Courtesy: AAIDD Mental Health Services SIG Webpage

Transcription

1 PURPOSE: These scoring rubrics are provided as guidelines to INFORM each reviewer about potential issues in each area of review. They are GUIDES rather than requirements as the actual score may incorporate other considerations the reviewer may apply. These rubrics are established by consensus of the committee and those presenting plans. Rubrics evolve over time based upon the needs of the committee, background of the active members, and experiences with the review form and submitted plans. EXCELLENT score is used when specific features are superior to most other plans. Committee item scores are decided by majority numbers, ties going to the higher score. 1. Does this plan contain: Corporal punishment, seclusion, or aversive physical stimuli? Restrictive procedures used in the absence of maladaptive behaviors? Punishment without the demonstration that varied, positive approaches that have been applied consistently have been ineffective? (A yes to any of these questions prompts disapproval) 0=Absent 1=Present 2=Appropriate/Not Applicable 3=Excellent 2. Target behaviors are operationally defined and measured. Target behavior term is defined in a measurable fashion Data is collected and presented in a graphic form Start, Stop, and Topography is described in brief but clear terms; Data in clear units Complex behavior is reduced to easily recognizable, discrete behavior to measure 3. Antecedents and consequences for each target behavior fully elaborated. Each target behavior, or group of TB s, is addressed Antecedents reflect SETTING, TIME, TRIGGER EVENTS, and PEOPLE Consequences reflect existing REINFORCING and SUSTAINING contingencies of each target behavior, or estimates of them, to reveal the behavior s FUNCTION All consequences are relevant to the MOTIVATIONAL FUNCTION of the behavior and AVOIDS the abstract social implications (consequences the person is not able to understand is related to the behavior e.g., hitting ruins friendships The analysis is exhaustive of all possible functions of the behavior 4. Reinforcing items identified and reviewed for effectiveness. At least a few items are identified that have motivational power for the person Reinforcing items are reviewed and updated to reflect changes Data is collected on the delivery of the reinforcers to assure effectiveness Data reflects a high rate of reinforcement delivery, or exposes delivery problems Reinforcing items are identified by the motivational importance to the person Page 1 of 5

2 5. Training methods related to the hypothesized behavioral functions. Nothing in the methods are inconsistent with the hypothesized functions Methods at least cursorily address all hypothesized functions Rationale of each method is clearly linked to the hypothesized functions All hypothesized functions are addressed in methods, with strategies to evaluate competing hypotheses when there is more than one 6. Teaching of adaptive skills & reinforcement schedules are fully outlined. Teaching methods are identified for staff to follow When to and not to reinforce is identified in Direct Treatment and Positive Programming sections Teaching methods are task analyzed or clearly outlined for training methods Method of reinforcement delivery, withholding, and error correction are detailed 7. Reactive strategies sequenced using least restrictive methods first. Each target behavior is addressed, either individually or in groups Staff instructions emphasize less intrusive methods before more intrusive Information on creative alternatives is sufficiently clear that a new staff member would understand the ideas to try to implement Crisis situations are clearly outlined including: hospitalizations; on-call staff and backup contact information; police guidance; and/or dealing with victims/neighbors. 8. Generalization of skills and fading of intrusive procedures are described. Intrusive or restrictive methods are identified for Fading Generalization of successful skill developed to each environment and across situations/people are outlined Each intrusive or restrictive methods has explicit criteria to remove it from the plan Step-down strategies are detailed to lesser restrictions towards elimination Generalization to targeted environments/situations/people are detailed Page 2 of 5

3 9. Data collection plans adequate to monitor effects of the interventions. All target behaviors are clearly identified for staff to collect, with definitions Frequency of data review, methods of graphing, staff feedback are useful Target behaviors and ancillary information, such as reinforcer delivery, are included Event markers (denoting condition changes) are recorded Methods to compensate for inter-rater reliability problems are described 10. Evidence that staff working with the individual fully trained on plan. Evidence includes documentation of at least one staff-training meeting per year for that program, with little or no change in the methods. There should be evidence of retraining if significant change in the methods was needed. Documentation includes who was in attendance. There is a brief overview (separate from the full program) of the critical methods prepared expressly for the staff, which enables them to quickly review things they need to know on a day-to-day basis. There is likely to be multiple staff training sessions per year. Please make a brief documentation as to the changes, or problems, that were addressed. Documentation includes who was/was not in attendance. A written or role-play test is given to staff to evaluate understanding of procedures. 11. Sufficient, appropriate resources are available, or plans to obtain them. Staff, teaching/training materials, funding, and living arrangements are adequate Referrals to appropriate authorities to obtain adequate resources are being made Team is making exceptional efforts to obtain critical resources Team is accomplishing highly unique arrangement of resources 12. Data (12 mos.) shows progress or reasonable efforts to make changes. Twelve months of data on all target behaviors is provided Team has made changes in the plan driven by issues identified in the data Data is clear, well-labeled, and separated sufficiently to reveal patterns 24 or more months of data available Reinforcement data is graphically provided Event markers are labeled to demonstrate impact Page 3 of 5

4 If psychoactive medications are NOT part of this plan, score all as Team has specified the behavioral outcomes sought from medications. Each medication and the targeted behaviors to be impacted are listed Vague references or symptoms that are NOT target behaviors are not included (except to explain how the target behaviors may relate to the symptoms of the diagnosis) Each medication and target behavior(s) are related by empirically-based relationships (e.g., antipsychotics for hallucinations vs. aggression) Co-pharmacy (different classes) is clearly delineated by relationship to target behaviors unique to the class (e.g., anti-depressant to social activity, antipsychotic to delusions) Poly-pharmacy (more than one medication of the same class) is not present. 14. Evidence that relevant data are reviewed by prescribing physician. Data was reported (e.g., Consult Form) to prescribing physician (usually psychiatrist) Evidence that data was reviewed by prescribing physician (initialed and dated graph) Prescribing physician used the data to inform their treatment Physician provided guidance to improve data and/or Increase/Decrease guidelines 15. Evidence is presented to demonstrate medication effectiveness. History and/or Current data suggests effectiveness, or clear information it was not INEFFECTIVE Medication holiday/decrease evident to suggest medication effectiveness Data clearly demonstrates an improvement relationship between the use, or dose, of the medication. This may be in the history or reflected in current 12 months data. Medication holiday/decrease data is evident such that it is clear that WITHDRAWAL symptoms do not account for problem behavior (duration of holiday/decrease of sufficient duration to separate this as a variable). Page 4 of 5

5 16. Team adequately specifies reduction/elimination of medications. Increase: General circumstances from HISTORY or of potential CONCERN are identified as a cue to the program coordinator to understand what might constitute a crisis requiring immediate physician attention Decrease: Conditions under which the team/physician would want to be considering a decrease/elimination of the medication. This should NOT be time-limited to a one-year time frame (up to five years can be appropriate). These guidelines reflect an understanding that it may never be achieved yet characterizes what is considered remarkably improved should those conditions occur. Increase: Clear criteria for the program coordinator to contact the prescribing physician about a potential increase/change in medication based upon PREVIOUS CRISES or CONDITIONS of CONCERN. Decrease: Criteria for considering a decrease discussion with the physician based upon TARGET BEHAVIOR OBJECTIVE Guidelines clearly reflect input from the physician for both Increase and Decrease. Recommended Review Intervals: Six months if required by regulations, no more than one year. Below 30 From 30 to 35 Above 35 Committee should consider review again within 3 months or less Committee should consider review at 6 months or less Committee should consider review at 12 months, earlier if concerns about supports are evident Implemented: January 2009 Page 5 of 5