Enhanced Choice Model: Two Case Studies
Melisa Santacroce, M.S. CCC-SLP, BCBA
ABSTRACT: Physical management procedures such as restraint or seclusion come with both psychological and physical risks to both the client and treatment team. The Enhanced Choice Model (ECM) as described by Rajaraman et al (2020) attempts to mitigate the need for such invasive strategies. In the following case studies, ECM was utilized with an adolescent and an adult client in the home and community settings over the course of one year. Dangerous escalation and physical management procedures were eliminated while increasing skill development and quality of life. Participating individuals were given three ongoing choices: (a) “practice” by participating in treatment tasks (b) “hangout” with noncontingent access to reinforcement or (c) “leave” by ending the session. For both individuals, safety was maintained within the treatment sessions over the course of one year while time spent in “practice” increased leading to improvements in community access and participation. Standardized and criterion-referenced assessment tools demonstrated gains in all areas across both clients over the course of treatment. Therapy sessions expanded to include community-based activities with peers, vocational tasks, and an increase in activities of daily living both inside and outside of the home. Both individuals participated to a greater extent in educational activities than they did at baseline without direct support from the ABA team. Implications for using the enhanced choice model to emphasize shared-governance, rapport and assent while maximizing safety for both adolescent and adult clients are discussed.
Hanley, G. P., Jin, C. S., Vanselow, N. R., & Hanratty, L. A. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Journal of Applied Behavior Analysis, 47(1), 16–36
Rajaraman, A., Hanley, G.P., Gover, H.C. et al. (2020). Minimizing Escalation by Treating Dangerous Problem Behavior Within an Enhanced Choice Model. Behavior Analysis in Practice, 1-24
Rajaraman, A., Austin, J. L., Gover, H. C., Cammilleri, A. P., Donnelly, D. R., & Hanley, G. P. (2021). Toward trauma-informed applications of behavior analysis. Journal of Applied Behavior Analysis, 1-22
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Frequently Asked Questions
WHAT IS BEHAVIOR THERAPY?
Applied Behavior Analysis utilizes the science of behavior to help discover why an individual might be doing something. For people with communication difficulties, it is very common to use behavior to communicate wants and needs - and sometimes this behavior can become problematic and limiting to their lives and loved ones. Any one of us who struggles to communicate would also likely begin engaging in these types of behaviors - and once we all learn healthier ways to communicate in order to get our wants and needs met, those problem behaviors can decrease. Individuals on the Autism Spectrum in particular can also struggle with managing day to day internal and external stimuli. One adult we work with describes it as "seeing the source code of life" and feeling overwhelmed. At Balance Speech and Behavior, we work closely to identify the obstacles that may stand in the way of the individual in achieving their goals and to design strategies to assist and teach new ways of interacting with their environment. For some people, that means moving closer to independence. For others, it means crafting a circle of care that promotes their choice, preferences and autonomy to the greatest degree possible. You don't usually hear about ABA being utilized in this way - often it is described as "reducing problem behavior" as it's aim. We believe that there is so much more to improving the lives of individuals with this science.
How are people referred to Balance Speech and Behavior?
Since opening, Balance Speech and Behavior has received most referrals by word of mouth. Other professionals in the area as well as families that have worked with employees of the agency have been the most common sources of referrals. We also get connected with families through working closely with Kaseman Hospital and care coordinators at Medicaid who are assisting individuals who may be transitioning between levels of more intensive care. Balance Speech and Behavior also works closely with school districts that request assistance to provide quality IEP services for their students.
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