But Does It Really Work?

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Transcript But Does It Really Work?

Gentle Teaching Evaluation Network
G-TEN
International Alliance to Produce
Evidence – Simple Yet Scientific
James W. Conroy, Ph.D.
The Center for Outcome Analysis
www.eoutcome.org
Outline
 Purpose
 Why Measure and Measure What?
 Paradigms and Resistance
 The Scientific Literature – Paradigm War
 Things are Changing, Especially in the Americas
 Now is a Very Good Time to Seek Evidence in a
Cooperative International Venture
 Dimensions We Must Measure
– Interactions, Qualities of Life (including feeling safe
and loved), Behavior, Person-Centeredness
 How to Move Forward: Pilot Studies, Home,
Funding,
Nations,
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Purpose
 Today – to share our thinking about how to
get new, reliable, valid scientific evidence
 Aiming toward publishing studies
 And obtaining serious funding from USA
organizations – government and
foundations
 GTEN – what is our best strategy toward
production of good evidence across our
nations?
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Why Seek Evidence?
 We have a common belief in Gentle Teaching
 We all hope that it will spread, and negative
approaches and aversives will end
 We will need more evidence to bring the skeptics
and the “undecideds” along
 Yet we must overcome powerful past rejection by
behavioral scientists
 GTEN – is there hope of achieving this?
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The Controversy in the “Scientific”
Literature, 1980s and 1990s
 Why all the resistance, skepticism?
 Because GT threatens established thinking
and funding?
 Look at this title from one of the critics:
 Bailey, J.S. (1992) Gentle teaching: trying
to win friends and influence people with
euphemism, metaphor, smoke, and mirrors.
J Appl Behav Anal. 1992 Winter; 25(4):
879–883.
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The Controversy in the “Scientific”
Literature, 1980s and 1990s
 McGee, J. J., Menolascino, F. J., Hobbs, D. C., &
Menousek, P. E. (1987). Gentle teaching: A non-aversive
approach to helping persons with mental retardation. New
York: Human Sciences Press.
 McGee, J. J., & Gonzalez, L. (1990). Gentle teaching and
the practice of human interdependence: A preliminary
group study of 15 persons with severe behavioral disorders
and their caregivers. In A. C. Repp & N. N. Singh (Eds.),
Perspectives on the use of nonaversive and aversive
interventions for persons with developmental disabilities
(pp. 237-254). Sycamore, IL: Sycamore.
– Caregiver’s Interactional Observation System (CIOS) and the
Person’s Interactional Observation System (PIOS)
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1989 JABA
 J Jordan, N N Singh, and A C Repp (1989). An evaluation




of gentle teaching and visual screening in the reduction of
stereotypy. J Appl Behav Anal. 1989 Spring; 22(1): 9–22.
Extremely complex behavioral research design with just 3
“subjects”
“…gentle teaching was found to be more effective than
task training for 2 subjects but less effective for the 3rd “
Published anyway – because their Discussion conclusions
were negative about GT
Footnote on Singh – Therapy Malls in big institutions and
DOJ witness history
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1992 Review of the Controversy
 A J Cuvo (1992). Gentle teaching: on the one
hand ... but on the other hand. J Appl Behav Anal.
1992 Winter; 25(4): 873–877.
 Perhaps the most balanced review of the early
controversy.
 This would be worthwhile reading because it
explains the harshness of the attacks on GT.
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Most Recently, 2003:
 Polirstok, Susan Rovet EdD; Dana, Lawrence PhD; Buono,
Serafino Dot.; Mongelli, Vita Dottssa.; Trubia, Grazia
Dottssa. Improving Functional Communication Skills in
Adolescents and Young Adults with Severe Autism Using
Gentle Teaching and Positive Approaches. Topics in
Language Disorders. 23(2):146-153, April/May/June 2003.
 Described positive findings, both for individuals and
workers.
 Working with 18 young people in Sicily.
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More Recent Rigorous Study in England
 Cullen C. & Mappin R. (1998). An examination of the effects of
gentle teaching on people with complex learning disabilities and
challenging behaviour. Br J Clin Psychol. 1998 May;37 ( Pt
2):199-211.
 13 students, 7 staff observed
 13 weeks “pre” and 23 weeks “post”
 45 hours direct observational data on handheld computers, 75
hours of video
 “Wherever there were differences between gentle teaching and IEP
these were in favour of gentle teaching, although they were generally
relatively minor in terms of clinical (rather than statistical)
significance.” NOTE the disclaimer
 Conclusions: all effects of GT unimportant, may be “useful adjunct”
 But who did the training, and how was it reinforced?
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Scientific Revolutions
 Thomas Kuhn’s “The Structure of Scientific
Revolution” 1963
 The source of the phrase “Paradigm Shift”
 When the prevailing “model” or “paradigm” fails
to explain something – an anomaly
 Sometimes a new worldview is required
 But there will be powerful resistance
 The thinking which was the cause of our success
in the past often becomes the reason for our failure
in the future.” - Einstein
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1.
2.
3.
4.
5.
6.
7.
8.
9.
Current paradigm does not “work” for some observations – anomaly and
crisis. Not all in the community will care about anomaly – too
comfortable
The proponents of the “new” are reviled, criticized, distrusted – Threat!
Competing camps form
a. One camp seeks to defend the old institutional constellation.
b. One (or more) camps seek to institute a new paradigm
Polarization: civil scientific discourse fails – Demonization, stridency,
desperate defense – paradigm wars
Circular arguments - Each group uses its own paradigm to defend its
paradigm – circular discussions
Finally, the new does replace the old, and the guardians of the old
“suddenly” embrace the new as though they had thought of it themselves
Gentle Teaching has been immersed in a paradigm war
But this paradigm shows every sign of success – allies have sprung up –
we will live to see it become the established belief system
To speed this up, evidenceCOA
developed
within the scientific method will
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help
Is the Paradigm Changing At Last?
 There’s reason to believe so
 Look at the insurgencies into the bastions of
resistance
 Look at the organizations that have embraced
positive approaches (not the same thing but
emerged from GT thinking) e.g. Herb Lovett
 Look at the rise of aversive regulations, concerns,
surveys, government requirements
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Even the ABA (Association for
Behavioral Analysis)…..
 Now has a Special Interest Group, the PBS
 ABA International Newsletter
– Volume 29 | 2006 | Number 2
 Positive Behavior Supports
– The Positive Behavior Support (PBS) SIG addresses
the interests of members engaged in experimental and
applied analyses of behavior who are proponents of
positive behavior support. Established in January 2005,
the goals of the SIG are to promote and disseminate
positive behavior support within ABA, and to ensure
that PBS is aligned with the science of behavior.
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PBS - SIG
 The PBS SIG currently has approximately 40 formal
members….electronic listserv with over 70 recipients,
many of whom belong to both ABA and the Association
for Positive Behavior Support (APBS).
 Goals of the PBS SIG are to:
– Increase the number and visibility of PBS presentations at the
ABA convention
– Disseminate accurate information about PBS to ABA’s
membership
– Promote methodologically sound, data-based PBS research
– Encourage open dialogue among behavior analysts and proponents
of PBS
 www.pbsaba.org
 www.pbsaba.org/newsletter
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Association for Positive Behavioral
Support, APBS.org
 http://www.apbs.org/main.htm
 Affiliated with TASH
 TASH has 20 years of commitment to
positive approaches
 Should GTI interact with the new emerging
groups with similar values?
 Or should GTI simply be aware that the
world is changing toward our values?
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USA – Nationwide Awareness
Is Finally Emerging
 Aversives Survey3.pdf
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Old Paradigm, New Paradigm
 Old – Behaviorism
– Mechanistic
– Ghost in the machine
– We can shape any
person’s behavior
– All means are fair, if
justified by ends
 New – GT & Positive
– Humanistic
– Presumes humanity
– We can make a real
connection with any
person
– The process is often as
important, sometimes
more important, than
the outcomes
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Dual Dimensions of Measurement
Individual
Caregiver
Feeling Safe
Protecting –
Confidence in Ability to Offer Safety
While Avoiding Negatives
Feeling Loved
Assisting Warmly –
Feeling of Offering Unconditional
Love
Enjoying Interactions
Enjoying Job
Self-Control (less challenge)
Feeling of Success in Job
Self-Control (choicemaking)
Pride in Sharing Power
Self-Actualization –
Becoming More Authentic
Human
Self-Actualization –
Becoming More Authentic Human
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Simple Rating Scale:
The Person Being Supported
Very
Cold,
Negative
Neutral
Very
Warm,
Positive
Response to Caregivers' Presence

Response to Caregivers’ Words


Response to Touch

Response to Food, Drink
Acceptance of Doing Things with Caregivers

Acceptance of Doing Things with Peers

Self-Esteem
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Simple Rating Scale:
The Caregivers
Close

Distant
Warm

Cold

Heart
Head
Warm Protection
Engagement
Restraint

Disengagement
Colleague/Friend

“Boss”
Unconditional Love

Conditional Rewards
New Memories

Old Memories
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Input, Process, and Outcomes
Measure
GT Here?
Input
Process
Outcomes
Effort, Resources,
Time, Emotional
Investment, Hope
Safe, Loving,
Positive,
Supportive,
Persistent, Patient
Relationships,
Qualities of Life,
Behavior Change
(Or is GT Here?)
Feedback After Success/Failure
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We Have Good Measures for the
Collateral Outcomes
 Control of one’s own life (DCI)
 Person-centered planning (EPP)
 Qualities of life (QOL Then & Now)
 Family perceptions of quality life and service
 Qualities of work life for the caregivers (QOWL)
 If we can get decent measures of Safe and Loved
from both perspectives, these other outcomes will
make a very strong case.
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Paradigm Shift – What It’s Like
 What Animal is This?
 Duck? Or Rabbit? The switch is what a Paradigm
Shift feels like.
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I’ve Already Seen….
 Two and a half paradigm shifts
 I came in at the end of the Medical Model in 1970
 I witnessed and studied the decline of belief in a need
for segregation – deinstitutionalization
 I took part in the self-determination movement from its
inception, studying and demonstrating
 And now the largest system of grants ever given from
the USA’s major funding source, “Money Follows the
Person,” $500 million, is aimed at individual control of
resources (SD) in community settings.
 I believe that the time of GT’s ascension is coming fast.
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We Are Going to Live to See it
Happen
 The signs are clear
 Our task is to gently develop and offer the
evidence
 People have begun to want to believe
 Gentle nudges and good solid science are all
that’s needed
 Our international cooperation via GTEN
will be very important – and FUN!
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We Need Partners
 This idea is now a year old
 We’ve been studying and thinking
 Siddhartha’s motto:
– I can think, I can wait, I can fast
 I think the time is right to move forward
with real data, real pilot studies, and plans
for large-scale evaluative research.
 Cross-nations: GTEN
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Comments and Ideas
 All ideas welcome
 Testers of these instruments needed
 Critiques needed
Thank you for your attention and
for the honor of appearing before
you at this conference
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Perceived Qualities of Life:
“Before S-D and Now”
Running own life
Privacy
Happiness
Treatment by staff
Comfort
Getting out/getting around
What he/she does all day
Then
Now
Overall quality of life
Relationship with friends
Food
Health care
Health
Relationship with family
Safety (NS)
0.0
0.5
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1.0
1.5
2.0
2.5
3.0
3.5
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How “Person-Centered” is the
Planning Process?
4.43
4.29
4.20
4.06
4.02
4.02
3.86
3.78
3.75
3.71
3.65
3.63
3.35
3.11
3.07
Are meetings held as needed?
Emphasis on cooperation in meetings?
Are meetings comfortable for focus
person?
Does respondent consider plan to be
Person-Centered?
Does process allow and deal with
conflicts?
Is the planing process flexible, trying
other ways?
Strong efforts to understand person's
hopes and dreams?
Does process emphasis creativity, new
ideas?
Are the person's relationships
considered?
Does the person have ultimate
authority in disagreements?
Is process governed by formal rules and
regulations?
Does the planning process take money
into consideration?
Does group have control over money
supporting the person?
Do the unpaid group members have the
real power?
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Are community
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informal support
networks emphasized?
31
How Many Friends?
12
10
10
8
8
6
6
5
4
4
4
Count
3
2
4
3
2
2
2
0
0
4
1
2
3
4
5
6
7
8
9
10
1
1
12
13
2
2
1
15
18
20
25
30
1
1
45
90
# OF FRIE ND S
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Who Are Your
Closest Friends?
NEIGHBOR
16
OTHER PAID
23
29
HOUSEMATE
STAFF OF DAY
PROGRAM
35
43
STAFF OF HOME
c
RELATIVE
43
45
OTHER
CO-WORKER OR
SCHOOLMATE
47
0
5
10
15
20
25
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35
40
45
50
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One Wish in 1994
One Wish in 1996
None
More contact with family
None
Meet Garth Brooks, go to Disney world, walk
None
Enjoy better health
None
Friends
None
Hair
None
To go on a plane to FL to see sister, make more $
None
To always be happy and grow into independence
Ham sandwich
More friends
To be finished work
Motorcycle
To be sleeping
Ride a bike, go to Disney with Steve
Bill Clinton
To be healthy, to be safe and alive
Get out of house and go to Keene
(Accomplished)
Go to Disney World
(Accomplished)
To go to California
Would like to visit FL + CA
To live near my parents
Go horseback riding
Vacation in Florida
Good health
Have a brain
Want to have a little boy baby
Get away from Keene housing authority To meet celebrities, to live in warm climate
Not to have a roommate
To live like royalty, a queen with loyal subjects
A friend
Go visit Maine someday, maybe have more money
That my father was still alive
I'd like to see Richard C
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To be married
To
have Keene