Complex Behavior

The Complex Behavior (CB) Program at Touchstone Health Services is comprised of BCBAs and behavior technicians who specialize in the assessment and treatment of severe challenging behavior. We value a collaborative approach to make the best decisions and recommendations for the member.

The Complex Behavior Program at Touchstone Health Services provides support to families and individuals who engage in challenging behavior that poses an imminent risk of serious harm to themselves and others. Through an evidence-based approach, our clinician’s use the science of Behavior Analysis to inform their assessment and treatment practices.

Our Approach

At Touchstone, we utilize the science of Applied Behavior Analysis (ABA). Clinicians in the CB department use the principles of reinforcement to teach functional replacement behaviors and reduce dangerous and very dangerous challenging behavior.  It is our goal that our members receive the support necessary to stay in the least restrictive setting possible.

The Complex Behavior team is designed to assess and treat a variety of challenging behaviors.  Below are some concerns that are typically listed upon referral:

  • Self-Injury (e.g. hitting head against objects, slapping face, skin picking etc.)

  • Aggression (e.g., hitting others, kicking others, biting others etc.)

  • Dangerous Property-Destruction (e.g., breaking items (glass, electronics), throwing objects, etc.)

  • Dangerous Elopement (running out of the house)

Members receiving services through CB typically receive 15-25 hours per week of intervention and training following assessment. CB is a short-term program lasting approximately 16-weeks and clinical hours will reduce through the process of successful treatment.  The determination of hours will be based on the results of the functional behavior assessment and the severity of the behaviors of concern.

Getting Started

Our Intake Specialists and Care Coordinators will work with you through the referral process.  After the intake process, the CB team led by a Board-Certified Behavior Analyst ® (BCBA) will work with the caregivers through the treatment process.  Our initial process includes a thorough assessment, creation of an individualized behavior intervention plan, and caregiver training.  In some cases, intensive support may be initially required to maintain safety while implementing the treatment recommendations.

Functional Behavior Assessment (FBA)

Every behavior serves a function.  Within the Complex Behavior department, our team of BCBAs and behavior technicians are highly specialized at figuring out what those functions are.  The process of determining function is called a Functional Behavior Assessment (FBA). The ultimate goal of an FBA is to determine the function of the challenging behaviors as well as the environmental factors that contribute to the behaviors (common antecedents and consequences).  This is done in a variety of ways but will likely include the following items:

Indirect Measurement

These historical documents can indicate what has been discovered, attempted before, and what barriers to treatment may be present.

These interviews help get information right from the source, things sometimes missed during record review.

This interview will focus on the values that are important to the individual caregivers.  Results will lead to the creation of meaningful caregiver goals to focus on in caregiver training.

These scales indicate why the behavior continues to occur.

Direct Measurement

The observation and data analysis of what comes before and after the behavior.

The observation and data analysis dimensions of behavior over time (frequency, duration, latency etc.).

This is sometimes useful to demonstrate what time of day a behavior occurs.

This is sometimes beneficial to show if behaviors occur closely to one another, they may be related in some way (timing), which is important to know.

This is an assessment to measure what the individual likes the most and least.

Putting It All Together

The results of the FBA will be reviewed with you and the rest of the child and family team.  These results will include common antecedents, consequences and the likely function of the behaviors of concern.  In addition, your assessment results will include clinical recommendations for the reduction of challenging behavior and alternative replacement behaviors to increase.

Behavior Intervention Plan

In addition to the FBA, the clinical team will provide you with a Behavior Intervention Plan (BIP).  The BIP is a guide to the strategies that will be used to reduce the behaviors of concern and increase the behaviors selected to replace them.  Each BIP is individualized based on the member’s behaviors and their environment but will include the following components:

We identify variables in the environment which precede the behavior and incorporate changes to those variables to make problem behavior less likely. By reducing those variables that evoke or bring about behavior, you as the parent can make behavior less likely.  For example: Sam hits himself and you give him attention (before), now you give Sam attention on a schedule or continuously so there is less need for him to hit himself.

We identify variables in the environment which follow behavior and incorporate changes to those variables to make behavior less likely.  Most problem behavior continues to occur because of a source of reinforcement in the environment (what the person experiences), and will continue to do so unless that consequence changes.  Through reinforcement, extinction, and sometimes punishment, parents change what follows the behavior and make it less likely to occur.  For example: Sam hits himself and you give him attention (before), now when Sam hits himself you withhold attention.

Just as all problem behavior occurs for a reason, all pro-social behavior must occur for a reason too! Through identifying appropriate alternative behaviors and changing antecedent and consequence procedures, we can make positive pro-social behaviors more likely to occur than problem behavior.  A good replacement behavior is: easier than problem behavior, results in more or quicker reinforcement, and results in the SAME type of reinforcement (function) as the problem behavior. For example: Sam hits himself and you give him attention, Sam could touch a large red button which the pre-recorded message “excuse me” which results in immediate and heightened attention from you.

Caregiver Training

Caregiver Training and Graduation

It is the role of the Complex Behavior department to empower our families through the treatment process to learn the skills in the FBA and BIP.  Meaningful outcomes are only achieved if our families have the skills to move beyond the need for formal supports.  Caregivers will receive extensive training on implementing program goals and all other behavior analytic recommendations. Our team also provides resources and tools for long-term success (e.g. tips for future teachers, using skills in different environments) and works collaboratively with other providers working closely with the member to ensure continuity of care.  Intensive training at the onset of treatment will reduce as the goals set in the treatment plan are achieved, and the CB team will work collaboratively with the family and the Care Coordination team to create meaningful goals and plan for the next steps after graduating from the program!

What Sets Us Apart?

At Touchstone Health Services, our therapeutic approach is centered on interventions established by the National Autism Center. NAC evaluates current practices in order to determine which are the most effective. While this specific report discusses ABA therapy for children with autism, the results can be generalized to many other children with learning needs. You may also review the National Autism Center’s National Standards Report.

We also offer these unique opportunities:

  • Partnerships with other Centers of Excellence

  • Collaboration with highly trained individuals in the field of ABA

  • Access to an integrated system of care with coordination by individuals that specialize in ASD

  • Consultation with the Language and Learning Center at Touchstone. The Language and Learning Center specializes in comprehensive approaches for targeting skill deficits across domains.