usual,
[01:06:36.640]which doesn't include as much reinforcement.
[01:06:38.860]So we do have to work in session to really work
[01:06:42.750]on giving things up, having unpredictable,
[01:06:46.270]you know, we talk about that in treatment,
[01:06:48.250]unpredictable expectations placed on you.
[01:06:52.150]Like sometimes you have to do a little bit of work.
[01:06:53.256]Sometimes you have to do a lot of work.
[01:06:54.760]You really don't know when you're getting your stuff back.
[01:06:56.903]And because that's the reality of life, right?
[01:07:00.190]Sometimes we think kids need to know everything.
[01:07:02.712]Everything needs to be a warning,
[01:07:04.750]or you get it back after you do five things, 10 things.
[01:07:07.230]Well, the problem with that is,
[01:07:08.443]as you tell them about a long delay,
[01:07:10.950]so they start to recognize signals of long delay,
[01:07:13.747]then you get a lot of problem behavior.
[01:07:15.520]So, to me, that sounds like things that we gotta
[01:07:17.570]teach in session before you can
[01:07:18.463]expect any improvements outside of session.
[01:07:22.190]And that is a hard sort of conversation and a reality
[01:07:25.440]that we have to talk about, that this process takes time.
[01:07:29.070]And initially when we start with our assessment
[01:07:30.695]and treatment, you're not actually going
[01:07:32.263]to see any improvement outside of our sessions for a while.
[01:07:36.280]'Cause these skills take time to teach.
[01:07:38.260]And so what I say outside of session is, to parents,
[01:07:41.520]to just manage it the way they have been managing it.
[01:07:44.140]And that includes potentially using some
[01:07:46.620]of those behavior mollification,
[01:07:48.220]behavior modification type tactics
[01:07:50.170]that we know are not effective long term,
[01:07:52.250]but right now you need them for survival.
[01:07:57.498]So you mentioned about we're
[01:07:59.540]spared all behaviors, but if we know this process,
[01:08:03.969]you have the problem behavior is the asked behavior.
[01:08:06.104](student speaking indistinctly)
[01:08:08.780]Sometimes kids...
[01:08:10.320]I've had it happen where we keep progressing
[01:08:12.739]and this wasn't part of the R2s that we describe, right?
[01:08:15.610]But we've had it where kids comply and comply and comply,
[01:08:18.870]and then you kind of have this whole shutting down, right?
[01:08:22.180]Like put their head down.
[01:08:23.570]Usually though we try and identify affect changes
[01:08:26.740]that happened before that and reinforce those things.
[01:08:29.680]Or we say, some kids there's been this long history,
[01:08:33.460]so they're doing a lot of sort of complying, complying,
[01:08:36.820]complying, complying, and then blowing up.
[01:08:39.430]But there's a lot of signals before that,
[01:08:42.158]that they're not actually happy about it,
[01:08:45.730]or there's a skill deficit.
[01:08:47.260]And so if a child stops responding,
[01:08:50.258]and they're kind of shutting down,
[01:08:52.460]we go ahead and reinforce it and say,
[01:08:54.357]"Oh, you look, this doesn't look like fun.
[01:08:56.887]"It doesn't look like you really wanna do this."
[01:08:59.320]And they're kind of surprised.
[01:09:00.480]They're like, "Oh," because that's never happened, right?
[01:09:04.670]And so it's a little bit harder in the sense
[01:09:08.300]that we might expose him to a longer EO before we realize,
[01:09:11.577]"Ah, you know, he's just shutting down."
[01:09:13.870]But as soon as we realize that,
[01:09:15.690]then we might even say, you know, we have our answer,
[01:09:17.740]let's go to treatment.
[01:09:24.050]All right, well, thank you so much, guys.
[01:09:26.230](woman speaking indistinctly)
[01:09:28.322]Before you leave, for the afternoon session,
[01:09:30.818]but if not...
[01:09:32.062](woman speaking indistinctly)
[01:09:47.326](microphone thumps)
[01:09:49.618](students chattering)

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Towards a Practical Functional Assessment and Skill-Based Treatment Process Addressing Severe Problem Behavior (Part 1)

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