Title: Opportunities and Considerations Applied Behavior Analysis in the Now-Person-Centered Landscape of Adult Services: Striving Towards Independence and Meaning

Authors: Stuart Law, Mark Malady and Brendan Böhr

Date Published/Presented: (in press)

Publication/Presentation Format: Book chapter published in Applications of Behavior Analysis to Healthcare and Beyond

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Transitioning into adulthood is a complex and often messy experience. There are a lot of selective pressures that act on the individual and success requires adaptation. When considering treatment goals for Individuals with Intellectual and Developmental Disabilities (IDDs), there is a tendency toward alleviating discomfort for people served, which can lead to limiting their experiences. This tendency interferes with full community integration through restrictive clinical practices. Learners can also experience challenges integrating into an environment if the organization has problems of leadership, inadequate staff training and management, and inefficient organizational systems. This chapter reviews the history of people with disabilities in residential settings and the ways that behavior analysts can affect change to promote effective treatment as well as respect and dignity for people with IDDs and those who support them. 

The establishment of the US Community Mental Health Centers Act of 1963 initiated deinstitutionalization; however, the Act brought new challenges for lawmakers and service providers. They were charged with developing community-based residential supports that provided quality care but also protected the rights of people with disabilities. These challenges are still being tackled today. Deinstitutionalization highlighted the varying needs of people with IDDs, which led to wavering systems of support and funding sources. Although best practices recommendations may vary across the various models, there is no data that points to an ideal one. The goals of the continuum of support logic are to match behavioral assessment to skill-building, to create growth opportunities, and to respect the values of the person served. However, many questions have not been answered related to how best to approach this situation. Behavior analysis can help answer questions in this area. 

There are two main career paths that may interest a behavior analyst relating to residential treatment settings: clinical practice, or systems management and workforce development. Though there are other career paths, the current chapter focuses on these two predominant paths. Best practices for these two career paths include a multitude of domains which are described in more detail in the full chapter. Given that supports for adult learners with disabilities have historically not been regulated, there is less published research and review of evidence-based practices in comparison to other settings (e.g., education settings, psychotherapeutic settings, Autism Spectrum Disorder). This is a fertile area of research for those interested. 

For the behavior analyst interested in the first path, clinical practice, there are various areas of skill and knowledge that are important. They include functional assessment and working with decelerative targets, skills-oriented assessment and habilitation, and teaching strategies. There are important considerations and best practices outlined in the chapter for each of these categories.

For the behavior analyst interest in the second path, behavior analytic leadership, it is important to recognize that other skills, in addition to clinical skills, are necessary since the bulk of this work is done through others. This situation makes the Organizational Behavior Management (OBM) knowledge base increasingly important for behavior analysts in leadership positions. The authors identify several key OBM strategies that behavior analysts working in service delivery should be familiar with, including systems design, feedback systems, staff training, and supervision.

Opportunity is abundant for the behavior analyst that would like to work with IDD populations. Reading the references cited in this chapter is a good starting place. It is also recommended that behavior analysts seek mentorship in their specific area of interest. Adults with disabilities have been suppressed and underserved in our society for a long time. Behavior analysts are in a unique position to help others live more meaningful lives. 

Relevance to our mission and vision: As an organization, we are committed to providing person-centered assessment and services that empower our learners to reach their self-identified goals and gain the skills to become increasingly autonomous, while respecting our learner’s rights and dignity. We also believe in creating evidence-based learning systems that use our resources effectively and efficiently for our learners and our staff. This chapter outlines best practices for behavior analysts that we strive to implement in our organization from top to bottom.  

Relevant genArete Skills Domains: Pivotal Skills, Movement, Complex Verbal Behavior, Committed Action, Community Contact, Close Relationships, 21st Century Skills (The authors recommend several of these areas as best practices for assessment for behavior analysts considering the clinical practice path. See full article for details)

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