Antecedent Manipulations

Transcription

Merrill
Winston, Ph.D., BCBA-D
Professional Crisis Management Association
Copyright 2013 PCMA, Inc.
1
iPad only
Kindle PC
Mac
Paperback
and ePub
2
Adventures
in Special
Education!
The movie!
Still “Winning”
3
Antecedent Manipulations: What are we
talking about?
The role of antecedent manipulations in
treatment
Antecedent manipulations AS treatment
Why are antecedent manipulations so
prevalent?
4
Person-centered planning gone wild
Elimination of aversives as antecedent
manipulations (or providing constant
reinforcers)
How can we make better decisions regarding
the elimination of aversives? What is
reasonable? What is unreasonable?
How else can we deal with aversives?
5


These can be very broad and may include
immediate antecedents, altering motivation,
changing general aspects of the environment,
and changing staff behavior
Immediate antecedents: “Triggers” Being told
“no” being asked to wait, certain noises,
certain places, certain people, certain
hairstyles
6


Altering Motivating Operations: keeping
deprivation low by supplying very high rates
(sometimes unrealistic rates) of reinforcement
Changing general aspects of the environment:
rearranging classrooms, changing the general
noise level, this would include prostheticizing
the environment
7

Changing staff behavior counts as antecedent
manipulations as well: This might include
approaching people differently, changing
proximity, changing interaction styles,
minimizing coercive interactions, changing
the way staff members prompt individuals,
etc.
8



Certainly, antecedent manipulations can
comprise an important part of behavioral
treatment, but there is a tendency to
overemphasize these manipulations because:
THEY DO NOT REQUIRE THAT YOU TEACH THE
PERSON ANYTHING!
People who are uncertain about WHICH
BEHAVIORS to teach and HOW to teach them
will often use antecedent manipulations as a
crutch.
9


There is absolutely nothing wrong with using
antecedent manipulations as PART of a wellrounded treatment program
It’s even quite reasonable to go a bit “heavy”
on antecedent manipulations to gain quick
control of a dangerous behavior problem until
more skill-acquisition based measures can be
put into place
10


Sure these can lead to stable behavior, but
how difficult is it to maintain these
manipulations no matter where the person
goes?
How specialized does the person’s physical
and social environment have to become to
“support” them?
11






They can work immediately
They require very little analysis
They require no time spent teaching skills
Anyone can implement them
It makes it appear as though we are helping
the person “get better.”
They reflect an understanding of the
person’s likes and dislikes, which is
generally a good thing to know about a
person.
12



Person centered planning (PCP) does NOT
mean that we blindly do whatever the person
wants all the time and always eliminate or
avoid what the person doesn’t want.
This is NOT how some people interpret PCP
however…
Merrill: Why has Jeffery been sitting in the
grass doing self-stim with a shiny DVD in the
sun sitting in the grass for 3 hours at his
“day-treatment program?”
13




Staff at day treatment program: Oh, that’s his
choice…
He sure was well behaved….
Merrill: Why is James being driven around by
staff in the van 4 hours per day?
Staff: That’s his choice…
14


You may notice that when a client “chooses”
to sit naked in the front yard waving at the
people passing by that this is no longer “their
choice.”
There is nothing wrong with giving people
some control over their lives. However, NONE
of us has control over every aspect. We must
be cautious about any strategy or choice that
may decrease the response
effort/responsibility of a provider
agency/staff
15


Rolando exhibited severe aggression, SIB, and
cigarette butt pica at the residential facility
and he had injured many staff members and
himself over many years
His frail, elderly mother said she had
absolutely no problem managing him at home
by herself…We visited her home…
16




He was transported home in a modified station wagon
with a police barrier separating the back seat from the
front seat…
There were barrel bolt slide locks on the outside of the
passenger doors…
There was a wrought-iron ceiling to floor partition
(bars) separating the kitchen from the rest of the home
Rolando ran around the house naked from the pool to
his bedroom all day and would get Cuban pastries
through the bars of the kitchen
17





Rolando was VERY happy and safe at home…
Was it wrong for mom to resort to these
measures given her circumstances?
Did Rolando learn anything that might help
him in different settings?
Is this person-centered treatment?
Is it “wrong” in any absolute sense?
18





Justine would eat anything she could
find on the floor
She could not be left alone even for a
moment because of the behavior
We crushed the motivation to engage in
pica by giving her a fanny-pack filled
with puffed rice
While wearing the fanny-pack….no pica!
Is this the optimal long-term solution?
19
 The
elimination of
reinforcers that are more
powerful than Superman,
Batman, Spiderman and The
Incredible Hulk put together
20
21





Zach loved TV, but he loved it a little too
much
Anytime he saw one he would try to play
videos
If you stopped him…..Crisis!
If he accessed it calmly, and it was time to
stop….Crisis!
Solution: The teacher removed the TV from
the classroom
22



Although some manipulations involve
altering motivation to engage in problem
behavior by upping the reinforcement
available, or eliminating über reinforcers,
many manipulations involve simply
eliminating aversives
It is reasonable to eliminate some, but do
we attempt to eliminate all?
How do we determine where to stop? What
is reasonable? What is unreasonable?
23



A Quote on the matter….
“Trying to eliminate ALL aversives is a road
you don’t want to travel. It’s poorly lit, filled
with potholes and it gets narrower the further
you travel.”
Merrill Winston---5 seconds ago…
24



Some people eliminate so many aversives that
soon we are “walking on eggshells”
Then we are walking on cotton balls on top of
eggshells on top of mouse-traps
If we are not careful we can end up creating a
situation in which the individual’s world starts
collapsing in on them and they may become
more and more sensitive to smaller and
smaller aversives…
25

It can be tough to determine where to draw
the line, but I like to turn to…
 “The
Grid of Acceptability!”
26
Situation
Behavior
Reasonable
Unreasonable
Unacceptable
Unreasonable Reasonable
1
2
3
Unacceptable
27




1: A reasonable reaction (behavior) to an
unacceptable situation. (What is reasonable
for the individual will depend in large part
on their level of functioning and skill level)
An individual bites, but only when attacked
by another individual
An individual begins to pound on furniture
when other clients are screaming
Is it a situation that would cause you to
possibly lose it?
28





2: An unreasonable reaction to an unreasonable
situation (an unreasonable situation is “not very
nice” but something that could possibly be
tolerated)
Many problems fall into this category.
Joey is playing with the fire-truck,
Billy grabs it from him
Joey commandeers a police car and clocks Billy
in the head with it! (may be borderline
unreasonable/unacceptable depending on
severity)
29



3: An unacceptable reaction to a reasonable
situation
Ricky begins to engage in self-injurious eyegouging (unacceptable behavior) whenever he
hears another student coughing (reasonable
situation)
Do we buy a case of Robitussin for the entire
classroom as an antecedent manipulation?
30


Most of the time we are working with people
who show unacceptable or unreasonable
behavior in response to either unreasonable
or reasonable situations
There are times, however, when WE say that
the person has a “behavior problem” but when
you look at some of the unacceptable
situations that happen to people with
disabilities, it’s hard to say that the client’s
behavior is truly unreasonable/unacceptable
31





Is the event something that happens to most people?
Is the event likely to be encountered by the person on
a regular or semi-regular basis?
Is the occurrence of the event difficult to control for or
does it occur frequently but unpredictably?
Example: One individual becomes agitated when he
hears the word “hello!”
Example: Mommy takes 20 extra minutes getting
home because she can’t take any right turns!
32

Eliminating aversives, although one of the
most popular ways of dealing with them, is
just one of a number of strategies that can
be used when faced with these problems…
33






Procrastinate
Eliminate
Terminate
Compensate
Acclimate
Tolerate
34
35




This is a good strategy for things that eventually
need to happen, but you want to give the person
the ability to delay it.
We all have things that we know we eventually
HAVE to face. Still, when given the ability to put
things off we value it.
You cannot evit the invevitable…but you can
delay it….
You will have to set limits on how many times
someone can delay or for how long, but given
the choice of being able to delay or have to do
something now, it’s a nice choice to have
36
37


Easily the most overused, but this is good for
situations that are simply intolerable for
anyone or for gaining quick control over a bad
situation until a comprehensive treatment
plan can be put into place
This is not so much “treatment” as it is
“support”
38
39




This is when we teach the person how to stop the
aversive in an appropriate manner (replacement
behavior)
It is reasonable to allow people the means to stop
things they don’t like under certain circumstances
Terminate may not always be possible but there are
other strategies that can be used when it isn’t
Once the terminating behavior is “solid” one can start
thinking about other strategies
40
41





Nothing makes a bad thing suck less like
MO’ MONEY!
We will tend to “put up with” things we
don’t like if there is another reinforcer
concurrently available
Listening to music while running
Having the TV on while working
Posting to facebook on your iPhone
while Merrill is droning on and on…
42


Sometimes just raising the general level of
reinforcement can reduce the aversive nature
of some events
For sibling rivalry types of problems you can
make powerful reinforcers freely available
ONLY when the siblings are together
43
44




This is essentially habituation
This particular strategy, like compensate
does not require the person to learn new
skills but it does require the aversive to be
repeatedly presented
This must be done in a manner in which the
aversive is presented purposely, carefully
and systematically (brief reinforcer removal)
It’s best to have something that can be
somewhat varied in duration or intensity
(fire alarm recording)
45
46



This is easily the toughest of the bunch, but
one of the most valuable
This is different from acclimate because with
acclimate you simply get “used to it” and it
doesn’t bother you very much anymore
Tolerating is where the event still bothers you
very much but you “keep your $%*! together”
47





You might want to think of tolerating as a
commodity that gets “used up” that is, you
only have so much of it.
You’re on my last nerve
That was the straw that broke the camel’s
back
It is something that you can get better at.
Many of the other “Ates” can work to together
to make tolerating easier
48

We DO want to be careful, however, that we
are not attempting to teach people to
“tolerate the intolerable.” We wouldn’t do it,
why should people with disabilities.
49



In addition to these strategies, there are a
couple of general skills that can help with
almost any kind of situation in which we must
be exposed to aversives
Learning to stay relaxed when already calm
Learning to GET relaxed when already upset
(much harder)
50


Steve Ward and Terry Grimes: Calm Counts
Wholechildconsulting.com
51


This is quite a bit harder, and like learning to
stay relaxed it requires using a hierarchy of
upsetting events and a strong repertoire of
self-calming behaviors (breathing deep,
covering one’s ears, engaging in soothing
types of self-stim, progressive muscle
relaxation, etc…)
I wouldn’t attempt this until the individual can
tolerate the presentation of an aversive when
already calm…
52




There’s nothing wrong with some antecedent
manipulations as PART of treatment
Be wary of behavior plans that tend to weigh too
heavily on antecedent manipulations
Simply eliminating unpleasant things, making
desirable things continuously available, and
preventing contact with potent reinforcers
creates highly restrictive lives
Teaching people to effectively cope with strong
reinforcers and strong aversives enables them to
be more successful in more situations
53

Antecedent Manipulations

Transcription

Similar documents

spring 2013 - Simmer Creative

awareness

Grammar and Style: Sentence Fragments

GEOCONCEPT E

Enlay Sign Series - Your Sign Company

Printable Bio - Spiraling Music

Image manipulation detection - Information Systems and Internet

Basic Item and Exam Analysis Focused Discussion (Session 1079)