THE ROLE OF BEHAVIOR ANALYSTS AND OTHER PRACTITIONERS REGARDING ACTIVITIES PROVIDED IN CENTER-BASED PROGRAMS
Earlier it was noted that typically services for adults with autism involve much less ABA than schools and related service settings for children who have autism. A primary reason for the reduced amount of ABA in the adult sector is there are far fewer behavior analysts working in adult services than in agencies for children with autism. This is particularly the case in center-based day programs for adults. There is, however, a small but growing trend to provide more intensive ABA services in adult, center-based programs in several parts of the United States. This trend has been due in large part to recognition among personnel in ABA programs for children with autism as well as parents of children who receive ABA services that there is a need for improved services as the children they support reach adulthood and leave school. A number of ABA programs for children have begun to expand their operations to include adults in attempts to provide improved services, and the latter services are provided under the direction of behavior analysts. Nonetheless, most adult day programs around the country have relatively minimal involvement of behavior analysts.
When behavior analysts and other clinical practitioners do work with adult service agencies, they are often employed on a part-time contractual basis with the primary responsibility of working with agency consumers who display challenging behavior. Among those agencies that employ behavior analysts as part of the agencies’ regular full-time staff contingent, the primary duty of the behavior analysts and related clinicians also usually involves addressing challenging behavior. In both situations the behavior analysts typically assess the nature of the problem behavior and what appears to occasion and maintain it, develop intervention plans, and then work with staff to carry out the plans. What is frequently missing in the work of practitioners in this regard is a focus on the environmental context in which their behavior support plans are to be implemented.
From the perspective of center-based activities, the environmental context pertains to what the adults with autism are doing while attending the center. If they are doing the types of nonmeaningful activities summarized earlier, then practitioners are in essence attempting to treat problem behavior in a problem environment, which can seriously undermine treatment success (Reid, Parsons, & Rotholz, 2015, Chapter 8). For example, if individuals are not engaging in meaningful and preferred activities, they are often likely to display problem behavior to escape from these activities and/or access more preferred activities.
Attempting to overcome challenging behavior among adults with autism in center-based settings that provide nonmeaningful activities is essentially trying to treat problem behavior in a problem environment.
To illustrate further, a relatively common behavioral intervention for challenging behavior is for staff to interrupt antecedents to such behavior and redirect an individual’s behavior to a more desirable activity. If there is no ongoing activity to which the individual can be redirected—other than sitting or aimlessly wandering around—then the individual is likely to resume whatever was previously ongoing that then leads to problem behavior.
Sometimes practitioners also have the responsibility of designing and overseeing teaching programs implemented by direct support staff in center-based programs for adults. The environmental context is likewise important in this situation. Specifically, there is little reason to train and otherwise work with human service staff to teach adults with autism if what they are teaching has no functional value for the learners. A recent example encountered in a center-based program involved a clinician training a staff member to teach an adult with autism how to stack toy blocks. Learning to stack toy blocks has little if any functional utility for an adult.
For these reasons as well as others to be addressed later, the quality of ongoing activities within center-based programs for adults often warrants attention from practitioners (as well as agency supervisors and related personnel). The intent here is to help practitioners recognize ongoing activities of a nonmeaningful nature and identify more meaningful and functional pursuits for the consumers of agency services. The intent is also to help equip practitioners to apply evidence-based staff training and supervision or consultation strategies to work with staff to bring about more meaningful experiences for adults with autism.