Contextual Fit: The Critical Missing Component of Behavioral Intervention & Instructional Planni

There has been a long held assumption in Behavior Analysis that a key to effective Behavioral Intervention/Instructional Plans (BIP) is principally connected to the technical aspects of the BIP to include the ‘clinical validity’ of the functional behavioral analytic (FBA) process.

Towards this is a large body of literature on behalf of Functional Behavior Analysis (FBAnalysis); a most often tightly controlled, clinically bound behavioral assessment system which includes sequentially changing environmental conditions (e.g., alone, enriched, impoverished, with and without social attention; with and without simple interventions for interfering behavior……).

While the correct administration of FBAnalysis can generate elegant data and graphs, it also can reflect a rather sterile process far more valid within the conditions in which it was run rather than those more natural to include homes, schools and the larger community where primary implementation is by such natural helpers as primary caregivers, family members and community-based providers.

Even the most impressively written, technically valid BIP generated by an FBAnalysis process can quickly lose relevance in a classroom with 28 other children, at home with siblings and working parents or a single parent where life can happen unexpectedly or in the local grocery store where lots of unfamiliar eyes are watching and additional assistance is not available.

On the other side of this coin is the Functional Behavior Assessment (FBAssessment) which blends self-report/interview, observation/data collection, in-context hypothesis testing and BIP development with (hopefully) carefully monitored implementation.

Even as a strong FBAssessment process can provide a counterweight to the concerns reflected on behalf of an FBAnalysis to include the identified decontextualized and experimentally controlled outcomes, the FBAssessment brings its own challenges. These range from reduced systems-based reliability to what can be a remarkable range of differential perspectives and interpretations connected to the particular clinician’s depth of professional training, knowledge, perceptions and experience.

I plan to look more closely at the debate between use of FBAnalysis and FBAssessment and offer specific thoughts and suggestions in another blog entry.

This writing, however, will focus on a pivotal and largely overlooked gap in both; that is, the Contextual Fit (Sandler, 2001)of BIPs since variables uniquely relevant to Contextual Fit will directly impact the durability, accuracy of implementation and, of particular importance, the user friendliness (or 'doability') of a BIP.

How many other readers – other fellow Behavior Analysts – have written what they consider valid, strong and person-centered BIPs then shared them with more than one site on behalf of a targeted individual to include the provision of training to key implementers?

How many of you have then gone back maybe a week or two later to find that one site is really into your BIP; they’re using it and have really good questions and feedback. When you go to the other site and ask folks how the BIP and target person is doing there, however, they look up and say; ‘did you give us a BIP?’

A reason for such sometimes starkly different responses and levels of implementation is very often directly related to the ‘Contextual Fit’ of the BIP; that is, whether or not the BIP does or does not have Contextual Fit.

As I wrote above, an assumption has long persisted that accurate and sustained implementation of a BIP is principally linked to its technical validity, soundness and the degree to which the procedures are based in a technically correct functional assessment process while representing the foundational principles of Applied Behavioral Analysis (Alberto & Troutman, 1999; O'Neill et al., 1997).

When such BIPs fail, clinicians too often blame the very persons who are working the hardest to help the target individual and have the day to day responsibility for implementation; that is, parents/caregivers, primary providers and direct care professionals.

This typically doesn't go over very well and clinicians who try to shift responsibility in this way are wrong. It is, instead, up to the clinician to take primary responsibility for what is (and is not) happening towards figuring things out together and deciding how to better make it work for the benefit of all involved.

Contextual Fit, fundamentally, is the perceived ability of primary implementers to implement the strategies in a BIP with 1) Fidelity (accurately); and 2) Durability (over an extended period of time); while 3) believing that the BIP will be effective (Sandler, 2001).

So…how can the active integration of Contextual Fit variables correct these problems and what, exactly, are the pivotal variables of Contextual Fit in the first place?

Above all, BIPs must be designed in a way that gives primary implementers a belief from the outset that they will be successful (Gersten, et al., 2001). The belief in the ultimate success and effectiveness of a BIP is then closely related to whether or not key implementers expect the BIP to:

1. Become less time and labor intensive (Allen & Warzak, 2000);

2. Allow for a wider range of social experiences and increased flexibility in day to day planning for the target person, the setting and primary persons in the setting (Risley, 1996);

3. Produce documented and positive change in the behaviors of both, the target person and key persons in the setting(s) which are obvious and pragmatic (Albin, et al. 1996);

4. Reflect a range of applicable intervention and teaching strategies (Gresham & Lopez, 1996) rather than being unidimensional or reflect singular, ‘canned’ programs (the ‘One Trick Pony’ approach);

5. Be able to be accurately implemented despite natural disruptions and/or significant changes in the environment (Guess & Sailor, 1993) and, of particular importance;

6. Be logical, applicable, and manageable to and by primary implementers over over time.

Contextual Fit, then, reflects the coming together of these multiple component pieces to include the broader blending of pivotal elements of social and treatment validity into a single construct; the construct of Contextual Fit.

One of the more unique aspects of Contextual Fit and doing a Contextual Fit assessment is in the primary need by the clinician to better understand and account for the personal perceptions and beliefs of those who will have primary responsibility for implementation.

The long held assumption that parents and other family caregivers, employed caregivers/staff and/or professional and paraprofessional providers will implement a BIP due to their connection to and role with the target person has never been reasonable. Even as these of these individuals are each uniquely invested – parents, family and other primary caregivers especially – individualized perceptions, belief systems, available resources and logistics remain of particular relevance.

While the construct of personal perceptions and belief systems may appear to be less aligned with a behavioral analytic approach, covert, less direct and otherwise derived relationships between public events (as is BIP implementation) and privately held sensitivities, previous history, values and points of view hold a unique and strong degree of relevance (Friman, Hayes & Wilson, 1998; Sandler, 2001).

Towards the Contextual Fit of a BIP, consider:

1. If the BIP reflects consistency with the belief systems and values of implementers;

• For instance, if primary implementers do not believe in the use of food as a reinforcer across a range of reasons, no matter the degree to which the clinician identifies their belief in the technical validity, the strategy will not be used.

1. Whether implementers believe they have been given adequate training to comfortably, adequately and consistently implement the BIP;

• Don’t just train, ask….listen and respond to the input/feedback offered!

1. The perception by implementers as to whether both ‘real’ and ‘perceived’ supports exist;

• ‘Real’ support includes a predictable schedule of reliable and positive contact with consultants and/or primary supervisors.

• 'Perceived’ support references whether implementers have reason to believe that they can easily access and receive a timely, responsive, respectful and effective support and feedback when they ask.

1. Whether implementers believe that the BIP is flexible (always adaptive) and that the BIP will become less labor intensive and rigid in its application while remaining open to needed and timely modification;

• Regular, open participatory, meetings and obvious use of feedback and data collection is important.

1. If implementers have the resources needed to initiate and sustain the implementation of the BSP (Albin et al., 1996; Dana, 1993; Kleinman, 1988; Sandler, 1998);

2. That implementers need to believe that the BIP will not only be positive for the target person but also improve the quality of life of others in that setting. One common complaint by primary implementers of even the strongest BIPs happens when that BIP requires a huge proportion of their time to the exclusion of primary others in the setting;

3. Whether an effort has been made to naturally embed BIP strategies, interventions and related instruction into natural, ongoing setting and individual routines rather than having to create something that is not ‘real’ for either the person or setting;

4. That the BIP must not be instantly compromised should something unexpected happen since real life continues on and cannot be experimentally controlled;

5. If implementers believe that the BIP developer(s) really do know and understand not only the target person but the primary setting(s); and,

6. That implementers must know and see that their input is considered relevant, valued and actively incorporated.

• Flexibility, or a shared willingness to make needed, timely and effective adaptations and modifications to a BIP, is a particularly important variable towards the Contextual Fit of BIPs.

Above all, if primary implementers do not believe a given BIP represents the combined needs of the target person and the setting to include being 'doable' in the setting; if the BIP developer is not believed to be connected to and understanding of what is really happening or not truly knowing the target individual, that BIP is most likely doomed to failure not matter how elegantly designed.

Clinicians must also consider their own interactive style and presentation. For instance, primary implementers often report that they consider excessive use of professional jargon and technical language to be deliberate and demeaning (Sandler, 2001).

Open, active, relaxed and jargon free channels of communication between key implementers, supervisors and the BIP developer(s) are critically important. And, again, flexibility and the ability to adapt and modify the BSP as needed is also important.

One way to ‘field test’ initial BIP development is to ask primary implementers, and particularly those with previous experience, to read the full final draft of the BIP and identify if they believe the BIP will be effective and ‘doable’ for the targeted person and across primary settings. The ongoing feedback of primary implementers during initial BIP development should also be incorporated.

The Contextual Fit of BIPs is a long discussed but still very often poorly applied construct which continues to need far more attention and prioritization to include effectively assessing for the specific variables of Contextual Fit as part of the FBAssessment process.

I routinely do just this as part of my own originally designed and blended self-report/interview FBAssessment system.

End Note: While I have actively cited this entry, I have not included the full Reference List. If any reader should be interested in more information about a particular citation to include where it appeared, please send me an email via this website and I will provide you with that information.

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I provide online BCBA/BCaBA supervision/Clinical Supervision and Telebehavior services through my website: http://www.drlousandler.com/

I WILL help you pass your BCBA/BCaBA exam.

I can help with challenging behavioral/structural needs in homes, community and classrooms towards positive and generalizable change; Qualify of Life outcomes.

I can also help working BCBAs serve more challenging clients - with behavioral, adaptive and feeding needs - through an online collaboration and capacity building.

I am open scheduling a conversation via phone, Skype or VSee to all inquiries.

__________________________________

I provide online BCBA/BCaBA supervision and Telebehavior services through my website: http://www.drlousandler.com/

I will help you pass your BCBA/BCaBA exam.

I can help with challenging behavioral/structural needs in homes, community and classrooms towards positive and generalizable change; Qualify of Life outcomes.

I am open scheduling a conversation via phone, Skype or VSee to all inquiries.

#BehaviorInterventionPlansLessonplanning #appliedbehavioranalysis