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I N S T I T U T E F O R A P P L I E D B E H A V I O R A N A L Y S I S

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Behavioral Technology in Support ofValuesGary W. LaVigna and Thomas J. Willis Institute for Applied Behavior Analysis, Los Angeles California

Introduction

The problem: Throwing the Baby Out with the Bath Water

One of the more exciting developments in the field of develop-

mental disabilities over the current years has been the introduction

of an explicit discussion about values. The impact of that on the field

has been enormous and to the great benefit of people who need

support, including those who have challenging behavior. The result

has clearly been that many more people have a significantly better

quality of life. There is, however, something that has troubled us.

That is, as sometimes happens during a revolution, people throw the

baby out with the bath water. Specifically, along with this discussion

of values and its infusion into the field, we see, from time to time,

behavioral technology dismissed, disregarded and thrown out, with

the implication that there is an inherent conflict with values. This

may even occur when behavioral technology can be helpful in

promoting the very values that are being expounded. The following

vignette illustrates why we are concerned:

THE

N E W S L E T T E R

C o n t e n t s

Behavioral Technology in Support of Values ............... 1

Editors’ Note ...................................................................... 2

Quality Monitoring at Church Parade ............................ 3

Definition of a Problem Behavior ................................. 17

Procedural Protocols -Behavioral Escalation .................................................... 18

Resource Focus: Competency Based Training ......... 22

IABA Resources .............................................................. 24

A quarterly publication dedicated to the advancement of positive practices in the field of challenging behavior

Volume I • Number 4 ISSN 1083-6187 • July 1996

nance of his own home and the prepa-ration of his own meals. He is notchoosing to go out and earn somemoney to contribute to his own life.As a result, he is living a very poorquality of life, separated from others,a life of routine and boredom thatseems devoid of any apparent joy orhappiness - all in the name of choice.In such a situation, relatively simple

behavioral technology, such as shapingor a formal schedule of reinforcementcould encourage him and provide someinducement for him to become more in-volved and in the long run have a betterquality of life. How many of you haveseen “choice,” for example, being used asan excuse not to be providing any ser-vices to a person, where people are say-ing, “Well, it is his choice.” That hap-pens, and that is just an example of wherethe baby is being thrown out with the bathwater. Where, for example, a simpleschedule of reinforcement, which mightbe very effective in providing an incen-tive for this person to get up, go out, doand so forth, is rejected in the name ofvalues. We have prepared this article to

Continued on page 7

Upon invitation, we enter aperson’s home and find that he issitting there at 2:00 o’clock in theafternoon. We ask questions aboutwhy he isn’t out working during thattime of day. The answer we get is:

“Well, it is his choice. He is choos-ing not to participate.” As we con-sider the quality of this person’s life,we see that he is not opting for goinginto the community at all. He is notopting to participate in the mainte-

P O S I T I V EPR A C T I C E S

P O S I T I V E P R A C T I C E S • V O L U M E I • N U M B E R 4 • J U L Y 1 9 9 6

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Positive Practices

PublisherInstitute for Applied Behavior Analysis

A Psychological Corporation

Co-EditorsGary W. LaVigna and Thomas J. Willis

Managing EditorJohn Q. Marshall, Jr.

Institute for Applied Behavior AnalysisGary W. LaVigna, PhD, Clinical DirectorThomas J. Willis, PhD, Assoc. Director

Service to Employ PeopleJulia F. Shaull, LCSW, MSW

Director of Supported EmploymentStacy L. Daniels, MA

Asst. Director Supported EmploymentSusan Caraway

Manager - Los AngelesAyndrea LaVigna

Manager - Ventura CountyKerry Costello, MA

Manager - West Los AngelesLeilah Sadd

Manager - North Los AngelesPatricia Speelman, MA

Manager - Orange County

Social/Community Integration andParticipation

Maryam Abedi, PhDDirector of Supported Living

Melissa ShapiroSupervisor - North Los Angeles

Ellen J. Lewis, PhDManager - Ventura County

Lori LeakSupervisor - Ventura County

Cheryl Stroll-Reisler, MAManager - Los Angeles

Peggy DreisbachSupervisor - Orange County

Competency Based Training ProgramDiane Sabiston, MEd

Program Consultant - Georgia

Professional Training ServicesJohn Q. Marshall, Jr., MEd

Director of Professional Training Services -South Carolina

Printed ResourcesBrenda LaVigna

Supervisor - Book Sales

AdministrationJonathan C. Mohn

Director Finance and AccountingRobert H. Shelton

Director of Human Resourcesand Administrative Services

Copyright 1996 by:Institute for Applied Behavior Analysis

5777 West Century Blvd. #675Los Angeles, CA 90045 USA

(310) 649-0499

All rights reserved. No portion of this newslettermay be reproduced by any means without theexpress written permission of the Institute for

Applied Behavior Analysis.

Positive Practices (ISSN 1083-6187) is aquarterly publication of the Institute for AppliedBehavior Analysis. Individual issues are $10.00

each. Subscriptions are $25.00 per year fordelivery within the US and $40.00 per year fordelivery outside of the US. For subscription

information, change of address or information onclassified advertisements contact: John Marshall;IABA; PO Box 5743; Greenville, SC 29606-5743

USA; (864) 271-4161.

Individuals wishing to contribute articles orletters to the publication are requested to contact

Gary LaVigna or Thomas Willis; IABA; 5777West Century Blvd. #675; Los Angeles, CA

90045 USA; (310) 649-0499.

Editors’ Note…It seems hard to believe but this is the fourth quarterly issue of Positive Practices. We have

been extremely gratified by the reception we have received and the positive comments you havemade about the usefulness of the information we have been providing. We fully intend to makeour second and all subsequent years equally rel-evant in providing information to help advancepositive practices in the field of challengingbehavior. If we have fallen short of one of ourgoals for Positive Practices this first year, it isthat we had hoped it would provoke more ques-tions, comments and, yes, even challenges fromyou. We think dialogue and debate is importantto clarifying and advancing our own thinking andwe would think that publishing that dialoguewould be of interest to our readers. To facilitatethis, we challenge each of you to submit a ques-tion or comment on any of the material you readin this issue or have read in any of the previousissues of the newsletter. Of course, you are freeto send us any comment or question relating topositive practices in the field of challengingbehavior. For those who would prefer sending usa letter or postcard, our address is:

IABA Newsletter; 6169 St. Andrews Rd., #123;Greenville, SC 29606-5743 USA. For those whowould prefer using E-Mail, our address is:[email protected]

In this issue of Positive Practices, we tackle anumber of things. First, we have written a articlewhich addresses what we believe is a growingproblem that many of us face. This is the rejec-tion of behavioral technology in the name of “values.” We believe that behavioral technologycan and should be used in support of values and that the rejection of this technology can lead tothe further exclusion and devaluation of the people we are trying to support. We try to clarifyour views on this topic in our lead article. In this issue, we have also included an article submittedby Jenny Beaty and Ivan Burchess, from Great Britain. In this article, they describe the earlystages of developing and implementing a Periodic Service Review (PSR) system in a qualityimprovement effort for a segment of their servicesystem. This is the first of many articles we hopeto publish in the future describing how the PSRsystem has been implemented by a variety ofagencies. In this issue, we have also includedanother behavioral definition and sample proce-dural protocol. The definition is for the problemof defiance, one of the challenging behaviorspresented by an adolescent girl who was consid-ered to have a severe emotional disturbance. Theprotocol is one designed to get control over esca-lating behavior. This was part of a support planfor a young man challenged with the problemsassociated with Autism.

We hope that once again you find this informa-tion interesting and useful. This month, weexpect to be very busy. As some of you are aware,we are having our eighth annual, two-week sum-mer institute. It is fully enrolled so we will all beworking very hard. We expect that you will bedoing the same. Even so, let’s all take some timeto slow down and savor what we do and all theother good things in life.

Gary W. LaVigna and Thomas J. WillisCo-editors

Gary W. LaVigna, PhDClinical Director

Thomas J. Willis, PhDAssociate Director


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Quality Monitoring at Church Parade:Report on a Quality Monitoring Initiativeat a Residential Unit for People withLearning DisabilitiesJenny Beaty, Learning Disability Service, Shropshire’s Community Health ServiceNational Health Service (NHS) Trust

Ivan Burchess Behavioral Services Team, Shropshire’s Community Health ServiceNHS Trust

Editors’ Note: It is a pleasure to include in this issue an article by Ivan Burchessand his associate, Jenny Beaty. We first met Ivan more than eight years ago whenhe attended one of the first seminars we held in Great Britain. Ivan then attendedour first Summer Institute in the summer of 1989. We have since valued the yearsof collaboration and friendship we have enjoyed with him. In this article, Jennyand Ivan describe the early results of installing the Periodic Service Review (PSR)system in a residential unit in Great Britain. While the real value of the PSR is inthe lasting improvements in service quality it produces, we often receive questionsof concern about the difficulty of developing and implementing the system. Thisarticle describes how the early stages of developing and implementing a PSRsystem can be carried out in a simple and straight forward manner in a well definedservice setting. We hope it acts as an inspiration for many of you to do the same.We’ll ask Jenny and Ivan for a follow-up report on this project next year. Anearlier version of this paper was submitted for the 1996 Shropshire CommunityHealth Authority Chairman’s Award for Quality.

Background to the Project

Church Parade

Church Parade is a six bedded unit in Telford designed to provide

short term residential services to people with a learning disability

who also display major behavioral problems. The unit is staffed by

a team of qualified nurses and nursing assistants. Four of the six beds

within the unit are available for short term treatment and assessment

purposes and two beds are available for planned respite care.

Periodic Service ReviewsThe quality monitoring system devel-

oped for Church Parade had not beenused before in the Community HealthService and was based on an idea fromthe Institute for Applied BehavioralAnalysis in America (LaVigna, Willis,Shaull, Abedi & Sweitzer, 1995).

Periodic Service Reviews (PSRs) mea-sure current performance against a num-ber of clearly defined standards and arecompleted on a regular basis to monitorthe quality of the major aspects of theservice being provided by the unit.

The PSR system is designed to presentinformation about the current status ofthe service in a positive fashion by em-phasizing areas of achievement ratherthan deficit. The system provides a methodof rewarding staff for providing a qualityservice as well as highlighting areas wherequality could be improved.

Developing the MonitoringTool

Generating a Vision of a QualityService

It was felt to be important to involvestaff at Church Parade from the outset inthe development of the quality monitor-ing package. Through this, we hoped toovercome the natural resistance to moni-toring procedures which is apparent inany staff group. Such resistance is usu-ally due to a lack of understanding of theaim of monitoring, differences of opinionover what is valid or useful to monitorand a fear of retribution if the results arenot as desired by the monitors. We wantedstaff to feel some ownership of the projectin order to enhance their motivation toachieve the standards set out and to con-sistently strive to improve their PSR scores.

With this in mind, the first stage of theproject involved a brainstorming sessionwith the staff on the unit and the Managerof the Behavioral Services Team to gen-erate ideas about what the ideal servicewould look like. It was important thatthese visions be challenging but at thesame time realistic and achievable givingan indication of where we wanted ChurchParade to be.

Aim of the ProjectDemonstrating the quality of the ser-

vices we provide is becoming increas-ingly important in the new National HealthService. This project was designed tomonitor the quality of the care providedat Church Parade and to provide a meansof measuring the outcomes for clientsusing the facility. The aim was to lookbeyond simple measures such as waiting

times and bed nights to a system thatwould look in detail at the service clientsreceive in comparison to a vision of whatthe ideal service would look like. Throughthis monitoring process it was hoped toencourage a culture of excellence withinthe organization with staff committed toconsistently achieving high standards ofcare for their clients.


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The ideas generated reflected the val-ues held by the staff team and looked atareas such as how clients would spendtheir time on the unit, what support planswould be set up for each client and howstaff development needs would be met. Alist of ideas was agreed to by all andincluded items such as:• Clients will have the opportunity to

access community facilities on aregular basis.

• All clients will have an assessmentand support plan set out to addresstheir challenging behaviors.

• Staff members will receive regularsupervision sessions from their linemanager.

Converting the Ideas intoMeasurable Standards

The second stage of the project in-volved converting these ideas into a set ofstandards which are directly measurableand sensitive to changes in the quality ofthe service so as to clearly reflect anyimprovements.

Thus:‘Clients will have the opportunity toaccess community facilities on aregular basis.’

Became:‘Clients will spend at least 2 hoursout of Church Parade every 24 hours’

Each standard has a clearly definedmethod of measurement which enablesthe monitor to give a score to indicate thecurrent performance of the unit in this area.

In the above example the monitor wouldcheck whether the standard had beenachieved for each of the clients on theunit in the previous 24 hours. The scoreobtained represents one point for eachclient for whom the standard has beenmet, with the maximum score achievablebeing the number of clients staying atChurch Parade.

Sixteen standards were defined in allfrom the visions generated by the staff.These fall into four areas:• general client issues• individual services• health and safety• staff development

The list of standards compiled and themethod of measuring each can be seen inTable 1 Parts A and B.

General Standards1. Community Participation - Clients will spend at least 2 hours out of

Church Parade every 24 hours.* Record for all clients, was standard achieved over the past 24 hours?Maximum score = 1 per client.

2. Client Timetables - All clients will have access to an individual dailytimetable/diary which is followed and lists activities by times of day. Itwill include at least 3 discrete activities per day.* Check if timetable is available and meets standard for all clients onday of spot check. Maximum score = 1 per client.

3. Age Appropriate (AA) and Functional Activities - Clients will partici-pate in activities which are meaningful and engaged in by others of thesame age.* Check for all clients at time of spot check. Score 1 point for each clientengaged in a functional activity within a 30 minute time period.Maximum score = 1 per client.

4. No Aversives Used - Staff are positive with clients at all times and theydo not use any aversive techniques.* Observe staff behavior during spot check, score minus points for eachaversive spotted: -2 for reprimand or ignoring, -4 for aversive techniquewritten in to formal program. Maximum score = 10.

Individual Service Standards1. Assessment and Individual Support Plans - All clients will have a

written plan which is up to date and available to staff. It will include thefollowing sections:a. description of the client’s challenging behaviorb. measurement of the frequency and/or severity of the behaviorc. list of contributing factors e.g. medical, ecologicald. identification of maintaining factorse. proactive intervention strategiesf. reactive/management strategies* Random selection of 1 client at spot check. Score 1 point per sectionincluded, 0 if no plan available. Maximum score = 6.

2. Reliability of implementation - Clients’ support plans will be followedaccurately and consistently by all members of the staff team.* Check for 1 client. Ask 1 member of staff about 5 aspects of the client’ssupport plan e.g. what would you do if? last time this behavior occurredhow was it handled? Score 1 point for each correct answer. Maximum score = 5.

3. Data Summary - Clients will have the progress of their support plansevaluated monthly and a summary of this data will be kept in their notes.* Check for 1 client. Score 1 if data summary completed in the lastmonth, 0 if not. Maximum score = 1.

4. Intervention Plan (IP) Meetings - Each client will have an individualplanning meeting within 1 month of moving into Church Parade andthereafter every 6 months. The client and/or an advocate will be invitedto this meeting and minutes will be documented and available.* Check for 1 client. Score 1 point if meeting occurred, 1 point if clientof advocate was invited, 1 point if minutes documented and available.Maximum score = 3.

Church Parade Periodic Service Review

Table 1 Part A - Church Parade Periodic Service Review


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Running the PSR system

Collecting the DataThe PSR system was put into operation

in October 1995. A Periodic ServiceReview is compiled by the Assistant Psy-chologist from the community team onceevery two weeks at an unannounced visitto Church Parade. In this way it is hopedthat the results reflect the true status ofthe unit at that time rather than giving thestaff a chance to prepare for monitoringthereby altering the outcome of the re-port.

Each PSR evaluates the current perfor-mance of the unit and compares it withthe 16 standards set out, assigning a scoreto each. A form was designed to recordthis information (see Table 2 on page 6).The scores achieved can then be totaledand compared with the overall score pos-sible to obtain a percentage which repre-sents the PSR score for that visit. It is alsopossible to calculate scores for each ofthe four general areas listed above.

The scores for each monitoring visitcan be displayed graphically to showclearly the changes in quality over time.This continuously updated graph is postedon the notice board at Church Parade sothat all can see the progress being made.The results are also fed back in detail tothe staff group at monthly meetings wherethe team are congratulated for theirachievements. Areas of need can be iden-tified at these meetings and strategies toimprove performance in these areas arediscussed with the aim of achieving higherPSR scores in the future and movingcloser towards the quality service we allenvisioned.

PSR ResultsResults to date demonstrate clear im-

provements in the quality of the serviceprovided at Church Parade since PSRmonitoring began. The score achieved atthe first monitoring visit was 54% andthis has risen to scores of 80% and aboveover the first 4 months of the project.

The PSR scores achieved for eachmonitoring visit are shown in the graphdepicted in Figure 1 on page 6.

Although the PSR system has only

Health and Safety Standards1. Medication - The following standards will be met for all clients:

a. medication will be clearly labeled and kept in a locked cupboardb. prescriptions will be clear and easy to readc. details will be available on:

• reasons for administration of medication• intended effect of medication• possible side effects to be aware of

d. medication will be given at the right time and in the correct dosese. a strategy will be in place for empirically evaluating the effective-

ness of the medication.* select 1 client at spot check. Score 1 point for each standard met.Maximum score = 5.

2. Fire Drills - Fire evacuation drills will be carried out once every 2months.* Check records. Score 2 if standard met, 0 if not. Maximum score=2.

3. Refrigerator - All items in the refrigerator will be clearly labeled with ause-by date and, where appropriate, with the date opened.* Spot check. Score 1 point if standard met, 0 if not. Maximum score=1.

Staff Development Standards1. Staff Meetings - The following standards will be met:

a. general staff meetings will take place once a month and minuteswill be available within 2 weeks. The unit leader and/or deputy willattend as well as 1 member of qualified staff and 1 or more careassistants.

b. trained staff will meet with Ivan Burchess once a month, at least 3/5 will attend and minutes will be available to all staff within 2 weeks.

c. Ivan Burchess, Dr. Langton and Mary Davies will meet weekly.* Check that each standard is met from diary and minutes.Maximum score = 3.

2. Supervision - The following standards will be met:a. Staff members will meet individually with their line manager at least

once every two weeks.b. All staff members will have an Individual Performance Review

(IPR) at least once a year.* Check for one staff member at spot check. Maximum score = 2.

3. Handover - All members of staff beginning a shift at Church Parade willreceive a handover from the nurse on the previous shift.* Check for 1 staff member. Maximum score = 1.

4. Professionalism - Staff will be appropriately attired and will exhibit apositive, professional attitude acting in accordance with client rightsand client advocacy.* Observe staff behavior during spot check. Score minus 1 point foreach evidence of unprofessionalism. Maximum score = 5.

5. Attendance and Punctuality - Staff will arrive for work within 10minutes of the start of their shift. If unable to do so they will follow theprotocol for absence or lateness.* Spot check at time of shift change, it all staff arrive within 10 minutesscore 1 point. Maximum score = 1.

Church Parade Periodic Service Review (Continued)

Table 1 Part B - Church Parade Periodic Service Review


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been in operation for four months, therehave already been noticeable changes inthe focus of the service and in the attitudeof the staff group. Through feedback ofthe PSR results staff are aware of theareas where they are falling short of theirown goals and are striving to meet thestandards in these areas thereby improv-ing the quality of the service provided toclients. The development of the monitor-ing system has focused everyone’s atten-tion on quality issues and has provided avision for all of a high quality service anda practical means of achieving it.

Advantages of the PSRSystem

We have identified a number of advan-tages in using the PSR as our qualityimprovement system, as follows:• Simple to set up and run - Setting up

the PSR for Church Parade took lessthan two weeks. Once in operationthe system requires very little timecommitment to keep it running. Eachmonitoring visit takes half an hourand the recording form makes it asimple task to calculate the scores.

• The unannounced evaluation visitsmean that quality practice forms partof the everyday work of the unit andis not something done only wheninspection is scheduled.

• Regular positive feedback to the staffgroup ensures continuing commit-ment to the monitoring process andencourages a culture of excellencewithin the organization.

• The measures are specific - The PSRhighlights specific areas of opportu-nities to improve and provides clearmethods of improving standards inthese areas so that staff know whatthey are aiming for.

• Regular evaluations mean that im-provements in quality are maintainedover time.

• The system is flexible - the standardsdeveloped for the service can be al-tered as they become easier to achieveso that staff are constantly aiming fora higher quality service.

Figure 1 - PSR Results

Date:

Standards Score Score Comments

Achieved Possible

General

1. Community Participation

2. Client Timetables

3. AA and Functional Activities

4. No Aversives 10

Individual Programs

1. Assessment & Treatment Plan 6

2. Reliability of implementation 5

3. Data Summary 1

4. IP Meetings 3

Health and Safety

1. Medication 5

2. Fire Drills 2

3. Refrigerator 1

Staff Development

1. Staff Meetings 3

2. Supervision 2

3. Handover 1

4. Professionalism 5

5. Attendance and Punctuality 1

TOTALS

PSR

Score

Table 2 - Church Parade Periodic Service Review Score Sheet

%

Date of Visit

% P

SR

Sco

re

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

04Oct95

19Oct95

03Nov95

23Nov95

22Dec95

10Jan96

07Feb96

06Mar96

Church Parade Periodic Service Review Score Sheet


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We may not have stated them; we maynot have considered them; we may nothave debated them, but whatever we do isbased on a set of values. What the valuesbased movement has done that we thinkis very, very productive, is that it hasbrought these values up toan explicit level, where wecan examine them, discussthem and debate them. Tosuggest, however, that oneagency, or one person orone group has a values basedapproach and another doesnot, is to miss the point.The only question is, “whatare the values that underliethe approach being taken?”So it is important for us toestablish what we meanwhen we talk about valuesand what are we referring to when we talkabout our values based approach.

Our values are based on social rolevalorization, which Wolfensberger(1983) defines as involving “...the en-ablement, establishment, enhancement,maintenance, and/or defense of valuedsocial roles for people—by using, as muchas possible, culturally valued means.”For us, this has meant that the support weprovide to people challenged with a de-velopment disability focuses on produc-ing five very specific outcomes:1. Community presence and participa-

tion, in ways that are age appropri-ate and valued by society. One of ourareas of focus is community pres-ence and participation. There is aqualifying clause, however, i.e., “...inways that are age appropriate andvalued by society.” The value out-come isn’t inclusion per se, but in-clusion in ways that are age appro-priate and valued by society. Forexample, we would think it’s a greatidea for a student to be in a regularclassroom, even though she may havesignificant support needs, but onlyas long as her presence there wasleading to her learning, her beingincluded and interacting with otherstudents, and the other students werealso able to continue to learn and togrow and to benefit from that educa-tional process. There would be some-

thing wrong if, by inclusion, sheended up being the focus of a lot ofhatred and her learning and the otherstudents’ learning was somehow be-ing impaired. Therefore, while in-clusion, i.e., community presence and

participation, is certainly one of ourvalues, it is a qualified value. It mustbe in ways that are age appropriateand valued by society.

2. Autonomy and self determination,through the exercise of increasinglyinformed choice. A second area offocus for us is autonomy and selfdetermination. However, this valueis qualified as well, “...through theexercise of increasingly informedchoice.” Therefore, while we aresaying choice is important, that au-tonomy and self determination areimportant, there is more to it. Spe-cifically, our responsibility is to sup-port a person in such a way, thatchoice and control are increasinglyinformed. We would be concerned ifwhat we were doing created a situa-tion in which the person made con-sistently bad choices, leading to harmor injury, or perhaps even to furtherdevaluation and exclusion of the per-son, and to a poor quality of life. Webelieve that this is an important point,because one of the things that’s hap-pened is that choice is often beingheld up as the ultimate value. Incontrast, our understanding of socialrole valorization is that there shouldbe a balance between values. Choice,autonomy and self determination maybe one set of values, but it may needto be balanced with others. This

The FutureNow that the PSR at Church Parade

has been in operation for a few monthsand significant improvements in qualityhave been achieved, a meeting with staffhas been scheduled to discuss the stan-dards set out with a view to altering someto make them harder to achieve and per-haps also adding some new standards inan attempt to continually push for a higherquality service for clients.

Once again staff will be involved in thediscussion and will have the opportunityto express their views about the PSRsystem and make any suggestions theymay have for alteration of the standardsor the method of measurement.

Having successfully installed the PSRmonitoring system at Church Parade, it isnow planned to develop the tool for use inother services within the Learning Dis-ability Service. The flexible nature of thePSR system means it is possible to adaptit for use in almost any context. We hopeto introduce positive monitoring for theother residential unit in the Trust as wellas for some aspects of the communityservice such as the Joint Behavioral Sup-port Team and the Psychology Depart-ment.

Reference

LaVigna, G.W., Willis, T.J., Shaull, J.F., Abedi, M., andSweitzer, M. (1994) The Periodic Service Review: Atotal quality assurance system for human services andeducation. Baltimore: Paul Brookes Publishing Co.

Continued from page 1

To suggest, however, that oneagency, or one person or one

group has a values basedapproach and another does

not, is to miss the point.

address the conflict between values andbehavioral technology that seems to existfor some people. We plan to address headon the false dichotomy that we some-times hear expressed that we can eithertake a values based approach on the onehand or we can take a behavioral ap-proach on the other. We will begin witha definition of terms.

Definition of TermsValues. First, let’s do away with the

notion that there is such a thing as avalueless or a value free approach toproviding services. Whatever we do inthis field of ours is based on a set ofvalues. Those values may be implicit.


8

need to strike a balance in the tensionthat may be created between valuesbecomes apparent given the follow-ing area of focus.

3. Continuous involvement in the on-going process of becoming. Thismay appear somewhat existential.We believe, however, that all peopleget dignity from a process of tran-scending, from a process of continu-

ous growth and development. If aperson’s choice is to have a “statusquo” life, it would almost define aform of death, not life. Our value isthat life is a continuous process ofgrowth, of learning and becoming,not just for the people we support,but for us as well. In other words, weare all a part of this human conditionand these values apply to all of us.Accordingly, if a person we are sup-porting chooses to “opt out,” ourresponsibility would be to be to at-tempt to establish a balance in thetension between values.

An example of how we might usebehavioral technology to help estab-lish this balance was fully describedin an earlier article (LaVigna &Willis, 1995), with reference to aperson whose self injurious behaviorwas instrumental in his efforts toescape demands to perform non-pre-ferred activities. These activitieswere thought to be ones that he couldpotentially enjoy if he “...would onlygive them a chance.” In fact, heopted out of so many activities thathe was living a very limited life, withvery little enjoyment. Positive pro-gramming, including functional com-munication training and tolerance

building, which employed behavioraltechniques such as discrete trialteaching, shaping and systematic re-inforcement, taught him to commu-nicate without being self injuriousand taught him to tolerate new ac-tivities to the point where he actuallybegan to enjoy them and seek themout for their own sake.

Using behavioral technology, staffintroduced him to anew activity, whilerespecting his au-tonomy in such away that he is nowmaking a more in-formed choice. Aswe think of all thosethings we enjoy inlife, we realize thatperiods of introduc-tion and initial learn-ing were so hard thatif we didn’t have

“stick-to-itiveness,” we never wouldhave gotten to the point where wenow enjoy that activity, or that game,or that process, or whatever. Sothere needs to be a process to getpeople involved up to the point wherethey can make more informed choicesabout what they want to do. This isan example of how a support teamcan strike a balance between choiceand control and their responsibilityto promote increasing independenceand productivity and continuous in-volvement in the process of becom-ing, resulting in a richer quality of life.

4. Increasing independence and pro-ductivity, to the point of economicself sufficiency. This fourth areaprovides even more focus. It saysthat we value increasing indepen-dence and productivity. The quali-fier here is “... to the point of eco-nomic self-sufficiency.” So while itwould truly be great to help a personget a real job with a real paycheck,we wouldn’t leave it there or “rest onour laurels.” We would say that untilthe person is economically self suffi-cient, i.e., no longer reliant on tax-payer support, then there is room forgrowth, room for transcending andbecoming. We might ask ourselves,

suppose we are supporting someonewho is choosing not to become inde-pendent, choosing not to go to work.Our challenge would be to strike abalance between the value of choiceand control with this value of in-creasing independence and produc-tivity.

5. The opportunity to develop a fullrange of social relationships andfriendships. Our final area of focusis the opportunity to develop a fullrange of social relationships andfriendships, and for us this wouldalso include, up to and includingmarriage and having a family. Thisis something to which many of usaspire. Many of us believe our liveswould be incomplete if we did nothave this part. If we don’t have it, weare often looking for it. We think thisis a value that we share in commonwith many of the people we support.

These five areas of focus are the valuesthat we refer to when we talk about ourvalues based approach. They may or maynot be your values, or anybody else’svalues. Nevertheless, these are the val-ues that guide our work at IABA in oureffort to help support people who havechallenging behavior associated with theirdevelopmental disability. We would notsuggest that an agency or group of people,do not have a values based approach. Thequestion would be, what are their values?What is it they are trying to accomplish intheir work with people? Having definedour values, we now turn to a definition of“behavioral technology.”

Behavioral Technology. We define“behavioral technology as including strat-egies, techniques and procedures derivedfrom the principles and procedures ofapplied behavior analysis and relatedfields. The hallmarks of this technologyare:1. Explicit, operationalized procedures

(i.e., process) designed to producespecified and measurable outcomes.

2. An accurate data base to evaluatethe effectiveness of the procedures(process) in producing the specifiedoutcomes.

Given this definition, there are a num-ber of behavioral procedures that we haveseen rejected in the name of “values.”

Our challenge would be to strikea balance between the value ofchoice and control with thisvalue of increasing independenceand productivity.


9

Perhaps most notable are formal sched-ules of reinforcement, which may beviewed as “contrived, stigmatizing, andcontrolling.” However, we have alsoseen systematic instruction, including databased, step-by-step approaches, such asdiscrete trial teaching and formal socialskills training, systematic desensitization,and shaping, among other techniques andstrategies, discounted and rejected. Fur-ther, this rejection of behavioral technol-ogy has not been limited to what might beviewed as sophisticated, “high” technol-ogy but has also included the rejection ofmight be considered to be simple, “low”technology, such as the use of a dailyschedule that lists hourly activities, whichmay be viewed as being behavioral andtherefore overly structured and controlling.

ThesisWhat we are suggesting is that there

may be a role for behavioral technologyin certain situations. Specifically, thesesituations would be when we are support-ing people whose behaviors or unrealizedcapacities can lead to devaluation by so-ciety and present a barrier to social rolevalorization. In these we would includethose behaviors or unrealized capacitiesthat produce risks for health and safety,those that limit opportunities, options andthe quality of life, and those that leaddirectly to devaluation or exclusion.Where those are what we face, we thinkthat there may be a role for behavioraltechnology. Our thesis is that behavioraltechnology can be harnessed to enable aperson to achieve a better quality of lifeand to reject technology may lead to contin-ued vulnerability and new wounding.

Severe and challengingbehavior: The apparentconflict between valuesand technology

Origins of ConflictIn the field of severe and challenging

behavior, there is an apparent conflictbetween values and the use of behavioraltechnology. We believe there are a num-

ber of reasons for this.Research/Program/Behavior Focus

vs. Person Focus. For one thing, behav-ioral technology in this field has oftenhad a research, program, or behavior fo-cus rather than a person focus. With all ofthe research we have read over the years,and all of the graphs we have looked atwhich show results, most of those graphsshow reductions in behavior and makeconclusions about different proceduresand the effects of those procedures onbehavior. If you consider this research,there aren’t too many graphs showingincreases in happiness, increases in ac-cess, increases in opportunity, or othermeasures of quality of life outcomes.Given that research in the use of behav-ioral technology has traditionally beenfocused on behavior change per se andnot on quality of life outcomes, i.e., thatit has had a behavior focus not a personfocus, helps explain why behavior technol-ogy is seen to be in conflict with values.

Virtually Exclusive Focus on RapidControl of Behavior vs. a Broad Spec-trum of Outcomes, Including Quality ofLife and Others. The second reason forthis apparent conflict is that with behav-ioral technology, there has been virtuallyan exclusive focus on the rapid control ofbehavior as opposed to a broader spec-trum of desired outcomes. A broad spec-trum of de-sired out-c o m e swould in-clude rapidcontrol overa challeng-ing behav-ior, but itwould alsoinclude du-rability, gen-eralization,minimizingp o s s i b l en e g a t i v eside affects, social validity and clinical/educational validity, i.e., quality of lifeoutcomes. There is acknowledgment inthe field of applied behavior analysis as itapplies to severe and challenging behav-ior that behavioral technology should beaddressing this broad range of outcomes

(Favell, et al., 1982). In the final analysis,however, the research that has been car-ried out, has primarily been focused onrapid control. There is only minimalresearch that shows the effects of behav-ioral technology on the other desired out-comes. Again, it may be understandablethat behavioral technology is rejected ifthis is the way it is viewed.

Reliance on Aversive Control. Fur-ther, although the trend may now bechanging, when it comes to severe andchallenging behavior, there has been analmost total reliance on aversive controland the use of punishment. In fact, whenyou mention behavior modification tolay people, they don’t think of positivereinforcement, they think of punishment.They think of shock, they think of timeout, they think of the punishment technol-ogy, and that is largely because this is whatthe field has relied on in the past for dealingwith severe and challenging behavior.

We believe these are some of the rea-sons behind the rejection of behavioraltechnology. There are, however, otherreasons.

Misunderstanding of Social RoleValorization. For one thing, there hasbeen a misunderstanding of social rolevalorization among some people. Thatis, some people mistakenly think thatthere is something inherent in social role

valorization that requires the rejection ofbehavioral technology. Our understand-ing of social role valorization is quitedifferent. We believe there is nothinginherent in social role valorization thatrequires the rejection of behavioral tech-nology. Rather, the question is how, and

Our thesis is that behavioraltechnology can be harnessed to

enable a person to achieve a betterquality of life and to reject

technology may lead to continuedvulnerability and new wounding.


10

toward what end, is behavioral technol-ogy being used? This is the issue forsocial role valorization, not whether be-havioral technology is being used per se.

Concern for Isolated Values vs. anInterrelated Mix of Values. Further, asbehavior analysts have tended to focus on

one narrow outcome, rapid control, to theexclusion of other desired outcomes, somepeople who say they are promoting theapproach advocated by social role valori-zation have focused on one value to theexclusion of others, namely, the value ofchoice, autonomy and self determina-tion. It even seems in some cases thatchoice has been risen to the alter of wor-ship. People have not always taken re-sponsibility for the other values positedby social role valorization. It is an analo-gous problem, with some behavior ana-lysts focusing on rapid control and nottaking responsibility for the other out-comes and some social role valorizationadvocates, not really understanding thefundamental principles involved, focus-ing on choice to the exclusion of becom-ing, and learning and independence andsocial and community integration and soforth. This focus on one value to theexclusion of others is another reason forthis apparent conflict, since behavioraltechnology may not be needed if onesimply acquiesces to the person’s de-sires, especially if the preference is to beuninvolved and to opt out of the processof becoming. In contrast, behavioral tech-nology may be necessary if the need is toactualize the other values and/or to estab-lish a balance between values.

Diminishment of Values to the Levelof Political Correctness. Another phe-nomenon we have seen is a diminishment

of social role valorization to the level ofpolitical correctness. When this hap-pens, people do not ask the importantquestions of why and how the behavioraltechnique is being used. The minute theyhear the technical term, they are turningaway from it. Nothing produces this kind

of turn-off reaction morethan saying you use sched-ules of reinforcement. Theuse of formal schedules ofreinforcement has beenrendered politically incor-rect. Rather than askingwhy and how the scheduleis being used, it seems thatsimply by virtue of the factthat you are using it isenough for some people tosay that you obviously donot subscribe to the values

of social role valorization. This is espe-cially true for a schedule that, heavenforbid, provides reinforcement for notexhibiting the targeted behavior, ratherthan providing reinforcement for desir-able behavior. “Oh! How can you usesuch dehumanizing schedules?”

Suppose you were working with anadult man who is very sensitive to criti-cism and when he is criticized or evenwhen he perceives something to be criti-cal, he becomes upset and breaks win-dows and other objects. You know that itwould be very good for him, in terms ofhis sense of self-esteem, in terms of hisability to support himself, in terms of hisbeing valued by those around him, forhim to have a real job. Further supposethat you have the opportunity to find hima real job, for example, working in adental office filing patient records. Youknow the problem is, however, that if hemisfiles something and somebody has tocorrect him or if he perceives somebodyis being critical to him, he might verywell break windows, furniture, and knockover file cabinets, because this is the kindof thing he has done in the past when hehas been criticized.

We know that in the long run, what weneed to do is to teach this fellow how totake the kind of criticism he is likely toget from the real world, because the realworld can be critical, without overreact-ing in this destructive way. This, how-

ever, may take six months, nine months;who knows, it may take a year or more toteach him how to cope with real worldcriticism. What can we do in the mean-while? Does this mean he can’t get a realjob until then? Alternatively, should weencourage him to take the job, even thoughwe feel certain it will end in failure, andcount on this “natural consequence” toteach him a better way to respond tocriticism, even though it is obvious thatsuch natural consequences in the pasthave failed to do so and that they haveresulted in an unending trail of failure,exclusion and devaluation in their wake?

We would suggest that in such circum-stances, it would be to his benefit, itwould impact his quality of life in a verypositive way, it would be very consistentwith our values, to provide him with atemporary behavioral prosthesis — aschedule of reinforcement that says,“...hey, if you can get through a day at thedental office without overreacting to criti-cism by breaking furniture and otherthings, then we could stop for a beer onthe way home each day to celebrate yoursuccess, your ability to control yourselfin an adult fashion.”

Eventually, we want him to be able torespond to respond to criticism in an adultand socially acceptable way, without anyartificial supports. Initially, however, abehavioral technique may be needed as aprosthetic, i.e., an artificial support. If wewere working with someone with a physi-cal disability, needing a wheel chair toachieve independent mobility in the com-munity, we would support that. In fact,we would say to society, “...you’ve got toprovide ramps, you’ve got to providerailings, you’ve got to make sure thatyour doorways are wide enough for himto get through.” If society says to us,“...this is artificial. This is not a naturalway of getting from place to place. Awheelchair is contrived, and we find ituncomfortable to be around people withwheelchairs,” we would say to society,“...sorry, he has a right to access. Youhave to learn to tolerate this. This personuses his prosthesis so that he can be outthere, so that he can enjoy all of the thingsthat other people enjoy. He deserves thataccess and you are going to have to livewith his prosthesis, negative and stigma-

We believe there is nothinginherent in social rolevalorization that requires therejection of behavioraltechnology.


11

tizing though it may be to you.” Well,those are the criticisms that are madeabout schedules of reinforcement (andother behavioral techniques): they areartificial, they are contrived, they attractnegative attention. They can be designedto minimize those qualities to be sure, butin the final analysis, we think you have tosay they are still artificial, contrived andpossibly attract negative attention.

Is that a reason to dismiss them? Wewouldn’t throw out a wheelchair for thatreason. Why would we throw out sched-ules of reinforcement for that reason? Aperson with a behavioral challenge has asmuch need for that behavioral prosthesisas a person with a physical challenge hasa need for the physical prosthesis. It’sabout time people stood up for this deval-ued minority, people with challengingbehavior, people who are dismissed ifthey need a behavioral prosthesis to besuccessful in society.

Philosophy vs. Process. One last pointon the origins of the apparent conflictbetween values and behavioral technol-ogy. By definition, behavioral technol-ogy takes responsibility for explicitlydefining its process. When you opera-tionalize a values based approach into aset of procedural steps, it never sounds asnice as the philosophical statement. Webelieve that this is yet another reason whybehavioral technology is seen as being inconflict with social role valorization. Whatwe would suggest is that by taking re-sponsibility for operationalizing our pro-cess, i.e., defining our process, we arebetter able to reach the goals of our phi-losophy and actualize our values than ifwe just leave what we do at a genericstatement of philosophy and values.Translating values into operationalizedprocess appears to diminish the quality ofthe values, but in fact empowers us tobetter actualize those values.

Toward a Subordinate andSupporting Technology That isPerson Centered

The previous paragraphs discussed se-vere and challenging behavior and theapparent conflict between technology andvalues as we defined those terms. Wenow move toward a discussion of behav-

ioral technology that is person centered, atechnology that is subordinate to and sup-portive of our values (LaVigna & Willis,1995). This is a technology that is notonly employed to reduce behavior prob-lems, but is also employed, with equalemphasis, to help people have the bestquality of life possible. Those of you whoare familiar with our seminars on positiveapproaches to severe and challengingbehavior and those who have read theprevious issues of our newsletter andother publications will recognize a lot ofthis material. Because this information isso widely available, we will just touchupon it in outline form.

Assessment. If we want a behavioraltechnology that is in support of people, insupport of values, then it needs to begin inthe assessment phase. This is where webegin our focus on the person and try tounderstand the meaning of the behaviorfor them (Willis & LaVigna, 1996a;1996b), try to understandthe person themselvesand how their life expe-riences have broughtthem to their current cir-cumstances. As part ofthe supporting living ser-vices we provide in Cali-fornia, that process of un-derstanding the persondoes not begin with aformal behavioral as-sessment and functionalanalysis. It begins witha profiling and positivefutures planning processthrough which we work with the person,their family and the other significantpeople in their lives to try and understandwhere the person has been, what theyhave experienced, what it has meant forthem, what works for them, and whatdoesn’t work for them. From that, we tryto understand, from the person’s point ofview, what their goals and aspirations arefor the future. Sometimes that futuresplanning process, which is very power-ful, is so useful, that even though theperson may have been referred to us be-cause of severe and challenging behav-ior, it is not necessary to do a behavioralassessment and functional analysis —problems are resolved. This is accom-

plished when we get fully oriented as towhat that person needs and when theseneeds can be met, even if doing so re-quires that we must break out of the boxand become more creative in our serviceprovision.

Once in a while, however, the com-plexity of the situation, the difficulty ofarranging the ideal circumstances are suchthat we need to do something further, andthis is when we would carry out a formalbehavioral assessment and functionalanalysis. We consider this process as acontinuation of our focus on the person,since it is focused on understanding themeaning of the behavior for the person.The whole assessment process, startingwith understanding the referral problemsand continuing with the gathering of back-ground information, performing a me-diator analysis, motivational analysis,ecological analysis, and a full functionalanalysis of the behavior, is one of focus-

ing in on the critical question: what doesthis behavior mean for the person? Asupport plan is based on an understand-ing of meaning. This approach gives usan opportunity to develop a support planthat is in support of that person and thatperson’s goals.

Support Plans. We explicitly designour support plans to include four majorstrategic components (LaVigna & Willis,1995). We believe that this allows us touse behavioral technology in such a wayas to be person centered, and in support ofthe values we talked about earlier.

Quality of life as process vs. outcome.First and foremost, we look at quality oflife as process. Even as we would hold

A person with a behavioralchallenge has as much need forthat behavioral prosthesis as a

person with a physicalchallenge has a need for the

physical prosthesis.


12

that the desired outcome of what we do isto improve the person’s quality of life, werecognize that quite separately, improv-ing the person’s quality of life can be acritical process strategy in resolving chal-lenging behavior. When we talk aboutecological manipulations, when we talkabout changes in the environment, we aretalking about making thosechanges to improve their qualityof life, in both the short and longrun. People who have a goodquality of life, are not as likely toexhibit severe and challengingbehavior as people who do nothave a good quality of life. Thecharacteristics of the physicalenvironment, the people whointeract with the person, the waythey interact, the amount ofchoice and control the personhas, the kinds of activities thatare available on a daily basis,etc., may be very importantthings to change in order to produce thebroad range of outcomes that are thefocus of our approach. Therefore, thefirst element of our multielement supportplan, would be changes in the person’squality of life.

There may, however, be some limita-tion and constraints in fully implement-ing this strategy. For one thing, theremay be some financial constraints. Whata person is asking for, what a personneeds, may require more money than isimmediately available, or even poten-tially available. Further, even when youknow the changes you need to make,there may be unavoidable delays due totime and effort. Further, sometimes whata person wants requires the cooperationof other people and that cooperation isnot forthcoming. The person desperatelywants to have, for example, an intimaterelationship with a particular other per-son, and that simply is not going to hap-pen. These are the kinds of limitations weall face, but they are examples of how theecological approach, the environmentalapproach, the quality of life approachmay not be sufficient to resolve problems.You can’t always work those things out.

Instruction. The second componentthat we would include in a person cen-tered support plan would be systematic

instruction, i.e., positive programming(LaVigna, Willis & Donnellan, 1989).We believe there are four categories ofcritical skills that people may need tolearn. These include:• General Skills - Functional, age ap-

propriate skills in the domestic, com-munity, recreational, and vocational

domains. While these would includeuseful skills such as bathing and streetsafety, we believe that instruction inthis area should emphasize skills thatwould serve the primary purpose ofbeing fun for the person, such as learn-ing to cook a favorite food or learningto use the CD player to play a favor-ite CD independently, i.e., withoutstaff presence or participation. Thatis, we recommend that we put the“FUN” back into “FUNctional.”

• Functionally Equivalent Skills - Newskills that serve the same functionfor the person as is being served bythe challenging behavior. Examplesof these are teaching the person howto use a sign, picture book or othercommunication system to commu-nicate critical messages such as pro-test, confusion, or the desire for some-thing. Equivalent skill training mayalso involve teaching the person toindependently satisfy their ownneeds, such as would be the casewhen teaching a person to access therefrigerator to get a snack, indepen-dent of staff presence or participa-tion, as opposed to teaching a personto “communicate” their hunger orotherwise asking another person forsomething to eat.

• Functionally Related Skills - Newskills that are related to the functionserved by the challenging behavior.This might include teaching the per-son how to discriminate more finely,for example, between criticism onthe one hand and helpful suggestionsor feedback on the other, how to

make choices, how to use aschedule to predict what is goingto happen, when and where toengage in certain behaviors, etc.• Coping and ToleranceSkills - Perhaps the most over-looked, and yet the most criticalset of related skills that may benecessary to produce the kindsof outcomes we want, is to ac-tively and systematically teachpeople how to cope with andtolerate real world aversiveevents. The real world out thereis a cold, cruel, punishing world.Let us just mention some real

world aversive events that we allhave to learn to cope with and toler-ate. Delayed gratification — not anyof us gets what we want wheneverwe want it. We have all had to learnhow to cope with and tolerate delay.Denial — that is, learning we can’thave something we want. Frustra-tion, failure, criticism, teasing, physi-cal discomfort! This is a big one:tolerance for the performance of non-preferred tasks. How many of usenjoy cleaning out the toilet bowl?How many of us do clean out thetoilet bowl? What we are suggestingis that we do not go through life justdoing the things we enjoy doing. Allof us have had to learn to tolerate theperformance of non-preferred tasks.

When you think of these real worldaversive events, there is an irony. Ifwe are successful in helping ourpeople live a real life, we have guar-anteed that they are going to have todeal with a lot of bad stuff out there.In fact, the more successful we are inhelping to liberate them from theprotected, segregated, isolated livesso many of them have led, the greaterthe exposure. Real life guaranteesthat they are going to experience therejections, delays, failures, criticisms,

People who have a goodquality of life, are not as likely

to exhibit severe andchallenging behavior as people

who do not have a goodquality of life.


13

the need to perform non-preferredtasks, etc. that the rest of us have todeal with day in and day out.

When we carry out a behavioralassessment and functional analysis,we find that such naturally occurringaversive events those are often theantecedents to severe and challeng-ing behavior. We may have,and we do have, nonaver-sive strategies for gettingrapid control over problembehavior. The real taskthough, is to teach peoplehow to cope with and toler-ate these naturally occur-ring aversive events so thatthose improvements can belasting; so people can goout there with a toughenough skin to deal with areal life. While there may be a lot ofgood stuff that happens in real life,there are some rough spots as well.The fabric of real life includes somegolden threads and some frayededges. We want people to be able toenjoy the golden threads of life evenwhile they are able to deal with thefrayed edges around life.

There are some issues regardingpositive programming that bear di-rectly on the use of behavioral tech-nology in support of values. Thefirst of these is that learning a newskill is itself an activity that may takea lot of effort and accordingly maylead a person to opt out. For ex-ample, what should be our responsewhen we are working with a personwhose lack of social skills and hisways of interacting with other peoplehave consistently led them to rejecthim. We may know that a welldesigned social skills training pro-gram would enhance his ability toestablish and maintain relationshipsand reduce his loneliness, yet he re-fuses to participate. Should we ac-quiesce to his choice not to partici-pate in the name of autonomy andself determination or should we usebehavioral technology, e.g., by of-fering an incentive for his participa-tion (i.e., use a formal schedule ofreinforcement) or “shape” his par-

ticipation using the “method of suc-cessive approximations?” We wouldsuggest that behavioral technologycan and should be used in support ofour values in this kind of situation.Eventually, we might even aim ourtechnology toward helping the per-son to learn how to enjoy learning

and to seek out new learning experi-ences on his own initiative.

In any case, we believe that ourresponsibility is to employ behav-ioral technology to establish a bal-ance in the tension created betweenvalues and not just to honor one tothe exclusion of the others. This isnot to say that we wouldn’t employincidental teaching, modeling orother “low technology” instructionalstrategies, but rather to recognizethat in any given case, they may notbe sufficient to achieve our valuedoutcomes. While it may make senseto employ the least technical strat-egy necessary to achieve the instruc-tional objectives, it must be suffi-cient to meet those ends.

Prosthetic Support. It may take a longperiod of time to give people a betterquality of life, considering the possibledelays and limitations you may have. Itmay also take a long period of time toteach people some of the things they needto know to be successful and effective infacing the real world. For these reason,we also include focused strategies in ourmultielement support plans for the nar-row but important role of giving the per-son rapid control over the challengingbehavior that puts them or others at risk.We call this prosthetic support since itmay only be necessary until the person’squality of life has improved and until

certain critical skills have been learned.One of the arguments in the support of

punishment is that punishment can pro-duce rapid effects, even while being ac-knowledged that it may not accomplishother desired goals. But the irony is thatpunishment is by definition an “after thefact” procedure. The minute you say you

need to solve problems with pun-ishment, you are resigning your-self to the fact that the behaviorwill occur. If you have a verydangerous behavior, the last thingyou want is a set of strategieswhich depend on the occurrenceof the behavior in order to usethem.

Fortunately, the principles ofapplied behavior analysis andresearch in the field have re-vealed two nonaversive strate-

gies, which by their nature, are poten-tially superior to punishment in produc-ing rapid effects. One is antecedent con-trol. If you can identify those anteced-ents associated with a problem behaviorand avoid those antecedents, you couldpreclude the problem from occurring. Wesay that antecedent control is potentiallysuperior to punishment in producing rapideffects, since punishment is an “after thefact” procedure while antecedent controlmay preclude the occurrence of challeng-ing behavior.

For example, if you are working with astudent who “acts up” whenever he isasked to do math, one way to avoid thatproblem in the classroom would be to notask him to do math. Antecedent controlcan provide a rapid, prosthetic reductionof the challenging behavior, clearing theway for us to teach the student copingstrategies and to gradually involve him inour math curriculum. Our responsibilityis that by the time he leaves school, heshould know how to add, subtract, multi-ply or whatever else the curriculum re-quires. Sometimes we may need to losethe battle in order to win the war. Some-times a short-term retreat gives us a verystrategic advantage for producing the ulti-mate outcomes we are trying to produce.

A second behavioral technique that canproduce rapid effects, precluding the oc-currence of the problem behavior, is re-ferred to as stimulus satiation. This in-

The real task though, is toteach people how to cope with

and tolerate these naturallyoccurring aversive events…


14

volves noncontingent availability of thereinforcer which is maintaining the prob-lem behavior. The idea is that if theperson has free access to the reinforcer,or greater than desired access to the rein-forcer, then there is no reason for theproblem behavior to occur.

For example, if a person’s challengingbehavior is reinforced by the attention itreceives from staff, immediate controlmay be established by assigning one-to-one support staff. Then, to avoid indefi-nite dependency, we can use positiveprogramming, i.e., our instructional strat-egies, to teach the person how to tolerateand cope with more normalized patternsof interaction.

Other nonaversive behavioral tech-niques may also be used to produce rapid,albeit prosthetic effects (LaVigna, andDonnellan, 1986). These include sched-ules of reinforcement such as the Differ-ential Reinforcement of Other Behavior(DRO) and the Differential Reinforce-ment of Low Rates of Responding (DRL).(While the Differential Reinforcement ofAlternative [i.e., desirable] Responses[Alt-R] is commonly used as a focusedsupport strategy, there are a variety oftechnical reasons why this strategy maynot produce rapid effects.) Such focusedsupport strategies may not be necessary,if simple to arrange ecological changesthemselves produce rapid changes. Theymay be necessary, however, if the eco-logical changes are elusive, if they aremade for reasons of long-term goals asopposed for the purpose of producingimmediate effects, or if critical skills,e.g., coping and tolerance, have not yetbeen mastered. We think that to rejectthis technology in the name of values is tomisunderstand how it can be used in amultielement support plan in support ofvalues and may put people at risk forfurther exclusion and devaluation due tothe continuation of their challenging be-havior. Further, the rejection of this tech-nology may unnecessarily increase theneed for reactive strategies.

Reactive Strategies. Our work at theInstitute for Applied Behavior Analysis,and our excitement about nonaversiveapproaches comes from a lot of experi-ence in which we have seen that punish-ment simply is not necessary. For thatTable 1 - An Example of Reactive Strategies Within a Multielement Context

enough to interrupt almost anythingthat she was doing. We also suggestedthat for the moment they not worryabout the possible reinforcement valueof the potentially distracting activity.After some thought, they said, “…well,we know this about her. She appearsto have this need. When you hand hera magazine, it seems she must open itup and take the staples out. Doing thisis something she seems compelled todo.” Accordingly, we recommendedthat when a “tantrum” began, or evenwhen it seemed about to begin, thatthey should hand her a magazine asquickly as possible. We predicted thatthis procedure should interrupt the tan-trum.

The concern with this advice in tradi-tional, single element terms, would bethat by handing her a magazine, wewould be reinforcing the tantrum. Themultielement rationale, however, is thatwe have enough strength in our proac-tive plans that we can compensate forand overcome the potential countertherapeutic effects of this reactive strat-egy. We can overcome the potential forthat reactive strategy to reinforce andstrengthen the problem behavior. Fur-ther, other elements of our proactiveplan would eventually get us to thepoint where we wouldn’t need any re-active strategies, because she wouldhave learned better ways of dealingwith her environment — for example,through the relaxation response.

That is multielement theory. Here iswhat actually happened. Immediately,not gradually, she was engaging in thetarget behavior less than five minutes aday. Another immediate effect wasspending more and more time in pro-ductive, instructional activity. Time ontask was an important side effect for usto track. If the cost of this strategy wasthat she was spending more and morewith magazines, and less and less timein educational activities, we would ques-tion whether the price was worth it. Thegradual effect was that she engaged inthis behavior less and less times. Fur-ther, it has now actually been morethan 2 years since she has engaged inany tantrum behavior. This multiele-ment plan produced the desired shortterm effects and long term effects. Itincluded a reactive strategy that wasnonaversive and very effective in es-tablishing rapid control without produc-ing a counter therapeutic effect.

This example involves a 14 year oldgirl. The problem was that she wasengaging in what was called “scream-ing tantrums.” This included her yellingvery loudly while she scratched herface with a downward raking of herhands. Although she had been in theschool program for 18 months, she wasstill engaging in this behavior an aver-age of 45 minutes a day. On bad days,it was occurring as long as 80 minutesa day. This behavior was injurious tothe student and very disruptive for theentire classroom. As part of an IABApracticum assignment, her teacher wasasked to do an assessment and todevelop a multielement support plan.

Based on her assessment, theteacher developed a very good proac-tive plan. For example, she planned tochange the curriculum to be more in-herently interesting to the student. Shereorganized the educational areas sothey would be less distracting in termsof the external or extraneous stimuli. Interms of positive programming, sheproposed teaching the student a relax-ation response so she could learn tocope with stressful situations. She alsoproposed teaching her how to use acommunication board. This was soshe could point to a picture to get ac-cess to the girl’s room; point to a pictureof a water fountain to get a drink ofwater; point to a magazine to look atone; point to the play room to take abreak from class activity; etc. Further,in terms of prosthetic support, theteacher proposed a schedule of rein-forcement in which she would providereinforcement for the student being ableto go longer and longer periods of timewithout exhibiting the target behavior.

Then the question came up, “...whatdo we do when she starts screamingand scratching?” What the staff wantedto do was to continue to use the “cornertime out” procedure that they had beenusing. They acknowledged that thishad not been a particularly effectivestrategy, even for prosthetic support,since after 18 months of “treatment”she still exhibited the problem behaviorat a significant level. They said, how-ever, “...when she starts screaming andscratching, we have to do something.”We agreed. We suggested that they goback to their assessment information tosee if they could identify at least oneactivity which had especially compel-ling qualities for the student, one strong


15

reason, we do not include punishment inour support plans. This creates an inter-esting situation. By not including pun-ishment, we have created a vacuum and aneed for one more component in ourmultielement plans. Improving a person’squality of life, instruction, and prostheticsupport are proactive strategies and areincluded to produce a future effect. What,however, do we do when a problem be-havior occurs? What should we do in thehere and now for situational manage-ment? This is the role that we reserve forour reactive strategies. Within ourmultielement model, a reactive strategyis defined as a procedure that is em-ployed to establish rapid and safe controlof an episode in which a person’s behav-ior is putting someone at risk or for otherreasons requires timely resolution.

What we are trying to accomplish withour reactive strategies is to control asrapidly and as safely as possible, danger-ous and escalating situations and, possi-bly, unduly disruptive situations. It is notthe reactive mode in which we try to teachthe person a better way of responding.That comes under the heading of instruc-tional strategies or positive programming.Reactive strategies have a very narrowrole. In our multielement approach, theyare liberated from the responsibility ofproducing a future effect. All we ask ofa reactive strategy is that it swiftly andsafely control the situation. Our proac-tive strategies address the future.

We received a surprising bonus in de-veloping the multielement model. Wediscovered that within the context of awell developed and comprehensive

proactive plan, it is possible to use asreactive strategies certain procedureswhich give us a very efficient, effective,rapid way of gaining control over a prob-lem situation, even though outside of thatcontext they might produce a countertherapeutic effect. Table 1 provides anexample of this.

A number of aspects bear emphasis inthis example. First, the quicker the bet-ter. We would not want to risk providingreinforcement for an extreme tantrum.Secondly, a picture of a magazine on hercommunication board gave her the abil-ity to ask for a magazine when she wantedto. In other words, her access to maga-zines was not limited to her exhibition oftantrum behavior. She had independent,noncontingent access. In addition to hercommunication board, a short stack ofmagazines were kept in the play room. Inother words, a safety valve was built intothis particular multielement plan whichreduced the likelihood that a counter thera-peutic effect would occur.

We think these kinds of approachesgive us a way of supporting people in away that helps them achieve the kinds ofvalued outcomes that we talked aboutearlier. Getting rapid control in an emer-gency situation by diverting a person to apotentially reinforcing activity has bothan intuitive element and a counterintui-tive element. Intuitively, we understandhow such distraction may gain rapid con-trol, even in an emergency situation. Whatgoes against our intuition is that we cando so without reinforcing and strengthen-ing the problem behavior and withoutcreating a counter therapeutic effect. We

discuss this and theuse of other counter-intuitive strategies foremergency manage-ment within a nonav-ersive multielementframework in a forth-coming publication(Willis and LaVigna,in press).

In that monograph,we also discuss thedifficulty of establish-ing the social validityof reactive strategieswithin a nonaversive

framework and the importance of ad-dressing the emotional needs of staff andparents. This challenge comes into sharpfocus when the topic of “natural conse-quences” is raised. We have noticed atendency among those who have rejectedbehavioral technology to rely on naturalconsequences as a way of reacting tochallenging behavior. The rationale hasbeen twofold. Firstly, it is argued that itis dignifying for and valuing of a personwith a developmental disability to expe-rience the same consequences for theirbehavior as would be experienced by aperson who is not challenged with a dis-ability. Secondly, as the rest of the popu-lation learns from experiencing naturalconsequences, so would a person with adisability. Accordingly, relying on natu-ral consequences would preclude the needto use any formal behavioral/instructionaltechnology.

While natural consequences may oftenbe aversive, our argument against the useof natural consequences as a major strat-egy within a values based approach are:

1. People with challenging behaviorhave demonstrated through their his-tory, typically going back to theirearly childhood, that they often havenot been able to learn from naturalconsequences. To rely on naturalconsequences as a primary methodof socialization is to restart the down-ward cycle of experiences that havecontributed to their current reputa-tions.

2. Natural consequences may them-selves lead to further exclusion anddevaluation and to that extent repre-sent a direct conflict with our values.Examples of this might be gettingfired from a job, going to jail or beinghospitalized in a psychiatric facilityas a consequence of one’s behavior.

3. To the extent that they are aversive,natural consequences may escalatethe situation. This conflicts with therole of a reactive strategy in ourmultielement model, which is to es-tablish the most rapid and safest con-trol possible.

With these concerns in mind, we rec-ommend caution in incorporating naturalconsequences in a support plan.

A Comparison of a Multielement Outline Using

Person Centered Terms vs. Technical Terms

Person Centered Terms Technical Terms

Support Plan .......................................... Intervention Plan

Quality of Life Improvements .... Ecological Manipulations

Instruction ......................................Positive Programming

Focused Support ................................... Direct Treatment

Situational Management .................... Reactive Strategies

Table 2 - A Comparison of a Multielement Outline UsingPerson Centered Terms vs. Technical Terms


16

LanguageIn the preceding paragraphs, we have

described a nonaversive, multielementmodel for using behavioral technology insupport of values. While we argue insupport of formal behavioral technologyto maximize our valued outcomes, it isimportant to recognize that the very lan-guage one uses to describe behavioraltechniques can lead to their rejection.“Technical jargon” is a real turn-off for alot of people, both for the consumers ofbehavioral services and for some of thestaff who provide those services. Ac-cordingly, it is important for the practi-tioner to use the language most suitable tothe audience being addressed. Technicallanguage may be the most efficient wayof communicating meaning and nuanceto a professional audience, but “personcentered” language or translation to ev-eryday terms may be important whencommunicating with consumers or staff.For example, a professional audiencemight thoroughly appreciate a detaileddescription of the technical requirementswhich must be met in order to use Differ-ential Reinforcement of Other Behavioreffectively to establish rapid control overchallenging behavior. Such details andthe language used to communicate them,however, might lead a consumer or theconsumer’s support staff to reject or notcooperate with the use of such a tech-nique. In contrast, consumers and staffmight be quite accepting of Guidelinesfor Providing Praise and Encouragement,which may in fact incorporate all of thetechnical requirements in lay terms.

Table 2 juxtaposes what we would char-acterize as language that is user friendly andperson centered with more technical termsin outlining a multielement support plan.

Collaboration and ConsentFinally, we have an obligation to ob-

tain the consent and collaboration of thepeople with whom we work. Our roleshould be one of supporting a person toachieve her or his own goals and aspira-tions, as we would have identified andunderstood them as part of our assess-ment and planning process. We shouldbe explicitly clear with our consumersabout these goals and objectives and themethods we propose using. It is funda-

mental to a values based approach toobtain the consumers collaboration andconsent for both the goals and objectivesand the methods. The use of behavioraltechnology in support of values does notdiminish this responsibility, even whenusing exclusively nonaversive procedures.

However, acceptable procedures forobtaining and documenting collaborationand consent in developing even a personcentered plan are not very well developedin the field, in our opinion. This is par-ticularly true for those people who havecommunication difficulties. We believethat parents and staff, with good inten-tions, are making decisions based on whatthey believe the person should want. Welack the methodology for giving us abetter understanding of what a persondoes want. Developing a better method-ology for obtaining collaboration and con-sent is an important area for future research.

Summary and ConclusionOur quest here was not just to reconcile

behavioral technology with values, but toshow how behavioral technology can beused in support of values. We concludethis article with our recommended guide-lines for assuring that behavioral tech-nology is used in a way that is subordi-nate to and supportive of our values anda person centered approach.

Focus on Quality of Life as PrimaryProcess Strategy

There should be a focus on quality oflife as a primary process strategy. Ourfirst responsibility should be to helppeople have a better quality of life. Im-proving a person’s quality of life shouldbe considered equally as both a processstrategy and as an outcome goal.

Use Natural Supports When Not inConflict With Values

Use and promote the use of naturalsupports when those are not in conflictwith our values, i.e., when natural sup-port and natural consequences don’t, inthemselves, lead to further exclusion anddevaluation.

Use Technology When NecessaryWe should use behavioral technology

when it is necessary or helpful in actual-izing our values and in helping the personhave a better quality of life.

Do Not Use Aversive ProceduresDo not use aversive strategies. They are

not necessary and they are in conflict withour values and with social role valorization.

Seek Balance Between ValuesA balance in the inherent tension be-

tween values should be established asopposed to just focusing on one value.

Address Broad Spectrum ofOutcome

When we use behavioral technology,we should take responsibility for equallyaddressing the broad spectrum of out-comes and not just limit our concerns onthe rapid control on behavior. Our pri-mary focus is, and should remain, onquality of life outcomes. This is wherevalues and behavioral technology inter-sect — the goal of producing an im-proved quality of life for people.

Maintain a Focus on the Person andUse Corresponding Language

We recommend and suggest that it isimportant to maintain a focus on the per-son and to use corresponding person cen-tered language when justified by the au-dience being addressed.

Collaborate and Obtain ConsentFinally, it is our responsibility to ob-

tain the collaboration and the consent ofthe person with whom we are workingand, where appropriate, their families.

References

Favell, J.E. (Chairperson), Azrin, N.H., Baumeister, A.A., Carr,E.G., Dorsey M.F., Forehand, R., Foxx, R.M., Lovaas, O.I.,Rincover, A., Risley, T.R., Romanczyk, R.G., Russo, D.C.,Schroeder, S.R., & Solnick, J.V. (1982). The treatment of self-injurious behavior (Monograph). Behavior Therapy, 13, 529-554.

LaVigna, G.W., & Donnellan, A.M. (1986). Alternatives topunishment: Solving behavior problems with nonaversivestrategies. New York, NY: Irvington Publishers.

LaVigna, G.W., & Willis, T.J. (1995). Challenging behavior: Amodel for breaking the barriers to social and communityintegration. Positive Practices, 1(1), 1, 8-15.

LaVigna, G.W., Willis, T.J. & Donnellan, A.M. (1989). The roleof positive programming in behavioral treatment. In E. Cipani(Ed.), Behavioral Approaches to the Treatment of OperantBehavior. AAMD Monograph series, American Association onMental Deficiency.

Willis, T.J. & LaVigna, G.W., (1996a). Behavioral assessment: Anoverview Positive Practices, 1(2), 1, 8-15.

Willis, T.J. & LaVigna, G.W., (1996b). Behavioral assessment: Anoverview part 2 Positive Practices, 1(3), 1, 11-19.

Willis, T.J., & LaVigna, G.W. (in press). Challenging behavior:Emergency management and reactive strategies within anonaversive framework. Los Angeles: Institute for AppliedBehavior Analysis.

Wolfensenberger, W. (1983). Social role valorization: A proposednew term for the principle of normalization. Mental Retardation,21, 234-239.


17

Definition of a Problem BehaviorEditor’s Note: Some of you have written in to ask that we include in our examples,references to students who are considered to have a severe emotional disturbanceand/or a conduct disorder. This issue’s “Definition” column responds to this byproviding a definition for a problem that was labeled Defiance in one of our recentreports. Fran was a 15-year-old girl who was living in a group home whileattending a public school. Her parents were still very much involved in her life andwere able to provide ample descriptive information of her challenges as they hadunfolded over the years. In addition to her running away, during which episodesshe would often engage in substance abuse and promiscuous sex, and self injury,which led to psychiatric hospitalization on more than one occasion, one area ofconcern they identified had to do with how their daughter responding to and treatedthem, her teachers and other authority figures. Such behaviors often elude good,operational definition. We hope you find this example helpful. You may also wantto note that our recommended observation and data collection for this problem didnot attempt to capture every occurrence of Defiance but rather was designed totrack a limited number of representatives from that response class, in order toprovide an indicator measure of progress, or lack thereof. If you have definitions ofchallenging behavior that you feel would be helpful to others, please send them in.We would like to include them in future issues.

Description of Behavior and Operational Definition ofDefiance

A. Topography. Defiance involves sev-eral distinct topographies, includingoppositional behavior and violationof established rules of conduct in thesetting.Oppositional Behavior - This cat-egory of behavior is defined as thefailure to follow a reasonable re-quest within a specified or reason-able period of time, and/or verbal-izations that indicate that Fran willnot or has no intention of doing whathas been asked. Examples of thiscategory of behavior as described bythe informants include the follow-ing:• Using the phone when she has

been told that she is not to usethe phone.

• Taking the phone away from aperson after they have prohib-ited her from using the phone.

• After being told to remove anose ring, she puts the ring backin some time later.

• Saying such things as “I won’tdo it, and you can’t make me.”“I don’t care and I am not goingto do it.”

• Not completing or doing class-room or homework assignments.

• While not doing what has beenasked (such as asking her to turnoff the TV) she will say thingssuch as “Leave me alone.” “I’mbusy now, don’t bother me.”

• Saying “I’ll do it later.”Opposition may be passive in thatFran simply does not do what hasbeen asked, or it can be active in thatshe tells those around that “shewon’t.” At the same time, she mayuse profanity and become verballyabusive as she is oppositional.Violation of Established Rules - Inthe settings where Fran lives andlearns, there are clear, well estab-lished, written rules regarding con-duct. For example, at her grouphome there are rules regarding loud-ness, presence in the staff bedroom,use of independent time, reading themail of others, contacts with incar-cerated individuals or people fromother group homes, school absences,homework, giving out phone num-bers, visitors, eating and drinkingothers’ food, room searches, walks,

smoking, use of over counter drugs,phone use, room cleanliness andchores, position in the car, and al-lowances. In addition, the schoolhas a number of established rules ofconduct at the school and for theclassroom (e.g., chewing gum andbeing in the wrong area) Defiance,in this context, is defined as the fail-ure to follow or violation of theseestablished rules.

B. Cycle:Oppositional Behavior - Opposi-tion, as it is used here, is consideredto have occurred when Fran fails toinitiate the requested activity withinthe specified time limits or within areasonable time period, or when shedoes something that she has beenrequested not to do. An event wouldalso be considered to have occurredupon the first verbalization that indi-cates that Fran is not going to dowhat has been asked or otherwiseintends to disregard the request.Violation of Established Rules - Arule violation begins at the initiationof each transgression. An episode ofrule violation is said to have endedwhen the transgression has ceasedfor a minimum of five minutes.

C. Course of the Behavior: Accordingto Fran’s teacher, she can usually tellthat something is wrong and thatFran is likely to have difficultieswith rules and directions. She mayappear anxious, show signs that sheis agitated, or may appear ill. Fran’sparents described that they have agood idea that it is going to be a “badday” when Fran appears tired andgrumpy, when she has a generallyunhappy demeanor, and when she isnot smiling. Additionally, in inter-actions with her, her answers to ques-tions may be short, curt or she maysimply be unresponsive. She mayshow irritability in her voice andmay give the impression of impatience.

D. Strength of The Behavior: Unfortu-nately, the methods of data collec-tion across settings differ greatly andprobably are not very accurate. Ac-cording to Carol Harris, she esti-mated that prior to 4/6/96 Fran mani-fested some form of defiance 4 to 12


18

times per day. Formal records (seereport dated 4/29/96) showed 7 inci-dents of Not Following Directionduring the period from 2/24/96 to 4/5/96. The same report described 23 ruleviolations during the same period (Notincluding AWOL). Ms. Harris re-ported that since 4/6/96, there has onlybeen one incident of rule breaking.

Ms. Wright reported that Frandoesn’t violate or break big rules atschool. Two to three times per month,she may have a bad day. Duringthese times there is a lot of “I won’tsaying.” The number of points accu-mulated in the classroom is the pri-mary form of data collection. Thisdoes not lend itself to easy assess-ment of the degree or percentage ofdefiance on a daily or weekly basis.

According to Fran’s parents, Franmanifested defiance about 70% ofthe available opportunities in 1994.They estimate that currently, she isdefiant between 5 and 20 percent ofopportunities.

Observation and DataCollectionA. Procedure: Given the nature of

Fran’s problems, it will be importantthat data are collected to show evi-dence of her progress. At a mini-mum, the following data should becollected:1. School - The teacher should

record:a. the number of assignments

given in class and com-pleted each day;

b. the number of homeworkassignments given andturned in each day;

c. the number of times each ofthe written rules were bro-ken each day.

Summary graphs should bemaintained for each of these.

2. Group Home - Staff should beassigned each day to record thenumber of times each of the

written rules were broken. Thesedata should be summarized on agraph maintained for this pur-pose.

B. Reliability Check: To assess theaccuracy of the data, once eachmonth, a comparison should be madebetween the raw data sheets, rein-forcement charts and token economyrecords, summary graphs, and staffnotes. The number of discrepanciesbetween the raw data and the otherrecords should be noted. A reliabil-ity index should be calculated bydividing the monthly total, as deter-mined by the raw data, into the num-ber of discrepancies noted in the sec-ondary records subtracted from theraw data total. The reliability indexcan then be calculated by multiply-ing this number by 100. If the reli-ability index is less than 85% for twoor more months in a raw, a differentmethod of data recording and reli-ability checking should be developedto improve the accuracy of the data.

IntroductionMr. Randolf engages in tantrums, physi-

cal aggression, and self injury. But theseactions are frequently preceded by early

signs that he is becoming agitated, or heappears to be upset. It is important tocatch Mr. Randolf EARLY in the escala-tion phase. Otherwise, he will escalate toa full-blown tantrum.

There are some clear signs that Mr.Randolf is agitated and that he is headingfor a TANTRUM. These early signs arePRECURSORS. The following is a de-scription of these precursors:

Objective Signs of Escalation/Precursors1. Clicking Sounds. Mr. Randolf makes

sounds with his mouth that soundlike clicks. They are made by press-ing his tongue against the roof of hismouth. Generally, the sounds areREPETITIVE. Reportedly, they arelikely to go on until someone saysSTOP. These sounds may be quitesoft in volume, or may be loud enoughto be heard across a room.

2. Opening and Closing Doors. Thiscategory of action typically involves

Procedural Protocol - BehavioralEscalationEditors’ Note: One of the reasons we emphasize including a description of the“course” of the behavior as part of our definition of a problem, along with acomprehensive antecedent analysis and consequence analysis (among other things)is that we can begin to discern staff patterns and interactions that increase thelikelihood of resolving the incident as a minor episode and those that increase thelikelihood of escalating the incident into a severe episode. The implications of suchinformation is that it may be used to develop systematic strategies designed toprevent escalation. Following is one such example. This protocol was one of manythat made up Mr. Randolf’s support plan. He is challenged by autism and when hebecomes agitated, he engages in physical aggression, self injury and tantrum. Thisparticular part of the plan is designed to prevent escalation to a full-blown tantrumwhen he becomes upset.

ProtocolConsumer’s Name: Mr. RandolfProtocol Name: Behavioral EscalationDate Initiated: June 1, 1995Updated: August 15, 1995


19

Mr. Randolf OPENING THE DOOROF HIS ROOM AND PEEKINGOUT, as if to see what is happeningin the living area. As this type ofbehavior continues, it ESCALATESfrom simply opening the door andpeering out to slamming the doorand running and jumping on his bed.At the same time, he may be makinga variety of vocalizations and shrieks.Opening and closing doors initiallymay be separated by from one to fiveminutes. But as the escalation con-tinues, the actions become louderand the intervals between incidentsshorter. IF HE IS ALLOWED TOENGAGE IN THIS ACTIVITYMORE THAN ONCE, HE ISLIKELY TO ESCALATE.

3. Perseveration. This category in-volves questions for which Mr.Randolf has the answer, or for whichhe has received an answer. The ques-tion or statement is considered to beperseverative if it occurs within oneminute of the last similar question.Included within this are statementsthat are out of context, which arerepeated within one minute of thelast. Some examples of these in-clude the following:a. Repetitive Questions:

• When am I going home?• Can I call daddy?• Can I have a pickle now?• Where is Barry?• No tantrums! Can I have a

pickle?• What am I wearing home

on Friday?• What is daddy wearing Fri-

day?• Can pack now?

b. Repetitive Statements:• I should stop jumping now.• Daddy says no clicking.• No tantrum, no pickle.• No silly talk.• I’m going to be a good boy

so I can earn the pickle.c. Silly Talk. This category in-

cludes questions or statementsthat occur OUT OF CONTEXTfor the situation, and that mayNOT HAVE TRADITIONALMEANING. Examples of state-

ments in this category includethe following:

1) Alex Trebeck or JeopardyStatements. Any commentor question related to AlexTrebeck or the televisionshow Jeopardy would becounted, e.g., “AlexTrebeck is the host of Jeop-ardy;” with the exceptionof such comments madewhile Mr. Randolf is watch-ing Jeopardy.

2) Nonmeaningful Questionsand Statements. This cat-egory involves statementsand questions that do notmake TRADITIONALSENSE to the listener.Some examples include thefollowing:• Does an “S” look like a

snake?• Sit said goes this• Daddy killed Wink

Martindale.• Gibberish. This in-

cludes a chain of non-communicative utter-ances that do not ap-pear to communicate amessage.

4. Bouncing in Place. This may bethe last objective sign beforeMr. Randolf begins a full-fledgetantrum. Mr. Randolf will be-gin bouncing up and down onthe balls of his feet, while stand-ing in one place. At the sametime, he may begin opening andclosing his hands in a crab-likefashion.

Strategies To Manage EscalationAnd To Avert Tantrums1. Clicking. Clicking is one of the early

signs that Mr. Randolf is agitated. Ifnot stopped, or if Mr. Randolf is notassisted, he is likely to escalate tofull-blown tantrums. The followingare suggested strategies for helpingMr. Randolf:a. Stop The Behavior. At the first

sign of clicking, it should becommunicated to Mr. Randolf

that he “needs to stop.” Here areseveral statements that youmight make that could have thedesired effect:• Ask Mr. Randolf in a polite

fashion to “stop.”• “Mr. Randolf, would you

please stop clicking?”• “Mr. Randolf, is that appro-

priate?”• “Mr. Randolf, is clicking

appropriate?”• “Mr. Randolf, cut it out!”• “Mr. Randolf, chill out!”• “Mr. Randolf, calm down!”• “Mr. Randolf, you need to

stay calm!”It would also be appropriate

to describe to Mr. Randolf theimpact his behavior has on youand others. But these explana-tions should not be too lengthy;the message will be lost. Forexample,• “Mr. Randolf, that bothers

me. Please stop!”• “Mr. Randolf, that is an-

noying. Please stop!”• “Mr. Randolf, I don’t like

that. Would you pleasestop?”

In public places, telling Mr.Randolf the impact on otherswould also be very appropriate.For example,• “Mr. Randolf, people don’t

like noises like that. Youneed to stop.!”

• “Mr. Randolf, you are be-ing rude. You need to cut itout!”

b. Diversionary Strategies. If theinitial strategies to “stop” theclicking are not successful, ev-ery effort should be made to“divert” Mr. Randolf. Somediversionary strategies mightinclude the following:• “Mr. Randolf, come sit

down and watch TV withme.”

• “Come join me.”• Give “high 5.”• Give DAP - i.e., physical

contact between people inwhich they touch fists to-


20

gether in a gentle manner.• “Would you like to read?”• “Lets go cook dinner now.”• “Do you want to take a bath

now?”c. Recovery and Communication.

After Mr. Randolf “stops” theclicking, or you have success-fully diverted him, it is time tohelp him identify and solve anypotential problems. Be concreteand to the point. Here are someexamples:• “Mr. Randolf, what is both-

ering you?”• “Mr. Randolf, is there some-

thing on your mind?”• “Mr. Randolf, are you ex-

cited about going home onFriday?”

• “Mr. Randolf, did you wantto talk to me?”

This may be the time to ex-plain to Mr. Randolf the impactof his behavior on others. Forexample,• “Mr. Randolf, those noises

are very annoying… …Thenoises bother people……People may get angry atyou.”

• If you use words such as“annoy” be sure that youexplain the word to Mr.Randolf. For example, youmight describe using othermore common words suchas “disturb,” “bother.” Youmight also describe the mean-ing using references to Mr.Randolf’s own experiences.

2. Opening and Closing Doors. Thereactions to this problem should varybased on the time of day or night thatthey may occur. If this behavioroccurs during daytime hours or be-fore 10 PM, the strategies suggestedabove might be used. These wouldinclude the following:a. Stop The Behavior. At the first

sign of “opening and closing”the door, it should be communi-cated to Mr. Randolf that he“needs to stop.” Here are sev-eral statements that you might

make that could have the de-sired effect:• Ask Mr. Randolf in a polite

fashion to “stop.”• “Mr. Randolf, would you

please stop opening andclosing ?”

• “Mr. Randolf, would youstop playing with the door?”

• “Mr. Randolf, is that appro-priate?”

• “Mr. Randolf, is openingand closing the door appro-priate?”

• “Mr. Randolf, cut it out!”• “Mr. Randolf, chill out!”• “Mr. Randolf, calm down!”• “Mr. Randolf, you need to

stay calm!”It would also be appropriate

to describe to Mr. Randolf theimpact his behavior has on youand others. But these explana-tions should not be too lengthy;the message will be lost. Forexample,• “Mr. Randolf, that bothers

me. Please stop!”• “Mr. Randolf, that is an-

noying. Please stop!”• “Mr. Randolf, I don’t like

that. Would you pleasestop?”

b. Diversionary Strategies. If theinitial strategies to “stop” theopening and closing the doorare not successful, every effortshould be made to “divert” Mr.Randolf. Some diversionarystrategies might include the fol-lowing:• “Mr. Randolf, come sit down

and watch TV with me.”• “Come join me.”• Give “high 5.”• Give DAP - i.e., physical

contact between people inwhich they touch fists to-gether in a gentle manner.

• “Would you like to read?”• “Lets go cook dinner now.”• “Do you want to take a bath

now?”• “Mr. Randolf, come over

here and lets hang out.”

c. Recovery and Communication.After Mr. Randolf “stops” theopening and closing of the door,or you have successfully di-verted him, it is time to help himidentify and solve any potentialproblems. Be concrete and tothe point. Here are some ex-amples:• “Mr. Randolf, what is both-





If this behavior occurs duringthe evening between 10 PM and12 AM the strategies suggestedabove might be used. In addi-tion, the following statementsmight be made; assuming thathe is not tired and does not wantto go to sleep:• “Mr. Randolf, do you want

to come out and watch TVwith me?”

• “Mr. Randolf, lets hang outbefore you go to sleep.”

If this behavior occurs at nightafter 12 AM, the communica-tion to Mr. Randolf should beone of its being late and that heshould be sleeping. Some ex-amples include:• “Mr. Randolf, it is _____

AM. It’s late and you needto be in bed.”

• “Mr. Randolf, its late. Youneed to go to work tomor-row. Go to bed.”

• “Mr. Randolf, its late. Doyou want to disturb theneighbors?”

• “Mr. Randolf, is your fa-ther asleep now? Whatshould you be doing?”

3. Perseveration. Mr. Randolf’sPerseveration sometimes serves acommunicative function and some-times it is simply a repetitive behav-ior that seems to serve no functionwithin the current context. Mr.


21

Randolf’s apparent inability to con-trol this behavior can contribute tohis agitation and escalation.a. Stop The Behavior. On the as-

sumption that the Perseverationis communicative, staff shouldattempt Active Listening (seeActive Listening Protocol).

b. Diversionary Strategies. If Ac-tive Listening does not work toget control over Perseveration,staff should attempt to divertMr. Randolf from Perseverationby using the remote control de-vice to switch on his favoriteCD, always kept ready for thiseventuality. At this point, staffcan say something like “doesthis music help you to think aboutsomething else?”

c. Recovery and Communication.After Mr. Randolf “stops” theperseveration, or you have suc-cessfully diverted him, it is timeto help him identify and solveany potential problems. Be con-crete and to the point, as de-scribed above.

4. Bouncing Up and Down In Place. IfMr. Randolf gets to this state, it isimportant to “stop” the behavior atthat point. While the responses de-scribed above should be used here, atthis point the statements should bemade in a more “forceful” manner.“Mr. Randolf, you need to stop. Now!”Other things you might want to do atthis point include the following”a. Stop The Behavior. Give the

directions and make the state-ments described above in an as-sertive manner, as if you reallymean what you are saying. Inthe above strategies, the state-ments might be given as a“buddy” might talk to another“buddy.” Not here.

As soon as he engages in thefirst sign of “bouncing,” DROPWHAT YOU ARE DOING andinteract as described here.

At this point, it might be agood idea to get close to him.While respecting his personalspace, get closer. Generally

speaking, close means NOTwithin arms reach. Mr. Randolfis sensitive to people being tooclose. Also, by being out orarms reach you will be moreable to effectively evade at-tempts at physical aggression.By closing the space betweenyou and Mr. Randolf, he maysee that it is important and thatyou mean business.

b. Diversionary Strategies. If theinitial strategies to “stop” thebouncing are not successful,every effort should be made to“divert” Mr. Randolf. Some ofdiversionary strategies mightinclude the following:• You might remind Mr.

Randolf what he will earn.“Mr. Randolf, you haveonly ___ hours before youearn _____. “ “Don’t blowit. You picked the prize.”“I hope you earn it.”

• Redirect him to the trampo-line where he can bounce inan adaptive way.

• Direct him to count to “10”or to engage in simple addi-tion, such as “Mr. Randolf,what are 2 + 2?”

• Direct Mr. Randolf to usehis coping skills. “Mr.Randolf, take a deep breath…Relax… …Calm down.”

• Direct Mr. Randolf to sitdown. “Mr. Randolf, comeover here and sit with me.”

• Once he is sitting down, itis time to redirect him intoyet another activity or ac-tion. For example:— Give him the TV re-mote so he can change thechannel.— Give him the TV guide.— Ask him to write hisschedule for the next day.Help him.— At night, redirect himback to bed.

• Ask Mr. Randolf to “countto 10.”

• There is some indication

that if he has not mastur-bated that day, he is morelikely to be frustrated. Youmay want to ask him “Mr.Randolf, have you mastur-bated today?” If the answeris “no” then you should re-direct him to the place wherehe can. “Mr. Randolf,maybe you need to go to thebathroom and masturbate?”

c. Recovery and Communication.After Mr. Randolf “stops” thebouncing, or you have success-fully diverted him, it is time tohelp him identify and solve anypotential problems. Be concreteand to the point. Here are someexamples:• “Mr. Randolf, what is both-





This may be the time to ex-plain to Mr. Randolf the impactof his behavior on others. Forexample,• “Mr. Randolf, it really up-

sets people when youbounce up and down andmake so much noise.”

• “Mr. Randolf, when youmake so much noise, it dis-turbs your neighbors. Youdon’t want to be kickedout?”

• “Mr. Randolf, if you maketoo much noise you mightget kicked out. You don’twant that!”

CommentsSome of Mr. Randolf’s behavior sug-

gest the possibility of a movement distur-bance in which some of these behaviorshave a neurological, nonvolitional base.Ongoing assessment is being carried outto determine the extent to which this maybe true and, if so, how this protocol maybe strengthened and revised accordingly.


22

Resource Focus: Competency BasedTraining (CBT)Diane Sabiston, Institute for Applied Behavior Analysis, Savannah, GA

Editors' Note: Many of you have requested more information regarding resourcesthat are available from IABA to assist you in providing quality services.Periodically, we will use this column to focus on resources available from us or onethat we know of and find useful. In this article, Diane Sabiston describes theCompetency Based Training series that we use to train our own staff and havemade available to other service agencies worldwide.

Introduction and BackgroundStaff training is generally defined as instruction to establish staff

competence to perform responsibilities. Many agencies worldwide,

providing services to persons with the challenge of developmental

disabilities, are struggling with the issue of how to best train staff and

give them the skills needed to provide quality services. Often,

agencies are limited in the amount of time scheduled for training

staff and may only offer a basic orientation in order to get staff on

board quickly. Perhaps some agencies can’t afford a full time trainer

and training occurs when there is someone available to schedule an

inservice training. Many agencies are looking for a comprehensive

approach to staff training with specific outcomes and without the

luxury of a full-time trainer. What kind of training do agencies offer

so that staff feel competent to carry out their challenging job

responsibilities?

in the real-life situation. The third levelof competence includes demonstratingthe skills out in the field with the person(s)receiving the support. Some of the prin-ciples and skills taught in the CBTs in-clude the principle of full inclusion, in-structional strategies, the function of be-havior challenges, public relations, posi-tive support strategies, problem-solving andtroubleshooting skills and more. To dem-onstrate competence for each module, staffmust meet specific criteria such as objec-tive tests, role-plays and field assignments.

The CBT package includes 16 moduleswith 73 competencies and 130 criteria, alibrary of 4 textbooks and 2 videotapes, anInstructor’s Manual and tests and answersfor each topic. There are 5 of the 16 topicswhich are customized to incorporate spe-cifics which may be unique to each agency.

Field Testing andImplementation

The Competency Based Training se-ries has been field tested for over 10 yearsin a variety of settings. It is complete,comprehensive and includes critical train-ing that direct care staff need and is flex-ible enough to be integrated with an agency’sunique needs and existing training.

Agencies throughout the U.S., Canada,United Kingdom, Australia, Spain andNew Zealand are effectively using theCompetency Based Training and the prin-ciples it teaches. A selected list of usersincludes the Loddon School in England(Basingstoke, UK), Residential SupportServices (Charlotte, NC), Isle of ManDepartment of Education (Douglas, Isleof Man, UK), Provident Industries(Yakima, WA), SC Programs for Indi-viduals with Autism (Greenville, SC),Grant-Blackford Mental Health (Marion,IN) and Cedar Hill Independent SchoolDistrict (Cedar Hill, TX). The state ofMontana’s Developmental Services Di-vision also purchased the right to distrib-ute the CBT series to all its providers asa state training curriculum.

For more information, call, fax or write:Diane Sabiston; Institute for AppliedBehavior Analysis; PO Box 30726;Savannah, GA 31410 USA; Telephone:(912) 898-0390; Fax: (912) 898-8077.

The Institute for Applied BehaviorAnalysis (IABA) has developed a sys-tematic, competency based, criterion-ref-erenced and self-instructional trainingcourse for staff working primarily in thefield of developmental disabilities. TheCompetency Based Training (CBT) se-ries was first developed by IABA Direc-tors, Julia Shaull, M.S.W., Gary LaVigna,Ph. D., and Thomas Willis, Ph. D. in 1985to be used in training its own staff. Theprinciples contained in the CBTs havebeen successfully used in the fields ofadult services (supported employment,supported living and other residential op-tions) as well as schools serving childrenand adolescents. Agencies serving other

populations (e.g., mental health andneurobe–havior centers) have also uti-lized the training series to increase thelevel of staff competence.

Organization of the CBTThe Competency Based Training se-

ries is designed to teach entry level staffskills at three levels of competence. Thefirst level is verbal. Staff are able toanswer questions regarding a specifictopic of training either verbally or on awritten test. The second level of compe-tence involves role-play or analog wherethe trainee demonstrates skills in a role-play situation before actually using them


23

Make your plans now to attend theNinth Annual

Two Week Summer Institute on

Assessment & Analysis ofSevere & Challenging

Behavior

July, 1997Los Angeles, California

For a complete description of the course,registration procedure and fees, contact:

John Q. Marshall, Jr.Director of Professional Training Services

Institute for Applied Behavior AnalysisPO Box 5743

Greenville, SC 29606-5743 USATelephone: (864) 271-4161 • Fax: (864) 271-4162

Training OpportunitiesAvailable

The Institute for Applied Behavior Analysis canschedule any of the following seminars orinstitutes in your area or for your agency.

• Assessment and Analysis of Severeand Challenging Behavior

• Positive Approaches to SolvingBehavior Challenges

• The Periodic Service Review• Supported Employment• Emergency Management Within a

Nonaversive Framework

For more information on any of the aboveprograms and how you can sponsor a program in

your area, contact:John Q. Marshall, Jr.

Director of Professional Training ServicesInstitute for Applied Behavior Analysis

PO Box 5743Greenville, SC 29606-5743 USA

Telephone: (864) 271-4161 • Fax: (864) 271-4162

29 W. Susquehanna Avenue, Suite 210, Baltimore, MD 21204

Make your plans now!The 22nd Annual TASH Conference

"Renewing the Promise" will be held

at the New Orleans Hilton Riverside,

November 21-23, 1996.

TASH is known for its advocacy for the full inclusion

of people with disabilities in community life. The

annual conference draws over 2,300 advocates from

around the world who are shaping the promise for

continued equity, social justice, and inclusion for all.

The unbeatable enthusiasm and combination of personal

experience and professional knowledge make this a

conference you can’t afford to miss. Over 450 total

sessions and special events will be presented. For more

information, please contact Rose Holsey at TASH (410) 828-8274 x100.


24

ResourcesTraining Calendar

Alternatives to Punishment: Solving BehaviorProblems with Nonaversive StrategiesG.W. LaVigna and A.M. Donnellan“(This book) provides a comprehensive treatment ofalternatives to punishment in dealing with behaviorproblems evidenced by human beings at various levelsof development and in various circumstances. Basedupon their own extensive observations and athoroughgoing analysis of relevant experimental studies,(the authors) have put together a document that is atonce a teaching instrument, a summary of research, andan argument for the use of positive reinforcement in thetreatment of inadequate or undesired behavior… alandmark volume which should forever lay the ghost thataversive methods (even the ubiquitous ‘time out’) needto be applied to the delinquent, the retarded, or thenormal ‘learner,’ whether in the home, the school, theclinic, or other situations.” — Fred S. Keller (From thePreface to Alternatives to Punishment) - paper, $19.50/ISBN 0-8290-1245-1

The Behavior Assessment GuideT.J. Willis, G.W. LaVigna and A.M. DonnellanThe Behavior Assessment Guide provides the user witha comprehensive set of data gathering and recordsabstraction forms to facilitate the assessment andfunctional analysis of a person’s challenging behaviorand the generation of nonaversive behavioral supportplans. Permission has been granted by the authors toreproduce the forms for professional use. -spiral, $21.00

Progress Without Punishment: EffectiveApproaches for Learners with Behavior ProblemsA.M. Donnellan, G.W. LaVigna, N. Negri-Schoultz,L. FassbenderAs individuals with special educational and developmentalneeds are increasingly being integrated into thecommunity, responding to their challenging behavior in adignified and appropriate manner becomes essential. In

this volume, the authors argue against the use ofpunishment, and instead advocate the use of alternativestrategies. The positive programming model describedin this volume is a gradual educational process forbehavior change, based on a functional analysis ofproblems, that involves systematic instruction in moreeffective ways of behaving. The work provides anoverview of nonaversive behavioral technology anddemonstrates how specific techniques change behaviorthrough positive means. The extensive examples andillustrative material make the book a particularly usefulresource for the field.-paper, $17.95/ISBN 8077-2911-6.

Social Skills Training for Psychiatric PatientsR.P. Liberman, W.J. DeRisi, K.T. MueserThis guide to the application of social skills training withpsychiatric patients systematically provides clinicianswith the ingredients necessary to start and run their ownsocial skills groups. Case examples, transcripts of socialskills training sessions and exercises aid the reader inapplying the training methods.-paper, $25.95/ISBN 0-08-034694-4

The Role of Positive Programming InBehavioral TreatmentG.W. LaVigna, T.J. Willis, A.M. DonnellanThis chapter describes the role of positive programmingin supporting people with severe and challengingbehavior. After discussing the need for positiveprogramming within a framework based on outcomeneeds, variations of this strategy are delineated. Then,assessment and analysis are described as critical forcomprehensive, positive, and effective support. A casestudy of severe aggression is presented to illustrate theprocess of assessment and analysis, the supports thatfollow from this process, and the long term results of thisapproach. - spiral, $5.00

The Periodic Service Review: A Total QualityAssurance System for Human Services &EducationG.W. LaVigna, T.J. Willis, J.F. Shaull, M. Abedi,M. SweitzerEvolving from more than a decade of work at IABA, thisbook provides the tools needed to enhance and maintainhigh quality service delivery. Translating the principlesof organizational behavior management and total qualitymanagement into concrete policies and procedures, thePeriodic Service Review (PSR) acts as both an instrumentand a system. As an instrument, the PSR provides easyto follow score sheets to assess staff performance andthe quality of services provided. As a system, it guidesmanagers step-by-step through 4 interrelated elements— performance standards, performance monitoring,performance feedback, and systematic training — tooffer an ongoing process for ensuring staff consistencyand a high level of quality for services and programs.Practical examples show how the PSR is applied togroup home, supported living, classroom, and supportedemployment settings, and the helpful appendices providenumerous tables and charts that can easily be tailored toa variety of programs. - $36.00/ISBN 1-55766-142-1

Add for Shipping and Handling:1st book (min.) $3.00 Each add’l book $0.50

Mail check or company purchase order to:Institute for Applied Behavior Analysis


Telephone: (864) 271-4161 • Fax: (864) 271-4162

Foreign orders must be made in U.S. currency bybank draft or international money order.

(Prices are subject to change without notice.)

Multimedia Training Programs

Competency Based Training ProgramThis is a systematic, criterion-referenced, self-instructional multimedia course for staff developmentthat is customized to your agency. It is being used byadult service agencies and schools in Australia, GreatBritain, Spain and the US. $1,500.00

For more information on the CBT, contact:Diane Sabiston

Institute for Applied Behavior AnalysisPO Box 30726

Savannah, GA 31410-0726 USATelephone: (912) 898-0390 • Fax: (912) 898-8077

Positive Approaches to Solving BehaviorChallengesThis is a 6 module video training program that teachesviewers IABA's person centered multielement model fordeveloping nonaversive support plans for people withchallenging behavior. Two text books, lecture notes andpre/post tests are included. $1,250.00

Staff Supervision and Management Strategies forQuality AssuranceThis is a 4 module video training program based on ThePeriodic Service Review: A Total Quality AssuranceSystem for Human Services and Education. Viewers willlearn concrete strategies to ensure that the highestquality services are being provided by their agency/school. Text book, lecture notes and participant exercisesare included. $750.00

For more information, contact:

John Q. Marshall, Jr.Director of Professional Training ServicesInstitute for Applied Behavior Analysis


Telephone: (864) 271-4161 • Fax: (864) 271-4162

September, 1996 - US Seminars(Clarksburg, WV, Louisville, KY andNashville, TN)

October, 1996 - UK Seminars (Manchester,Sheffield, Telford, Edinburgh, Cardiff,London); Norway Seminars (Oslo)

November, 1996 - Australian Seminars(Perth, Townsville, Melbourne); CanadianSeminars (Halifax, NS)

December, 1996 - US Seminars(Sacramento, CA)

Other venues will be arranged andannounced at a later date. For detailed,current information on any seminar,contact:

John Q. Marshall, Jr.Director of Professional Training ServicesInstitute for Applied Behavior Analysis


Telephone: (864) 271-4161Fax: (864) 271-4162

Internet: [email protected] Free (USA and Canada): (800) 457-5575

In Australia - Jeffrey McCubbery (054) 395 305In England - Cherry Isherwood (01562) 747 881

Assessment and Analysis of Severeand Challenging BehaviorGary W. LaVigna & Thomas J. WillisThis competency-based training practicumprovides participants with the clinical skillsrequired to design a multielementnonaversive support plan.London • October, 1996Los Angeles • July, 1997

Positive Approaches to SolvingBehavior Challenges and The PeriodicService ReviewGary W. LaVigna & Thomas J. WillisPositive Approaches… are 2 and 3 dayseminars that present IABA's multielementmodel for providing person centerednonaversive behavioral supports to peoplewith challenging behavior. These seminarscover Basic Principles of NonaversiveBehavior Support, Behavioral Assessmentand Emergency Management. The PeriodicService Review is a 1 day seminar thatteaches participants a staff managementsystem that ensures the agency/school isproviding quality services.

August, 1996 - US Seminars (GrandJunction, CO and Longmont, CO)

Printed Resources Available from IABA

institute for applied behavior analysis the …express written permission of the institute for...

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