Ethical Considerations in Integrated Care: Behavioral Health Consultation and Care Management Models
Chapter 20 Behavioral Assessment: Initial Considerations.
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Transcript of Chapter 20 Behavioral Assessment: Initial Considerations.
Chapter 20
Behavioral Assessment: Initial Considerations
Behavior Modification Program Phases Screening/Intake:
Presenting concerns
Agency Policies
Crisis screening
Diagnosis (insurance)
Behavior Modification Program Phases (cont.) Baseline Phase: Assess behavior quantitatively
(frequency, duration, etiology severity, quality, environmental controls).
Treatment Phase: Design a program using the tools we’ve learned thus far. Assess success, redesign if necessary and fade stimuli/reduce consequences to bring behavior under control of natural reinforcers.
Follow-up Phase: See if behavior maintains, adjust natural reinforcers or begin treatment again.
Indirect Assessment Procedures
Interviews with the Client and Significant Others (See Table 20-1)
Rapport
Non-judgmental
Confidentiality
Set target behaviors
Indirect Assessment Procedures (cont.)
Questionnaires Life History
Survey
Rating scales and checklists (CBCL, Conners, BASC, etc.)
Indirect Assessment Procedures (cont.)
Role Playing ( to assess behavior in office).
Information from Consulting Professionals.
Client Self-Monitoring ( not as good as trained observers).
Direct Assessment Procedures
More accurate but more time consuming and thus costly.
Covert behaviors not observable.
Experimental Assessment Procedures
Experimental functional analysis See Chap 22
DATA: Why Bother? To Determine whether behavioral treatment is
appropriate.
Maybe the behavior isn’t in your area of expertise.
Maybe the behavior is not really a problem.
Data can lead to treatment by discovering controlling environmental variables.
DATA: Why Bother? (cont)
To see if Treatment is working. To prompt and/or reinforce the treatment
providers. Counting behavior may impact its frequency
apart from treatment effects. Reactivity is the effect of being watched (keeping track of weight loss/gain, exercise, etc. can be motivating).
Chapter 21
Direct Behavioral assessment: What to Record and How
Characteristics of Behavior to be Recorded Topography Amount
Rate/frequency.
Frequency graphs. Pg. 271
Cumulative Graphs pg. 273
(If comparing more than one behavior and/or rate changes are small)
Characteristics of Behavior to be Recorded (cont.) Duration Intensity (may need instrumentation such as
voice meter). Stimulus Control What in the environment
PROMPTS the behavior? Latency between stimulus and response. Quality just an arbitrary rating along one of the
previously listed quantitative dimensions.
How to Record Behavior
Continuous recording: every instance Interval recording
Partial interval recording: maximum one instance within a specified time interval.
Whole interval recording: record only if the behavior persists throughout the entire interval.
Time-Sampling Recording: intervals are separated by longer periods of time to save time in sampling.
Assessing Accuracy of Observations Response definition may be vague. Observational situation: may be difficult
to detect behavior. Observer: may be poorly trained. Data Sheets/recording procedures: may
be poorly designed.
Assessing Accuracy of Observations (cont.) Interobserver Reliability (IOR) 80-100%
acceptable
Frequency recordings: smaller number
larger number X 100%
Interval recordings:
# of intervals agreed # intervals either observer recorded a behavior X 100%
Chapter 22
Functional Assessment of the Causes of Problem Behavior
What is Functional Analysis?
Examination of the relationship between behavior and its antecedents and consequences
Antecedentseliciting stimuli
ConsequencesPositive or negative reinforcement
Types of Assessment
QuestionnaireCompleted by those familiar with clientReliability issues
ObservationObserve what is going onForm hypotheses about antecedents and
consequences
Types of Assessment
Functional AnalysisSystematic manipulation of environmental
events to experimentally test their role in behavior maintenance
Limitations Infrequent behaviors Not applicable in dangerous behaviors Expensive and time consuming
Causes of Problem Behavior
Attention From Others – Social Positive ReinforcementAttention follows behavior Individual approaches attention giver prior to
behaviorSmiling prior to behaviorTreatment
Give attention at other times Reduce attention to behavior
Causes of Problem Behavior
Self Stimulation – Internal Sensory Positive ReinforcementContinues doing the behavior because it offers
a desired level of stimulationBehavior continues at steady rateTreatment:
Increase sensory stimulation Reduce stimulation level of behavior
Causes of Problem Behavior
Environmental Consequences – External Sensory Positive Reinforcement Behavior maintained by reinforcing sights and
sounds from the nonsocial external environment Behavior continues undiminished even though it
appears to have no social consequences over numerous occasions
Treatment: Sensory reinforcement of a desirable alternate behavior
Causes of Problem Behavior Escape From Demands – Social Negative
Reinforcement Escape from aversive stimuli Problem behavior as a way to escape various
undesirable demands Behavior only happens when certain types of
requests are made of the person Treatment
Persist with requests (demands) until compliance Teach other responses Program where level of difficulty of requested behavior
starts low and is gradually increased
Causes of Problem Behavior
Elicited – RespondentSome behavior is elicited rather than
controlled by consequencesBehavior consistently occurs in a certain
situation or in the presence of certain stimuliBehavior seems involuntaryTreatment
Establishing one or more responses that compete with problem behavior (counterconditioning)
Causes of Problem Behavior
Medical Problem emerges suddenly and does not seem
to be related to any changes in the individual’s environment
Behavioral diagnostics Therapist diagnoses the problem after examining
antecedents, consequences, and medical and nutritional variables as potential causes of problem behaviors
Develop treatment plan based on diagnosis Physician should be consulted prior to treatment
Guidelines for Conducting Functional Assessment
Define the problem behavior Identify antecedents Identify consequences Consider health/medical/personal variables Form hypothesis based on information collected Collect data to determine if hypothesis is correct If possible, do a functional analysis by directly testing the
hypothesis Design treatment program If treatment is successful, accept the causal analysis as
confirmed. If treatment is not successful, redo the functional analysis
Examples of FBA measures
FAST FBA Inventory ABC chart See pg. 295 of text
Chapter 23
Doing Research in Behavior Modification
Reversal-Replication (ABAB) Research Designs
Baseline (A) is followed by treatment (B), return to baseline (A) condition, and then treatment again (B)
Allows for replication of treatment effect Replication makes it clearer that treatment
caused change in behavior
Reversal-Replication (ABAB) Research Designs
Reversal-Replication (ABAB) Research Designs
Reversal-Replication (ABAB) Research DesignsConsiderations
Do baseline until pattern is stable and predictable
May be undesirable to do a reversal (dangerous behaviors)
May be unable to do a reversal if natural reinforcers have already taken effect (behavioral trapping)
How many reversals and replications are necessary? Less replications if large effects are observed and a lot of previous
research exists in the area Limitations
Withdrawal of treatment may not lead to return to baseline Withdrawal may be undesirable or unethical
Multiple-Baseline Designs
Conduct more than one AB design concurrently with treatments beginning at different times
Useful when reversals cannot be introduced
Multiple-Baseline Designs
Across behaviorsBaselining several similar behaviors within an
individual Across subjects
Applying the same treatment to the same behavior problems of two or more individuals
Across situationsBaselining one type of behavior for a single
individual in more than one setting
Multiple-Baseline Designs
Changing-Criterion Designs
Change over time the criterion for success and look for relationship between criteria changes and behavior change
Can increase or decrease:Frequency requirementsRate requirementsDuration requirementsEtc.
Changing-Criterion Designs
Multiple-Baseline Designs (cont.)
Compare effects of two or more treatment conditions considerably more rapidly than in ABAB design Applied at alternating times within the same time period Also known as multielement design
Does not require reversal Several treatments can be evaluated at the same
time Disadvantage: treatment effects interaction
Data Analysis and Interpretation
Data typically analyzed without control groups and statistical techniques used in other areas of psychology
Behavior modifiers interested in understanding and improving the behavior of individuals, not groups
Data Analysis and Interpretation No control groups or statistics, just visual inspection of
data graphs to draw conclusions. Number of replications. Quantitative difference between baseline and treatment
behavior. Latency of treatment effects. Number of overlaps baseline and treatment. Precision of treatment procedures. Reliability of response measures. Consistency of findings with existing data and theory. Practical impact of results. Consumer satisfaction.
Data Analysis and Interpretation
Social Validity Behavior modifiers need to socially validate their work
on at least three levels (Wolf, 1978): Must examine the extent to which target behaviors
identified for treatment programs are really the most important for client and society
Must be concerned with the acceptability to the client of the particular procedures used
Must ensure that the consumers are satisfied with the results
Advantages of Within Subjects (Single-case, N of 1) Designs
Repeated measurements vs. Data at single point in time
Small number of subjects vs. Large number of subjects
No resistance to control group participation from subjects
No need for statistical assumptions of normal distribution of DV and random selection of subjects from population