Multiphase Comprehensive Program to resolve Self Injurious Behavior. Dr Nadeem Ghayas
August 31, 2024
Thorough multiphased self injurious behavior intervention is evidence based structured intervention model aimed at lessening harmful behavior and encouraging positive and adaptive alternatives. Self injurious behavior also known as SIB is the type of behavior where the person is self abusive; that is, they intentionally abuse their own bodies by banging their heads, biting their skin, and scratching their bodies. Meta description: Patients will learn about the effectiveness of a multiphase program on self injurious behavior, which relies on the use of reinforcement, fading restraint, positive behavior support, and caregiver training to help reduce SIB in a safe and effective manner.
The autism spectrum disorder and intellectual disability, along with other neurodevelopmental disorders, in general, are associated with self injurious behavior. It has been noted that up to 50 percent of people with developmental disabilities can at some point in their lives commit some type of SIB Cooper et al., 2020. Lack of proper intervention, SIB may result in severe physical harm, mental distress, and a decrease in quality of life. As such, behavioral intervention programs that are based on applied behavior analysis are important.
This paper is a detailed analysis of a behavior intervention program in stages which brings about the discipline of reinforcement, progressive extinction, other coping mechanisms, tokens economy and the education of the caregiver as a means of providing a solution to self injurious behavior in an ethical and effective manner.
Insight into Self Injury Behavior.
Self injurious behavior consists of repetitive behaviors, which inflict immediate bodily damage to oneself. Such behaviors can be used to fulfill various purposes such as attention seeking, avoidance, sensory stimulation, or distress.
Common Self Injury Behaviour.
Head banging
Self hitting
Self biting
Skin scratching
Hair pulling
It is necessary to conduct functional behavior assessment, which is necessary to understand why the behavior takes place. The National Institutes of Health says that determining the role of SIB is the basis of designing effective interventions NIH, 2022.
Phase One First reinforced intervention and protective intervention.
Safety is the main issue in the initial phase of intervention. Interim measures can be taken in order to avoid instant damage until reinforcement measures are launched.
Protective Intervention Effect.
Short term physical restraint, when needed to avoid injury, must be implemented under the supervision of ethics. It is not punishment but direct security. Ethics dictate that restrictions procedures must have time limits and undergo constant review Cooper et al., 2020.
At the same time, the strategy of differential reinforcement is presented. The person is strengthened in between self injury. The time that is taken to reinforce is gradually increased.
Practical Application
As an illustration, when a child is banging his/her head, first, the staff may intervene so that no injury is inflicted on the child. Provided the child avoids self injury within five minutes, praise or other activity of his/her choice is given. With time, the interval is raised to ten or fifteen minutes, which encourages prolonged behavioral control.
Phase Two Progressive Easing of Restrictive Measures.
The restrictive procedures are gradually dropped as the individual progressively shows better self control. This process is referred to as fading.
Fading Procedures
The amount of the restraint time and frequency become shorter. Reinforcement is further reinforced and other responses reinforced. Literature confirms reinforcement based interventions as an effective approach in the reduction of severe behavior without necessarily using any restrictive approaches Carr et al., 2002.
Ethical Considerations
The international guidelines emphasize the need that restrictive interventions should be the least restrictive and should only be used when less restrictive approaches do not work World Health Organization, 2022. The final goal is limitless restraint eradication.
Phase Three The introduction of Less Restrictive Alternatives.
This stage involves substituting self harm by positive ones.
Behavior Strategy alternates.
Educating functional communication skills.
Provision of sensory control devices.
Introduction of relaxing conditions.
Providing framed options.
As an illustration, in place of hitting the self in order to avoid a challenging task, such a person is taught to ask to take a break either orally or via a communication machine. Overstimulation could be minimized with sensory aids like heavy blankets or dark rooms.
Positive behavior support models stress the importance of replacing harmful behavior through teaching other replacement skills as opposed to suppressing harmful behaviors only Carr et al., 2002.
Phase Four Token Reinforcement System.
The systems of token reinforcement are very effective to support the positive change in behavior.
How Token Economies Work
The tokens are given in case of proper behavior or self injury-free intervals. Such tokens are then traded to valuable rewards. This positive reinforcement is organized and reinforces adaptive behaviors and motivates more.
As an illustration, a person gets one token every half an hour without self injury. Five tokens can be traded in activities of choice like screen time or recreational chances. Reinforcement schedules are also changed as the progress is made in an effort to encourage long term maintenance.
The evidence based practice of token economies has been supported by research at all times regarding the application in behavior analysis Cooper et al., 2020.
Phase Five Parent and Staff Training.
Change in behavior should be sustainable, which entails consistency within the setting. The education of parents, teachers, and vocational personnel makes sure that interventions are implemented in a similar manner.
Relevance of Caregiver Involvement.
Caregivers are taught how to recognize triggers.
They apply reinforcement systems.
They use de escalation techniques.
Data collection is monitored by them.
Consistency minimizes confusion and helps to avoid encouraging self injurious behavior. Research indicates that interventions that are implemented by the parent enhance better long term outcomes and generalization of skills NIH, 2022.
Oversight and Data Driven Decision Making.
The information gathering is very important in a multiphased program. The frequency, duration and the intensity of SIB are noted on a daily basis.
Evaluating Effectiveness
Thinning of reinforcement schedules can be made in case they demonstrate decreased frequency and severity. In case of increased behavior, functional assessment can be reconsidered. Accountability and ethical practice is guaranteed through data driven decision making.
Advantages of a Multiphase Strategy.
There are a number of benefits of a multiphase program:
Improved safety
Less dependence on repressive action.
Enhanced adaptive skills
Increased independence
Better quality of life
Through emphasis on positive reinforcement and gradual change, people learn to control themselves as opposed to relying on control based approaches.
Frequently Asked Questions.
What precipitates self injurious behavior?
Sensory needs, communication problems, avoidance of demands, medical discomfort or attention seeking may be the causes of self injurious behavior. The reason is determined under functional assessment.
Does physical restraint offer a recommendation in SIB?
The only way through which physical restraint can be applied is as a safety measure but with close ethical considerations. Minimization of restrictive procedures and the eradication is the objective.
What is the effectiveness of token reinforcement.
The use of token reinforcement is very effective when it is done regularly and grounded on functional evaluation. It enhances motivation and boosts positive behaviors.
Is this program applicable by parents at home?
Yes, through good training and professional advice parents can be in a position to use successfully the reinforcement methods and alternative training of behavior at home.
What is the duration of time to decrease self injurious behavior?
The time is different according to the severity, consistency, and needs of the person. Others improve within weeks, whereas others necessitate a long term intervention.
Conclusion
The combination of safety, reinforcement, skills development and caregiver training into an organized and ethical intervention model is a comprehensive multiphased program to address self injurious behavior. This method is successful in reducing SIB and improving the overall quality of life by gradually decreasing the restrictive procedures, reinforcing the adaptive behaviors, and making sure the implementation of such approaches should be consistent across settings. Reinforcement based and function driven approaches are the most effective long term solutions supported by evidence of applied behavior analysis as well as public health research.
References
Carr, E. G., Dunlap, G., Horner, R. H., Koegel, R. L., Turnbull, A. P., Sailor, W., and others 2002. Positive behavior support development of an applied science. Journal of Positive Behavior Interventions, 4(1), 416.
Cooper, J. O., Heron, T. E., and Heward, W. L. 2020. Applied B.A.N.P. 3 rd. Pearson Education.
National Institutes of Health. 2022. Overview Self injurious behavior research. Accessed online through the Internet at https://www.nih.gov.
World Health Organization. 2022. Recommendations on community mental health services that facilitate person centered and rights based approaches. Accessed on 5th April 2020.