By: Jonelle Lupero, MsEd, BCBA, LBA (NY)
Note: The following is a fictional vignette created for the purposes of demonstrating common situations encountered by professionals in this field.
Every week, I meet with a fellow Board Certified Behavior Analyst (BCBA®), “Lauren,” my supervisee who has been working in the field as a BCBA® for almost one year, is currently earning her supervision hours and working towards licensure as a behavior analyst in New York State. We have weekly meetings where I give her feedback about specific clients, treatment plans, and anything else pertinent that she would like to speak about. Recently, we have been conversing about her patient, “Julie,” a non-vocal 7 year old girl with Autism Spectrum Disorder (ASD). Lauren supervises Julie’s home-based ABA therapy program. Recently, Lauren has been expressing frustration about the way treatment sessions have been going. This week the conversation went like this:
Me: “Hi Lauren! How have the sessions been going with Julie?”
Lauren: “Ugh. I am super frustrated; I feel like I have tried everything! Julie is not making progress on her treatment plan goals”
Me: “So let’s take a few steps back. What specifically is the major issue you are dealing with?”
Lauren: “After working for 30 minutes, Julie earns a break. Every single time she goes on her break, she has a severe temper tantrum.”
Me: “Is she requesting a break?”
Lauren: “No, she has a very limited mand repertoire. We are working on shaping her mands now.”
Me: “What are her reinforcers?”
Lauren: “M&M’s, IPAD, break.”
Me: “When did you conduct the last preference assessment? Did you conduct a reinforcer assessment?”
Lauren: “I haven’t.”
Me: “So how do you know that the “break” is a reinforcer for her?”
Lauren: “It states it in the initial assessment.”
Me: “What are the dates of the assessment?”
Lauren: “It’s from almost one year ago.”
Me: “So how do you know that the break is still a reinforcer for her?”
Lauren: “It states it in the report.”
Me: “Sometimes we need to reassess. Just because a break might have been reinforcing for her one year ago doesn’t mean that it is a reinforcer for her now.”
Lauren: “Do you think that is why she is having temper tantrums?”
Me: “It could be; perhaps she doesn’t want the break.”
Lauren: “So what are my next steps?”
Me: “First, you need to conduct a preference assessment to see what things might function as reinforcers for Julie.”
Me: “Then, I would test it out. Conduct a session using the suspected reinforcers that you identified during your preference assessment. This will help you determine if these “preferred” stimuli will actually function as reinforcers for Julie. In other words, does the presentation of these stimuli actually result in an increase in the future frequency of the behavior that preceded it?”
Me: “Let’s see how that goes first and then we will discuss the results the next time we meet.”
Lauren: “Okay. Thank you for your feedback.”
In ABA therapy, or any other type of therapy for that matter, it is true that sometimes treatment plans simply do not work out as planned. Problem behavior may increase, and the individual may not make progress with the specific treatment goals.
The great news for individuals receiving ABA therapy is that BCBAs® are perfectly equipped and trained to deal with this. ABA is a science, and because of that, the data guides our decision making. All of the data recorded during each session will be carefully analyzed on a regular basis so that the BCBA® can make immediate changes to the treatment plan when the outcomes aren’t what we expect.
Since data are recorded and analyzed constantly, an ineffective treatment plan will not stay in place for long. In fact, one of the 7 dimensions of ABA is that it is effective—therefore, if the treatment plan isn’t effective, it means that ABA is not being done correctly, and the treatment must be monitored and adjusted until there is a positive impact on the target behavior.
So, what can we do when this happens? The previous scenario is one example regarding what we can do when our treatment plan isn’t working the way it was planned: reach out to a colleague… (of course protecting PHI)
Here are some other recommendations:
- Revisit the original assessment. When was it done? What are the behaviors targeted for increase? What are the behaviors targeted for decrease? Does it match the client’s deficits now?
- Revisit the FBA/BIP. Does the FBA/BIP need to be updated? Do the interventions being implemented match the functions of the behaviors?
- Is there treatment integrity? Is the treatment plan being implemented the way it was intended?
- Are the patient’s reinforcers updated? When was the last preference assessment done? Was a reinforcer assessment conducted following a preference assessment?
- Communication. Is everybody on the team communicating including parents, technicians, and the BCBA®?
- Is parent training taking place? Have there been any significant changes in the individual’s life (e.g. moving, new sibling, change in school)?
- Coordinate care. Did you coordinate care with other professionals who work with the individual? Is the individual on any medications? Are there any medical conditions or limitations you should account for? Are multiple treatments being implemented?
- Collaborate with a fellow BCBA®. The field of ABA is very big and not one person knows everything!
- Do the research! There is a vast amount of resources available to us including “ABAI”, Association for Applied Behavior Analysis International, “BACB”, Behavior Analyst Certification Board, JABA (Journal of Applied Behavior Analysis) and many more!
- Consistency, Is the individual receiving the recommended frequency and duration of ABA therapy? Do adjustments need to be made to the schedule?
As a behavior analyst we have many options when our treatment plans are not working. I hope you found this information useful and can implement some of these recommendations.
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