Naomi sat in front of a handful of toys arranged in a semi-circle. She tossed aside a Rubik’s Cube to begin playing instead with a stack of Magna-Tiles.
And when her Magna-Tile structure was nearly finished, she smashed the tower and sent tiles scattering across the floor.
That scenario was one of many filmed by the iEXCEL team at UNMC as part of an online toolkit for clinicians when assessing patients with behavioral issues.
The project, “Developing a Decision-Making Clinical Manual for Assessment of Challenging Behavior,” is spearheaded by two Munroe-Meyer Institute faculty and is funded by an 18-month grant from Autism Speaks.
Board-certified behavioral analysts Amanda Zangrillo, PsyD, director of the Munroe-Meyer Institute’s Severe Behavior Department, and Tara Fahmie, PhD, associate director of the department, are the primary investigators.
“This project is one of the first of its kind,” Dr. Zangrillo said.
Some people struggle with harmful or destructive behaviors, and this occurs at a higher rate for autistic individuals, she said. Not all practitioners have access to decision supports to guide their assessment and treatment practices, the grant proposal reads. Instead, they may rely on a relatively narrow subset of available strategies to assess challenging behavior.
The project is designed to develop a decision-making manual — including decision supports, written protocols, and video models — that guides providers through selection of evidence-based practices to assess severe challenging behaviors. The manual also intentionally highlights client strengths and characteristics to arrange for individualized selection of assessment components matched with available practitioner and caregiver resources.
“We use function-based interventions,” Dr. Zangrillo said. “A critical first step in this process is identifying the function of challenging behavior. Once we understand function we work with the client and stakeholders to develop an intervention.”
Ideally, practitioners can find a procedure or assessment that fits their individual client’s needs rather than a one-size fits all approach, said Isaac Melanson, a PhD student in UNMC’s Applied Behavior Analysis PhD Program.
“The idea here is that it gives practitioners more options to expand their toolbox,” Melanson said.
Practitioners can visit the free online resource and enter their patient’s demographic information to populate suggested assessment protocols. Those will be accompanied by videos and written directions.
“We’re learning about why and how practitioners make decisions,” Dr. Zangrillo said. “Our approach to patient care should use the right tool for the job — individualizing and prioritizing patients care with the variables and resources we have available to us.”
The technology-enhanced platform is set to launch in late March 2024.