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Generalization and Extension of the Skill-Based Treatment in a School Setting

SEARCH Day Program is a private, non-profit school in Ocean Township, New Jersey. Approximately 80 students, ages 3-21, are currently enrolled in the program. The school embraces research-based teaching strategies that are derived from applied behavior analysis while taking a multi-discipline approach to educating individuals with Autism. In the Winter 2021 issue of Autism Spectrum News, SEARCH board-certified behavior analysts (BCBAs) described their implementation of the interview-informed synthesized contingency analysis (IISCA) and skill-based treatment (SBT) as a pilot program for their school setting (Sidley, McParland & Algor, 2021). Since the initial four students were included in the pilot program, SEARCH behavior analysts have implemented SBT with 20 additional students on campus. In the current article, different elements of generalization and extension of the skill-based treatment are discussed.

Edward Sidley, MA, BCBA, Kirsten Algor MEd, BCBA, and Ashley McParland, MEd, BCBA

Edward Sidley, MA, BCBA, Kirsten Algor MEd, BCBA, and Ashley McParland, MEd, BCBA

The Pilot Program

In our program, we recognized a number of students who routinely engaged in severe challenging behavior, regardless of the collective efforts made by teachers, behavior analysts, and related services. We sought a function-based treatment that not only decreased target behavior, but did so by teaching replacement skills in communication, tolerance and cooperation. Until recently, there has been a lack of research showing the effects of function-based treatments implemented by ecologically relevant individuals in applied settings, such as teachers in schools (Santiago, Hanley, Moore, & Jin, 2016).

In looking at the IISCA and subsequent SBT (Hanley, Jin, Vanselow, & Hanratty, 2014), we found a process that could be implemented by a BCBA, classroom teacher, or therapist within the school setting. Four students were selected as part of the pilot based on the following criteria: they routinely engaged in severe problem behavior; the behavior they engaged in often resulted in Crisis Prevention Intervention to keep the student and those around them safe; and they had previously undergone inconclusive functional behavior assessments which led to interventions making use of arbitrary reinforcement or programs based on hypothesized antecedents of problem behavior. The IISCAs for each of the four students yielded differentiated results and the subsequent treatment for all included functional communication, tolerance training, and the shaping of contextually appropriate behaviors (CABs). There was a significant decrease in problem behavior during SBT (compared to functional analysis which served as baseline) for each of the four students. Additionally, the skills and tolerance were generalized to other people (e.g., teaching assistants, parents) and places (e.g., classroom).

Beyond the Pilot

Following the pilot study, we began implementing the IISCA and SBT with more students on campus. Similar to the results of the four pilot students, the IISCAs implemented continue to yield differentiated results and demonstrate that problem behavior is controlled by multiple reinforcing contingencies (Ghaemmaghami, Hanley, Jin & Vanselow, 2016). The analyses for our learners also continue to demonstrate syntheses of establishing operations (EO) for challenging behavior including: a.) delay and denial to desired activities, b.) transitioning away from preferred contexts, and, c.) a variety of school work demands. We continue to focus on and treat precursor behaviors (i.e., less severe forms of problem behavior serving same function) in order to maintain safety and avoid emotional responding from the students (Warner, Hanley, Landa, Ruppel, Rajaraman, Ghaemmaghami, Slaton & Gover, 2020). Following analysis, the SBT for each student includes functional communication and tolerance training as well as the shaping of progressively longer CABs.

Since the start of the initial pilot study, all 4 students have generalized their treatment to multiple staff members and classrooms. Currently, over 30% of students on campus are participating in SBT across 12 classrooms. Elements of treatment extension include novel people and locations, increasingly longer durations of adult-led activity time, the development of additional CAB branches, and the introduction of ambiguity between learner-led and adult-led time. The remainder of the article will discuss staff training, multi-disciplinary collaboration, and the generalization and extension of SBT that enables learners to progress from working in an intensive, “pull-out” model to practicing their skills in natural contexts.

Behavior Skills Training

With an increasing number of students participating in SBT comes the necessity to have many staff trained in both the general process as well as learner-specific programs. Behavior skills training is used by SEARCH behavior analysts to teach staff members the skills necessary for SBT implementation. Behavior skills training is a competency-based method (i.e., skills taught until observable and measurable competency has been demonstrated) of teaching individuals to perform particular steps of a procedure. The training includes 6 steps: description of the skills (spoken and written), modeling, practice, performance feedback, and the repeating of practice/practice feedback, as necessary (Parsons, Rollyson & Reid, 2012). At SEARCH, the initial training includes discussion of the process as well as a series of written and visual materials (e.g., powerpoint slides, handouts, etc.). Modeling includes both video analysis of SBT sessions as well as a live demonstration during sessions. Practice includes both role-play as well as direct implementation of SBT trials with learners. Feedback occurs in the form of direct conversation (in the moment), de-brief conversations (after sessions are over), and written session notes.

Multi-Disciplinary Collaboration

SEARCH Day Program embraces a multi-disciplinary model which fits well within the inclusionary nature of the PFA and SBT process. From the beginning, those closest to the learner are considered “the experts” and provide vital information on possible controlling variables and contingencies for problem behavior. In the school setting, these individuals often include classroom teachers and assistants. As the treatment is developed and implemented, more contexts (including related service providers and treatments) are folded into the process. Collaboration with OTs and SLPs helps bring these other services into a student’s SBT. These additions are introduced in the form of additional activities within established branches or the development of new branches altogether. For example, a learner who receives speech and language services will often have articulation or pacing goals as part of their table-top branch of SBT. A learner who receives occupational therapy may have an entire OT branch comprised of various exercises designed to improve posture, core strength, etc. The collaboration between behavior analysts, classroom teachers, and related service providers is essential for extending the SBT to relevant contexts within the learner’s school day.

Generalization and Extension

When beginning the process for extending SBT into new environments and to new staff individuals, it is important to change only one of these variables at a time. For example, if the treatment is being extended into a novel location, the current implementers run the sessions while the learner generalizes skills in the new space. Conversely, when introducing a new staff member into the process, the trainee is typically brought into the designated treatment space for the modeling and practicing portions of SBT. Changing only one of these variables at a time allows for analysis of potential effects on synthesized reinforcement, new EOs that have developed, and the extent to which the learner is happy, relaxed, and engaged in the new context.

We also shape increasingly longer periods of cooperation by continuing the performance-based model implemented from the start of treatment. The critical goal of SBT is to teach learners skills for when preferred items and activities are unavailable for an undetermined period of time (Coffey, Shawler, Jessel, Bain, Nye & Dorsey, 2020). Stretching the response requirement (by using unpredictable and intermittent reinforcement) effectively thins reinforcement by teaching the learner to engage in other activities while synthesized reinforcement is delayed and denied for progressively longer periods of time. While we primarily use performance-based increments in SBT, time units of cooperation (TUCs) are sometimes used for activities in which it is difficult to measure or account for individual responses (e.g., leisure activities such as “reading or looking at books”).

An important component of SBT is the eventual introduction of ambiguity to what in the beginning is a clear delineation between learner-led and adult-led time. This introduction of ambiguity can be referred to as “gray” reinforcement because the distinctions between reinforcement and EO time may appear less “black and white” to the learner. Our successful implementation of specific mand (i.e., request) branches during learner-led time (i.e., the withholding of different elements of synthesized reinforcement in order to occasion requests) supports research suggesting the teaching of omnibus mands in FCT does not preclude the development of specific mands (Ward, Hanley, Warner & Gage, 2021). The inclusion of preferred items and activities during adult-led time (i.e., participation or play is guided by the staff member) are described as “fun” branches and occasion the teaching of skills in joint attention, following rules, turn-taking, etc. In addition, for some learners who have experienced sensitivity to specific words or phrases (i.e., “trigger words”) the eventual next step after developing tolerance during adult-led time is to introduce these same words in the synthesized reinforcement context.

Conclusion

The Interview Informed Contingency Analysis and Skill-Based Treatment has continued to be a rewarding, safe, and effective method of treating severe problem behavior for students at SEARCH Day Program. Building upon the success of an initial pilot program, the behavior analysts have implemented the process with students of many different learning profiles who routinely demonstrated challenging behavior sensitive to synthesized contingencies. As SEARCH implements the process with more students, and the programs of individual learners are extended and generalized to more contexts, a deeper understanding of these synthesized contingencies is developed. Throughout this process, safety and rapport-building remain the values in which SEARCH staff continue to assess behaviors targeted for reduction as well as the skill development necessary for meaningful outcomes.

To learn more about the program, visit searchdayprogram.com.

References

Coffey A.L., Shawler L.A., Jessel J., Bain T., Nye M., Dorsey M.F., (2020). Generality of the practical functional assessment and skill‐based treatment among individuals with autism and mental health disorders. Behavioral Interventions. 2020; 1–17.

Ghaemmaghami, M., Hanley, G. P., Jin, S. C., and Vanselow, N. R. ( 2016). Affirming Control      by Multiple Reinforcers via Progressive Treatment Analysis. Behavior Intervention, 31: 70– 86.

Hanley, G.P., Jin, C.S., Vanselow, N.R. and Hanratty, L.A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47: 16-36.

Parsons MB, Rollyson JH, Reid DH. Evidence-based staff training: a guide for practitioners. Behavior Analysis Practice. 2012; 5(2):2-11.

Santiago, J. L., Hanley, G. P., Moore, K., & Jin, C. S. (2016). The generality of interview-informed functional analyses: Systematic replications in school and home. Journal of Autism and Developmental Disorders, 46, 797–811.

Sidley, E., McParland, A., Algor, K. (2021). Achieving Meaningful Behavioral Outcomes in a School Setting. Autism Spectrum News: https://autismspectrumnews.org/achieving-meaningful-behavioral-outcomes-in-the-school-setting/

Ward, S.N., Hanley, G.P., Warner, C.A. and Gage, E.E. (2021), Does teaching an omnibus mand preclude the development of specifying mands? Journal of Applied Behavior Analysis, 54: 248-269.

Warner, C.A., Hanley, G.P., Landa, R.K., Ruppel, K.W., Rajaraman, A., Ghaemmaghami, M., Slaton, J.D. and Gover, H.C. (2020), Toward accurate inferences of response class membership. Journal of Applied Behavior Analysis, 53: 331-354.

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