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THE JOURNEY TO COMMUNITY HOUSING WITH SUPPORTS
The agency operates three homes serving individuals with similar support needs. They cluster their homes within a five- mile radius so that supportive medical, clinical and supervisory personnel can be shared among the residents. Utilizing Applied Behavior Analysis (ABA), all staff receive extensive training on the principles and practices of ethical and effective behavior support. To figure out why Walter acted this way, staff carefully defined and recorded the frequency, intensity, and duration of his challenging behavior as well as what occurred right before and after the behavior under the direct supervision of a Board Certified Behavior Analyst (BCBA). Then the team generated hypothesis statements regarding the purposes the behavior served for Walter and the likelihood of the behavior occurring or not occurring during various situations. These hypotheses served as the basis of the behavior intervention plan that outlined skills to teach Walter how to meet his own needs and get along with others in more adaptive ways. Staff were trained on the plan’s implementation and consistently followed it to prevent and minimize challenging behaviors. Staff’s adherence to the behavior plan kept everyone safe and taught Walter more adaptive behavior. As the behavior program proved to be effective, the agency nurse communicated with his physician to review and adjust his medications with the goal of reducing them as much as possible. A medical practitioner and a psychiatrist consulted with a team of professionals regarding a comprehensive treatment plan maximizing the effectiveness of the behavior program while minimizing the use of medications that could result in more long-term detrimental effects.
Technology in a home permits the clinical staff to observe the person as they interact with staff and residents. When a resident engages in a challenging behavior, the behavior analyst can
support the individual and staff during the incident through a remote monitoring system from any location, while not providing undue attention to the episode.
Walter continued to make progress as a result of ongoing behavioral assessment and the use of technology during transitions. Previously, staff noted Walter engaged in aggressive behavior during changes in his routine, especially when they intervened. Following direct observation, the behavior analysts taught the staff how to use antecedent- based interventions such as structuring Walter’s daily activities, teaching him how to handle transitions appropriately, and teaching him how to use a watch to signal upcoming changes. These interventions have drastically reduced his aggression and increased his independence in maintaining his own schedule. Walter is eating healthy meals and participating in his daily hygiene routines. He has more opportunities for recreation and socializing with family and friends.
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