2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

How ABA Improved Executive Functioning Deficits

Rosie is a young woman in her early 20s, who attends one of the senior CUNY colleges in New York City, Baruch University. Rosie is diagnosed with mild intellectual disability and schizoaffective disorder. She entered into her third year of her bachelor program in January 2015 realizing that she had significantly fallen behind with several assignments and exams due to poor organization skills and time management. She was at risk for failing out of the program. In late Spring 2015, Rosie found herself completely overwhelmed emotionally and did not know how to get herself back on track. Due to overwhelming stress, she was admitted to the hospital for a psychiatric break. That summer, Rosie’s parents were concerned that she would not finish her degree and began looking for additional supports to help her finish college and gain the necessary skills needed for fulltime employment.

During this time, Services for the UnderServed was awarded a Balancing Innovation Program (BIP) Grant that would support 25 individuals with disabilities. Five of these individuals were targeted because they were living at home, but were at risk for more restrictive residential settings or frequent psychiatric hospitalizations due to challenging behaviors. The grant allowed for a team of behaviorally trained specialists, Board Certified Behavior Analysts (BCBAs) and Registered Behavior Technicians (RBTs), to develop and implement strategies based on the principles of Applied Behavior Analysis to promote independence and minimize high risk incidents that often lead to emergency services.

In August 2015, the team began working with Rosie twice a week for two-hour sessions. Initially, the behavior team met with Rosie to identify goals that would assist her with obtaining her bachelor’s degree and gaining fulltime employment. In addition, Rosie identified specific skill deficits related to education, employment, and social skills that she wanted the team’s assistance to improve. Once these goals were identified, the team developed strategies utilizing visual cues, such as daily and weekly schedules, and incentive programs to increase the motivation for her to complete assigned tasks.

To start, Rosie wanted to file an appeal to return to her BA program in Business. In order to accomplish this task, she had to meet several deadlines and provide her support providers at Baruch the information she received from her professors. Without the support of the behavior team, this would have been a daunting task that Rosie would have difficulty completing on her own. The BCaBA developed a task analysis for Rosie and identified organizational skills that she would need to maintain these behaviors in the future. The RBTs created checklists and color-coded tasks by date and importance. In addition, the RBTs supported Rosie with organizing a meeting with her school counselor and developed a list of her specific needs so that she could independently advocate for herself during the meeting. As part of the instruction, the RBTs taught her how to use visual cues and electronic devices as prompts to remind her daily obligations.

As the team worked with Rosie, they realized that she had a very low motivation to complete the steps necessary to graduate. The BCaBA developed an incentive program to increase her motivation to meet her deadlines. Rosie successfully filed her appeal!

Following the appeal, the team observed that Rosie was productive in completing tasks, but was not using the organization tools that the RBTs were using with her between sessions, thus not generalizing the skills. In order to implement a successful fading program and foster generalization, the BCaBA expanded on the incentive program to motivate her to complete tasks outside of her session time. For instance, if Rosie completed the tasks outlined during the first session, her second session would allow her access to a preferred activity where she would be accompanied by the RBT, who was also a preferred staff. If the assignments were not completed by the second session, Rosie would complete the tasks on the checklist and would not have access to the preferred activity.

Rosie has a part time job on the weekends, but had difficulty in following a budget and wanted the RBTs to assist her with this skill. The RBTs introduced Rosie to banking apps and a spending log app that she could download onto her phone. The team then tied these skills into her incentive program and planning goals by having her identify social activities that she wanted to access, determine the cost of the activities, and develop a plan to budget for these activities. For instance, Rosie wanted to get sushi with the RBT. In order to do that, Rosie had to identify a sushi restaurant that she could access via public transportation, determine the cost of menu options, how much her meal would cost, and then determining if she could afford to eat at that establishment. This strategy was generalized to social activities with peers so that she could maintain her budget outside of her sessions with the RBTs.

Over the past six months, Rosie has acquired and mastered the skills necessary to move forward with reaching her goals. In addition to organization and time management skills, she has learned self-advocacy skills and as a result is receiving assistance from her University’s Office of Disabilities to maintain the necessary support she needs to graduate. She is another semester closer to receiving her BA in Business and has the same goals as her peers like: gaining fulltime employment, entering into a loving relationship with a significant other and living on her own. Through the support systems the RBTs and BCaBA developed, Rosie is on her way to reaching this level of independence.

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