ConnOTA ConferenceCromwell, CTMarch 5, 2016

Amy Burton OTD, OTR/L

OT and ABA Collaboration:Establishing mutual respect through effective interprofessional education, advocacy, and teaming

Learning Objectives Discuss current barriers to OT and ABA collaboration

Analyze ABA methods and terminology; compare to

OT

Learn strategies for improving OT and ABA

collaboration through interprofessional education

Discover ways to advocate for and incorporate OT

theory and techniques into behavior programs without

sacrificing OT foundations

Is it…

SENSORY

or

BEHAVIOR

OTA science-driven and evidence-based

profession in which practitioners seek to understand individuals’ ability to adapt,

organize, and integrate sensory information in the environment that affects participation.

ABAA scientific approach for discovering

environmental variables that influence behavior.

(AOTA, 2009; 2015; Cooper, Heron, & Heward, 2007, p.3)

Barriers to professional collaboration

between OT and ABA

Foundational & philosophical differences

Disagreements regarding interventions and goals

How should deficit areas be addressed and who is best suited to work on them?

(Perez, Carlson, Ziviani, & Cuskelly, 2012)

Barriers to professional collaboration

between OT and ABA

Research shows that…

• ABA practitioners express a lower likelihood of adopting recommendations made by OT practitioners

• ABA practitioners are more apt to make recommendations within the behavioral field only

• ABA practitioners believe interprofessional collaboration will result in minor changes to tasks and solutions

(Kelly and Tincani, 2013)

Barriers to professional collaboration

between OT and ABA

Professional Conflicts:

• Research and Response letters

• Official letters written to the AOTA

requesting research

Barriers to professional collaboration

between OT and ABA

ABA is seeking licensure

• May limit overlapping practice areas with

OT

• May limit OT practitioners using

behavior techniques

(Veverka, 2014, February)

What barriers have you

seen at the practice

level?

Why are you here today?

Let’s take a walk in ABA’s shoes…

1/6 children is identified with a developmental disability in the US

Autism has risen 289.5% over the past 12 years

ABA grew from 500 to 6000 practitioners in just 7 years (2000-2007)

(CDC, 2015; Shook & Favell, 2008)

ABA Foundations

ABA Instructor, Therapist, Shadow, Paraprofessional (Huh?)

RBT = Registered Behavior Technician

BCaBA = Board Certified Assistant Behavior Analyst

BCBA = Board Certified Behavior Analyst

BCBA-D = Doctoral-level Board Certified Behavior Analyst

ABA-based Programs…

Use a Functional Behavior Assessment (FBA) to…

• define target behaviors• identify the function of target behaviors• develop methods to address target

behaviors

This information leads to the development of a Behavior Intervention Plan (BIP)

(Iwata, Dorsey, Slifer, Bauman, & Richman; 1982/1994)

Terminology

OT ABA Activity Analysis

Proactive Strategies

Demonstrate

Prompt or Command

Screen

Task Analysis (TA)

Non-contingent methods

Model

Discriminative Stimulus (Sd)

Probe

Prompting

OT ABAIn many cases, assess

level of function, promote

initiation of movement,

then prompt

LEAST MOST

Level of physical

prompting is graded (D,

Max, Min, etc.)

Promotion of errorless

learning. Prompting

hierarchy is from

MOST LEAST

Level of physical

prompting may or may not

be graded (full vs. partial)

ADLs and other functional tasks

OT ABA Look at quality of

movements within

each step

May not bridge to

motor planning a

sequence of steps

right away

Chaining (Forward

and Backward)

May look at target

outcomes within each

routine

Many differences… but we

share the same VISION!!!

What we have to offer to behavior-

based programs

OT practitioners understand...

Holistic and person-centered practice models

Creative behavioral approaches

Disability theories

Understanding the influence of environmental

context and adaptation

Neurological and Sensory underpinnings

Effectiveness of Integrated OT and

ABA Models

• Research-supported interventions from different theoretical perspectives are effective in the treatment of ASD when strategically planned for quality and rigor

• Multi-disciplinary approaches produce significant improvements in • core autistic features• behavior• sensorimotor integration• posture and coordination• acquisition of new skills• social skills• sterotypy and self-stimulatory behaviors

(Mukherjee et al., 2014; Odom, Hume, Boyd, & Stabel, 2012)

A Hopeful Shift…

ABA and OT practitioners can begin to utilize

and embrace a more multi-disciplinary

approach at the practice level

“Talk the talk,” without speaking the same

language

In order to design comprehensive

and rigorous programs for

students with special needs,

effective interprofessional

collaboration must occur

Contribute to the development of the

FBA

&

incorporate OT strategies into the BIP

(Burton, 2015a)

Design Clear and Appropriate Methods and Outcome Measures

Functional, occupation-based, and focused on participation (Kadar,

McDonald, & Lentin, 2012)

Realistic and Specific

Age-appropriate

Generalization (reproducible product)

(Burton, 2015a)

Work on Common Ground Areas

Life Skills

Social Skills

ADLs

Self-regulation

And more!!

(Burton, 2015a)

Offer Interprofessional Education and Training

BCBAs value research and theory

RBT/ABA practitioners value a review of practical approaches

Training can improve ABA practitioners’ perception of using sensory strategies in the BIP

Training can improve implementation of sensory-based supports

(Burton, 2015b)

Create Time for Training and Collaboration

Formal staff training

Classroom, collaborative approach

Consult/Data review meetings

(Burton, 2015a; Burton, 2015b)

Share Responsibility

Mutual respect

Be open-minded

Advocate

Sensory processing…

Should have an occupation-centered focus

and outcomes (Rodger, Ashburner, Cartmill, Bourke-Taylor, 2010)

Supports play and leisure, social participation, ADL/IADLs, rest and sleep, education, and

work (Koenig & Rudney, 2010)

Be Prepared to Explain

What We Do

Think Beyond…Individual supports

vs.

Classroom supports

vs.

School-wide supports

Listen to people… do they need equip or training?

(Burton, 2015b)

Diffusion of Innovations

1. Prove effectiveness2. Share scientific evidence3. Create a “fit” between OT strategies and

the norms, beliefs, and context of the program

4. Be a “champion”(Rogers, 1983)

Be together, not the same…

https://www.youtube.com/watch?v=vnVuqfXohxc

References

American Occupational Therapy Association (2009). Providing occupational therapy using sensory integration theory and methods inschool-based practice. American Journal of Occupational Therapy, 63, 823-842.

American Occupational Therapy Association (2015). Students and the Centennial Vision. Retrieved from http://www.aota.org/aboutaota/centennial-vision/cv.aspx

Burton, A. Y. (2015a). Building acceptance: Blending occupational therapy principles in an ABA-based program. (Currently unpublished doctoral paper). Quinnipiac University, Hamden, CT.

Burton, A. Y. (2015b). Applied behavior analysis practitioner perceptions: Influence of an occupational therapy training in sensory processing. (Currently unpublished doctoral research). Quinnipiac University, Hamden, CT.

Centers for Disease Control and Prevention [CDC]. (2015). Key findings: Trends in the prevalence of developmental disabilities in U.S. children, 1997-2008. Retrieved from http://www.cdc.gov/ncbddd/developmentaldisabilities/features/birthdefects-dd-keyfindings.html

Cooper, J.O, Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Prentice Hall.

Iwata, B., Dorsey, M., Slifer, K., Bauman, K., & Richman, G. (1982/1994). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 3-20. Reprinted in Journal of Applied Behavior Analysis, 27, 197-209.

Kadar, M., McDonald, R., & Lentin, P. (2012). Evidence-based practice in occupational therapy services for children with autism spectrum disorders in Victoria, Australia. Australian Occupational Therapy Journal, 59, 284-293.

Kelly, A. & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 48(1), 120-131.

Koenig, K. P. & Rudney, S. G. (2010). Performance challenges for children and adolescents with difficulty processing and integrating sensory information: A systematic review. American Journal of Occupational Therapy, 64, 430-442.

Perez, M., Carlson, G., Ziviani, J., & Cuskelly, M. (2012). Contribution of occupational therapists in positive behavior support. Australian Occupational Therapy Journal, 59, 428-436.

Rodger, S., Ashburner, J., Cartmill, L. & Bourke-Taylor, H. (2010). Helping children with autism spectrum disorders and their families: Are we losing our occupation-centered focus? Australian Occupational Therapy Journal, 57, 276-280.

Rogers, E. M. (1983). Diffusion of innovation (3rd ed.). New York: The Free Press.

Shook, G. L. & Favell, J. E. (2008). The Behavior Analyst Certification Board and the profession of behavior analysts. Behavior Analysis in Practice, 1(1), 44-48.

Veverka, J. (2014, February). 2014 State Legislative Forecast. OT Practice, 7.