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The Right To Treatment

Seminar in Behavior Modification
by

Kimberly Foerster

on 28 March 2013

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Transcript of The Right To Treatment

Presenter: Kimberly The Right to Treatment Bannerman et al. Breaks down the right to habilitation and a client’s right to personal liberties
Disucsses perceived choice and the illusion of choice
Presents arguments opposing the right to choice and those in favor of the right to choice
Discusses protecting right to habilitation and choice Habilitation & Personal Liberites Balancing the right to habilitation with the right to personal liberties: the rights of people with developmental disabilities to eat too many doughnuts and take a nap Van Houten et al. The right to effective behavioral treatment Discusses 6 rights of individual's that should be considered when applying behavioral treatment in order to make it the most effective treatment possible
Lays out the responsibility of a behavior analyst in order to achieve most effective treatment Habilitation Ruling of the case Wyatt v. Stickney set minimum standards that included:
Individualized habilitation plans
A humane physical environment
Assurance of enough qualified staff to administer adequate treatment Teaching the skills needed to live as As of 1975 a constitutional right to habilitation had not been established; as of 1982 the Court guaranteed only as much habilitation as needed to ensure freedom from undue restraint Personal Liberties
Some may argue even more basic than the rights detailed by the constitution (i.e. right to be alone, right to go where someone pleases)

At issue is whether habilitative service providers actually allow clients with D.D. all the

interest. A person with a disability shall be entitled to such habilitation and rehabilitation services as available and needed for the development or restoration of their capabilities to the fullest extent possible. Such services shall include, but not be limited to, education, training, treatment and other services to provide for adequate food, clothing, housing and transportation during the course of education, training and treatment. A person with a disability shall be entitled to these rights subject only to the conditions and limitations established by law and applicable alike to all persons. (1973, c. 493, s. 1; 2005450, s. 1.)

Massachusetts Developmental Disabilities Council (MDDC) 1. Clients may have little or no input in decisions regarding their priority treatment goals, impacting preference and motivation
2. Teachers or staff may teach behaviors with no regard for the client’s preference or past learning in the area (May make decisions based on their own interests of time, money, protectiveness and preference)
3. Choice making is not often taught
4. Opportunities for choice are not often given. Rights guaranteed by the Constitution Ways Personal Liberties Can Be Compromised
Often times compromise is due to service providers attempting to meet the standards for habilitation Services Whose Overriding Goal is Personal Welfare An Individual has the Right to... a Therapeutic Environment Treatment by a Competent Behavior Analyst Programs That Teach Functional Skills the Most Effective Treatment Procedures Available Behavioral Assessment and Ongoing Evaluation A physical and social environment that is safe, humane, and responsive to

Access to therapeutic services, leisure activities, enjoyable and instructive materials
Parents, teachers, and staff who are competent, responsive, and caring
A Both immediate and long-term welfare taken in account by active participation in making treatment decisions by the client or an authorized proxy The primary purpose of behavioral treatment is to assist individuals in acquiring functional skills that promote . exist to ensure personal welfare remains uncompromised when behavioral treatment choices are being made Peer Review Committees Human Rights Committees Impose professional standards to determine the clinical propriety of treatment programs Impose community standards to determine the acceptability of programs and the extent to which a program comprises an individual’s basic rights to:
physical examination prior to the initiation of a program that may affect or be affected by an individual’s health status.
dignity, privacy, and human care
appropriate education and training
prompt medical treatment
access to personal possessions, social interaction, and physical exercise
humane discipline The ultimate goal of all services is to increase the ability of individuals to function effectively in their immediate environment and the larger society Achievement of this may require:
Acquisition, maintenance, or
to gain a wider access to preferred material, activities, or social interaction
Acquisition of behaviors that allow the individual to terminate or reduce

Reduction or elimination of certain behaviors that are dangerous or serve as barriers in some way that furthers independence or social acceptability
Services that assist in the development of behaviors beneficial to society at large Individuals in charge of delivering, directing, or evaluating the effects of behavioral treatment should possess appropriate should reflect thorough knowledge of behavioral principles, methods of assessment and treatment, research methodology , and professional ethics Academic training should include adequate practicum training and supervision, and experience with the relevant client population Clinical competence If a problem or treatment is complex or poses a risk, an individual has the right to direct involvement by a a clients
that their services are scientifically accurate and up to date
that treatment is provided at
that individuals in need are not Entitled to effective and
It is a BA's obligation to use only techniques that have been demonstrated by research to be effective, to acquaint consumers and the public with the advantages and disadvantages of these techniques and to search continuously for the most optimal means of changing behavior Exposure of an individual to restrictive procedures is unacceptable unless it can be shown that such procedures are necessary to produce safe and clinically significant behavior change; and vise versa A client's right to effective treatment may dictate the immediate use of quicker acting, but temporarily more restrictive, procedures. Overall Level of Restrictiveness Absolute level of restrictiveness A COMBINED FUNCTION OF: Consequences associated with delayed intervention Amount of time required to produce a clinically acceptable outcome BA needs can maintain accountability and solicit timely input into decision-making processes by sharing data regularly with all concerned parties Prior to treatment, individuals are entitled to a complete diagnostic evaluation to identify factors that contribute to the presence of a skill deficit or a behavioral disorder Conduct Complete Functional Analysis for ABCs
Initial Analysis is 3 Stages: Successful intervention requires ongoing evaluation in the form of objective
the effects of treatment, to quickly 1. Interview
2. Direct Observation
3. Systematic Treatment Plan A Behavior Analyst has the responsibility to ensure CHOICE and what about the Right of Choice? Arguments People with developmental disabilities may make choices

of a client may be for a skill they have not mastered

Individuals are often unaware of

associated with their choices

Allowing freedom of choice may hinder their acquisition of critical independent living skills– abridging personal liberties in order to teach independent living skills is an appropriate trade off Brigham (1979) defines The opportunity to make an as choice The illusion of freedom and choice play an important role in an individual's successful functioning Behavior analysts may argue that choice is not Idea that perceived choice is extremely valued by many people Protecting Both the Right to Habilitation and the Right to Choice The Right to Choice The ability of a client to exercise choice may prepare him or her to live in the community where individuals are expected to make decisions and choices Legislation guarentees it Declaration of Rights of Mentally Retarded Persons, 1972 and Developmental Disabilities Assistance and bill of Rights Act, 1979 Experimental research reflecting the support for individual liberties has demonstrated that individuals frequently prefer situations in which they have choice OPPOSING SUPPORTING Effects of Choice on Preference When given the option, clients most frequently chose a situation in which choice was made available Individuals appear to participate
when opportunities for choice are made available Effects of Choice on Responses to Aversive Stimuli Effects of Choice on Problem Behavior Effects of Choice on Task Performance Effects of Choice on Participation Opportunities to make choices in a situation may improve performance Exhibited Subjects who could control an aspect of an aversive situation (eg choice of termination, duration, or presentation) reported less discomfort and had less extreme autonomic responding than subjects who received the same stimulus but had no control over it Few studies use within-subject analyses with repeated measurement of the DVs
Most employed between-subject group design
Difficult to determine responses of
Many statistics did not indicate strong clinical effects
Some studies conducted in analogue or laboratory situations
Many studies were on undergraduates
Effects of choosing per se may be
Subject perception of whether or not they made choices was rarely assessed
Overall, research indicates that individuals frequently prefer situations in which they have ; choice may have benefits for individuals, especially in increasing participation and reducing problem behaviors Issues with Research 1. Service providers should emphasize teaching independent living skills and other functional behaviors that are

2. Clients should have in decisions about what skills they will learn and how they will be taught

3. Clients should be taught how to

4. Clients at every functioning level should be given
choices in their residential and work settings, within and between scheduled activities All people have the right to choice, but with rights come responsibilites Teaching clients how to exercise their freedoms responsibly should be an integral part of the habilitation process. Encouraged to make choices as thier abilities allow, as long as these choices are not detrimental to the client or others. DEBATE! Conclusions needs environment ensuring safety and development and -level behavior analyst of behaviors that allow the individual sources of stimulation validated treatment unanticipated problems, and, if necessary, to to determine the treatment plan. are protected level of excellence effective treatment as possible they are entitled to and if they do so in a way that has the client’s best selection from two or more alternative events, consequences, or responses frequently when an individual has opportunities for choice in activities and the effects of the variables over time by obtaining preferred outcomes the multitude of by the client to make
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