Safety First: Home and Community Issues Regarding ASD and Aggressive Behavior

Transcription

1 Safety First: Home and Community Issues Regarding ASD and Aggressive Behavior - Eugene Bensinger, board member with Autism Speaks Chicagoland Chpt. - Mike Carlson, Police Officer and First Responder Trainer - Natalie Deutsch, BCBA, Easter Seals Metropolitan Chicago - Mia McNary, board member with Autism Speaks Chicagoland Chpt.

2 Objectives 1. Attendees will gain understanding of the challenges and supports needed for families who have a child with a developmental disability and aggressive behavior. 2. Attendee will have enhanced knowledge of evidence based strategies, such as Therapeutic Crisis Intervention, that have been successfully implemented in educational settings to ameliorate aggressive behavior and to promote safety for all when aggressive or self injurious behavior does occur. 3. Health care providers will gain knowledge of resources, such as the First Responders program, to enhance safety in the community for people with ASD and related neurodevelopmental disabilities.

3 Mia McNary, board member with Autism Speaks Chicagoland Chpt.

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7 Resources/Research articles: Gray D. E. (2003) Gender and coping: Parents of children with high functioning autism. Social, Science, and Medicine, Hastings R. P. and Johnson E. ( 2001) Stress in UK families conducting intensive home-base behavioral intervention for their young child with Autism Journal of Autism and Developmental Disorders 31, Lecavalier L, Leone S., Wiltz J. (2006) The impact of behavior problems on caregiver stress in young people with autism spectrum disorders. Journal of Intellectual Disability Research 50 (Pt 3), Lessenbery B.M. and Rehfeldt R.A. (2004) Evaluating the stress levels of parents of children with disabilities. Exceptional children,

8 BEHAVIOR MANAGEMENT WITHIN THE SCHOOLS Nathalie Deutsch, MA BCBA Lead Behavior Analyst Easter Seals Autism Therapeutic School- Chicago

9 IDEA AND FUNCTIONAL BEHAVIOR ASSESSMENTS School districts are required to provide FBA s under certain circumstances: Disability Student was removed for more than 10 days For misconduct: Is a manifestation of the student s disability Is not a manifestation of the student s disability Involves drugs, weapons, or serious bodily injury regardless of the manifestation review Behaviors that interfere with student s ability to learn

10 IDEA AND FUNCTIONAL BEHAVIOR ASSESSMENTS IDEA does not specify who conducts functional behavior assessments (mostly IEP team) It also does not specify who will create a Behavior Intervention Plan The Behavior Intervention Plan must be linked with the results of the FBA and strategies mentioned within the BIP must be linked with the function of the behavior. Failure to do this can result in ineffective procedures as well as more restrictive procedures.

11 EXAMPLE A student is screaming when a task is presented because he/she does not want to do the task. Staff then provide the student with a time-out for being disruptive. Will this be effective in decreasing the student s screaming? Probably not because the student ultimately got what he/she wanted, which was to escape the task. Without a proper functional assessment being conducted, an inappropriate intervention may be selected.

12 TRAINING Schools are to have properly trained professionals available to conduct these FBA s as well as developing BIPs. It is the district s responsibility to provide professional development, in-service training, and technical assistance for school staff to conduct FBA s well. Schools often have their Social Workers trained in conducting FBA s, which is generally a workshop that they attend to obtain information on how to complete an FBA and subsequently BIP. However, this may not be enough.

13 BEHAVIOR ANALYSIS Natural science approach to studying the behavior of humans. A systematic, data-based approach to understanding, analyzing, and changing behavior. Concerned with environmental factors that occasion and strengthen/decrease responding. Antecedents and Consequences Antecedents- any stimulus that precedes a response (that signal the availability or absence of reinforcement) Consequence- any stimulus that follows a response (that increases or decreases the probability that the response will maintain)

14 SCIENCE OF BEHAVIOR ANALYSIS The science of behavior analysis focuses on principles about how behavior works or how learning takes place. Behavior Analysts have developed many techniques for increasing useful behaviors and reducing those that may be harmful or that interfere with learning. Applied behavior analysis (ABA) is the application/use of those techniques and principles to address socially important problems and to bring about meaningful behavior change.

15 CHANGING BEHAVIOR In order to change behavior, you need to understand the function of the behavior. All behavior serves a purpose: communicate, meet a need, have an impact on the environment. Find an alternative behavior that the student can perform in order to get the same reinforcement. Teach the student to perform this behavior in a systematic way. Change will not occur rapidly. Teach the alternative behavior when student is motivated to learn, not in the midst of a behavior problem.

16 BCBA Board Certified Behavior Analyst Has established a minimum set of both academic and applied skills as attested to by their training, supervision, and passage of the BACB examination. Minimum of: Masters Degree in a human service field like Behavior Analysis, psychology, special education, etc., which includes 6 required Behavior Analytic courses. Supervised experience under someone who holds a BCBA for at most 1500 hours. Essentially, these are the people you want analyzing behaviors to determine the most effective plan.

17 FOR MORE INFORMATION For more general information about behavior analysis and ABA, see: [The Association of Professional Behavior Analysts] [The Association for Behavior Analysis International] [Behavior Analyst Certification Board] [American Psychological Association Archival Description of Behavioral Psychology] [Cambridge Center for Behavioral Studies]

18 EVIDENCED BASED STRATEGIES The National Standards Project was an initiative by the National Autism Center to determine guidelines for evidence-based practices for Autism Spectrum Disorder. They divided the practices into: Established Emerging Unestablished Ineffective/Harmful

19 ESTABLISHED TREATMENTS Antecedent Package Behavioral Package Comprehensive Behavioral Treatment for Young Children Joint Attention Intervention Modeling Naturalistic Teaching Strategies Peer Training Package Pivotal Response Treatment Schedules Self-management Story based Intervention Package

20 ESTABLISHED TREATMENTS Two-thirds of the Established Treatments were developed from behavioral literature such as Applied Behavior Analysis, Behavioral Psychology, and Positive Behavioral Supports. Therefore, treatments from the behavioral literature has the strongest research support. For more information:

21 CRISIS PREVENTION Some maladaptive behaviors require physical intervention in order to ensure safety for all those who are involved. This is a highly restrictive intervention and should only be used when all other interventions have failed or the risk of severe injury or harm to others is imminent.

22 CRISIS PREVENTION WITHIN SCHOOLS Many public schools are not taught physical interventions to utilize when students are exhibiting severe maladaptive behaviors. However, many nonpublic/therapeutic schools have received training in crisis prevention. These include: Therapeutic Crisis Intervention PCM Safety Care Crisis Prevention Institute

23 THERAPEUTIC CRISIS INTERVENTION (TCI) Developed by Cornell University for residential child care organizations as part of the Residential Child Care Project. Assists organizations in preventing crises from occurring, de-escalating potential crises, managing acute physical behavior, reducing potential and actual injury to young people and staff, teaching young people adaptive coping skills, and developing a learning organization. Goal of TCI is to teach staff members to help young people develop new responses to their environment that will enable them to achieve a higher level of social and emotional maturity.

24 CRISIS PREVENTION INSTITUTE (CPI) Nonviolent Crisis Intervention program Teaches staff to respond to warning signs that someone is beginning to escalate and addresses how staff can deal and manage their own stress, anxieties, and emotions when confronted with these challenges. Holistic Behavior Management System based on the philosophy of providing the best Care, Welfare, Safety, and Security for staff and individuals in their care. Focuses on preventing disruptive behavior by communicating with individuals respectfully and with concern for their well-being.

25 PROFESSIONAL CRISIS MANAGEMENT (PCM) Developed by a BCBA out of more than 15 years of experience in dealing with individuals who are severely aggressive in homes, residential facilities, hospitals, and school settings. Derived from scientifically verified principles in behavioral psychology for the prevention or reduction of maladaptive behavior. Utilizes four primary strategies and interventions: Crisis prevention strategies Crisis de-escalation strategies Crisis intervention procedures Post-crisis strategies

26 SAFETY CARE Competency-based crisis prevention training program that bases its procedures from research on applied behavior analysis. Entirely based upon positive reinforcement paradigm. De-escalation procedures are based on identification, prompting, and reinforcement of alternative behaviors. This procedure is less likely to reinforce crisis behaviors. Focused on practical methods for preventing, minimizing, and managing behavioral crises.

27 MORE INFORMATION Safety Care: PCMA: CPI: iolent-crisis-intervention/our-program TCI:

28 THANK YOU

29 3 rd Annual ABC Conference Friday November 16, 2012 Gene Bensinger Board Member, Chairperson Programs and Services Committee Autism Speaks Chicagoland Chapter and Parent Advocate S

30 Children with ASD s are much more likely to exhibit severe aggression than typical kids or even those with ID s like Down syndrome S

31 It is a BIG problem S In a recent study distributed by Kennedy- Krieger s Interactive Autism Network, of 1,380 children surveyed with ASD s, 68% had engaged in aggressive behavior to caregivers versus 11% in people with Intellectual Disability, but not an ASD. mmunity/aggression_and_asd

32 Involuntary aggression isn t well understood S Aggression can be dismissed as an attention seeking or a communication strategy, rather than the result of a more fundamental underlying neurological or biological issue (including things like epilepsy or GI dysfunction). S An incorrect assumption that the aggression is attention seeking may lead to ineffective attempts at behavioral intervention, wasted time and resources, and potential escalation of the problem.

33 General Discussion S The neurology and metabolic processes in ASD s can be really different than typical kids or those with ID s in many ways. Behavioral interventions may need medical help to work. S Experts are gravitating to Autisms, not AUTISM. Need to get away from one size fits all definitions and interventions, including behavioral, and drill down into what helps the individual and common subtypes best.

34 Pharmacological Issues S Big need to understand the current advances in pharmacological interventions almost everything being used by clinicians today for aggression is off-label. No consistent protocols exist. Only Rispderdal and Aripiprazole are FDA approved. S ATN/AIR-P Medication Decision Aid S The subtype of autism and individual response to drugs will likely guide optimal intervention strategies going forward.

35 Advances in autism research S Include the latest in autism research in study materials. Thanks to parents and advocates successfully pushing for funding (CAA, CARA, private sources), research is now happening at furious pace. 15 years ago next to nothing in the scientific and medical literature. Autism research was viewed as an academic dead end and career killer. Now changed.

36 Helpful Tips for Healthcare Providers S Perfect behavior isn t a realistic outcome in ASD or for typical people. Parents and caregivers need to have a plan in place for aggressive behavior at home or in the community (examples). S Collaborate with the family team and other professionals when aggression or self injurious behavior is involved: Pediatric Neurologists & Gastroenterologists/Behavior Therapists/Teachers can help identify the issues, triggers, and potential solutions. Remember increased prevalence of seizure disorders and GI problems among individuals with ASD that may contribute to irritability and aggression.

37 Helpful Tips for Healthcare Providers S Visits to medical providers are by their infrequent nature potential behavior minefields. Family rehearsals are good. Staff training, a calm environment, and eliminating waiting time can make all the difference to prevent an aggressive response and have a successful appointment. (examples) S Dental interventions commonly trigger aggression. Sedation is sometimes the only course of action. Layering procedures can work (ex. ear tubes + fillings = big cost savings using 1 OR visit)

38 Helpful Tips for Healthcare Providers S Consider asking the family to organize and communicate concerns ahead of an appointment, perhaps via a checklist or so you can optimize the limited time available with the patient without having to play detective in the limited time available. S Keep in mind that travel is a big problem for some. (examples) S Aggressive behaviors are a critical safety issue and often a big reason why ASD s isolate families and individuals. They can lead to seclusion and restraint and restrictive long term placements to avoid physical injury to all involved. For some, controlling aggression may be a life or death proposition.

39 Resources Autism Speaks is dedicated to getting resources where they are needed. We have developed an extensive series of free, downloadable toolkits, put together with input from top experts in their fields, on a wide variety of topics, from our 100 day kit to guide the families of newly diagnosed to autism safety issues to enhancing the school community environment to housing and adult supports. You can find them on our website below:

40 Resources S Here is the link directly to our new Challenging Behaviors Tool Kit There s a ton of very useful information in Autism Speaks Tool Kits. Please take a look and encourage your patients to access these free resources.

41 Resources S An excellent place to survey a lot of autism focused research is the International Society for Autism Research (INSAR) S Going forward we should see more focus on treatments, including aggression, from AAP with Autism Treatment Network Head Dr. James Perrin as President-elect. S INSAR holds an annual meeting (IMFAR) Ten years ago, 100 folks showed up. Last year over a thousand researchers, clinicians, and others attended. Check out the abstracts. There are quite a few focused on aggressive behaviors and potentially useful interventions.

42 Thank You