Medications
Medical or physical problems
Sleep cycles
Eating routines and diet
Daily schedule
Staffing patterns
Density of people (too many people present)
Stimulation (is the environment overly stimulating, this can change over time where initially it is not overly stimulating but becomes so as the person reaches and goes beyond capacity).
What are intervening variables ie motivation, fatigue, hunger, intelligence, expectations?
Additional resources and links:
Dependent and independent variables
http://msxml.excite.com/excite/ws/results/Web/independent%20variables/1/417/TopNavigation/Relevance/iq=true/zoom=off/_iceUrlFlag=7?_IceUrl=true
Intervening variable
http://en.wikipedia.org/wiki/Intervening_variable
Variable
http://en.wikipedia.org/wiki/Variable
Supplemental Material:
Setting Events
Setting Events Checklist
Tuesday, October 21, 2008
Saturday, October 18, 2008
Manipulating (and understanding) Variables: Getting an idea of what might and what might not work.
Sometimes you have to poke around a little, turn over a few rocks. You have to test some hypothesis. Sometimes this may be a part of the functional behavioral analysis; sometimes it may be part of the ongoing assessment you are (or at least should always be) conducting. Taking everything at face value is usually not good enough. Is a hug always reinforcing? Just with certain people? Are there times when it is more reinforcing than another? Is it possible to reach the point of satiation?
Sometimes this is called in-situational hypothesis testing. Sometimes simply: hypothesis testing by manipulating the independent variables.
I remember many years ago as a mental health counselor working with a family of children who had been severely and ritualistically sexually abused. One of the older children who had become very sexualized was also working one on one with a tall gorgeous blond therapist in her late 20’s. The therapist once commented to me that every time the boy would get out of control, have bursts or anger, or become non-compliant she would hold him tightly (he was about 10) and he would almost immediately calm down. Upon hearing this I immediately thought of many variables including some possibly unintended consequences and reinforcing that might be going on. The important point though is that I did not know for sure. This was an opportunity to test a lot of different variables before adhering to a specific plan of intervention for any extended period of time.
Testing variables can be quite tricky. If you manipulate more than one variable at a time, how do you know which variable is influencing any change that may occur? Is it possible that the change is caused by a compounding of the two variables?
In the case mentioned above, there are a number of ways we could test some of the variables. First, collect detailed data about when and where behaviors occur and with whom. If there is an increase in certain behaviors in the presence of the therapist, then there is a possibility that the holding by the therapist is reinforcing and actually having the effect of increasing the behavior. Note, while this is a possibility, we still don’t know for sure. What are some of the other variables that could influence this behavior at this time? Sometimes children will display aggressive behaviors in the presence of the therapist or another outside authority figure because it’s safe. They understand at some level that while they may have a consequence, they are not going to get knocked around…at least at that time. It becomes a safe place to blow up. Sometimes victims of domestic violence display violent behavior against their perpetrator when the police show up. This can take place because they have so much emotion and anger built up that when the police show up, they realize there is safety and they explode. They may then get hauled away and charged, but in the immediate situation that too may be the lesser of two evils. The bottom line here is that you still don’t know the cause of the behavior.
Even after you develop a good working hypothesis; it is always a “working hypothesis.” This is why you continually take data and periodically adjust your plan as needed. So what else can we do to further assess the behavior (manipulate the variables)? Here are a few possibilities:
1. Teach the child that it’s ok to ask for a hug and that he can get one when he appropriately requests one. (Stop using holding as a consequence.)
2. Change to a male therapist.
3. Keep the same therapist but use a different consequence.
4. Teach and help the child to implement more appropriate ways to release frustrations and/or get his needs and appropriate wants met.
These are just a few possibilities.
Before you write a plan, it is critical to review existing data, gather data and try out your hypotheses to the extent possible. Once the plan is written, take the time to manipulate one variable at a time and find out what happens if???? Allow an appropriate amount of time to find out if a manipulated variable is actually helping or making the situation worse.
Additional resources:
Functional Assessment and Program Development for Problem Behavior: A Practical Handbook O'Neill, Horner et al &
Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings Cipani & Schock
Click here for additonal information on writing measurable behavioral objectives
Sometimes this is called in-situational hypothesis testing. Sometimes simply: hypothesis testing by manipulating the independent variables.
I remember many years ago as a mental health counselor working with a family of children who had been severely and ritualistically sexually abused. One of the older children who had become very sexualized was also working one on one with a tall gorgeous blond therapist in her late 20’s. The therapist once commented to me that every time the boy would get out of control, have bursts or anger, or become non-compliant she would hold him tightly (he was about 10) and he would almost immediately calm down. Upon hearing this I immediately thought of many variables including some possibly unintended consequences and reinforcing that might be going on. The important point though is that I did not know for sure. This was an opportunity to test a lot of different variables before adhering to a specific plan of intervention for any extended period of time.
Testing variables can be quite tricky. If you manipulate more than one variable at a time, how do you know which variable is influencing any change that may occur? Is it possible that the change is caused by a compounding of the two variables?
In the case mentioned above, there are a number of ways we could test some of the variables. First, collect detailed data about when and where behaviors occur and with whom. If there is an increase in certain behaviors in the presence of the therapist, then there is a possibility that the holding by the therapist is reinforcing and actually having the effect of increasing the behavior. Note, while this is a possibility, we still don’t know for sure. What are some of the other variables that could influence this behavior at this time? Sometimes children will display aggressive behaviors in the presence of the therapist or another outside authority figure because it’s safe. They understand at some level that while they may have a consequence, they are not going to get knocked around…at least at that time. It becomes a safe place to blow up. Sometimes victims of domestic violence display violent behavior against their perpetrator when the police show up. This can take place because they have so much emotion and anger built up that when the police show up, they realize there is safety and they explode. They may then get hauled away and charged, but in the immediate situation that too may be the lesser of two evils. The bottom line here is that you still don’t know the cause of the behavior.
Even after you develop a good working hypothesis; it is always a “working hypothesis.” This is why you continually take data and periodically adjust your plan as needed. So what else can we do to further assess the behavior (manipulate the variables)? Here are a few possibilities:
1. Teach the child that it’s ok to ask for a hug and that he can get one when he appropriately requests one. (Stop using holding as a consequence.)
2. Change to a male therapist.
3. Keep the same therapist but use a different consequence.
4. Teach and help the child to implement more appropriate ways to release frustrations and/or get his needs and appropriate wants met.
These are just a few possibilities.
Before you write a plan, it is critical to review existing data, gather data and try out your hypotheses to the extent possible. Once the plan is written, take the time to manipulate one variable at a time and find out what happens if???? Allow an appropriate amount of time to find out if a manipulated variable is actually helping or making the situation worse.
Additional resources:
Functional Assessment and Program Development for Problem Behavior: A Practical Handbook O'Neill, Horner et al &
Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings Cipani & Schock
Click here for additonal information on writing measurable behavioral objectives
Friday, September 12, 2008
When teaching calming or de-escalation skills.
When teaching calming activities and de-escalation skills, it is important to include a program to teach those skills when the child/individual is already relatively calm. Some activities to focus on are aerobic activities (within the safety range that the child/individual's physician will approve), such as walking, and big bubble blowing activities (I say big bubbles because big bubbles require slow deep breathing), deep breathing, and sometimes just taking a safe break away from things/people. When these things are taught as a part of the overall program it makes it easier to access these skills in an emerging crisis situation if needed.
Click here for additional information on writing measurable behavioral objectives
Click here for additional information on writing measurable behavioral objectives
Friday, September 5, 2008
Getting what they want
One of the simplest but often overlooked concepts is helping an individual in therapy get what they want. Therapists have actually taught kids how to request a hug and then given them a “high five” or a “thumbs up” or another reinforcement other than a hug. Sometimes therapists try to teach a frustrated client who wants/needs something, how to identify their feelings or deescalate without actually dealing with what they want/need.
Your priorities should be, (after safety, because safety is always first):
1. Help clients identify what they want.
2. Help clients request what they want in a socially appropriate manner.
Once this is done, there are three options.
1. They get what they want. No need for further reinforcement.
2. They get what they want at a more appropriate time/place. In this case it may be helpful to teach de-escalation/coping techniques and/or feeling identification (may need some reinforcement). The appropriate time and place must be made clear as well as what they need to do (if anything further needs to be done) in order to get what they want. When the person finally gets what they want, there is no further need for reinforcement.
3. They do not and can not get what they want. In this case, there are two things to consider and do. Teach coping techniques (may need reinforcement) and discover underlying needs/wants and teach alternative ways to get underlying needs/wants met (no need for further reinforcement when they get their underlying needs/wants met).
Click here for more information on writing measurable behavioral objectives
Your priorities should be, (after safety, because safety is always first):
1. Help clients identify what they want.
2. Help clients request what they want in a socially appropriate manner.
Once this is done, there are three options.
1. They get what they want. No need for further reinforcement.
2. They get what they want at a more appropriate time/place. In this case it may be helpful to teach de-escalation/coping techniques and/or feeling identification (may need some reinforcement). The appropriate time and place must be made clear as well as what they need to do (if anything further needs to be done) in order to get what they want. When the person finally gets what they want, there is no further need for reinforcement.
3. They do not and can not get what they want. In this case, there are two things to consider and do. Teach coping techniques (may need reinforcement) and discover underlying needs/wants and teach alternative ways to get underlying needs/wants met (no need for further reinforcement when they get their underlying needs/wants met).
Click here for more information on writing measurable behavioral objectives
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