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In July, 2002, Dr. Matthew Israel, JRC’s Executive Director, presented a paper at the annual conference of the International Association for Behavior Analysis in which he reviewed JRC’s entire treatment program. The following is the portion of that paper that deals with JRC’s positive programming procedures.
POSITIVE PROGRAMMING PROCEDURES AT THE JUDGE ROTENBERG CENTER
Matthew L. Israel, Ph.D.
[Portion of paper presented at the annual meeting of the Association for Behavior Analysis, May 2002]
Figures 1 and 2 present the key steps in JRC's behavior modification treatment program. Each is explained in greater detail below.
1. Identify the behaviors to be changed (Figure 3).
At JRC we analyze the student's problems in terms of sets of behaviors that need to be increased or decreased in frequency. By the term "behaviors" we include externally-observed behaviors such as overt actions as well as internal behaviors that are more difficult to observe, such as thoughts, feelings, emotions and urges.
We have found it convenient to categorize problematic behaviors as belonging to one of seven broad categories, which are these:
If a particular student needs more than these seven standard categories, additional categories are created. And if a clinician wishes to divide one of these categories into smaller sub-categories, he/she may do this.
Most of the target behaviors we initially seek to change are external, observable behaviors. However, as the external behaviors improve, internal behaviors, such as the student's thoughts, feelings, urges and emotions, tend to show an automatic improvement. For example, as the student begins to pass behavioral contracts, succeed in his/her academic work, etc., he/she feels better and his/her self-concept, self-esteem and confidence improves.
2. Record and chart the frequencies of the behaviors (Figure 4).
At JRC we record the daily frequencies of each of these major behavior categories. This recording is done around the clock, 24 hours each day, seven days a week. To accomplish this, a "Daily Recording Sheet" (see Figure 5) is prepared for each student. It has a separate row for each of the major categories of problem behaviors. The name, or abbreviation, of each category is listed at the left end of its row in capital letters, and to the right is a listing of the specific behaviors that will be recorded as part of this category.
Each of the columns is for one hour of the day. If the student exhibits a certain targeted behavior, the staff member makes a mark in the cell that is at the intersection of the row for the behavior, and the column for the time when it occurred. The number of marks at the end of the day shows the number of times that the behavior occurred on that day. That data is then entered in a database by a member of the charting staff at JRC and software converts the data in the database to daily, weekly, monthly and yearly charts.
Figure 6 shows a typical daily behavior chart that we use. The vertical scale is logarithmic. This enables us to use one standard chart that can accommodate a very wide range of behavior frequencies-anywhere from 1/day to 100,000/day. When an important change is made in the treatment procedures-e.g., the introduction of the skin-shock procedure-a vertical "intervention" line is drawn to indicate when this change was made and to help the reader of the chart interpret whether the intervention appears to be associated with any subsequent changes in the behavior's frequency.
The software automatically plots the same behavior data on weekly (Figure 7), monthly (Figure 8) or yearly (Figure 9) charts so that trends over longer periods of time can be detected.
Our system of charting makes use of the principles and procedures known as Precision Teaching or Standard Celeration Charting, which was developed by Dr. Ogden Lindsley and his students.
The same type of charting system is used to measure positive behaviors that the students are taught in their educational program. In some cases, the software we use has a built-in charting system.
3. Establish a powerful set of rewards that the student will want to earn (Figure 10).
At the heart of any successful behavior modification system is a set of rewards that the student will want to earn. Some of the most prominent at JRC are these (the list is only partial):
4. Set up point or token reward systems (Figure 21).
These are systems in which points can be earned by the display of target behaviors and the points can be spent to purchase rewards. For some developmentally delayed students, pennies may be used instead of points. Each student who earns and spends points has a "point sheet" (see Figure 22) that specifies what behaviors earn points, how much various rewards cost in points and what the maximum number of points are that the student is allowed to earn in one day.
5. Arranging a system of behavioral contracts (Figure 23).
Contracts are arrangements in which if the student goes for a specified period of time without displaying certain specified problem behaviors, he or she earns a specified reward at the end of the contract period. If, however, the student exhibits the specified problem behavior(s), the contract is "broken," a new contract is set up and the student tries again. There are many types of contracts that are used at JRC. Normally several will be used at the same time for a given student.
Sometimes the student must pass a certain contract in order to gain access to a place where the student's points or pennies can be spent. For example, the student might have a contract which, if it is passed successfully, allows him/her to go to the Big Reward Store. Once there, however, the student must have earned some points in order to purchase the items that are available in the Reward Store.
See Figure 24 for a more complete description of various contracts that JRC uses with a typical student.
6. Establish a "Loss-of-Privileges" (LOP) procedure (Figure 25).
If the student displays certain major inappropriate behaviors, all opportunities to earn contract rewards or to spend points are suspended. At JRC we call this a "Loss of Privileges" period. The duration of the LOP can vary from minutes to several weeks. Sometimes an LOP status may be combined with shifting the student's residence or classroom to place him in a more highly staffed and less desirable residence or classroom.
7. Teach self-management procedure (Figure 26).
Each of the emotionally disturbed students are taught to select at least one "outer" problem behavior (such as being aggressive) and one "inner" behavior (such as having urges to be aggressive), to count and chart those behaviors, and to select and arrange their own rewards or penalties to change the frequency of the behaviors. Figure 27 shows the chart of a student who is counting his urges to hurt himself. The students meet each week (Figure 28) with other students and with a supervising clinician or other staff member to share the data, display their behavior data and discuss their behavior management techniques.
8. Minimize or eliminate the use of psychotropic medication (Figure 29)
If a student is on medication when he or she enrolls at JRC, the medication may be removed under the guidance of a psychiatrist. Psychotropic medication is employed only if the charted behavior data support the need to use it as an adjunct to JRC's behavioral treatment program. More information about JRC's policies in this area may be found by clicking here.
9. Insure that all counseling is behaviorally oriented. (Figure 30)
It is important that all aspects of the treatment program, including any counseling (Figure 31) that is provided to the student, be fully coordinated with the rest of the JRC program and that the counseling be conducted and offered in a behavioral manner. See www.judgerc.org for further details on JRC's policies on behavioral counseling.
10. (Figure 32) Teach the student to cope successfully with events that normally trigger problem behaviors ("Programmed Opportunities").
It is important to important to identify those stimuli and events that normally trigger the occurrence of the student's problem behaviors. These should be presented to the student on planned occasions; the student should be taught how to cope with these successfully; and he/she should be rewarded when he does so.
11. Set up Safety Procedures to Handle Aggressive Behaviors Safely. (Figure 33)
If a student displays violent behaviors that are a danger to him/herself or others, JRC employs emergency manual restraint in a safe and carefully supervised manner.
12. Changing the components of the treatment system until the charts show the desired changes in behaviors (Figure 34).
At JRC a behaviorally-trained clinician, assisted by the student's case manager, and with consultation from others such as the nurse, psychiatrist, and classroom teacher, oversees the progress of each student. The clinician is responsible for reviewing the charts on a regular basis, meeting with the student from time to time, entering progress notes and writing progress reports, and making changes in all interventions until the treatment program is working with sufficient effectiveness.
At JRC the philosophy is that the student is never "wrong." If the student is not behaving the way we want him or her to behave what is wrong is simply the current set of interventions-they need to be changed until they work more effectively. The clinician who supervises the treatment team is held responsible for making the needed changes.
Each week one of the clinicians presents the charts of his or her students at a "data sharing" session (Figure 35) attended by all of the other clinicians, case managers, other administrators and the executive director. JRC's charting software makes it possible to display all of the important charts of each student on one screen at the same time in "thumbnail" views, as shown in Figure 36. This type of display enables all behaviors being treated to be reviewed quickly and to enables relationships among them to be seen easily.. The group makes suggestions for improving the treatment and becomes immediately aware of any case where a student is not progressing satisfactorily. In effect, through these sessions the group holds the clinician responsible for producing progress in all of the students under his or her care.