Functional Behavioral Assessment, Diagnosis, and Treatment: A Complete System for Education and Mental Health Settings - Ennio Cipani PhD 2018

Preface

Purpose of This Book

This book provides a comprehensive approach to designing behavioral treatments for children in homes and residential facilities, students in special and general education settings, and adults residing in inpatient units and facilities. Providing effective behavioral treatment strategies in these settings requires an understanding of the problem behavior’s environmental function. A comprehensive approach to a behavior-analytic model involves the following: (a) conducting a functional behavioral assessment (FBA), (b) selecting a function-based hypothesis or classification of the problem, and (c) designing a function-based behavioral intervention or treatment. In regard to the hypothesis or classification activity, the forthcoming content of this text features the Cipani Behavioral Classification System (BCS). The Cipani BCS is a pioneering and groundbreaking taxonomy for classifying the functions of problem behaviors (Cipani & Cipani, 2017; Cipani & Schock, 2007, 2011). Codification of problem behaviors on the basis of the form of behavior or clusters of behaviors is the prevalent model in education and human services. But such a taxonomy is both insufficient and immaterial for a functional behavioral treatment approach. To provide treatment related to the problem behavior’s contextual factors, a classification system must provide a framework for classifying behavioral phenomena that represent the same or similar environmental context factors. The Cipani BCS does so! Additionally, the same pragmatic model needs to be existent for behaviors that should be strengthened in the individual client or student’s repertoire. This text also provides a revolutionary classification system for determining the strength of replacement behaviors and functions: The Cipani Diagnostic Classification System for Replacement Functions.

How is a functional approach different from merely prescribing treatment based on the form of behavior? Let us say we have identified the following target behaviors for a student in a special education class for behavior disorders: aggressive behavior, noncompliance, and tantrum behaviors. Suppose behavioral assessment data reveal that all these behaviors occur when the student is asked to read a passage aloud. The child may initially refuse to read when called upon. The child’s refusal to read is unsuccessful, as the teacher moves closer to the child to “coax” him or her, the child then throws a tantrum. As the child finds the tantrum doesn’t work, he or she does find that the teacher becomes more coercive. Finally, the student gets out of his or her seat and issues profanities about the assignment. By understanding that all these behaviors have the same environmental function, a functional treatment can address them as a response class. Further, one may be able to determine why such a task generates escape behavior with this child.

In the 21^st century, selecting effective treatment for specific individual problem behaviors requires a greater understanding of the environmental function of problem behavior. This book addresses that need for a variety of potential users of behavioral technology. At the heart of this approach there are three sequential phases: (a) an FBA, (b) a function-based diagnostic classification of problem behavior, that is, Cipani BCS, and (c) a designation of a functional behavior-analytic treatment with consideration and analysis of the strength of the designated replacement function.

We take the position that a complete understanding of a behavioral function is necessary to conduct FBAs, diagnose the putative function via a classification system, and prescribe a function-based treatment. It is not simply enough for a text to offer boilerplate forms for use. One must ensure that an underpinning theoretical framework is offered and understood by the user as a prerequisite for utilizing provided fill-in-the-blank forms. It is to this end that this text provides a comprehensive discussion of basic concepts of the environmental function of behavior, prior to the chapters that detail assessment and treatment procedures.

This functional approach is suited for cases in which the problem behaviors are primarily operant in nature. The rate of operant behaviors is determined by their consequences. In some cases, referred problems may be respondent in nature (e.g., crying due to extreme physical pain; see Bailey & Pyles, 1989, for greater delineation of these factors). In these cases, this classification system is not applicable because the behavior may not be a function of any desired consequence (on the part of the client). Under these circumstances, it might be advisable to consult with a professional who may have experience with such problems.

Audience

Textbook Market

This book can serve as a primary text for university graduate training programs in applied behavior analysis (ABA). Such programs may have a sequence of courses approved as meeting the Board Certified Behavior Analyst (BCBA) task list requirement by the Behavior Analysis Certification Board (BACB). This text is of great utility in such ABA programs as it can be used in several different courses. Several chapters address assessment concerns that would fit into courses involving behavioral functional assessment. Several of the later chapters in the text that focus on functional treatment would be appropriate for courses covering application and intervention. The task lists objectives that are addressed by each chapter are delineated in the front part of the Chapters 1 through 4.

This third edition has undergone changes and revisions that would make it more user-friendly for preservice programs that are not necessarily BCBA-approved track programs. Graduate programs in school psychology and special education can also use this material as an adopted text requirement for several courses. Again, because of the nature of this text covering both assessment and intervention, it can be used in multiple courses in school psychology: behavioral assessment, emotional behavioral assessment, and school consultation. Special education programs also share courses that deal with school consultation, as well as courses covering behavior management and methods courses that deal with behavioral intervention. Both sets of courses would find this text appropriate as a required text for their course objectives. Chapter 3 of this current text could be supplemented with several classes covering the diagnostic manual material of the Cipani BCS (Cipani & Cipani, 2017).

Practitioner Market

This book is also intended for applied personnel who design behavioral programs for persons with challenging behaviors in a variety of settings, such as individual homes or group residences; public or private facilities; schools; hospital, community, or clinic settings; and inpatient settings. This book should be helpful to people who are trained in ABA and are looking for an additional resource to guide them in their assessment and treatmen-design activities. It is written also to serve personnel who have some familiarity with behavioral programs but have not discerned how to provide a functional behavioral treatment for specific functions of target problem behavior. The following clinical and educational practice areas are particularly pertinent for personnel with some familiarity regarding FBA and positive behavioral intervention.

School Personnel Working With Special Needs Student. The use of behavioral technology, involving assessment and treatment activities, has proliferated in school settings in the last several decades. The explosion in utilization was the result of the 1997 Federal Individuals With Disabilities Education Act statute and promulgated regulations. This law required FBAs and positive behavioral interventions for students with challenging behaviors who are served in some capacity in special education via an Individual Education Plan. As a result, school psychologists and others are tasked with conducting an FBA if certain behavioral criteria are met for a given student. Teachers are subsequently tasked with data collection efforts during the assessment phase. They also have a primary responsibility in implementing any prescribed behavioral intervention to address the challenging behaviors in the student’s school settings.

Personnel Who Work in Inpatient Units and Residential Facilities. The use of behavior-analytic treatments is finding its way into inpatient units, residential facilities, and community settings for persons with severe mental illness, developmental disabilities, and sustained brain injury. Although there is no federal or state imperative requiring an FBA or functional behavioral intervention plan in these settings, simply designing arbitrary contingency interventions can lead to ineffective treatment or worse, disastrous treatment. Mental health providers in these settings who determine what the function of presenting problem behaviors serve will be more capable in ameliorating behavior problems. The client’s possible reintegration into mainstream settings will hinge on such progress.

Personnel Who Provide Parent Training/Consultation. Parent training and consultation, from a behavioral framework, has been verified as an efficacious treatment for child problems in home settings. Psychologists, psychiatrists, nurses, and other mental health providers should be providing technical behavioral assistance to parents who need specific help for problem behaviors. This book provides such professionals with a resource for designing individualized functional behavioral treatment programs.

Overview of Material

This book is now divided into six chapters, which is a change from the prior two editions. Due to the increasing length of material covered in Chapter 5 in previous editions, the material has now been separated into two chapters: Chapter 5 covers access functions and Chapter 6 covers protocols and illustrations of escape functions.

In Chapter 1, material will be presented that will allow the reader to acquire the basics of an ABA approach to understanding human behavior. This edition provides an analysis of the role of establishing operations (EO) and abolishing operations (AO) in the section of the first chapter titled “What Makes a Reinforcer a Reinforcer?” It has added material in this section to enhance a basic understanding of EOs and AOs as the “driving force” of any operant behavioral function. This third edition also has pulled out some of the theoretical material on unconditioned and conditioned EOs and AOs from the written text. Also, a section discussing the nature of contrived contingencies and their relation to behavioral function is presented at the end of Chapter 1. Understanding why contrived contingencies may work is important for behavior analysts who intervene at a group level, not just at an individual case level.

Chapter 2 allows the user to develop skills in collecting the requisite behavioral data needed for an FBA. Each step of data collection is detailed with multiple examples of hypothetical data provided for the reader. The analysis of EO variables in all the assessment methods is delineated in this third edition. All the same methods of functional assessment from the prior edition are clearly delineated in this edition as well. A useful addition for practice in this third edition involving a newly developed methodology for conducting a behavioral interview is presented: The Cipani EO School Behavioral Interview Form. This interview form will be particularly useful for practitioners as a starting point for discerning the problem areas and their antecedent and consequent factors. A form for ready use can be found in the relevant Appendix, with permission granted contingent on the appropriate reference credit given to this rating system in any report.

While this book provides content on FBA, not all applied problems in clinical settings require only an individual analysis of behavioral function. It can often be the case that problem behaviors are generated by the systemic contingencies that are misdirected. The last part of Chapter 2 involves a presentation of an ecosystemic assessment within classrooms to determine if classroom contingencies might be at the heart of a referred student’s problem behavior. By conducting such an assessment, the behavior analyst might uncover systemic contingencies that do not facilitate student or client performance, which allow other contingencies that detract from such to flourish. For example, in a classroom, one might find that a system that provides powerful reinforcers for academic performance is lacking. The installation of such a class-wide reinforcement system across the group would significantly alter performance problems in the target student and others.

Chapter 3 covers the four major categories of the Cipani Behavioral Classification System, a unique function-based, diagnostic classification system for problem behavior. This system provides a distinctive numbering system for delineating major diagnostic categories as well as subcategories within each major category. There are many illustrative real-life examples from my own experience and the experience of my former coauthor, Keven Schock, as well as hypothetical examples, which are drawn again from our decades of clinical experience.

Chapter 4 covers the identification of the replacement behavior and the delineation of a number of replacement function options for each major function. It provides multiple examples of how each differential reinforcement strategy is used for the particular major function. This edition also introduces the concept of a replacement function. Some of the treatment options cannot be defined as a behavior (e.g., tolerance training). This change in nomenclature allows for a more encompassing term to fit such phenomena.

Chapter 4 also presents a method for evaluating potential extinction bursts and their severity and length via a trigger analysis. The Cipani Diagnostic Classification System of Replacement Function, a unique, three-category classification system for determining the current strength of the replacement behavior(s), is presented at the end of Chapter 4. This section includes a presentation of the behavioral criteria for each classification. It also provides analogue experimental tests to determine whether a misdirected contingency diagnosis or inept repertoire diagnosis best explains why the replacement behavior/function is at low or nonexistent levels. With permission, Appendix B is taken from the book Triumphs in Early Autism Treatment (Cipani, 2008). It provides an analysis of persistent error patterns through the findings of basic research in stimulus overselectivity.

Chapters 5 and 6 provide the same compendium of behavioral treatment protocols as the earlier edition. A hypothetical example taken from the previous chapters is used to illustrate how all the phases are linked in designing a functional treatment. Each functional treatment program follows a uniform format in Chapters 5 and 6. First, we present a brief description of the procedures involved, as well as definitions of terms. Next, we delineate the procedures for collecting baseline data, and we present the procedural components of the treatment. Finally, we present a hypothetical example illustrating the application.

A Note to Instructors: Third Edition Changes

There are significant pedagogical changes in this edition to the text and supplemental material to make it more amenable for university-training programs in applied behavior analysis, school psychology, and special education teacher training. Here are some of the changes in this third edition that will enhance student learning of applied skills for teaching faculty.

Chapter Objectives and BACB Tasks Addressed

At the beginning of each chapter, the list of objectives addressed in each chapter appears. This should allow the instructor to match these up with the fourth and fifth editions of the BACB (2013, 2017) task lists tasks addressed in the chapter are provided below the chapter objectives) or other such accrediting agencies’ specifications. Word files of this material as well as other information that may be helpful in building a course syllabus is available to qualified adopters in the password protected instructors resources.

Narrated Lectures and Text-Embedded Assignments

References to related online lecture presentations are embedded in the text and highlighted by this icon, placed in the margin of the page. Such lectures are accessed via Springer Publishing’s website (www.springerpub.com/fbadt) with lectures clearly marked with the name delineated in the text under the icon. The content of the lectures covers additional material as well as applied demonstrations of FBA and functional treatment with diverse clinical and school populations in various settings. The specifics of the assignment are demarcated in the text below the special icon signifying narrated material. The criteria for each assignment are delineated and may serve as rubrics for grading purposes. Chapter 1 has one assignment, Chapter 2 contains three assignments, Chapter 3 has two assignments and Chapter 4 contains three assignments.

Simulation Exercises

A format for classroom exercises that simulate some of the assessment methods (e.g., Chapter 2) in the text is delineated. These practice exercises can be performed in class to facilitate students’ acquisition of actual skill in data collection and the conduct of the designated assessment and its procedures. The specific method for providing the classroom simulation is presented under the caption where indicated. There is also a simulation found in Chapter 1; it provides demonstrations of the four major functions. A simulation exercise in Chapter 4 allows students to observe how to “shape” an alternate behavior involving an appropriate request or protest (termed mand).

Chapter 1

✵Type of access or escape function

Chapter 2

✵Data Recording

✵Trigger analysis of access functions

✵Trigger analysis of escape functions

✵Analogue assessment

Chapter 4

✵The “Yes” game

Discussions

Discussions of the presented content are embedded throughout the text in the first four chapters. This inserted material can be used for class discussions (make sure students bring their texts to class to refresh their memory) or as online discussion threads.

✵Chapter 1: 1A—1D

✵Chapter 2: 2A—2F

✵Chapter 3: 3A—3H

✵Chapter 4: 4A— 4F

Using Chapters 5 and 6; Signature Assignment

The protocol material in Chapters 5 and 6 allows the reader to view the longitudinal conduct of an FBA, diagnostic classification selection and design, and implementation of functional treatment with hypothetical cases. We recommend that faculty using this book save this chapter for the end of the course, and that the material be used to develop ­case-presentation skills (possibly the signature assignment). Each student can be assigned (or choose) a given protocol for study and prepare a case presentation in front of the class. In these presentations, the student steps into the “role of the teacher or therapist” of the particular hypothetical case and covers the following in a half-hour to one-hour oral presentation:

✵Presenting behavior problem

✵Analysis of “why”—hypothesized function of problem behavior and relevant classification category

✵Data collection from assessment method used and results

✵Functional treatment developed and deployed

✵Treatment results

✵Summary (why did it work)

In many cases, the graduate students in the course do not have access to students with challenging behavior in which to conduct an actual FBA. Or often, privacy and confidentiality issues, as well as legal issues involving the parents and IEP team’s school personnel consent to conduct such an assessment, preclude such an assignment to students. Hence, a signature assignment involving real-life data collection is frequently precluded. In those circumstances, the earlier case presentations are an approximation of the genuine longitudinal process of assessment—classification—treatment personnel conduct with actual students requiring an FBA.

Instructor’s Resources

The password protected online instructor’s resources are available to qualfied adopters upon request. Instructors will find the following:

✵An extensive slide presentation for each chapter is available. It contains “presentation units” within each chapter that cover a section of the chapter’s content in the slide presentation. Each presentation unit is followed by slides that pose questions from both the slide material as well as the text. This facilitates “active student engagement and responding.” The questions are generally short answer. Students can convey their responses to such questions in any number of mediums deemed viable by the instructor (dry erase boards, paper, vocal responses, etc.). It is therefore important that students bring their text to class to be able to address such questions that are derived from the text. This format will also facilitate more active student engagement in the instructor lecture with the PowerPoint slides. If you do not desire such slides they can always be hidden using the tool in the main navigation bar.

✵A pool of chapter test items (multiple-choice and true/false items) that are separated into areas of content within each chapter (e.g., items measuring student’s comprehension of analogue assessment methods)

✵Measurement items (short answer) for determining student competency with each chapter objective

✵A narrated presentation detailing the supplemental materials and suggestions for use

✵“Modularized” chapter PowerPoint slide presentations with group answer test items (called active student responses or ASRs) within each module section

✵Course Syllabus Builder: provides Word files that can be copied and pasted to develop many of the components required in a course syllabus, such as:

○Brief descriptions of each chapter

○Chapter topics

○Chapter objectives and BACB task lists for each chapter

○Assignment details and rubrics for scoring (including signature assignments)

✵“What to Read if You Used the Second Edition,” a conversion guide for current adopters highlighting changes between the second and third editions

Student Resources

Supplemental lecture videos and PowerPoints are available to students to help further clarify key concepts reviewed in the text. Students can access the additional material by visiting http://www.springerpub.com/fbadt.

REFERENCES

Bailey, J. S., & Pyles, D. A. M. (1989). Behavioral diagnostics. In E. Cipani (Ed.), The treatment of severe behavior disorders: Behavior analysis approach (pp. 85—107). Washington, DC: American Association on Mental Retardation.

Behavior Analyst Certification Board. (2013). Fourth edition task list. Retrieved from https://bacb.com/fourth-edition-task-list

Behavior Analyst Certification Board. (2017). Fifth edition task list. Retrieved from https://bacb.com/wp-content/uploads/2017/01/170113-BCBA-BCaBA-task-list-5th-ed-english.pdf

Cipani, E. (2008). Triumphs in early autism treatment. New York, NY: Springer Publishing.

Cipani, E., & Cipani, A. L. (2017). Behavioral classification system for problem behaviors in schools: A diagnostic manual. New York, NY: Springer Publishing.

Cipani, E., & Schock, K. (2007). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings. New York, NY: Springer Publishing.

Cipani, E., & Schock, K. (2011). Functional behavioral assessment, diagnosis, and treatment: A complete system for education and mental health settings (2nd ed.). New York, NY: Springer Publishing.

Acknowledgments

I want to thank my co-author of the first and second edition of this text, Keven Schock, BCBA, for his contributions to the previous and current material. The actual cases he presents in this 3rd edition will be denoted via his name. The functional behavioral diagnostic system delineated in this text are an outgrowth of our collective experience in clinical and teaching positions over several decades. An earlier version of this system, called the Cipani Behavioral Assessment and Diagnostic (C-BAD) System, provided us with feedback and input from many behavior analysts who utilized that system in the 1990s. Such feedback improved the basic concepts and instructional content presented in the first edition. In particular, the authors would like to recognize Dr. Heidi Toro of the Florida Department of Children and Families, Dr. Merrill Winston of Professional Crisis Management, Dr. Steve Eversol of Behavior Development Solutions, and Mr. Chris Clay of the Community Re-Entry Program for their valuable suggestions over the years. Our association with them has allowed us to improve our analysis and presentation of the conceptual and methodological model that embodies the current form. Finally, I wish to thank Dr. Jose Martinez-Diaz of the Florida Institute of Technology for making the distinction between motivative variables and discriminative stimuli more clear to me.

Objectives

✵Students will be able to describe and provide an illustration of a direct access function

✵Students will be able to describe and provide an illustration of a direct escape function

✵Students will be able to describe and provide an illustration of a socially mediated access function

✵Students will be able to describe and provide an illustration of a socially mediated escape function

✵Students will be able to identify an establishing operation for a number of access functions as one of a state of deprivation

✵Students will be able to identify an establishing operation for a number of escape functions as one of a presenting state of aversion

✵Students will be able to discuss what a contrived contingency is and how it can “override” existing motivational variables