H-3: Recommend intervention goals and strategies based on factors such as client preferences, supporting environments, risks, constraints, and social validity. ©
Important note: Fictionalized clients are used to demonstrate the skill items in the second half of the task list, sections F-I. They make the most sense when read in order. Please remember that there is not substitute for real-life supervision and consultation. Get your case-specific advice from professionals – not from the internet! These examples are just that – examples of how behavior analytic skills might be applied.
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Jada
Case example: Jada is an elementary school student. She experiences Level 3 Autism Spectrum Disorder (ASD). Level 3 is the severity level of Autism which is characterized by “requiring very substantial support.” Jada has also been diagnosed with a severe Intellectual Disability (ID). Jada has just transferred to a private school for individuals with global needs. She loves all kinds of play and messy activities, such as finger paint and water play. She also enjoys swinging on the playground, eating popcorn, and watching Disney movies. She loves to be read to, and laughs when staff make dramatic gestures while reading picture books. Jada does not use any vocal speech. She makes noises sometimes, such as humming. Jada engages in motor stimming, including upper body tensing and flapping her arms. Jada engages in severe challenging behavior, including self injury (hand to head and head to surface) and aggression (including hitting and biting). Jada has a mom, dad, and older brother living together in one home. Jada’s family has advocated for her to attend a private program, and they are excited for her to get high quality services. Jada’s new behavior analyst is Dr. Brown-Davis, who is a BCBA-D employed by the private program.
Example of Item H-3: Throughout the assessment and treatment process, Dr. Brown-Davis takes into account Jada’s contexts, needs, and family perspectives. Although Jada does not speak, her programming captures her preferences through assessments (including preference assessments, assessments of function, and treatment intervention evaluations). Dr. Brown Davis works collaboratively to develop treatment that is realistic for the settings in which Jada lives and learns, and takes into account the environmental and resource constraints present in Jada’s case. He understands that behavior intervention involves risks, and works to ensure that the risks Jada is exposed to are proportional to the benefit of treatment and the risks associated with no treatment. At the outset of intake, and periodically thereafter, Dr. Brown-Davis gathers social validity data via questionnaires for staff and family members.
Donovan
Case example: Donovan is a high school student. He has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). He attends a public school and has been placed in a support program for students with social/emotional/behavioral needs. Donovan enjoys playing video games and drawing in his sketchbook. He would like to be a welder when he is an adult. Academic achievement and attendance have been challenges for Donovan historically, and he is currently not on track to graduate with his peers due to missed work and failing grades in several classes. Donovan’s team has identified challenges including frequent non-attendance to school, walking the halls during class times, non-attendance at expected guidance appointments, and non-completion of classwork. Donovan lives with his mother and older brother. Donovan’s mother is concerned about her son’s school challenges and expresses frustration about his “lack of commitment” to his education. She wants Donovan to understand how important it is to graduate from high school. Donovan’s behavior analyst is Ms. Bailey, who has just started contracting with Donovan’s school district through the agency she works for.
Example of Item H-3: Ms. Bailey takes into account Donovan’s unique needs and perspectives throughout the assessment and intervention process. She also considers that her job is to create interventions that meet the needs of all involved, given the resources and limitations of the setting. She remains flexible and “thinks like a scientist” when considering how to best program for Donovan. For example, Ms. Bailey is aware that escape extinction has been demonstrated to be highly effective in controlled environments. However, she knows that the research literature also demonstrates that positive reinforcement can be used to successfully treat escape maintained behavior. In reflecting on the resources available, Ms. Bailey clearly sees that escape extinction will not be feasible (not enough staff or consistency, possible physical safety issues) or consistent with Donovan’s long term success (possible damage to rapport, breakdown of peer relationships, possibly setting the occasion for additional maladaptive behavior maintained by perceived control). A socially valid intervention for Donovan is one in which he is personally invested, and learning skills within a framework which his team can realistically implement and maintain.