Monday, May 19, 2014

The "Why" of Selecting Goals for Intervention




Reference: “Balancing the right to habilitation with the right to personal liberties: The rights of people with Developmental Disabilities to eat too many doughnuts and take a nap”, D. J. Bannerman, J. B. Sheldon, J. A. Sherman, and A. E. Harchik (1990)

Just the other day a direct therapist asked me how do BCBA’s decide on what targets to teach, what skills to improve on, and in what order to teach skills. It’s a very loaded question.  There are multiple factors to consider when determining what to work on with a client: funding source (how much time do we have to teach the child), wishes of the family/caregivers, are severe behaviors present, are barriers to learning present, is the child in school or not, etc. It’s a heavy crown of responsibility. Selecting goals for intervention is made simpler with the use of assessment tools, such as the VB-MAPP or ABLLS-R, or through a proper intake process where caregivers are carefully interviewed.

Beyond just deciding “What am I going to teach this individual”, much consideration and thought needs to go into “Why am I selecting these goals?”. ABA is a powerful method of implementing behavior change. It’s like glue; when you apply it to something, it will stick. If you accidentally apply it to the wrong area, or you put too much glue in one spot, glue still sticks.

Who gets to decide what an individual receiving treatment needs to work on? If the individual is over the age of 18 and mentally capable, they can just tell you. When working with cognitively capable adults (or even adolescents), they are involved with their own treatment. Their consent, or assent, must be obtained before treating them. 
However, what about those kiddos who are either young, or not mentally capable of saying “Tameika, you’re right. I should decrease the frequency of my tantrums”.

These are important things to think about as a professional. Why should a child’s stimming behaviors be reduced? Why should an introverted, shy child be required to socially interact? Why should a child have their hyperactive behaviors decreased, or extinguished?  What about client choice?

There will be times when as the professional, you do not agree with the goals the caregivers or teacher want to work on. I think many of us have been in the situation of working with a teacher who wants your client to “calm down and be still” during class. Well, there is a difference between using ABA as a magic wand to create perfect children, and utilizing ABA to intervene on socially significant behaviors that interfere with learning. Sometimes as professionals, we have to explain that difference to people. 


 Some of the things you see as “problem behaviors”, the parents will not. The parent may have no issue with their child jumping off furniture at home, or talking back to adults. Creating a treatment plan must involve the primary caregivers, and as much as possible the individual receiving treatment. Client preferences, personality, family culture, and client choice must be considered.

As professionals designing interventions we yield a lot of control over what the client will learn and what behaviors will be reduced. It’s critical to avoid a heavy hand with that control, and to provide multiple opportunities for client choice. Avoid cookie-cutter programming that has Program A for hyperactivity, Program B for social deficits, etc., as these types of treatment act as if all the clients are the same.

Ask yourself does the target behavior cause harm to the child or others, does it interfere with learning, or does it cause (harmful) social stigma. I emphasize harmful social stigma, because all of us experience social stigma to some degree, at some point in our lives.

Think about some of the behaviors you have: Do you get angry at your spouse and furiously stew in your anger for days instead of talking it out? Do you have difficulty sharing your belongings? Do you sometimes fail to eat all your vegetables?  Do you leave dirty dishes in the sink when you go to bed? What if someone decided these behaviors were “maladaptive”, and implemented an intervention to modify your behavior? I bet if someone were writing your behavior plan, you'd definitely want to give your input.


*Recommended Reading: “Burden of Choice
 

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