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Notes: A Stepwise Guidebook on Finalizing Qabf North Carolina Association For Behavior Analysis Online

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The Definite Guide to Qabf North Carolina Association For Behavior Analysis

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Instruction of Qabf North Carolina Association For Behavior Analysis

I'm Mandy Mijares I'm the clinical.director of the Seattle Children's.Autism Center and also the director of.the applied behavior analysis early.intervention program I'm gonna introduce.and then Liz my colleague who I'll tell.you about in just a minute is gonna do a.big chunk of our content tonight and.then I'll be kind of coming back in.toward the end with some comments about.kind of it's a little bit of the history.of the field the current status and kind.of where we think the field is headed so.Liz gave me some facts about herself.today I wish they were more interesting.so I'm gonna try to spice it up because.she didn't give me the real you know.like the inside scoop gave me all the.professional profile which is what she's.supposed to do but you know I'm gonna.give you a few of those highlights so.Liz has an undergraduate degree in.special education with a cross.endorsement in general education which I.think sounds very impressive it means.she's a very well-rounded and well.trained teacher and that's from the.University of st. Joseph in Connecticut.she then had got a master's degree in.autism and a behavior analysis from the.same University and she has had.experience both teaching in the.classroom and then also as a lead.behavior analyst therapist designing and.conducting ABA intervention plans for us.here at Children's she's really the.brains and the muscle behind our ABA.early intervention program I oversee you.know kind of all the components in the.program at a high level that liz is.really the one leading the way as far as.developing the programming developing.the interventions overseeing the.therapists and so on so we are gonna.hear from her first about you know just.sort of we want this talk to especially.because it's going to be posted online.afterwards we want it to sort of live as.a description or a definition of what.ABA is because there's you know you guys.probably have varying degrees of.understanding about yourselves but if.you do have some you know background.knowledge about what ABA is which of.course many of you will you're also.aware that there are you know there's a.lot of confusion there's a lot of.miscommunication there's even some.controversy in the field of ABA.and so we're hoping that this can be.like I said sort of live or exist as a.what is a BA so it's a nuts and bolts.kind of a background is is you know a.big portion of what liz is going to go.over with you guys and then what are.some of the challenges that the field.faces and sort of what are our thoughts.about some of those challenges so that's.where I'll sort of come back in a little.bit more towards the end so I'm gonna.not take up any more time I'm gonna hand.it over to Liz she's got her she's miked.up there and I'll see you guys in a bit.okay Thank You Mandy and thank you for.everyone who is able to attend here.physically and also who is.live-streaming with us I'm very excited.to be here tonight to talk to you about.applied behavior analysis so to give you.an overview of what we will be covering.we're gonna start by looking at what is.applied behavior analysis or ABA we'll.talk about a little bit about some of.the basic so some of those concepts and.terminology that you'll frequently hear.will get a little bit into some of the.application some quality indicators of.ABA and then we're gonna finish by.talking a little bit about the evolution.of the field in some past present and.future directions so to start what is.ABA so ABA is a science of behavior.change it is how we learn and what the.field has done has looked to identify.and describe some principles that govern.behavior change and learning for all of.us so so that's one thing to really.emphasize is that this learning occurs.for all of us regardless of our ability.so for example a person is more likely.to repeat a behavior if it's followed by.a positive outcome so think about it.from the perspective of if there is a.specific Starbucks location that makes.your favorite drink you are going to be.more likely to engage in that behavior.to go to that Starbucks to get your.favorite drink just the way you want it.and so that learning is occurring.whether or not you're really paying.attention to it when we're talking about.the treatment.ASD we're looking at how ABA principles.can be used in a very intentional manner.to create learning through different.contingencies and things that we're.going to talk a little bit about in just.a moment so here is the official.definition of ABA this comes from Cooper.herein and he word in 2009 so ABA is the.process of systematically applying.interventions based on the principles of.learning to help improve socially.significant behaviors to a meaningful.degree and to demonstrate that the.interventions that we're using are what.is responsible for the change in.behavior so that's a that's a lot of.language so we're going to unpack that a.little bit and talk a little bit about.the defining characteristics of the.field so the first one is this word.applied and when we're talking about.applied we're talking about improving.socially significant behavior so.thinking about the behaviors that are.really meaningful for an individual so.things like helping them to use their.words to get their needs and wants met.those types of behaviors the next.characteristic is behavioral so what.we're looking at our behaviors in an.observable and measurable way and so.we're going to talk a little bit later.on in terms of how we define behaviors.how we track behaviors so that we can.all agree about what we're looking at.the next characteristic is analytic so.this is when you might hear you know the.terms it's demonstrating experimental.control and all that means is that we.are looking at whether or not the.interventions we're using are what is.causing the behavior to change and not.something else the next characteristic.is technological so for this one I want.you to think of a recipe so are the.procedures and the protocols that we're.using are written out in such a way that.they are defined very very clearly and.in great detail so that everyone can be.sure of what they're supposed to be.doing.the next characteristic conceptually.systematic so this refers to the idea.that everything we're doing the.procedures were implementing are tied.back to the basic principles of behavior.that have been well researched and.proven to be effective across a large.body of literature and we're going to.talk about what some of those basic.principles are a little bit later on the.next one is effective so this one is.kind of telling you what it is right off.the bat so making sure that the behavior.change is changed to a socially.significant degree so it was meaningful.for that individual that it was changed.in whatever way we were trying to change.it and then the last characteristic that.we talked about is generality or you may.have heard it referred to as.generalization so I often like to tell.parents that a behavior is really no.good if an individual can only do it in.one location with a certain set of.materials or a certain group of big.people instead what we want to happen.have happen is that we teach a skill we.teach a behavior and it lasts over time.we see it happening in other areas with.other people so we're saying that that.skill has been generalized to other.settings to different environments and.again and extending over time so.shifting gears and thinking more.specifically in terms of how this.relates to the treatment of autism.spectrum disorders or other.developmental disabilities is how we're.using these procedures to help improve.the core symptoms of ASD and so what ABA.is doing in those situations is.providing services that support learning.and school sorry about that and skill.development to help in a variety of.domains so for example we might be.working on teaching social skills so.greeting peers sharing maybe turn-taking.we might be looking at communication so.you often hear functional communication.train.and that basically just means helping.somebody to learn to use their words to.in order to get their needs and wants.met play is another domain that we might.look at teaching skills in especially if.you're thinking about an early.intervention approach because play is.one way that we teach some foundational.social behaviors and young children.things like joint attention and those.sorts of behaviors in addition we might.be teaching behavior skills such as.learning how to handle frustrating.situations like being told you have to.wait for something that you really want.those can be really challenging.situations for for individuals so we.look at teaching waiting skills that.would be an example also looking at.adaptive skill so maybe toileting or.feeding or dressing perhaps motor skills.whether those are fine motor or gross.motor skills and also some cognitive.skills so you might have heard things.like teaching matching or teaching.imitation and while sometimes those.skills can seem very basic.they're so essential for the foundation.of learning and they're they're.oftentimes skills that many typically.developing individuals have acquired in.a very organic and natural way just.through their development but are.sometimes skills that we have to.explicitly teach to individuals with.autism spectrum disorders or other.developmental disabilities in order for.them to then be able to engage in more.advanced types of learning and one thing.I like to point out about this is that.ABA is not a standalone treatment we are.consistently collaborating with a.variety of other providers whether.that's a speech and language therapist.maybe an occupational therapist.maybe individuals who are other behavior.analysts who have an expertise in an.area like feeding or intensive behavior.so that's an that's an important idea to.keep in mind is that we are not the only.ones in there.providing this treatment we're really.working collaboratively with a variety.of other professionals so what is ABA.all it is is this relationship between.behavior and the environment that.governed behavioral changes every single.day and that's learning so for example.maybe a child is tantruming in order to.attempt to gain access to a toy but in.that moment the individual does not give.the toy to the to the child and so they.learned that okay maybe the tantrum.isn't effective and gaining access to.what I want or on the flip side maybe.the child uses their words and asks.really nicely for that toy and the.parent or caregiver brings them that toy.and now they've learned that they can.use their words in order to gain access.to what they want so those are just a.quick a couple examples of some of the.learning and again ABA is just.systematically applying these behavior.principles to purposely create behavior.change in learning so now that we've.talked a little bit about what is ABA.now we're going to start talking about.some of the very basics of applied.behavior analysis so you're gonna hear.us talk a lot about this three term.contingency the ABC sequence so the a.stands for antecedent and that means.whatever happens right before the.behavior that might cue the behavior or.trigger the behavior the behavior is.just the response and I like to make a.clarification on this because oftentimes.this is something that can be a little.bit confusing sometimes when parents.here oh your child had a behavior today.that sounds bad but in reality behavior.could be a lot of things behavior is me.talking behavior is me raising my hand.in the classroom so it can be a variety.of responses and then the C stands for a.consequence and all that is is whatever.happens right after the behavior that.either increases or decreases the future.ly.hood that that behavior will occur again.again I always like to mention that this.word consequence sometimes we hear it.and it sounds like it's a bad thing and.that's not necessarily the case when.we're talking about it within the.framework of the ABC contingency it's.just whether or not the behavior is.going to increase or decrease in the.future so here's a quick example for you.the antecedent is mom asks what do you.want and the child responds goldfish and.the consequence is mom gives that child.the goldfish so in this situation likely.what will happen is the child will use.the word goldfish in the future in order.to gain access to that favorite snack so.now we're going to talk a little bit.about how we utilize the ABC contingency.to help teach skills and help teach.individuals to learn and so really what.these interventions focus on doing is.understanding and altering those.environmental conditions at different.places within the contingency so again.there are naturally occurring.contingencies happening all of the time.that result in learning that's but what.we're doing specifically in the.treatment of autism is controlling some.of these contingencies and we're doing.that to either increase desirable.behaviors so to teach skills by creating.opportunities or to help decrease.undesirable behaviors so reducing.destructive or maladaptive behaviors.again by understanding and altering the.existing three term or ABC contingency.and so there are three basic principles.of applied behavior analysis the first.is reinforcement and that means that we.are adding or taking away something from.the environment that's going to increase.the future frequency of behavior so.we're what we're going to talk a little.bit about this more when we're talking.about tea.new skills that we want to see continue.to occur and there's either positive.reinforcement or negative reinforcement.and again sometimes those were is.positive and negative can have carry.certain connotations with them but when.we're talking about them within the.context of the basic principle of.reinforcement or punishment all the word.all all that positive means is an.addition whereas negative means the.removal of something so positive.reinforcement adds a stimulus to the.environment and that word stimulus is.just a fancy word to mean something so.maybe we're adding our verbal behavior.maybe we're adding an item maybe we're.adding some kind of activity or event or.access to something so some examples.that I gave were maybe saying a great.job or giving access to a preferred toy.on the flip side of that negative.reinforcement means that we're removing.something from the environment such as.some kind of aversive situation so for.example let's say that some siblings are.playing together and one of the siblings.says stop I don't like that and that.gets that other sibling to stop their.behavior to remove that aversive.situation that would be an example of.negative reinforcement in contrast to.that we have punishment and punishment.means that we are decreasing the future.frequency of behavior and again you're.gonna have either positive punishment or.negative punishment so you're either.adding something to the environment such.as saying no or stop doing that that's.making the behavior decrease or.sometimes giving a timeout could be an.example of positive punishment and then.again negative punishment would be.removing something from the stem the.environment so maybe taking away a.preferred toy or something like that I.also like to point out that there are.ethical considerations when we're using.these types of principles within our.treatments.and intervention approaches so we're.going to talk a little bit about that.later on but just something to keep in.mind that you know for instance we're.always going to try to use reinforcement.first before we look at using punishment.procedures and the last basic principle.is extinction.so extinction just looks at removing.specific reinforcement that was.previously available so for example if.Robert was engaging in inappropriate.attention-seeking behaviors we would.look at no longer providing that.attention to Robert while he is while.he's engaging in some of those.challenging behaviors but again what.would be important to note about that is.that if we're going to remove.reinforcement for the inappropriate.behaviors we want to make sure that.we're providing it for an appropriate.behavior and that's where you're gonna.hear us talk a little bit later on in.terms of replacement behaviors and those.things like that but the goal of.extinction is that it's helping to.decrease the likelihood that a behavior.will will occur in the future with.extinction sometimes you may hear or.learn about an extinction burst this.means that a behavior might temporarily.increase in intensity or a duration so.it's something that again there has to.be some ethical considerations made.around in terms of making sure that.everyone feels comfortable with the.procedures and that there's plans in.place while this while this may occur so.now that we've talked a little bit about.some of the basic principles we're going.to look at how that is applied in ABA so.one of my very favorite things about.applied behavior analysis is that.although I have a love and passion for.using it to help treat autism spectrum.disorders I think it's really cool that.it is effective in a lot of different.areas and again it's really something I.like to point out to people and have.them be aware of that.aba has been shown to be effective.across a variety of different fields and.this is not necessarily a comprehensive.list of that it's just a few examples.and I can point them out to you so for.example organizational behavior.management there are behavior analysts.that will go into businesses or.corporations and look at helping the.company to design procedures that help.employees or groups of employees maybe.work more efficiently which in turn.might save the company some money.something like that with health and.exercise there's been research done to.help individuals engage in things called.contingency contracts or self monitoring.of their behavior in order to help them.stay on track with maybe a new exercise.regimen in order to improve their health.in industrial safety there has been.research around helping to provide.feedback to staff members in order to.increase their safety awareness and.their engagement in safety behaviors.which is obviously certainly important.and then another one like Environmental.Conservation there's been a bunch of.research that has looked at helping to.increase awareness around recycling.using a variety of antecedent strategies.which we'll talk a little bit about what.that means again - and looking at.reinforcing people for engaging in those.behaviors so that we're working towards.having a more sustainable planet so.again oftentimes we hear a BA paired.with autism but it's not solely for.autism it just happens to be very.effective in helping to treat some of.those core symptoms but there's a lot.there's a lot more out there in the.world of ABA that's pretty cool so.jumping back in to what we would be.looking at in terms of helping to treat.autism spectrum disorder there are -.there are two different things that we.would be doing two main things.we would be doing one would be looking.at increasing appropriate behaviors and.teaching new skills the other would be.looking at how we can help decrease.challenging behavior so when we're.looking specifically at skill.acquisition and increasing appropriate.behavior we are looking at just teaching.new skills and we are doing that by.purposely using cues to help signal when.a behavior should occur and again we're.gonna use this three term contingency.the antecedent behavior consequence.contingency in order to be able to do.that so when we're talking about things.like antecedent we're asking ourselves.what's the child's or what's the.learners cue to engage in this behavior.so there is some sort of instructional.opportunity or situation or you know.visual signal somewhere in the.environment so that they are cued to.engage in the behavior we want to make.sure that we're teaching the right.behavior depending on what we're looking.to do in terms of increasing or.decreasing behaviors so we're looking at.what type of response is required for.that skill set and then in terms of the.consequence we're going to be focusing.on reinforcement right because we're.looking to increase that future.frequency of the new behavior and again.that's going to be anything that is.either provided or taken away that.increases or to strengthen and maintain.that behavior in the learners repertoire.so here's a quick example in this.situation antecedent is that the parent.and child walk up to a closed door which.is the hue and then the parent prompts.the child to say open so oftentimes when.we're teaching skills there's going to.be some kind of prompt or teaching.strategy to help the learner engage in.the correct response in this situation.they use the verbal prompt open so the.behavior the response is the child says.open and the consequence is a natural.consequence the parent opens the door.and they get access to what's ever on.the other.side so in this case that increases the.likelihood that the child is going to.say open the next time they encounter a.closed door which means that learning.has happened which is very exciting.so this is just one kind of isolated.simple example but there are lots of.different skills that we teach and when.we're looking at ABA interventions as a.whole there's a there's a broad.continuum of intervention models and I.like to emphasize this point because.there's a there are you're gonna hear.about structured intervention models.compared to naturalistic ones and really.we should be thinking of those as tools.in our toolkit we're gonna talk a little.bit about some of the differences.between them but there's research to.support that both are effective and.again it comes down to clinical.expertise and collaborating with the.team in order to determine what's going.to work best for an individual so if.we're looking at a more structured.approach where these approaches are.typically going to be more in structure.instructor-led the pace will be.controlled by the instructor and they're.gonna present the opportunities for that.learner to respond to individual.learning trials on the flip side of that.a naturalistic approach would have the.habit be learner initiated usually.through requests or gestures prefer.preferred items so you know there's.really good motivation for that.individual to engage in the learning.trial with structured interventions this.is where you're gonna see some more of.those traditional sit down sessions and.the the setting and environment will.probably minimize distractions whereas.in a naturalistic setting you're going.to see that it the learning is happening.within the context of a variety of other.activities that are naturally occurring.we're not necessarily limiting any.distractions in the environment because.we're teaching right where we would want.the behavior to occur.with structured approaches we're going.to be using teaching materials that are.again teacher selected and oftentimes.they're reinforcers that are used to.increase the behavior are going to be.unrelated to to the teaching materials.and that's contrasted with a.naturalistic approach where learn the.learning materials would be learner.selected items so you know there's.potentially a high level of interest.with those items and those items can be.used as reinforcement when you provide.contingent access to them um so to go a.little bit more in-depth on some of the.structured models some key.characteristics are that oftentimes.those skills are broken down into much.smaller steps and they frequently allow.for repeated practice so those trials.are presented over and over again in a.concentrated time period the trials.again are not in a natural context and.the reinforcement is probably unrelated.to the task so there's going to be some.advantages potential advantages and.drawbacks to each type of model so some.advantages of using a structured.approach may be that there's faster.acquisition rates right because they're.getting that that repeated practice with.a skill so they're getting lots of.opportunities to practice it and have it.be reinforced some individuals learn.better with more structured learning.they need those minimize distractions in.order to be able to better attend to.what they need to be doing and.oftentimes structured models are going.to have a very structured data.collection procedure that's going to.allow us to really closely monitor.progress so that we can quickly make.changes to intervention when they're.warranted some potential drawbacks to.these types of approaches might be that.there's difficulty with generalization.and maintenance of those skills right so.if a child was learning a certain skill.while they're sitting down at the table.and.actually in the environment that we.would be expecting that there's we we.need to make sure that they're.generalizing that and that might be a.little bit trickier with some of the.structured models there might.potentially be an increase in disruptive.behavior so if you had a child who may.be and gate engages in some.non-compliant behaviors trying to get.them to sit down at a table might be a.little bit more challenging for them.initially or sometimes with that.repetition of trials there may be kind.of a source of boredom of learning that.way so you might see some other.behaviors for that reason um and and.sometimes it might not always be.developmentally appropriate right so if.you're working with a really little kid.it might not make sense for them to sit.down at a table yet so some just.considerations to keep in mind when.you're looking at those who structured.models and there's a couple of examples.listed for you.in looking at naturalistic models some.of the key characteristics are that.teaching is going to be embedded in that.natural environment and the.reinforcement is directly related to the.task and it often incorporates a.developmental perspective so this is.going to maybe be occurring during play.within the daily routine that the.individual is are engaging in and it's.going to be child driven or child led so.some advantage of advantages of this.might be that this might better help.facilitate maintenance and.generalization of skills right because.they're learning to do the behavior.exactly in the environment that they.need to be able to perform it in it also.allows the child to stay in their.natural environment and it facilitates.creator' parent and caregiver.involvement and it can be easier to.adapt to some developmentally.appropriate activities potential.drawbacks of this type of model may be.that the some children just don't learn.as well in a less structured environment.so that might be a little bit more.challenging for them initially with a.naturalistic approach.and sometimes the data collection can be.a little bit trickier with some of the.within some of the natural settings.again there's some examples for you and.but again to keep in mind that although.there's advantages and disadvantages of.each we should really be looking at.these as tools in our toolbox and really.selecting what we think is going to be.most appropriate for an individual and.majd monitoring the data to make sure.that we're being successful in helping.to teach the behaviors so on the flip.side of kind of one of our main focuses.is that when we're looking to modify.inappropriate behavior we're starting.with what we would call a functional.behavior assessment and it's important.to keep in mind that behavior is not.occurring in isolation but rather it's.occurring within a context of Anna.science and consequences and all sorts.of environmental variables and that.these ABCs these contingencies are.already happening and either triggered.triggering and/or maintaining the.challenging behavior so what we need to.do is look at the relationship between.all of these and see if we can find.patterns within them in order to start.to make some predictions about why we.think the behavior is happening and and.when we're making some of those.predictions we're calling those.hypotheses so we're developing our.hypotheses about why we think the.behavior is happening what is the.function of that behavior that's.something that we're going to talk about.in just a minute then what we do is we.look at confirming or modifying our.hypotheses based on what we find from.our assessments and then our next step.is that once we're sure of the function.of a behavior is that we're going to.look at how we can make changes to the.antecedents the consequences and some of.the environmental variables that may be.in place for that learner then we're.going to look at teaching replacement.behaviors so replacement behaviors just.means what some.one can do instead so what would be a.more appropriate way for them to gain.access to the reinforcements that.they're seeking and in addition looking.at maybe teaching additional skills that.help to support overall functioning so.oftentimes within the early intervention.program I'm looking at some readiness.skills for children or what some of.those learning behaviors they would need.in order to be really successful with.learning more challenging skills so.functions of behavior functions just.means why is a behavior happening and.these are so important to look at.because they're not always as obvious.and straightforward as we think so we.really need to make sure that we're.relying on closely monitoring those ABC.contingencies in order to understand.what is happening with a behavior and.every behavior serves a function and.this is really important to keep in mind.because the individual is engaging in.that behavior because it's working for.them they've learned over time that they.can maybe tantrum because they get their.toy that they want or they can maybe.start crying because somebody's gonna.pay attention and provide some sort of.reinforcement in that manner there are.four functions of behavior but the.caveat to that is that behavior can.sometimes be a bit complex so oftentimes.there are multiple functions to a.behavior but to give you a brief example.attention is just what it sounds like.although I like to point out to parents.during training that sometimes attention.can be physical proximity to a child.sometimes maybe across arms or a certain.look on Earth on our face can serve as a.source of attention for children because.they know they're getting some sort of.reaction out of us.the tangible function would be something.they're gaining access to some kind of.preferred item or event so maybe they're.gaining access to their favorite toy.behavior can also be done in order to.escape and avoid thing so to either.delay having to do something that we.really don't want to do or try to get.out of something that we really don't.want to do and then there's also this.automatic or sensory function which is.something that we provide to ourselves.that maybe feels good or has some sort.of self-stimulatory component to it and.it's so important that we're identifying.these functions because they lead us to.design interventions that are really.going to focus on the underlying cause.of that behavior so we're going to talk.a little bit in a moment about.functional equivalents when we show you.an example so in this case the.antecedent is another child in the.classroom is presented with their snack.and the behavior is that the child that.I'm working with goes and grabs that.other friend's snack and eats it and the.consequence is that the adult that's.working with them gives the child food.to keep him from grabbing the food from.the peer so in this case we're looking.at a tangible function of behavior and.that that positive outcome that them.receiving that food is going to maintain.that grabbing behavior in the future so.if you look at the chart below the.inappropriate behavior is grabbing to.get the food but instead we need to.teach them a replacement behavior and.what's important about this is that we.need to make sure that whatever.replacement behavior we're teaching them.is still getting them access to the food.that's what we're referring to when.we're saying functional equivalent so.you know another example is you know.although I love my job.I get paid for going to work and if.suddenly somebody was only going to give.me a high-five and a way to go Liz that.might not really do it for me.so it's the same kind of thinking or.mindset with this.if there you want food in that moment we.need to be able to provide that same.reinforcement to them and again we're.gonna be modifying inappropriate.behaviors by looking at our ABC.contingency so looking at some.antecedent strategies these are going to.help us decrease the likelihood of the.behavior occurring so for example in.that last scenario maybe we provide the.child and his peers snacks at the same.time where maybe we provide the child.who was grabbing his snack first so that.he's less likely to engage in that.grabbing behavior we also would look at.teaching different behaviors so there's.a whole bunch of teaching strategies in.order to do this but maybe we teach the.child to point to the snack that they.want or maybe they use a vocal request.to ask for the snack that they want and.then we can reinforce that and then in.terms of consequence strategies this is.where we would be differentiating our.reinforcement depending on how the.learner is responding so we're either.going to reinforce the child when they.engage in the inappropriate behavior or.we're going to potentially withhold that.reinforcement if they're engaging in the.inappropriate behavior so in this.scenario if the child grabs the snack.we're gonna withhold the snack then.we're going to help them to use some.sort of new communication skill to ask.for appropriately and then provide them.that access with the snack and maybe.some attention all right so now we're.going to talk a little bit about some of.the quality indicators in ABA programs.some so some of these include clear.treatment plans goals and objectives.clear lesson plans ongoing data.collection and database decision-making.and and based on visual inspection we.call this visual analysis so we're.looking at the graphs in determining.whether we're seeing the trends go in.the direction that we're hoping so it's.also good for everyone to know that the.field of ABA.is oversight by the behavior analyst.certification board so the bacb is who.certifies us they have an ethical code.that we have to be a compliant with they.require that we are engaging in.continuing education to make sure that.we're staying current with the.literature that's currently out in the.field so and there also is a large.international influence as well too.there are a variety of professional.organizations that hold conferences for.us to help us with some of that ongoing.training and learning and but two big.examples or common examples would be the.Association for behavior analysis.International and also the association.of professional behavior analysts so.looking a little bit more into the.quality indicator of clear goals so when.we're talking about clear treatment.plans goals and objectives there's going.to be a couple of things to look for one.is we're gonna want to make sure that.our target behaviors are operationally.defined we'll show you an example of.that and that our goals are written in.such a way that we clearly understand.what's supposed to happen in good detail.and that concludes the component of.having that mastery criteria so we know.when a learner has met their goal so an.example of a clear goal would be.something like when engaged in play with.a toy and a play partner asks Jonathan.for a tour turn with the toy Jonathan.will respond by relinquishing the toy.within three seconds of the request he.will do so an 80 percent of.opportunities across a minimum of ten.trials and three days so you can see.there's a lot of language in that but it.really helps set it up so we know what.the expected response is how it should.be carried out within what context we.know the accuracy that the child has to.do that in and we also see that there's.consistency tied to the objective and.that's really important too so it's no.good if somebody can have just a really.on day and hit 80 or 90 percent and.we would say Oh they've got it we really.want to make sure that we're seeing that.consistency across T's and then checking.in on maintenance later on an example of.an unclear goal would be something like.Jonathan will improve his ability to.share what this appears so that word.improved doesn't really tell us much.that could mean a lot of different.things to different people here is an.example of a program so it's not.necessarily the case that programs have.to look like this it's more more so.important that there are some main kind.of components or essential components.that you would be able to see in the.program again they should be written in.a technological manner right so kind of.like that recipe that we were talking.about before so there's a lot of detail.and it's very clear in terms of what.needs to happen and so you should see.things about the teaching sequence the.prompting strategies how feedback is.provided so if the child or learner.responds correctly we do this if the.child or learner does not respond.correctly then this is what we do and so.on and so forth here's an example of a.data form again these could look.different but you can see that there is.a box for each skill about this.individual is working on and there's a.very clear and systematic way in which.they're going which the behavior.technician would go about collecting.data moving through session type so.maybe collecting baseline data being.able to run heirless teaching trials and.then probing or testing to see how that.errorless instruction was completed so.again these would be some some kind of.indicators to look out for in addition.to you can see that maintenance skills.are being tracked within this data form.as well too.here's an example of a data collection.form it's just a pretty straightforward.ABC data form but here's an example of.an operational definition and anytime.you have one of these definitions you.want to make sure that the target.behavior is defined with some detail and.then.there are some examples and non-examples.so it's really clear in terms of what's.included and not included but for the.sake of time we're just gonna keep going.here's an example of a graph where you.might do some of that visual analysis so.you can see that the number one in the.upper left-hand corner corresponds to.the one under the current item so that.skill is teaching the child to follow.the direction of clean up you can see.that initially the child did not have.that skill they score at zero percent.but then over just a couple of days.they've quickly acquired that skill and.there's that up or a trend in the data.so this is what we're talking about when.we're engaging in that visual analysis.in order to determine whether or not.learning is occurring and progress is.being made so each of these examples has.pretty quick acquisition rate the last.one number four sit down is a little bit.slower but you can still see that every.time we're probing this behavior we're.seeing that upward trend and increase in.the behavior this is another example for.a different skill and this is a really.great example of why visual analysis is.so helpful to us.because you can see that that first.skill sharing one of many items.initially the learner made a little bit.of progress but then they're starting to.plateau so what this visual analysis.allows us to do is quickly make a change.to the intervention and try something.else in order to get that learning to.increase by by changing maybe the.prompting strategy or changing something.about how we're teaching this skill so.again that is a really important part of.using that visual analysis so that we're.not wasting teaching time um so just in.summary a BA is the science of how.environmental variables can alter the.behavior and these are impacting.learning all the time.and interventions are defined and.tracked and tracking behaviors.systematically and regularly with.location of applied behavior analysis so.in for the sake of time I'm gonna hand.it over back over to Mende so that we.can talk a little bit about some of the.past present and future directions okay.I'm gonna use the mic because I like to.pretend that I'm a stand-up comic even.so that was a great overview of ABA as.we were going through it I was thinking.wow I didn't even realize how much we.captured in a very short period of time.that that represents a field that the.textbook is this thick for so hopefully.you guys feel like you just got a crash.course in ABA because I feel like I did.I feel like I've already introduced all.kinds of things that we do every day but.don't always articulate so nicely so I.want to go now into you know we we.wanted to in some ways this might seem a.little backwards because we're gonna.give you for example some history in the.field now that we've been talking about.the field and but we did that on purpose.and the reason is because we wanted.first for you guys to just have an.understanding of what ABA is and how we.think about it how we conceptualize it.and so so now we're gonna you know sort.of try to put it into context in terms.of the bigger picture of the field so.you know when we're thinking about past.present and future I think in general.it's helpful for us to you know kind of.provide context like why is this even.relevant why is this relevant to the.field of ABA and you know when we think.about that in general in terms of.science or medicine or any kind of feel.where research is occurring you know all.fields begin with initial discoveries.right all fields begin with somebody has.a you know either accidentally comes.across something has a Eureka moment.draws a conclusion based on something.that has happened and then they start to.test that so we don't start with perfect.right we start with whatever wherever we.started I mean penicillin was discovered.by mistake right.and that's very typical in science and.then what we do in you know in any.scientific fields we progress of course.right so then we start to realize oh.this might have value you know this this.intervention is causing kids to learn.skills or this medicine is causing.people to not be so sick wow we better.explore this some more and so then we.start studying it right we start.researching it and so in the field of.ABA there's been an incredible evolution.since those early days and so we want to.you know talk some with you guys about.that and sort of what that progression.has been because we certainly have many.more tools available now than we did you.know when the field was was initially.sort of born if you will and we have.much more flexibility in how we.implement ABA interventions than we did.kind of back in the old days if you will.and then I want to talk a little bit.about where we think the field is going.because just like any scientific field.by no stretch of the imagination is our.work done by no stretch of the.imagination is this field perfect we.haven't discovered everything there is.to know we never will right and so kind.of having a sense for where we're at and.then what some of the next steps might.be in terms of how we continue to evolve.this science.so again liz has mentioned a couple.times you know that we have some some.ethical considerations in ABA and that.the bacb has an ethics code that.behavior analysts adhere to and and I.want to you know kind of touch on this.for a minute because there there are.some you know some areas that the field.has been challenged by in the past and.there's a lot of ethics around that and.I think people don't always realize you.know you hear certain things or you're.reading online and something does it.make sense to you and you think well.that sounds weird or why would you do.that or and I think that especially the.general public and consumers of ABA.don't always realize that there is an.entire you know I don't know how many.page document that outlines the ethics.around what.our responsibility if we're gonna use.interventions to change the behavior of.others that's a big responsibility right.I don't want that responsibility alone.no behavior analyst wants that.responsibility alone so there are.ethical considerations that we rely on.and and which is one of the biggest.reasons that we rely upon science this.is not you know we're not pulling these.principles out of the air and saying hey.we think this is a good idea there's.really a body of principles and.considerations in science that we're.relying upon so some of the ethical.considerations you know that I think are.most relevant when we're when we're.thinking about ABA and and this is a.fraction of what's actually in the.ethics code for behavior analysts but.you've heard Liz mentioned quite a bit.about you know how the field uses data.and how this is a science and how this.you know there's been an evolution of.this science and so on so in the field.of ABA we we don't ever use procedures.that are not supported by research in.fact it would be considered of like a.violation of a defining feature if you.will for us to use a procedure that.didn't have research to back it so.behavior analysts do not go rogue that.is the behavior analysts are like a.straight and narrow crew they are on the.straight and narrow they are following.the path and it is based on science and.a big part of that is again the.responsibility that comes with having an.understanding of tools that are used to.change behavior directly following from.that is we don't just rely on past.research to say yeah what I'm doing now.is a good idea.we rely on actual data that what I'm.doing now works with this person in.front of me that I'm working with so you.know I oftentimes say when I'm teaching.parents we never go based on our.impression in ABA you should never hear.a behavior analysts say to you well I.think child is doing better or yeah it.seems like it's going well like these.are not scientific words right this is.your opinion this is your impression but.if we're gonna make decisions about.treatment in ABA what we're gonna do it.based on is proof essentially I will I.want to see a you know how many times.did you do this behavior today.what were the antecedents that led up to.this challenging behavior and I'm gonna.rely on those data those graphs that Liz.showed us for example to make my.decisions about what to do next.because then I can feel very confident.that I'm doing my due diligence in.making decisions about what's gonna.happen for the person that I'm working.with based on evidence and not based on.just what I think so again this is part.of the responsibility there's also a.principle in ABA of least restrictive.procedures and it's a fancy way of.saying like do the minimum intervention.you can do to get the effect you need.before you move to a more invasive or.intensive intervention and you know so.you hear about some of these procedures.particularly for challenging behavior.that are really intense and really you.know sometimes can carry risk like when.Liz was talking about that extinction.burst like if we're gonna let a child go.through behavior for example in order to.reduce it that carries risk and we're.not necessarily gonna use that strategy.if we have a different strategy that.carries less risk so we're always.engaging in that pro/con analysis or.that sort of risk management framework.and we're always gonna start with our.least restrictive and also then our most.positive procedure before we move to.something that's more challenging.potentially one of the real keys to this.is the partnership that is required.between the therapist and the patient.and family so this is what we what we.mean when we start talking about.informed consent for assessment and.treatment so again I think you know the.idea that like I've got a set of tools.that I can use to change your behavior.like that can sound pretty onerous and.you know scary and sinister right but as.a therapist I'm not gonna use those.tools to change your behavior without.making sure that you're engaged in that.process jointly with me so informed.consent is literally what it sounds like.it is you know saying to a patient into.a family this is what we've identified.needs to be in your treatment plan you.need to work on these you know these.goals or we need to reduce these.challenging.these are the strategies that we.recommend you know be used to work on.those skills or reduce those behaviors.these are the advantages of those.strategies these are the risks of those.strategies let's talk about how that all.sounds to you if the mandate of informed.consent is not just I gave you the.treatment plan or you signed the consent.form it's we have really had a dialogue.where you have had an opportunity to ask.questions and raise concerns and.converse with me about what it is that.we're about to embark upon and we have a.shared vision that this is what's.appropriate for this you know for this.individual or for this child and family.so that is that is a mandate of being a.therapist of any kind but it's taken.very seriously by the field of ABA for.the kinds of reasons that we're talking.about and then the last one which also.does kind of relate to the least.restrictive procedures one is you know a.lot of special consideration when we're.using punishment procedures and some.punishment procedures are pretty benign.right I mean if you clock me over the.head with a train track which has.happened to me I am going to take it.from you trust me I am NOT gonna like.that and that is gonna be the natural.consequence for your behavior and the.goose egg that comes afterwards will.make me never want to give you train.tracks again that's pretty benign right.or at least in theory.now it could have risk because if I take.it from you knowing that you're going to.break everything in the house and become.extremely aggressive with me well again.then I have to consider consider the use.of that punishment procedure but we'll.assume it's more benign than some other.procedures so you know we don't just use.those types of procedures off the cuff.without thinking about again the kind of.the risk benefit ratio etc we are always.gonna start with the most positive.procedure first if we can use.reinforcements we're going to use it.absolutely I mean you know why wouldn't.we there would be no there would be no.drawback to that and and we're gonna.really you know sort of consider does.the severity or the danger of the.behavior necessitate the use of a.punishment procedure so you know.sometimes we get in this.in this kind of ethical quandary of like.well this child is engaging an.incredibly dangerous behavior they're.banging their head so hard on the table.that they're going to the emergency.department all the time or they're so.aggressive with others that you know the.teacher and the parents have been.assaulted.well the ethical mandate of you know of.doing the least you know the least.amount of harm and the most amount of.good to leave that child untreated is.actually far less ethical than to say.you know we're out of other treatment.options we might have to use some some.treatment options that carry challenges.but to leave that child untreated is.actually the least ethical thing to do.and we've got to have our you know our.risk benefit analysis have an.appropriate ratio there now again the.field takes this stuff very seriously so.there are recommendations you know in.the ethical code about if you are using.procedures that carry risk or if you are.using procedures that you know will.increase challenging behavior.temporarily before it decreases for.example you should be doing things like.seeking increased supervision seeking.increased consultation really weighing.out your options carefully and.documenting them etc so I really think.it's important to emphasize this because.the field does not take the.responsibilities lightly of you know.using the tools that that are available.to you know to work with individuals.whether it's individuals with autism or.any other you know kind of behavior.change.so since Liz kind of first talked about.skills acquisition and then went on to.challenging behavior we're gonna kind of.take this in the same order and we're.gonna talk a little bit about kind of.past present and future of each of these.areas and what some of the you know past.challenges have been and what some of.the progress has been and then you know.kind of what where we hope the field.goes next so you know we heard about.some of the differences between.structured interventions more.naturalistic interventions you know Liz.did a really nice job of highlighting.that there's pros and cons to both and.you know in our program we certainly.follow the philosophy that all types of.interventions or tools in the toolbox.so you know you will definitely hear.people say well we only do discreet.trial teaching everything else is bad or.doesn't work or we only do naturalistic.intervention everything else doesn't.work or is bad or what isn't.developmentally appropriate and we don't.have research to support any of those.assertions what we have is again the.evolution of a field that now leaves us.at you know kind of a current state of.we have many tools in the toolbox and.still some more progress to make so in.the past there were there was not really.so much focus on the more flexible and.naturalistic kinds of interventions the.focus was really much more on the highly.structured more repetitive kind of.narrow interventions that we heard about.and those were the majority of the tools.in the toolbox and you can imagine there.are situations where that might not be.ideal for every behavior for every kid.and there were kind of side effects if.you will like decreases in motivation or.challenging behavior some of the things.we heard about but the early research on.this you know in this area demonstrated.that these procedures worked to teach.people with ASD skills that no one had.previously taught them before so let me.repeat that.because it's incredibly important no one.had previously taught these skills to.people with ASD before so these were.these were individual individuals that.were deemed.unteachable uneducable that's horrifying.to me when you when you think about an.entire population of individuals being.essentially written off including by the.public education system I mean under.under special education law at that time.these individuals were sort of deemed a.lost cause essentially and and the early.behavior analysts who made some of these.discoveries were actually incredible.advocates for these individuals the.early behavior analysts got these.individuals out into the community they.taught them job skills they they gave.them increased functionality and quality.of life and meaning and this was a break.this was you know in the in the 70s and.in the early 80s these were really.monumental breakthroughs so were there.some drawbacks to those early approaches.yeah.like did kids get bored yes you know I.mean you ask parents of adult kids now.and they're like yeah it would you know.it was repetitive it was hard to hang in.there sometimes but my kid talks now you.know my adult is verbal and they became.verbal in ABA for example so you know.although there were some drawbacks to.that past there were many many.advantages now the good news is is we've.progressed right we I mean if the.science is science then it's gonna.progress so where we've come to now is.we have many more tools in the toolbox.we've got this nice continuum that Liz.was talking about from the more.structured approaches when we need them.to the very naturalistic approaches when.we can use them and we've got a lot of.you know approaches in-between and we've.got lots of flexibility to combine this.approach with that approach and do what.we think is clinically appropriate for.an individual to teach a specific.behavior we also have a lot more focus.on developmentally appropriate.approaches so you know we did used to.put very young kids in chairs at tables.and try to work with them in this.discrete trial fashion because that was.the tool we had and those kids gained.skills but there were drawbacks for that.right two-year-olds don't sit in chairs.not any two-year-olds I know and and and.now we have a much greater ability to.flexibly apply these kinds of strategies.across you know both the age range but.also the range of developmental levels.and we have a really nice significant.body of research to support this.flexible application of ABA principles.so again when people tell you you know.there are definitely people who have a.philosophy of ABA you know my philosophy.of ABA is discrete trials or my.philosophy of ABA is naturalistic and.and I will again repeat the literature.doesn't support the superiority of one.approach over.another what the literature supports is.that these approaches all do result in.skill acquisition so if someone has a.preference that's exactly what it is is.their preference or their philosophy but.that is not actually supported by data.that or research that compares these.models so you know and I think one of.the other things that's really salient.is again we took a group of individuals.who were you know essentially deemed.individuals who couldn't learn and.suddenly these things are considered.rights it's not like oh you'll get.therapy if you can get access or if.you're lucky no special education is a.right and there are mandates for access.to things like a BA through insurance so.what was you know 20 30 years ago sort.of a pioneered an early you know a field.in its early pioneering days is now a.right and a mandate and that's really.significant progress so where do we go.with skills acquisition so I think we're.at a super cool place in the field of.ABA in terms of skills acquisition.because we've got really a lot of.research to support all kinds of great.tools and now we get to just like dig in.and you know continue to fine-tune these.things and develop new strategies and.combine them in new ways and try this.strategy for that behavior that it's.never been applied to before and you.know we have so much depth now of.empirical support now we get to start.answering some really cool and.interesting questions like the behavior.analyst we can all you know sort of nerd.out on this stuff we start diving into.our data and we get really excited and.happy but it also has important meaning.right for individuals who are receiving.treatment because it means that our.ability to really start engaging in a.much more precise way of applying these.principles you know this child learns.best in this way or you know we know.that kids with these characteristics you.know tend to learn better with this type.of strategy that allows us to really.start to individualize much more than we.did in the past.so you know I think one of the really.cool questions is this third point we.can start to ask questions about.characteristics of people you know kids.that predict which treatments might be.the best for them you know so the child.is nonverbal let's let's compare a group.of nonverbal kids who got this treatment.and a group of nonverbal kids who got.that treatment and compared their.responses and try to have so we know all.the treatments will work so nobody will.be stuck in a placebo group where they.won't be getting treatment but like can.we start to really have some.differentiated ways of saying a child.with this profile might benefit from.these treatments you know first and so.let's start there and then continue to.develop it so predictors of treatment.responses are our fancy you know.research lingo for that but really what.it means is which treatments are tools.for which individuals and for which.behavior so that's research that has not.been done that is gonna be fascinating.and is really gonna add to the field and.you know I think one of the other things.that we really need is it's been a fight.getting insurance coverage for this.stuff right it has been a fight I don't.have to tell all of you guys because.you've lived it it is been a fight and.and the fight is not over to get.insurance coverage for these kinds of.treatments and so we really need more.robust research methodology that.insurance companies are gonna recognize.so that so that they aren't stuck in the.position of kind of questioning the.history of the research methodology and.so what we don't have a ton of an ABA.we're starting to have some but we don't.have a ton of randomized controlled.trials and I won't bore you with the.details if that's if that's not a.familiar term to you but it's a it's.considered the gold standard or the most.rigorous way to test any medical.treatment and a little bit of that has.been done in our field but not a lot so.that's a really exciting next step in.terms of skills acquisition.so when we're talking about addressing.challenging behavior so again we'll go.back to the past again the earliest.forms of interventions for challenging.behavior primary primarily relied on.highly structured approaches especially.in assessment and most of that occurred.in clinical or research settings you.know there was there was not a lot or.not as much going out into the natural.environment and operating in the.community it was much more about how do.we demonstrate you know that we can.change this behavior by changing this.variable in the laboratory setting so.that had you know a lot of limitations.to it and there is definitely a history.in the field of ABA of using aversive.approaches so the you know things like.punishment like we have talked about and.these approaches were used because.research demonstrated their.effectiveness again it wasn't because.someone woke up one day and was in a bad.mood and wanted to you know have a.negative intervention it was because.research demonstrated that these things.worked and again it was the first time.that anybody had decreased some of these.severe behaviors you know we had a.history of especially adults with a.significant level of impairment with.severe self injurious behavior and.aggressive behavior a lot of them in.institutions minimal quality of life.minimal meaning in their lives etc no.functional skills and nobody who had.figured out how to reduce those.behaviors and increase these people's.quality of lives so again this was a.huge breakthrough I mean if you've been.in the field long enough I have seen.some astonishing videos of adults who.had gone years without any intervention.for their self-injury for example and.who then through these procedures of.applied behavior analysis had a.significant reduction in their.self-injury and again there's that risk.that cost-benefit ratio or that risk.analysis right how are we what.procedures are we needing to use to.decrease that self-injury but if you're.gonna get yourself in the hospital.because you're engaging that behavior.that is absolutely part of our risk.analysis so and you know so again these.individuals who previously did.a very significant harm to themselves.and other people made progress and that.was the first time that had ever.happened so then when we come up to the.present we again we have a lot more.tools now you know this allowed us to.say okay this stuff works but how do we.fine-tune it how do we use positive.approaches whenever we can how do we.minimize the use of punishment minimize.the you know the use of any kind of.aversive procedures and as we started to.make progress the field started to call.for a reduction in you know the use of.punishment strategies and aversive.procedures and so this is where you know.the current ethics code for example.really reflects that if the the.providers of ABA were no more satisfied.with the use of those procedures then.you know anybody else who might view.that negatively but if that was our only.tool when you weigh it out sometimes.that was the you know the way that we.had to go so we now have many more.strategies and you know again many more.sort of tools in the toolbox we also.have a lot more sophistication in our.assessment strategies so that allows us.to you know we heard from Liz about that.functional assessment process the tools.that are involved in that allow us now.to have a much more detailed analysis.and to understand complex situations and.situations that have multiple functions.or you know it's not uncommon for there.to be sequential functions like the.behavior starts for this reason and then.the function shifts as over the course.of the episode or so there's a lot of.layers to peel back right a lot of.complexity there and our assessment.tools have improved a lot for doing that.but you know no question this work is.still hard you know the behaviors being.treated are severe oftentimes they're.dangerous oftentimes and so we still.have a lot of ethical considerations.that we have to really be thoughtful.about this you know this work has gotten.more sophisticated and it has improved.but it's not easy work and it won't ever.be easy work because of the nature of.the kinds of behaviors that were.targeting.so where do we think we're gonna go in.the field of challenging behavior again.we there's so much more room for.continuing to develop more tools and one.of the things that I think has been.really cool in you know kind of more of.the recent literature and challenging.behavior is the assessment methodology.is really getting very sophisticated.there's there used to be like one or two.methods for assessing function of.behavior now there are many methods.there's many different ways to gather.this information many different ways to.observe the variables that you're trying.to observe or try things out and see.what the effect is and some of those are.again really nuanced like very very.useful tools that we now have I think we.have a much broader focus and we're.gonna continue to have even more you.know continued broadening of our focus.in terms of generalization outside of.clinical and research settings we do.have a lot of challenges in the field.still where you know again this work.takes a high level of training this work.takes a high level of expertise not.every behavior analyst graduates.graduate school with the skillset to do.this work and so oftentimes it you know.these services remain isolated to.specialty care clinics and specific.providers and they're not always readily.available because it's not just a matter.of finding a behavior analyst or a.behavior therapist it's a matter of.finding one who has the skill set to do.this work and so you know I think we.just really need kind of an ongoing.focus on you know people who are out.there in the community who can really.help us to take these services outside.of clinical and research settings and.into community-based settings so that's.a you know it's a generalization issue.for the patient but it's a dissemination.and training issue for the field and so.this is a big a big focus same thing as.the other one.you know predictors of treatment.response every you know kid with X.behavior is not going to benefit from.the same approach to that behavior so we.need to really be looking at individual.you know profiles and and having a much.more precise approach and then of course.ethical considerations are always going.to remain a focus in.no especially in this particular part of.the field because their inherent in.working with challenging behavior there.are risks when individuals are engaging.in challenging behavior and that's by.definition that has nothing to do with.the treatment strategies being used it's.a result of the behavior and so of.course there's gonna be ongoing you know.attention to those ethical.considerations so I want to kind of.finish with also you know I wanna we've.been we've been very honed in on the.field of ABA I want us to actually.finish by broadening our perspective.because I think this is also you know.kind of an area where it's it's easy for.people to feel like a BIA is the only.field that has these challenges or you.know like we're the first ones who.thought of these challenges and in fact.all therapy is carries risk right it's.in the field of psychology informed.consent is one of the very first ethical.principles if you're gonna sit with.someone in a room as a psychologist and.you know ask them to pour their heart.out to you or talk about their trauma or.you know target something that's really.challenging for them that carries.inherent risks much like any medical.intervention would so these you know.kind of ethical type concerns and these.risk-benefit analyses these are not.unique to the field of ABA and i think.sometimes we get focused so inward that.we sort of forget like they're you know.the field of medicine for example has a.very long history that we can draw upon.of how we think about and address these.kinds of issues you know if you if you.need a heart transplant.how do you consider the you know the.risks and the benefits of that if you.need chemo how do you consider the risks.and the benefits of that and and there's.many many years of thought and you know.discovery that have gone into some.really robust principles for how we.think about these things across all of.medicine and mental health so you know.so I think we having having that.perspective that this is not unique to.ABA is useful and I want to highlight a.couple of examples for you guys from.that the you know sort of broader field.of psychology because these types of.therapies have come under.some of the same types of criticism that.ABA has come under they've just been.around for longer so some of that is you.know a little bit more water under the.bridge in some of these other fields so.you know cognitive behavioral therapy.which people may or may not be familiar.with but it takes a lot of the.components of ABA and then adds in.additional components that have to do.with how our thoughts and how our.feelings affect how we behave and what.we do and how we're functioning and.there's a there are several kinds of.cognitive behavioral therapy.specifically that have some similar.kinds of characteristics that we can.sort of use for you know in an analogous.way so exposure and response prevention.is a treatment for obsessive-compulsive.disorder fears and phobias that has come.over come under lots of scrutiny over.the years so it was called in 2003 in a.New York Times Magazine article the.cruelest cure sounds very ominous right.and and what exposure and response.prevention does is it says okay you're.scared of germs we are going to make a.hierarchy of all kinds of situations.that involve germs from easy ones that.you can pretty much tolerate to.something you cannot imagine and then we.are going to have you work through that.hierarchy and actually practice exposing.yourself to those things and we are not.going to allow you to avoid it because.what we know again based on many many.years of research is that if you do that.eventually your responses your anxiety.responses both the physical responses.like erasing heart or sweating but also.the psychological responses will.habituate they will decrease because.your your body and your mind will find.out that actually when I touch the.trashcan.nothing terrible happens and if you do.that enough times you stop having the.response right and so so this is hard.this is hard work like you guys tell me.who would want to be you know thrown.into a pit of snakes raise your hand if.you would like that I would not write we.wouldn't actually do that because that's.not something you need to be able to do.to function in life but if you can't.even hear the word snake.then that could be a problem right I.mean if you have a panic attack every.time someone says the word snake that.could impair you functionally so this is.hard right but what we know again based.on research of many many years of.research is that it works trauma focused.cognitive behavioral therapy is another.example and this is another population.that really struggled to have success in.therapy trauma survivors.you know rape victims people with PTSD.people who are victims of violence.veterans these are hard things to.overcome right and one of the things.that we know just like an exposure and.response prevention is if you don't.avoid your trauma if you face it.essentially kind of head-on your anxiety.response will habituate to the trauma.the same way as it will habituate if you.touch a trash can and you have a phobia.of germs so some of these types of.interventions again can be really.challenging I mean I have seen videos of.people doing cognitive behavioral.therapy for trauma where like a rape.victim for example was in excruciating.detail replaying verbally for the.therapist every detail of the trauma.every detail of the event and what they.do in that situation is they develop.what's called a trauma narrative where.you know there's essentially there's a.story that's developed from the person's.perspective of what happened and then.they continuously continuously.continuously fine tune and hone but.review the trauma narrative until it's.no longer traumatic for you now that.doesn't sound easy right that sounds.incredibly hard so so there are many I.highlight these examples because they're.very stark they're very.you know they illustrate these points.very well but in the field of psychology.and in the field of medicine again we.have this much broader context for some.of the challenges that can be associated.with doing the hard work of behavior.change essentially so to kind of wrap it.all up.because we're definitely getting near.art near the end of our time to wrap up.Liz's part you know it can be summed up.in this first point all ABA is is the.science of behavior.right it's learning theory it's how we.can get people to change their behavior.it's a teaching methodology and behavior.change is never easy and it's never.risk-free and that's true in ABA as well.as in any other type of therapy and you.know as a result of that the field has a.very significant focus on the ethics and.the responsibility that's associated.with being in that role as a therapist.so like I've mentioned a whole bunch of.times kind of that pro and con or that.risk benefit you know ratio of the.treatment approach versus not treating.at all is always at the core of you know.everything that we do when were.treatment planning and I think most.importantly I don't have it up on this.slide actually most importantly it's.always done in partnership with the.patient and the family the patient.certainly has to have certain.capabilities to do that and that's.variable depending on age and.developmental level but in the case that.they don't have the ability then it's.done in conjunction with the family and.that informed consent and not focus on a.partnership and a team approach an.agreement that this is what we're gonna.do is of paramount importance so I think.we have about somewhere between seven.and twelve minutes for questions let's.do it so we have a question in the back.and I'm gonna repeat the questions so.that the online users.[Music].yes so let me repeat the question first.and then we have the expertise of our.zoo in the room so I'm gonna partially.answer it but I'm ours oh do you mind.also chiming in about the school part.because I saw you kind of perk right up.on that and I think you're more.up-to-date on the school part than I am.so but for the online viewers so the.question is about how do we increase ABA.access how do we you know grapple with.the fact that there are not enough.providers there are very long waiting.lists kids are in school and if you want.to have an after-school slot or if a.parent has to work how do we coordinate.all this am i capturing all the okay so.and and so the question is is what's.happening in the field to try to improve.those issues so so one thing that I.would say is is happening is the field.of ABA is growing at a very rapid pace.so training programs are you know.popping up all over the place training.programs are growing there are more.online training programs so just in.general I think the you know the field.realizes it's not lost on the field that.these are real challenges and the field.is really responding to that but that's.like for the next generation of kids.it's not for the kid who's sitting on.the waiting list now right so I think.you know one of the things that we work.with families a lot on and you sound.like you're a pretty good advocate but.this is part of my answer as well for.for other folks we work a lot with.families on the advocacy part of it.because a lot of times you know you.might be on ten waiting lists but if.you're the person who if you're not if.you're not a person who's calling back.regularly checking in everybody's so.inundated that kids are falling off the.radar and getting lost in the shuffle.and so any parent that's you're.listening you know be the parent who.calls every other week be the parent who.makes sure that your kid is on the.waiting list still be the parent who has.your kid on ten waiting lists like.you're providing a great example for you.know for parents who aren't as far along.in this process as you are because the.advocacy does definitely make a.difference the school piece is huge.Arthur do you mind giving us an update.on the status of a.being delivered in the schools in.Washington I'm gonna hand the mic over.to you.and if you come here you'll be thank you.for asking that question it right now.it's really hard for school districts to.hire behavior analysts as employees to.work in within schools however there are.efforts underway to credential behavior.analysts as ESA s so that they would be.employed in school districts as in the.same way as school psychologists as.speech and language pathologists as.occupational therapists so that behavior.analysts could be employed and work with.students in schools this effort is.underway and on track and we hope to see.it in place by September so so this.legislative session it's working through.this session very well the other thing.for you to be mindful of it is a.difference between medically necessary.ABA and services that are provided to a.student under by the IDE a and so if.you're trying to get access to medically.necessary ABA and you're on a waiting.list because of your insurance company.not having enough people within your.network contact us offline and we'll.work with you to see if we can get your.provider your insurance company to.expand their network so that you are not.facing this long waiting list yeah oh.she - not to some Alliance - that yeah.yeah that's a good question right um so.the question so the question just again.for the viewers is if cognitive.behavioral therapy is sort of the close.cousin of ABA if you will would that be.worth trying.while you're waiting for ABA.and unfortunately the answer is is a.clearest mud kind of answer it depends.yeah because although you know a lot of.the principles are very similar.cognitive behavioral therapy is is not.equipped to handle the skill instruction.and the reduction of challenging.behaviors at the level that is.oftentimes needed and so it really would.depend on what kinds of things you might.be working on like if we're working on.something like self monitoring your.social behavior let's say and you know.that the child needs to learn how to.understand I need to be able to monitor.how I'm interacting with others and.monitor this set of cues social cues.coming from them and be aware that I'm.doing a good job and control my impulses.and not blurt out or you know like those.kinds of things are actually pretty.closely aligned with a lot of strategies.used in cognitive behavioral therapy but.if the child needs to learn toilet.training and dressing and basic.functional communication and reduction.of significant challenging behaviors.cognitive behavioral therapy isn't going.to come close that therapist is going to.tell you in the first visit they don't.have this skill set so it's it's really.gonna depend on the treatment targets.and so a lot of times what we you know.what we recommend while you're waiting.there's a couple things I mean one is.can you get I mean you guys have seen.today like a lot of these principals are.not overly complicated right like some.parts of this are pretty complicated and.pretty nuanced and pretty challenging.but some of the basics of like how do we.teach a basic skill how do we reinforce.behavior in the natural environment is.not that complicated and so parents can.to a certain extent pick up some books.and some resources and start doing some.reading on how do I teach this skill and.do that with some reasonable effect if.we're not talking about highly.specialized needs so you know kind of.trusting yourself to have a sense for.what your child needs and getting some.resources you know that that might guide.you on how you could start approaching.that would definitely be a reasonable.thing to try the other thing that we're.seeing a little bit.you know some agencies might tell you.you're crazy if you ask them this.question but we're seeing it a little in.in the field and especially in.Washington is you know this problem of.lack of access to care really go ends up.sort of falling back on the shoulders of.the insurance companies because if an.insurance company is mandated by.Washington state law to provide you with.ABA they can't use the excuse so they.don't have a provider if they if they.don't have a provider for you they're.obligated to try to to get one for you.if they're governed by Washington state.law which is there's a lot of nuances.there but but so what some agencies are.doing in that context to help out and.insurance is paying for it because it is.their mandate is doing things like short.term parent training programs for.parents who are waiting so you know they.might say okay we're gonna have you come.in for three sessions six session twelve.sessions of one to one parent training.or group parent training and this is by.no means you're like comprehensive.treatment plan but this is something for.you in the meantime and so that's not an.unreasonable question to start asking.agencies is like hey while I'm waiting.do you guys offer anything less.intensive or more just like parent.education focus that I could be doing in.the meantime so those are a few.suggestions other questions in the room.or do we want to take an online question.okay so I'm going to repeat the question.so thank you sac the question came from.Zac Sadiq who we do have some we have.some personal relationships with him.he's a very active member of our.community and advocate and the question.is what kinds of ethical considerations.sorry repeat the rest of it.okay so what types of ethical oversight.does the BAC be so that's that governing.body use when it comes to oversight of.using least restrictive interventions.yes okay so I am actually gonna give you.I think your mic is actually on so Liz.is a BCBA I am NOT certified by the VA.CV so I have good working knowledge of.the ethics code but I'm gonna turn that.over to you if I can for just a minute.and then I might have a few thoughts to.add so based upon our compliance code.part of that involves having supervision.by other BC das who have more experience.in the field maybe have been around for.a little bit longer and so you often are.developing partnerships with those.people and are encouraged to be mentored.by those individuals if you are going to.look at taking on a case that's outside.of your area of expertise for example in.addition to making sure that you're.staying current on all of the literature.that's out there that's been coming out.those are overseen by the bacb by making.sure that there are seee events that.you're attending and specifically see.events that you're attending that's.continuing education events that are.specific to ethics so part of that means.that not only are you learning about you.know new research in terms of new.intervention strategies but also making.sure that you're staying up-to-date with.those ethical practices and in many of.those they're sitting down and going.through different case scenarios with.you talking about the types of decisions.you're making and if you're at a point.where you're not sure you should.certainly be seeking supervision in.those situations as well yeah and a.piece that I would add to that is I mean.the the bacb is an oversight board so a.complaint can be filed with.a CB and then there is a whole body.within that organization who has the job.of investigating those you know types of.complaints so certainly we hope that the.behavior analysts in the field are.conducting themselves in such a way that.it doesn't get to that point but that is.a very direct way that the BA CB would.potentially have involvement and you.know more and more in most states or in.many states practicing ABA without the.appropriate credentials which for the.most part is that the BC be a credential.is is not legal so many states are.passing legislation or insurance.mandates that you have to be.credentialed in this way so being.sanctioned by the VA ACB is a very.serious thing in the field or having.your you know your BC be a revoked it.would be an incredibly serious thing you.can't continue practicing so you know.this is again they're there they're not.just sort of a an idealistic body that.puts forth guidelines like their if they.have jurisdiction there is there's teeth.in that process for sure sure well what.it what are we supposed to I think we.started at 7:25 so what is our stopping.point supposed to be like I don't want.to hold people up if they're trying to.should we go five more minutes.is that okay if anyone needs to go.please feel free to scoot on your way.[Music].I'm gonna give you the mic so you can.read it for the so this mess this.question came in from Natasha if your.focus is on measurable behavior change.do you have any way to monitor for.causing an increase in internalizing.symptoms such as anxiety or depression.okay that is a very good question I'll.take a stab at this one and if you want.to add you can take turns.so what do you think I'm gonna say it.depends right certainly there are many.many people who are clients or patients.in ABA therapy who have a very good.ability to report on these things and it.is definitely not to say that because.that's not the behavior we were.measuring that we're gonna disregard.that information that would absolutely.be relevant information and if we were.receiving that information we would.absolutely be working again in a you.know team like fashion with the patient.or with the family to determine again.what are the risks and what are the.benefits you're experiencing distress.that's a risk the benefit is we're gonna.change your behavior in this way if that.you know consistent or it's our we are.we out of whack in our risk benefit.analysis are you experiencing so much to.stress that this is not tolerable and.it's not worth the behavior change that.we're trying to accomplish so so it's.not at all to say that we would.disregard that data I think for.individuals who are more impaired it's.more challenging right and by definition.autism is a disorder of social.communication which comes along with of.course not being able to verbalize.necessarily your internal state but also.not actually being very aware of your.internal state I mean impairments in.emotional awareness and emotional.regulation are part of autism and so you.know sometimes we can't rely upon those.kinds of things and so then we have to.really work with people who know that.person well to identify whether you know.behaviors that they're exhibiting are.kind of signs and symptoms of distress.or of you know something that's becoming.intolerable so we might be working with.a family or a caregiver or you know a.team of folks who know that individual.well and can again help us to make that.assessment and help us to understand our.kind of risk benefit ratio and decide.whether we're gonna proceed and and.again we wouldn't disregard those.impressions we would work to sort of.reconcile that situation and have a.treatment plan that everyone could feel.like was appropriate would you add.anything yeah I would just say in.addition to that when we were talking.about like operational definition.of behaviors there are some situations.where we might be able to help do that.with a child or an individual that has.you know the cognitive capacity to be.able to maybe show that to us on some.sort of rating scale or depict it by you.know some kind of number so that we can.have a little bit better of a way of.trying to define that in a more.objective manner and in a manner that.doesn't require as much sophistication.in your social communication if you can.point to a picture of where you're at or.pick a number a color that's associated.with like your you know your emotional.state amongst individuals who are less.able to articulate that can give us a.lot of information and actually in.cognitive behavioral therapy you know.when we were talking about exposure.therapy having people make a rating of.their distress is part of how the.intervention gets planned so there is a.scale that people use in cognitive.behavioral therapy they refer to it as.suds which stands for subjective units.of distress and it's a it's essentially.just what liz is saying it's a way of.kind of putting a numeric rating or some.kind of a scale to how much distress are.you going to experience when I make you.touch the trashcan and we don't start.with a 10 out of 10 right we the whole.point is is we work up the hierarchy we.say okay we're gonna start with a 2 out.of 10 and get you really good at that.and then we're gonna go to a 4 to 6 and.and find what by the time we get to 10.that is probably not a 10 anymore.because you've made so much progress in.treatment that your biggest fear is.maybe only a 5 now and we would do the.same kinds of things when we're you know.using ABA interventions we're not gonna.just start with like total cold-turkey.remove the reinforcer even though we.know you're gonna you know completely go.through the roof we're gonna we have all.kinds of analyses that we're gonna do of.all the teeny tiny baby steps all the.gradations of how we can work up to this.skill or fade out the adult support and.so it's it's a thousand shades of gray.in in most cases it's not black and.white and in that way we can avoid a lot.of that distress so that's that's a.really good question.okay well does anyone in there else in.the room have any other questions.certainly very very helpful.I mean it's fundamental if you can do it.and in autism one of the things that we.you know we spent lots of time thinking.about in like the broader field of.autism treatment is you know many.individuals with autism really struggle.with that and so we make all kinds of.adaptations to the traditional ways of.these therapies are implemented so for.example in cognitive behavioral.therapies for anxiety there's now a much.more robust body of literature.supporting versions of those.interventions that have been around for.a long time that are adapted in ways.that are more suitable for individuals.with autism so you know how we make.though those types of you know ratings.more visual and more concrete and how we.adapt language and kick out jargon and.so yeah there's quite a bit in the way.of adaptations okay so this one and I'm.hopefully I'm not messing up this name.but my apologies if I do this is from.McKee mer Marr is there a tool to.distinguish whether a kid would benefit.more on the OT versus ABA take this one.um well I think it's going you know.obviously certain you know this is gonna.be a theme that this is going to be.dependent on an individual and and.oftentimes if we're looking at something.like occupational therapy we might be.doing that in conjunction in.collaboration so that's going to require.that or looking at multiple assessments.in order to determine what's really.going to be hopeful little helpful for.the child and perhaps looking at using.both approaches I think one thing that.we can do as behavior analysts although.you know.don't have the expertise in occupational.therapy and the training that they.undergo one thing that we do have that.could be potentially helpful in that.situation is using a really good system.for implementing interventions helping.to collect the data around that and.helping the team to then assess whether.or not something is working or not good.questions.yeah online community is cracking today.sometimes it's like crickets out there.you know but yeah this is yeah.Arzu I'm gonna give you the mic so the.online users can hear you that was an.excellent comment on that question but I.also wanted to say that depending on the.goals of the therapy occupational.therapist sometimes work on sensory.issues and sensory difficulties much.like what you were describing and.cognitive behavior therapy now how you.approach something that's very difficult.occupational therapists also work in.helping children overcome sensory.difficulties but they also work with.certain fine motor yeah and I think that.coat reit is I mean that goes back to.Liz your point from the very beginning.of your presentation like as behavior.analysts you know we don't ever assume.that we're working in a vacuum you know.these are are usually individuals that.have comprehensive needs and there's a.lot of you know different skill sets or.sets of expertise that can potentially.be really beneficial.whether it's occupational therapy.whether it's speech therapy whether it's.educators or specialists in a VA and so.yeah the more we can be like you're.saying doing those Co treats oftentimes.better okay thank you you guys you were.supposed to be out of here so long ago.we really appreciated.

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Qabf North Carolina Association For Behavior Analysis FAQs

Comply with the below common problems about Qabf North Carolina Association For Behavior Analysis . Talk to directly if you still have other queries.

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How do I fill out the SS-4 form for a new Delaware C-Corp to get an EIN?

You indicate this is a Delaware C Corp so check corporation and you will file Form 1120. Check that you are starting a new corporation. Date business started is the date you actually started the business. Typically you would look on the paperwork from Delaware and put the date of incorporation. December is the standard closing month for most corporations. Unless you have a significant business reason to pick a different month use Dec. If you plan to pay yourself wages put one. If you don't know put zero. Unless you are fairly sure you will owe payroll taxes the first year check that you will not have payroll or check that your liability will be less than $1,000. Anything else and the IRS will expect you to file quarterly payroll tax returns. Indicate the type of SaaS services you will offer.

How can I make sure to get a post in North India while filling preference form for SSC CGL?

When it comes to post filling , I have seen many candidates making wrong decisions and ending up taking the next CGL even after scoring high. Every year this happens with many candidates and what I believe is that the commission and concerned departments should come forward with more explicit information to help aspirants in getting their preferred location. To get a posting in North India , one can fill the following posts:- Starting from Delhi based posts:- ASO in Central Secretariat Service , Election Commission , Vice-President Secretariat , Ministry of Parliamentary affairs , Armed force HQ , Ministry of Railways. Other posts to prefer are:- Excise Inspector(Delhi Zone), DA in UP,Rajasthan , Haryana. There are many other posts also that can give you initial posting in the North but upon promotion to Class-1 gazetted officer you become liable to serve anywhere in the country.

How can I make it easier for users to fill out a form on mobile apps?

Make it fast. Ask them as few questions as possible (don't collect unnecessary information) and pre-populate as many fields as possible. Don't ask offputting questions where the respondent might have to enter sensitive personal information. If some users see you collecting sensitive information, they might not be ready to share that with you yet based on what you are offering, and they will think twice about completing the form.

What is a functional assessment?

The reason people need long-term care benefits, is that they lose functional ability usually (but not exclusively) with age. In this context, a “functional assessment” will look at your abilities - typically around what are called Activities of Daily Living (and others), to determine the level of support you will require. The loss of muscle mass and strength with age is called sarcopenia, and this affects your ability to do these essential everyday activities (and others). HOWEVER - it is NOT INEVITABLE that you will lose these abilities at a particular age (in the evidence I’ve seen it started in 2% of men and 3% of women at age 42 - but a small % had no loss at age 100.) Even if you have lost some, it may be possible to recover some or all - there is plenty of academic evidence, and numerous real life stories of people who have regained abilities. The graphic below shows the pattern of functional decline as a result of ageing (and two different trajectories - driven by choices and to a much lesser extent genetics). You can see from the markers how as someone declines with this pattern, they will need more help from specialist equipment and/or people. If someone cannot do all of these 15 activities, they cannot live independently, and will need significant levels of help (care). The ADL Lifecurve(TM) shown below is one metric, but many, many others are used. They are all ways of measuring the level of ability, and the resulting need for care. (If you want to understand this process in more depth, here is a link to an academic paper New horizons in the compression of functional decline )

How do I respond to a request for a restraining order? Do I need to fill out a form?

It’s a very, very serious thing a restraining order. You don’t need the right form - you NEED A LAWYER!! Get a lawyer straight away - one that knows about restraining orders…

What is a functional behavior assessment?

The goals of a functional behavioral assessment is to evaluate an individual’s behavior with the focus as to how the negative behaviors interfere with the student's academic and social progress. An internet search found, “A Functional Behavior Assessment (FBA) is a process that identifies specific target behavior, the purpose of the behavior, and what factors maintain the behavior that is interfering with the student's educational progress.” The search also revealed the Components of a Functional Behavior Assessment (cited verbatim): Observable and measurable, operationally-defined behaviors of concern. Identification of events and situations which predict when the target behavior will and will not occur. Identification of what functions the behaviors appear to serve and replacement behaviors.

What is the QABF assessment?

I was a huge MBTI geek for several years, and I personally have never found any online survey or test to be convincingly effective. If you really want to figure out your MBTI type, the only real way is to dig your teeth into its mechanics and figure out exactly what your functional preferences are. You CAN be sociable and introverted, compassionate yet "thinking"-dominant, messy yet "judging", organized yet "perceiving", etc. "Improvement For Not Answering The Question": The most accurate free online Myers-Brigg test is the one you give yourself after doing the readings and research that you ne Continue Reading

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