Common Challenges with the TBI Population
Therapy at Behavior Consultants targets each client’s individualized area of need. Many challenges with our TBI clients include difficulty with impulsivity, impaired judgment, inappropriate social skills and challenging or aggressive behaviors in the home and/or community settings. These behaviors can significantly impact a client’s ability to participate in many aspects of their everyday life. Our clinicians can assess and target these areas and work on the development of new, socially appropriate replacement behaviors.
In addition, Behavior Consultants works on skill acquisition or reacquisition of behaviors which may have been lost following the injury. Acquisition skill training also includes establishing structure into daily routines, increasing independence or compliance with activities of daily living, and teaching adaptive social skills.
Our focus is to work with the client and family using applied behavior analysis (ABA) to help the client become as independent and live in the least restrictive environment as possible. Behavior Consultants delivers most of its programming in our clients’ home, school, or work environments. Our goal is to teach, train and modify behavior in the setting where it needs it the most. We accomplish this working closely with family members, teachers, and caregivers to get the best possible outcomes across settings.
Starting the Process
Therapy with our TBI population typically begins with a physician’s referral for behavioral services. The client’s family and/or multidisciplinary team member identifies a need for support behaviorally and a prescription for services is requested by a member of that team. A behavior analyst is then assigned to the case and an assessment is conducted.
Treatment goals for all clients are individualized based on the results of an assessment completed by one of our highly trained clinicians. Our clinicians are trained in completing assessments for challenging behavior, verbal behavior, daily living, and adaptive skills. Assessments are often completed in the form of direct client assessment, observation, and a family, caregiver, and multi-disciplinary team interview.
Treatment and Programming
A program plan for each client is developed based on the priorities of the client and the team of professionals working with the client. Behavior goals chosen are most often those that are impacting the clients’ ability to participate in everyday activities. Teaching procedures used with a client may include:
Natural Environment Teaching (NET): NET is all about naturalistic learning in the natural setting, so that teaching is not just occurring while sitting at a table, but across a variety of environments. Using a client’s interests and motivation, the therapist will look for opportunities to create “teachable” moments targeted toward their goals. Using the principles of ABA, this type of teaching allows for skills learned to be more readily generalized to different environments, stimuli, and people.
Discrete Trial Training (DTT): DTT is a one-to-one instructional approach, using the principles of ABA, to teach skills in a planned, controlled, and systematic manner. DTT is used when a learner needs to learn a skill best taught in small, repeated steps. Positive praise and/or tangible rewards are used to reinforce the targeted skills or behaviors.
Supports and Independence
Following the development of a program plan, a clinician will determine the level of support needed to implement the plan. In some cases, a behavior technician is assigned work with a client to aide in the implementation of the recommended plan. The goal of technician services is to ensure success with the program and fade out as clients develops the skills needed to meet their goals independently. In other cases, there may not be a need for a behavior technician. The support of a behavior analyst may be all that is needed for independence and success in getting back as close to their pre-accident levels of functioning as possible.