Association for Behavior Analysis International

Serving children with severe behavior challenges within a residential delivery system requires extensive clinical supports and resources. The direct care personnel within these homes are critical to the eventual success of these children and it is imperative that the clinical systems provide the necessary training and oversight by qualified on-site clinicians. This symposium will present three papers which focus on residential services and will emphasize programming that addresses the importance of personal welfare, on-going assessment, functionasl skill development, function based interventions and the presence of working BCBA clinicians within the group homes. Data will be presented that will demonstrate positive long-term outcomes in regards to both behavior reduction and adaptive skill development. The Discussant will generate a discussion among attendees regarding the integrity of services within residential programs, the need to ensure clinical resources are made available to the needs of our most vulnerable consumers, the role of a BCBA in providing direct supervision and training for direct staff, and the need to make sure the residential environment has been behaviorally prepared.

This paper will discuss the implementation of behavioral programming and clinical oversight within a residential service delivery system. The paper will discuss the importance of assessing the 'Rights to Effective Treatment" (Van Houten, et al., 1985), including, establishing behavior support plans, implementing a clinical operating system which emphasizes ongoing assessment and review, and the critical feature of staff training and development. The authors will discuss some of the premises of "Lessons Learned: Thirty Years of Applied Behavior Analysis in Trerating Problem Behaviors (Foxx, 2001) as it relates to residential servives including making sure the environment is proactive in its design, that behavioral expertise must be present within the setting and be an active contributor to program design and implementation, using a hypothesis-driven treatment model, employing skill building interventions, and maintaining treatment effects. A case study highlighting the critical features of the clinical model will be demonstrated by reviewing a case study that exhibits significant behavior reduction over an extended period of time and the simultaneous increase of adaptive and functional skills.

Making transitions from children's services to adult services is an area that is far too often left open for errors. There is no standard way that has found to be successful; often a transition can vary depending on the situation surrounding the need to transition. In many cases a provider has a base vacancy that needs to be filled and an individual in need will be placed within that vacancy. Ensuring effective system supports for individuals transitioning into residential programming can be a challenge for providers. System supports include family involvement, staff training, medical and clinical over site as well as funding source involvement. The following case study outlines how continuity in care is essential in creating a seamless transition from children services to adult services at the age of 22. This individual was supported within a 24 hour residential educational setting. Active transition planning and preparation for the transition to adult services begansixmonths in advance of her 22nd birthday. Although transition planning initiated six months prior to entering adult services, providers and options had been explored by family members and stakeholders prior to this time. Lead staff were identified to assist and be part of the transition. Through an overlap with service delivery, essential staff familiar with the individual's history would likewise make the conversion from working within children's services to adult services. The primary focus of the training included transferring stimulus control from familiar staff to new staff who would be supporting the individual in adult programming. Prior to the transition this individual's target behaviors were at a stable rate of responding. Initially after the transition there was a slight increase with one target behavior while the other two showed a significant decrease in rates. Through effective system management, clinical supports remained consistent across both settings. System supports that were put in place were proven to be effective in creating a flawless transition into adult services.

One case study will be presented that will demonstrate positive long-term effects of behavior intervention within a group home setting. This individual attended a nonprofit private school for children and young adults with severe behavior challenges. The young adult with autism exhibited high rates of aggression and self-injury and required 1:1 services throughout the day in the residence. A comprehensive multicomponent intervention plan was developed emphasizing functional communication training, progressive relaxation training, reinforcement contingencies and a functionally-based consequence for problem behaviors. Data exhibiting the reduction of targeted behaviors and the development of prosocial behaviors will be shown. The paper will discuss generalization and maintenance effects over a 9 year period and this individual's transition from a group home into an apartment setting with faded results. The success of this individual resulted from a comprehansive model of clinical supports within the residence emphasizing direct care training, feedback, and the presence of a skilled BCBA clinician during programming hours.