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ConnOTA ConferenceCromwell, CTMarch 5, 2016
Amy Burton OTD, OTR/L
OT and ABA Collaboration:Establishing mutual respect through effective interprofessional education, advocacy, and teaming
Learning Objectives Discuss current barriers to OT and ABA collaboration
Analyze ABA methods and terminology; compare to
OT
Learn strategies for improving OT and ABA
collaboration through interprofessional education
Discover ways to advocate for and incorporate OT
theory and techniques into behavior programs without
sacrificing OT foundations
OTA science-driven and evidence-based
profession in which practitioners seek to understand individuals’ ability to adapt,
organize, and integrate sensory information in the environment that affects participation.
ABAA scientific approach for discovering
environmental variables that influence behavior.
(AOTA, 2009; 2015; Cooper, Heron, & Heward, 2007, p.3)
Barriers to professional collaboration
between OT and ABA
Foundational & philosophical differences
Disagreements regarding interventions and goals
How should deficit areas be addressed and who is best suited to work on them?
(Perez, Carlson, Ziviani, & Cuskelly, 2012)
Barriers to professional collaboration
between OT and ABA
Research shows that…
• ABA practitioners express a lower likelihood of adopting recommendations made by OT practitioners
• ABA practitioners are more apt to make recommendations within the behavioral field only
• ABA practitioners believe interprofessional collaboration will result in minor changes to tasks and solutions
(Kelly and Tincani, 2013)
Barriers to professional collaboration
between OT and ABA
Professional Conflicts:
• Research and Response letters
• Official letters written to the AOTA
requesting research
Barriers to professional collaboration
between OT and ABA
ABA is seeking licensure
• May limit overlapping practice areas with
OT
• May limit OT practitioners using
behavior techniques
(Veverka, 2014, February)
Let’s take a walk in ABA’s shoes…
1/6 children is identified with a developmental disability in the US
Autism has risen 289.5% over the past 12 years
ABA grew from 500 to 6000 practitioners in just 7 years (2000-2007)
(CDC, 2015; Shook & Favell, 2008)
ABA Foundations
ABA Instructor, Therapist, Shadow, Paraprofessional (Huh?)
RBT = Registered Behavior Technician
BCaBA = Board Certified Assistant Behavior Analyst
BCBA = Board Certified Behavior Analyst
BCBA-D = Doctoral-level Board Certified Behavior Analyst
ABA-based Programs…
Use a Functional Behavior Assessment (FBA) to…
• define target behaviors• identify the function of target behaviors• develop methods to address target
behaviors
This information leads to the development of a Behavior Intervention Plan (BIP)
(Iwata, Dorsey, Slifer, Bauman, & Richman; 1982/1994)
Terminology
OT ABA Activity Analysis
Proactive Strategies
Demonstrate
Prompt or Command
Screen
Task Analysis (TA)
Non-contingent methods
Model
Discriminative Stimulus (Sd)
Probe
Prompting
OT ABAIn many cases, assess
level of function, promote
initiation of movement,
then prompt
LEAST MOST
Level of physical
prompting is graded (D,
Max, Min, etc.)
Promotion of errorless
learning. Prompting
hierarchy is from
MOST LEAST
Level of physical
prompting may or may not
be graded (full vs. partial)
ADLs and other functional tasks
OT ABA Look at quality of
movements within
each step
May not bridge to
motor planning a
sequence of steps
right away
Chaining (Forward
and Backward)
May look at target
outcomes within each
routine
What we have to offer to behavior-
based programs
OT practitioners understand...
Holistic and person-centered practice models
Creative behavioral approaches
Disability theories
Understanding the influence of environmental
context and adaptation
Neurological and Sensory underpinnings
Effectiveness of Integrated OT and
ABA Models
• Research-supported interventions from different theoretical perspectives are effective in the treatment of ASD when strategically planned for quality and rigor
• Multi-disciplinary approaches produce significant improvements in • core autistic features• behavior• sensorimotor integration• posture and coordination• acquisition of new skills• social skills• sterotypy and self-stimulatory behaviors
(Mukherjee et al., 2014; Odom, Hume, Boyd, & Stabel, 2012)
A Hopeful Shift…
ABA and OT practitioners can begin to utilize
and embrace a more multi-disciplinary
approach at the practice level
“Talk the talk,” without speaking the same
language
In order to design comprehensive
and rigorous programs for
students with special needs,
effective interprofessional
collaboration must occur
Design Clear and Appropriate Methods and Outcome Measures
Functional, occupation-based, and focused on participation (Kadar,
McDonald, & Lentin, 2012)
Realistic and Specific
Age-appropriate
Generalization (reproducible product)
(Burton, 2015a)
Work on Common Ground Areas
Life Skills
Social Skills
ADLs
Self-regulation
And more!!
(Burton, 2015a)
Offer Interprofessional Education and Training
BCBAs value research and theory
RBT/ABA practitioners value a review of practical approaches
Training can improve ABA practitioners’ perception of using sensory strategies in the BIP
Training can improve implementation of sensory-based supports
(Burton, 2015b)
Create Time for Training and Collaboration
Formal staff training
Classroom, collaborative approach
Consult/Data review meetings
(Burton, 2015a; Burton, 2015b)
Advocate
Sensory processing…
Should have an occupation-centered focus
and outcomes (Rodger, Ashburner, Cartmill, Bourke-Taylor, 2010)
Supports play and leisure, social participation, ADL/IADLs, rest and sleep, education, and
work (Koenig & Rudney, 2010)
Think Beyond…Individual supports
vs.
Classroom supports
vs.
School-wide supports
Listen to people… do they need equip or training?
(Burton, 2015b)
Diffusion of Innovations
1. Prove effectiveness2. Share scientific evidence3. Create a “fit” between OT strategies and
the norms, beliefs, and context of the program
4. Be a “champion”(Rogers, 1983)
Be together, not the same…
https://www.youtube.com/watch?v=vnVuqfXohxc
References
American Occupational Therapy Association (2009). Providing occupational therapy using sensory integration theory and methods inschool-based practice. American Journal of Occupational Therapy, 63, 823-842.
American Occupational Therapy Association (2015). Students and the Centennial Vision. Retrieved from http://www.aota.org/aboutaota/centennial-vision/cv.aspx
Burton, A. Y. (2015a). Building acceptance: Blending occupational therapy principles in an ABA-based program. (Currently unpublished doctoral paper). Quinnipiac University, Hamden, CT.
Burton, A. Y. (2015b). Applied behavior analysis practitioner perceptions: Influence of an occupational therapy training in sensory processing. (Currently unpublished doctoral research). Quinnipiac University, Hamden, CT.
Centers for Disease Control and Prevention [CDC]. (2015). Key findings: Trends in the prevalence of developmental disabilities in U.S. children, 1997-2008. Retrieved from http://www.cdc.gov/ncbddd/developmentaldisabilities/features/birthdefects-dd-keyfindings.html
Cooper, J.O, Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Prentice Hall.
Iwata, B., Dorsey, M., Slifer, K., Bauman, K., & Richman, G. (1982/1994). Toward a functional analysis of self-injury. Analysis and Intervention in Developmental Disabilities, 3-20. Reprinted in Journal of Applied Behavior Analysis, 27, 197-209.
Kadar, M., McDonald, R., & Lentin, P. (2012). Evidence-based practice in occupational therapy services for children with autism spectrum disorders in Victoria, Australia. Australian Occupational Therapy Journal, 59, 284-293.
Kelly, A. & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 48(1), 120-131.
Koenig, K. P. & Rudney, S. G. (2010). Performance challenges for children and adolescents with difficulty processing and integrating sensory information: A systematic review. American Journal of Occupational Therapy, 64, 430-442.
Perez, M., Carlson, G., Ziviani, J., & Cuskelly, M. (2012). Contribution of occupational therapists in positive behavior support. Australian Occupational Therapy Journal, 59, 428-436.
Rodger, S., Ashburner, J., Cartmill, L. & Bourke-Taylor, H. (2010). Helping children with autism spectrum disorders and their families: Are we losing our occupation-centered focus? Australian Occupational Therapy Journal, 57, 276-280.
Rogers, E. M. (1983). Diffusion of innovation (3rd ed.). New York: The Free Press.
Shook, G. L. & Favell, J. E. (2008). The Behavior Analyst Certification Board and the profession of behavior analysts. Behavior Analysis in Practice, 1(1), 44-48.
Veverka, J. (2014, February). 2014 State Legislative Forecast. OT Practice, 7.