E Test 1 Flashcards
How war Dr. Es treatment program characterized?
superb behaviour modification program
Sunland Miami scandal - what were the immediate consequences of the investigation?
7 ppl suspended
formation of the blue ribbon panel
What were the findings/conclusions regarding program activities provided by the Achievement Division?
.lack of programmed activities, resulting in boredom
-lack of privacy, public humiliation etc.
one resident died from dehydration
What was the key ingredient left out of the token program
monitoring of individual resident behaviour
What is meant by behavioural drift?
A pattern had been established when dealing with behaviour by the staff.
Gradual escalation.
What was the statewide peer review committee for the behaviour modification (PRC)?
established a set of guidelines for the use of Bx modification procedures.
-began making visits to institutions to educate staff and make recommendations for more ethical treatment
What is meant by Do no Harm and what were 3 ethical examples?
.increase the benefices, limit or eliminate any downfalls.
- BCBA practicing outside area of expertise
- SSB didn’t get enough info, discontinued program which lead to hospital visit
- bath routine, could work on Bx but more harm than good since it would be better to train someone to prep baths.
What is meant by Autonomy and what ethical issues may arise?
promote independence or self-sufficiency
- problems with family (and for treats?)
- ind may put the client in harms way(fall)
- car she, don’t want ind.
Benefiting others - what ethical issues may arise
who is the client teacher/parent or kid. working with client will increase benefit. Teacher example
Being Just - what is this basic principle?
treat others as you would like to be treated
-example medicine for SIB
Being faithful refers to?
be truthful and honest with clients will give you a good reputation
Why is being truthful important to you and the profession
make you dependable and reliable source of counsel, and effective. create long term success in ones career.
According Dignity - when is a choice a choice
http://selfadvocacy.org
What is meant by treating others with caring and compassion
.it will happen when you respect autonomy, work to benefit them, devise programs maintaining their dignity you will automatically treat with care and compassion.
- dad morning examaple
How does one demonstrate pursuit of excellence
being aware of the latest research, incorporating up to date methods and procedures.
look for additional trainings
What is meant by the client does not fail, the program does
you need to take the time and accept your mistakes and make changes.
What are 2 dimensions that must be considered when discussing ethics cases
experience level and complexity of the case
Why was the BARS developed
Behaviourally anchored rating system
rates violations severity, and how complex the ethics case is
-Characteristics of ethics cases and their level of complexity
Why is it important to determine whether the incident is covered by the ethics code?
You then have a basis for moving forward.
Why is it important to identify the players when considering ethical violations
.-do you have the strength to take them on
- deal with others involved
- do the right thing
- client is often vulnerable and would benefit the most (there may be multiple clients )
- owner is the player in example
Why is it important to have contingency plans
- What to do when your first attempt was unsuccessful
- should reflect the unique circumstances of the case
Why must we be aware of the conduct of other behaviour analysis’s?
in order to have a robust, responsible, and respected profession we must be aware of the conduct of others BAs and be prepared to stand up for our client rights to effective treatment.
What is the clout factor
influence of position power or authority to make something happen.
Why is it important to document everything
in case someone takes legal action always have record to show you proceed in good faith
-or if new issues come up you can look back to see how it turned out last time
Where do we learn our rules of ethical conduct
communities, religions, cultures throughout childhood
What are personal ethics?
.cumulative result of cild-adult experiences produce individuals with loosely formed rules called personal ethics
What are professional ethics
rules are explicit
How do favours impact professional ethics
.slippery slope. car example
How does gossip impact professional ethics
- is considered normal in society
- clients may ask about other clients - leads to revealing confidential information
How do white lies impact professional ethics
.they can lead to bigger problems (if they don’t take the hint)
What is the impact of exchanging gifts and favours
.can create dual relationships
What are the pitfalls of giving advice.
- need to be careful when giving advice
- not your client
- people trust you
- dont have all the info
How does responsibility impact a behaviour analyst
should be aware there are families that defer the Childs responsibility - can effect treatment
What is meant by the behaviour analyst must transition from a civilian to a professional
- don’t want personal ethics to interfere with professional ones.
- take on new responsibility as a BA
What did governor Youngdahl do in 1949?
eliminated almost all restraints in mental institutions
What must we be on guard for
that forms of restraints do not creep up in other ways.
What was METO and who did they serve
Minnesota Extended Treatment Options (METO) is a program operated by Minnesota’s Department of Human Service’s State Operated Services Division.
for DD with challenging behaviours
What were the 2 complaints investigated by the office of Ombudsman
- physical restraints on these disabled citizens that included the use of metal, law enforcement style handcuffs
- families worried about retaliation if they did not agree to them
When can restraints be used.
imminent risk to the client or others and only for as long as the risk is present
What did the complaint find regarding alternative approaches
positive behavioral supports
What did the Minnesota Office of Health Facility Complaints and DHS Licensing Division find
- report with 99 pages of problems and citations
- report outlining additional rule violations
What do all citizens of Minnesota deserve.
deserve treatment with dignity and respect
What rights does the 14th amendment provide
Amendment due process right to reasonably safe conditions of confinement, freedom from unreasonable bodily restraints, reasonable protection from harm, and adequate food, shelter, clothing, and medical care..
How is adequacy of treatment determined
The facility will implement a quality management process to ensure that the QMRP makes changes to client IPPs such that adequate treatment velocity is maintained for all clients
Why was METO developed
METO was developed to meet a specific need for a resource to provide treatment to a small subset of the developmentally disabled receiving services for some of the most challenging maladaptive behaviors that have led to either criminal proceedings or a loss of a less restrictive community placement
Where all beds certified under ICF/MR rules and regulations
yes
What is rule 40
rules that govern the use of aversive and deprivation procedures such as seclusion and restraints.
Does rule 40 promote the use of aversive and deprivation procedures
not to promote the use of aversive and deprivation procedures, but rather to encourage the use of positive approaches as an alternative and to establish specific standards that must be met when other less restrictive alternatives have been attempted and proven unsuccessful.
How did coercion apply to the complaint received by the Ombudsman
The caller also expressed what they believed to be threats and
coercion by certain METO staff if they did not sign the aversive program developed by the behavioral staff.
What was the criteria for being placed into restraints
.It was explained that any person displaying their target behavior for two minutes who could not be redirected, is placed in mechanical restraints
What was the rationale provided for the use of restraints
mechanical restraints was preferable to manual restraints as it lessened the risk of injury to staff and clients and was the least restrictive way to manage behavior. Management, as well as other staff, stated that this was the only method to get person’s behavior under control so they could be discharged to the community.
What did the review of medical files find
In reviewing the medical files there was documentation of individuals with asthma, seizure disorders, history of lung abscesses and other medical issues being cleared for the use of mechanical restraints.
The physician identified only one individual for whom the use of certain mechanical restraints and a takedown to a prone position would be considered contraindicated.
- Out of 40 files
- at least 65% of the persons at METO at that time had been restrained at least once since their admittance to the facility.
What was the problem with the reasons listed as why a person was put in restraints
METO staff and management argued that these behaviors may not appear to be aggressive, but were precursors to dangerous behavior.
What did documentation reveal regarding when a person was placed into restraints
Documents in individual records revealed that
people were being routinely restrained in a
prone, face down position and placed in metal
handcuffs and leg hobbles.
What did the Office of Health Facility Complaints find
The Minnesota Office of Health Facility Complaints (OHFC) issued a report with 99 pages of problems and citations.
???
DHS licensing issued 6 citations that can be summarized as
- Failure to ensure that all the required standards and conditions for the use of controlled procedures were met.
- Failure to submit data on the use and effectiveness of the controlled procedures to the expanded interdisciplinary team, the internal review committee, and the regional review committee on a quarterly basis.
- Failure to obtain the required assessment information on persons who had a controlled procedure as part of their Individual Program Plan (IPP).
- Failure to ensure necessary conditions were met when an emergency use of a controlled procedure was implemented on a client.
- Failure to implement the program’s own policy on the emergency use of controlled procedures.
- Failure to “complete the required reporting and reviewing” of the use of emergency controlled procedures.
When describing the clients placed in METO the staff insinuated that most of the persons came through the criminal courts, how many clients were adjudicated.
5 of the 40
Who’s fault was it that a person was placed in METO
- from the hospital as there were no other placements
- from a state operated facility
- civil commitment
- family committed
When the guardian suggested alternative behavioural methods for persons with autism what was the results
not readily accepted by staff
-severely limit visitation by the parent
-
What was the finding regarding the claim the METO is a nationally recognized program
- For example, if a person was restrained 50 times in the first six months of the year and only 30 times in the second six months of the year, the mechanical restraint program was said to be an effective program in reducing maladaptive behaviors. Documents obtained during this investigation indicate this is an incomplete evaluation of program effectiveness.
- no indication of actual reduction in target Bx
What constrains were on the system
system under stress.
- There are not sufficient facilities with the capacity to handle the most difficult to serve individuals. When resources are limited, there can be cutbacks on staff training in community facilities
- they found it challenging to find providers able to treat those with difficult needs.
Without immediate and substantive change the state is at risk of what
Without immediate and substantive change, the state is at risk of further federal intervention.
