Adult Core Competencies Curriculum: Teaching Skills to Adults with Autism and Severe Behavioral Challenges

Transcription

1 Adult Core Competencies Curriculum: Teaching Skills to Adults with Autism and Severe Behavioral Challenges John M. Guercio, Ph.D., BCBA-D, CBIST, LBA Clinical Director-Beh Licensed Behavior Analyst Benchmark Human Services St. Louis, Missouri

2 The Numbers 5.5 million adults over the age of 20 with ASD. 1.3 million kids and adolescents (ages of 3-19). (Nightingale, 2012) Fewer than half of the adults are employed. Less than half live in a fully independent environment. (Gerhardt, 2009) They present with complex clinical needs. An average of 3 psychiatric diagnosis. (Buck et. Al., 2014) Recent surveys found that 75% of this population had an anxiety disorder diagnosis. Another 75% reported a depression diagnosis.

3 Service Projections Fewer services available as adults. The service cliff plays a large role. Social skills raining and medication management are the biggest missing services. Our service system is being flooded and it may not be prepared. The waiver systems statewide are primarily equipped to treat people with ID or MI diagnosis. In 2010, 40 states had 428,571 people on waitlists for 149 waivers. Average wait time of 21 months. (Turcotte, Mathew, Shea, & Brusilovskiy, 2016).

4 More Facts Early improvements in autism behavioral phenotype slow or stop after high school (Taylor & Seltzer, 2010). No formal mandates for services after high school. (Shattuck, et. Al. 2011). A novel and distinct set of services are required. The literature mentions career/vocational, speech language services. What about behavioral supports? We are training a generation of behavior analysts that primarily treat children.

5 Origins: The Lovaas Studies Conducted at UCLA over the course of many years. Initial outcome data reported in Kanner (1943) first identified autism as a disorder. He defined it as: Lack of social interaction prior to 30 months of age. Slow/no language development. Ritualistic /obsessional behaviors. Potential for normal intelligence.

6 Assessment Process 8 primary measures from parent interviews: 1. Verbal behavior 2. Toy Play 3. Emotional attachment 4. Peer play 5. Self-stimulatory behavior 6. Tantrums 7. Toilet training 8. Eye contact

7 % "normal" functioning Powerful Results "Normal" Intellectual and Educational Functioning Treatment Groups Controls

8 Aggression and its correlates. The use of aversives. Primary Differences Educational and social skills being the primary dependent variables.

9 Some Numbers

10 Age Group Comparisons

11 Vocational Options

12 Contact with Law Enforcement

13 A Case Example Children s Hospital for over 8 months from his academic setting due to a series of violent behavioral issues that posed significant safety risks. Had been living with his mother and being transported to the program via a cab service on a regular basis. Aggression ranged from breaking light bulbs in the home, burning the comforter on his brother s bed, cutting up his mother s clothing and some live wires in the home, urinating in inappropriate places, and frequent elopement. 6 4 and being over 240 pounds, he has required up to 6 staff to keep him safe at times. Mom almost died from a choke hold that he placed on her.

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15 Approaches to Transitions Autism Pre-instruction recommended. Visual displays/use of video. Environmental labeling. Structure. ABI/DD Spontaneous presentation. Sabotage. Allow no time for perseveration. Decrease SIB

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20 Transition Efforts Hospital Food delivered on a schedule. No food present in room. Periodic walks. Devoid of peers. Lack of behavioral expertise. ISL Free access to food. Vehicle transport Peer interaction. RBT and BCBA staff. Systematic Desensitization. Multiple trips.

21 Manipulable Schedule

22 Quick Interaction Rings

23 Tolerance for Delays

24 Tacting Emotional States

25 Building Progressive Delays

26 Building a Voice

27 Behavioral Progress

28 Implications ABA with adults = ABA w/ kids. Expertise in crisis management. Positive interaction training/protocols. Functional communication strategies. Staff training.

29 Background on the ASSET The ASSET was developed based upon the School- Wide Evaluation Tool (SET) that is used to provide behavioral supports in school systems. Research based on the SET is listed below: Horner, R.H., Todd, A. W., Lewis-Palmer, T., Irvin, L. K., Sugai, G., & Boland, J.B. (2004). The School-Wide Evaluation Tool (SET): A Research Instrument for Assessing School-Wide Positive Behavior Support. Journal of Positive Behavioral Interventions. Vol 6. (1). pp For an abstract of this paper, or to purchase its full version, go to

30 Agency Systems Support Evaluation Tool (ASSET) Implementation Manual Assessment tool used by The Department of Mental Health. Based in Positive Behavioral Supports. Goals: To determine the extent to which sites are already using agency-wide positive behavior supports (AW-PBS), To determine if training and technical assistance efforts result in change when using AW-PBS and To determine if use of AW-PBS procedures is related to valued change in the safety, social culture, and violent behavior in sites.

31 What is a Behavioral Technician? T/RBT_Task_List.pdf

32 Data Based Decision Making

33 Evolution of a Form The initial forms were separate.

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36 Transportation Tolerance

37 Data Based Outcomes A Detailed Forward Chaining Procedure

38 Ricky s Data

39 Fulton State Hospital

40 Joe s Story 40 year old male. 20+ years of forensic placement. No community access. No telephones. Mattress on concrete floor. No other peers.

41 Joe s Story Sporadic access to grounds. Staff used boxing pads on all outings on grounds. Foods could not touch.

42 Fading Protocol

43 Community Tolerance Data

44 minutes in the community # of instances of aggression Aggressive Behavior 160 Instances of aggression Minutes in the community Aggressive Behavior / / Present 23 Sessions 0

45 Policy

46 Minutes Escorts Community Trips Minutes Spent in Community Dr.'s Appointment Begin Reinforcer / / Present 23 Sessions 0

47 11/3/2014 1/3/2015 3/3/2015 5/3/2015 7/3/2015 9/3/ /3/2015 1/3/2016 3/3/2016 5/3/2016 7/3/2016 9/3/ /3/2016 1/3/2017 3/3/2017 5/3/2017 7/3/2017 9/3/ /3/2017 1/3/2018 # of reported issues Joe SIB 10 Self-Injurious Behavior Community Access Started Weeks

48 Mindfulness in Autism

49 Avoidance Assessment

50 Steps Completed

51 Outcomes

52 Development of a Curriculum Comprehensive Risk Assessment (Overt Aggression Scale, Yudofsky, 1986).

53 Assessment OAS informed functional behavioral assessment. Institutional visits/evaluations. Detailed phone interviews with caregivers. Systematic transition process. Gathering of forensic/legal information as indicated.

54 The Curriculum

55 The Curriculum

56 Measures of Well Being

57 THANK YOU

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