Component Analysis - How is this different from a Parametric analysis?

Evaluation of a multiple components/treatments within a treatment package Parametric analysis is the evaluation of a range of parameters/values of a single component/treatment

- Also called sequential Withdrawal - Removal of aspects of a treatment Package Uses: Evaluate maintenance of treatment: -Without intervention As intervention -is Faded

Unit 3 Vid Notes Flashcards by GIA Y

April

Notes

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Elements of Medication Evaluation

Informed consent
Cooperation of a prescriber
Target Bx
Sensitive measures
Drug protocol
Identity phases
Experimental design

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Elements of Medication Evaluation

Informed Consent

3 Requirements for informed Consent

Capacity: Ability to make decisions
Information: Can ans basic ques
Voluntariness: Free of Coercion

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Elements of Medication Evaluation

-Informed Consent
Cooperation of a prescriber

What if a prescriber will not work with us to evaluate medication?
Then we do not do an evaluation

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Elements of Medication Evaluation

*Target Behaviors

Who should we involve in the identifying/defining of these?
Prescriber (ask about diagnosis characteristics)
Parents, teachers, caregivers, etc…

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Which measures are more sensitive: Continuous or discontinuous?

*Continuous

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How can we make a discontinuous measure more sensitive?

A. Increase the interval length
B. Decrease the interval length
C. Neither of these, discontinuous measures are equally sensitive regardless of interval length

B. Decrease the interval length

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Drug Protocol

How can we assist here?

-Documentation, Training

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Which dimensions of the 7 Dimensions of ABA does the creation of detailed protocols most relate to?

A. Applied
B. Effective
C. Generality
D. Technological

D) Technological

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Single Subject Research Designs

Common varieties that Dr. Blakely describes?

Withdrawal design - Time consuming
Multielement/Alternating treatments design
Require short half-life and fast-acting effects *Multiple baseline design
Across subjects and settings, not across behaviors

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Carry over effects are more likely if using a multielement design to evaluate the effects of a drug that has a long half-life.

A. True
B. False

A) True

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Drug Holidays

A drug holiday is the removal of a medication for a period of time.

*Why?
- Evaluate strength of drug effects
(and side effects)
- Tolerance issues (may take set time “off” from the drug)

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A drug holiday can serve as a(n):

A. Placebo phase
B. Return to baseline
C. Means to reduce lethality
D. Opportunity to experiment with new prescriptions

B) Return to baseline

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A parametric analysis involves evaluating different _____ on behavior.

A. Medications
B. Doses of a medication 
C. Treatment components 
D. Any of these
E. B and C, but not A

B. Doses of a medication

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Which of the following is likely able to write a prescription for psychotropic medication

A. Counselor
B. Neurologist
C. Nurse practitioner D. All of these
E. B and C, but not A

E. B and C, but not A

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Which step in the medication evaluation process does Tom Freeman state is most likely to be rejected by a prescriber?

A. Design experimental evaluation
B. Identification of behavioral targets
C. Identification of sensitive measures
D. Creation/ documentation of medication protocols

A. Design experimental evaluation-Also cooperation with prescriber and identification of test conditions

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Generally speaking, psychotropic medications can be made more effective by:

A. Including behavior treatment
B. Swapping the drug for placebo
C. Using medications that do not have side effects
D. Reducing dosage of non-psychoactive medications

A. Including behavior treatment

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If you are Not Measuring….

(And Graphing) Then you’re not doing Bx analysis

We can assist in measuring:
Relevant Bx, Side effects, medication/dose changes

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Which of the following is the most sensitive measure:

A. PIR of one school day
B. Rate per school week
C. Duration per day
D. Rate per hour

D. Rate per hour

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If a member of an interdisciplinary team is suggesting the use of a non-behavioral treatment the behavior analyst may suggest which of the following:

A. An evaluation of that treatment’s effects of relevant targets
B. That implementation of this treatment not coincide with other treatment changes
C. Bothofthese
D. Neither of these as we are not responsible for non-behavioral treatments

c) Both of these

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Component Analysis

- How is this different from a Parametric analysis?

Evaluation of a multiple components/treatments within a treatment package
Parametric analysis is the evaluation of a range of parameters/values of a single component/treatment

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Component Analysis

Also called sequential Withdrawal
Removal of aspects of a treatment Package

*Uses: Evaluate maintenance of treatment:
-Without intervention
As intervention -is Faded

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Parametric Analysis

-Observation of Bx under a range of IV values
-Maybe
SR schedule
Strength of procedure
etc….
*Uses
-Determine Effective or sustainable values of IV

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Helen has been diagnosed with autism spectrum disorder. In addition to ABA services, her doctor has prescribed an antipsychotic, her OT has been using a brushing procedure, and her parents take Helen to sessions in a hyperbaric chamber. Assuming the behavior analyst has support from all parties, the best way to evaluate the effects of these on Helen’s behavior is a:

A. Component analysis
B. Parametric analysis

A. Component analysis

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If we do not have support to manipulate the other treatments that a client is receiving then there is no way for us to evaluate the effects of behavioral treatment upon behavior. A. True B. False

B. False-How can we control for changes in other treatments? Coordinate timing to ensure we are not changing our treatment when changes in other treatments are occurring (only one variable changes at a time)

Review/ Summary of BA Roles:

- Measurement Design & Data Collection - Supply Graphs - Interfacing/ Interactions with Prescribers - Design & Documentation of Treatment Effect Evaluations

Jasper is working with a client who receives a range of services including medication. Jasper interacts with his client’s prescriber frequently and gets their feedback on targets to measure and graph. During meetings he supplies graphs and makes suggestions for what to do next with the medication.

Q1) Has Jasper done anything outside his role as a behavior analyst? *Yes, we do not suggest changes to medications Q2) What is Jasper doing that is within his role as a behavior analyst? *Identifying targets and taking data, providing graphs, interacting with prescriber when appropriate Q3) What else might Jasper be able to assist in? *Evaluating drug effects-with the support of the prescriber

Building a Professional Relationship 1) Selection

1) Selection: May be limited based on: location, accepted insurance, diagnoses a prescriber works with

Building a Professional Relationship 2) Assessment

Get to know the prescriber: Interests, professional work, type of caseload

Building a Professional Relationship 3) Professional Relationship

-Rapport building (pairing), identify and provide reinforcers (based on interests), shaping

The shaping procedure Dr. Blakely describes as part of rapport building with prescribers starts with: A. Interacting with prescriber in a friendly manner B. Introducing the graphs we use to track behavioral targets C. Asking questions about possible side effects of client’s medications D. Suggesting the evaluation of the effects of a medication on behavior

A. Interacting with prescriber in a friendly manner

To obtain informed consent related for medication evaluations consumers should be informed of: ``` A. The risks and benefits B. Their right to withdraw consent C. Popular opinions on the drug being evaluated D. All of these E. A and B, but not C ```

E. A and B, but not C

The single-case research design selected for a drug evaluation will be heavily influenced by the: A. kinetics of the drug B. site of action of the drug C. neurotransmitters effected by the drug D. All of these

A. kinetics of the drug

Josey has been working with a prescriber to evaluate the effects of a medication one of their client’s is taking in hopes of reducing the dose. Which type of analysis will be used? A. Parametric B. Component

A) Parametric

Julianna is part of an interdisciplinary team serving a client. Over time the team has put together a very effective treatment package, but unfortunately parts of the package were not introduced in a way that allowed for them to be individually evaluated. Which type of analysis will be used? A. Parametric B. Component

B) Component

When other service providers are not agreeable to manipulating components of a treatment plan what should the behavior analyst do to evaluate treatment effects? A. Nothing, the behavior analyst must have control over all components of a treatment package to evaluate efficacy B. Ensure they are not changing behavioral interventions while other service providers are changing aspects of their interventions C. Leave the treatment team as it is unethical to provide services without the behavior analyst controlling all aspects of service delivery

B. Ensure they are not changing behavioral interventions while other service providers are changing aspects of their interventions

Christi

Reed Notes

INFORMED CONSENT 1) Competence

1) Competence (Capacity): Legally competent (Age 18, adjudicated incompetent). Can they make decisions?

Informed Consent 2) Information (Knowledge)

given all the facts so that they make a decision. Informed of right to refuse to give consent & to withdraw consent anytime with no penalty. Exact Nature, Expected Benefits, Potential Risks of procedure/drug & risks/benefits of alternative approaches. Can they answer questions?

Informed Consent 3) Volition (Voluntariness)

No coercion or duress in obtaining | consent! Discontinue if clear signs of unwillingness

Informed Consent (contd....)

1) Ask ques regarding risks, benefits & alternatives to check understanding 2) Give them time to think, discuss & review all options 3) Should NOT use "Blanket consents" 4) Update signatures before changes are implemented

*Formal or Informal Considerations

-Implied (They go along with it) -Oral (They say, "Yes") •Written/Recorded (includes details of the person’s understanding to be reviewed by indep. party) •obtain written approval from the client!

Incapable/No One to Sign?

*Bx Analyst should: -Discontinue/Don't implement (explain y) if person gives clear signs of unwillingness •Obtain permission from legally authorized person •ONLY implement without consent if clear imminent danger to self/others •ONLY implement if likely to produce: • Beneficial effects • WITHOUT harmful effects • WITH procedural safeguards in place

Necessary For a Proper Medication Evaluation

- Cooperation of a licensed prescriber - Informed consent - Bx targets for reduction/change

Issues Relating To Data Collection

o Rate per waking hour is a more precise & sensitive evaluation measure than rate per day o Collect data on side effects relating to psychotropic medication o Plot medication changes on graphs

Drug Protocol

- Where - When - How - What data

Identify Phases/Test Conditions

- Work with Prescriber - Orient to single subject design - Use of ABA tools - Baseline/Placebo - Drug doses: ascending/descending

Single Subject Experimental Designs Used By BAS To Conduct Medication Evaluations

1) Multiple baseline 2) Alternating treatment design 3) Withdrawal Design

Multiple Baseline

-Across Settings -Across People Note: Can't be across Bx

Alternating Treatments/ Multi-Element Design in a Medication Evaluation

- Allows to see changes even if variability in the data - Can see effects of tx condition quickly - Requires short half-life & fast acting drug effects

WithDrawal Design In a Medication Evaluation

- Provides info even as the experimental conditions are being changed - Time consuming - Drugs with a medium half-life - Consider utilizing drug holidays

DRUG HOLIDAY

``` o Evaluation of the benefit of the therapeutic effect versus the cost/risk of the side effects oReduces the effect of tolerance oProvides a brief return to baseline to provide a withdrawal probe oConsiderations: • Tolerance effects •Side effects •Withdrawal effects ```

Negative Effects Of A Drug Holiday

•Loss of positive therapeutic effect during holiday period •When discontinuing the medication would most likely produce significant & difficult withdrawal effects •When the medication appears to have been effective at significantly reducing severe problem bx •When ongoing clinical oversight is not currently available for this consumer (e.g., the person lives alone)

*PARAMETRIC ANALYSIS

•Separate dosage levels of one drug •Results: •Potential side effects are likely minimized •Toxicity from over-medication is less likely •A good therapeutic effect will be produced by the lowest necessary dose

ABA & THE USE OF MEDICATIONS SUMMARY

•Studies demonstrate medication alone is less effective than medication with ABA services •Discuss side effects w/ physician, & determine way to monitor •Train on bx & potential side effects, track, graph & share with prescriber •Use the PDR (Physicians Desk Reference)

Roles In Interfacing with Medical Personal

1) Medication Evaluation 2) Testing Therapies 3) Relationship

3. Capacity, Information, and _______ are three considerations related to informed consent. a. Confidentiality b. Honesty c. Consent d. Voluntariness

d) Voluntariness

Who can prescribe medication? a. A. Medical doctor/Neurologist (MD) b. B. Psychiatrist (MD) c. C. Physician’s Assistant (PA) Psychiatric Nurse Practitioner (NP) d. D. All of the above e. E. Only A & B

d) All of the above

When working with Prescribers it may help to show them ______ in order to reduce concerns about _____. a. A. Behavior Plans/ safety b. B. CV or resume/ your qualifications c. C. Confidentiality releases/ HIPAA d. D. All of the above

c. C. Confidentiality releases/ HIPAA

Which of the following is the prescriber most likely to object to: a. A. Implementation of ABA Programming & the behavior plan b. B. Documentation and training in medication protocols c. C. Identification and use of sensitive measures d. D. Implementation of experimental evaluation

d. D. Implementation of experimental evaluation

Which type of measurement should be used for target behavior as it is most sensitive ? a. A. Whole Interval b. B. Frequency c. C. Partial Interval d. D. Duration e. E. Any of these

B) Frequency

Drug protocol may include which of the following? a. A. When and how to give the drug. b. B. Measures for staff behavior. c. C. Data collection to help the prescriber. d. D. All of the above. e. E. Only A and C.

D) All of the above

Regarding drug evaluation. An ______can be used if the drug is a fast acting/ short half life. a. A. Multiple baseline (across settings) b. B. Withdrawal c. C. Alternating/Multi-element design d. D. A and C e. E. all of the above

D) A and C

. What is a drug holiday? a. A. A most excellent party with Tom and Eb! b. B. Removing the drug administration for a long period of time c. C. Removing the drug administration for a short period of time. d. D. Fading out the drug administration once tolerance occurs.

C. Removing the drug administration for a short period of time.

Tolerance is the ____ of drug effects with repeated administrations. a. A. increase b. B. decrease c. C. opposite d. D. return to baseline e. E. None of the above

b) decrease

This type of design is most likely used with a drug holiday: A. Alternating treatments B. Multiple baseline (across individuals or settings) C. Withdrawal D. Any of the above

C) Withdrawal

Behavior analysts may face a challenge in finding health care providers who will…. A. treat your population of clients B. accept funding sources for your clients C. collaborate with a behavior analyst D. use experimental design (single subject design) E. All of the above F. C & D only

E) All of the above

What do you do if a member of treatment team or a parent suggests a non-evidenced based treatment?!?! A. Refuse to work with them and site the BACB Code. B. Suggest an evaluation of the treatment effects. C. Implement the IV when it doesn’t coincide with any other changes & measure for effects. D. both B & C E. All of the above

D) both B & C

Research shows that psychotropic medications A. can be more effective if combined with ABA services. B. are rarely effective. C. are more effective if combined with more than one drug. D. are more effective in an ascending dosage. E. A and C

A. can be more effective if combined with ABA services.

We may assist medical practitioners by measuring: A. Target behavior B. Side effects C. Change in IV (medication doses) D. All of the above

D) All of the above.

17. Our role as behavior analysts When working with medical professionals is to: A. Follow the BACB Professional and Ethics Code B. Operationally define, track and graph behavior, side effects and medication changes/doses C. Only change one variable at a time, whether it is a behavior program change or a change in the medication or a change using a new intervention D. Assist clients to live better, happier, healthier lives E. All of the above

E) All of the above

18. Which measurement is likely the most sensitive: ``` A. WIR per waking hour B. rate per minute C. PIR per day D. rate per work week E. Duration per day ```

B. rate per minute

19. Who can sign for an individual to receive treatment prior to implementation? ``` A. the individual B. The caseworker or case manager C. The client advocate D. The parent/legal guardian E. All of the above F. only A & D ```

F. only A & D

Scotty is a 14 yr. old male with a very limited verbal repertoire. He has recently started head banging & punching his face. Staff describe it as “out of the blue” We should first: a. call a team meeting with all team members & parents b. conduct a functional assessment c. implement a DRA schedule d. rule out any medical issues e. Recommend psychotropic medications

d. rule out any medical issues

21. If severe behavior suddenly emerges- first rule out: a. Medical, then environmental, psychiatric only if specific symptoms b. Environmental, then medical, psychiatric if specific symptoms c. Psychiatric, then medical, then environmental d. None of these

a. Medical, then environmental, psychiatric only if specific symptoms

Unit 3 Vid Notes Flashcards

(75 cards)