Behavior Support Plan for the Client - Case Study Example

Behavior Support Plan Client: McNeal Boyd 2. Birth: 20th January 1989 3. support plan: 10th October 2014 4. Assessment Location: a. At a Café near the client’s place of residence where the client frequents. b. The client’s place of residence Informants: a. Waiter at the Café where the assessment occurred b. The client’s next-door neighbor 5. Author: 6. Primary Diagnosis: Post Traumatic Stress Disorder Generalized Anxiety Disorder 7. Behaviors targeted for Decrease: i. Self-stimulatory behavior ii. Physical Aggression iii. Property Destruction iv. Self-injurious behavior 8. Behaviors targeted for Increase i. Self-stimulatory behavior ii. Physical Aggression iii. Property Destruction iv. Self-injurious behavior 9. Interventions : Punishment interventions Differential reinforcement intervention Token economy Fading Functional Communication Training Rationale for behavior analytic services The case study of these types of psychological disorders involves McNeal, a twenty five years boy who developed post traumatic stress disorder and generalized anxiety symptoms a few months after the demise of his wife. In most instances, McNeal had sleeping problems, difficulty concentrating on his daily activities of research, flashbacks and feeling isolated. This condition developed after his lovely wife died in hospital while undergoing treatment. It was traumatic for him because his wife died on his watch and also considering the fact that they were a young couple. During his childhood, Mr. McNeal loved football and played it during his free time. The neighbor also says that before the death of his wife, he was a social and jovial person. Additionally, before the death of his wife, McNeal had previously faced divorce. These frustrations made him feel isolated and almost lost hope in life. Social Situations At times McNeal could indulge himself in drug abuse just to try to erase the memories. According to McNeal’s neighbor, he started developing strange behaviors after the death of his wife. In most instances, he isolated himself, got physically aggressive and even destroyed his own property. He also avoided family members and friends whenever they came to visit him. This was as a result of the depression he was facing. Assessment Tools: a. Functional Analysis Interview (FAI) b. Functional Analysis Screening Tool (FAST) Medical Status: Disorder #1 (Post Traumatic Stress Disorder) McNeal Boyd displayed the below signs and symptoms criteria for Chronic Post Traumatic Stress disorder which is an advanced form of the Post Traumatic Stress disorder (National Institute of Mental Health). Hyper arousal symptoms which included: Difficulty sleeping Feeling startled Feeling tensed or on the edge Difficulties eating and concentrating Re-experiencing signs and symptoms: Flashbacks Frightening thoughts Bad dreams Difficulty concentrating in the daily routine jobs Avoidance symptoms: concerned mostly with the feelings or emotions of McNeal. Worries by Mr. McNeal Depressions Loss of interest in previously enjoyed activities such as football Emotional numb feeling Inability to sometimes remember the events Medical Status: Disorder #2 (Generalized Anxiety Disorder) Excessive worries and anxieties are the symptoms mostly associated with generalized anxiety disorder (Psych Central, p1). Other signs and symptoms include: Feeling on the edge Restlessness Fatigue Irritability Difficulties concentrating in the daily activities Difficulties in sleeping at night or any other time Social phobia- being easily embarrassed in public gatherings Medication a. Medication #1 i. Name: Paroxetine ii. Dosage: 10 mg per day This was to be increased to 20mg in the next week and used for the next six months in order to prevent McNeals’s relapsing after termination of psychotherapy. iii. Delivery: oral iv. Reason: Paroxetine is an antidepressant classified under the Selective Serotonin Re-uptake Inhibitors (SSRIs). It is useful in treating symptoms of depression and anxiety disorders. v. Side Effects: General side effects include dizziness, confusion, skin rash, chest pains, cold chills. More rare side effects include fever, absence of body movement, dry mouth, convulsions (seizures). d. Medication #2 i. Name: Restoril ii. Dosage: 5mg per day iii. Used only for two weeks, after which, persistence of insomnia mandates a review of the medication by the psychiatrist. iv. Delivery: Oral v. Reason: Used to treat insomnia by helping the individuals fall asleep faster, lessen frequency of waking up or helping one sleep longer. vi. Side Effects: Temporary memory loss e. Medication #3 Name: Seroquel i. Dosage: 5mg per day Used only for more than six weeks, after which, the psychiatrist reviews dosage depending on the client’s reaction to the medication. ii. Delivery: Oral iii. Reason: Used as an atypical anti-psychotic iv. Side Effects: Nausea f. Medication #4 i. Name: Lithium ii. Dosage: 5mg per day Used for six to eight weeks, after which the dosage is reviewed depending on whether the symptoms have not dissipated iii. Delivery: Oral iv. Reason: Used to strengthen the efficiency of the anti-depressant and as a mood stabilizer v. Side Effects: Lightheadedness, fatigue Communication: Verbal communication involves the use of word of mouth to relay information by answering questions asked (Castella et al., p 520-525). Mr. McNeal answered questions asked by word of mouth. Although he could express some point using his hands, he mostly communicated verbally. 1. Operational Definitions: Behavior #1 Self-Stimulatory Behavior i. Operational Definition Defined as the process through which individuals repetitively move their bodies or objects. It is an autonomous behavior that sometimes involves flapping of hands, swirling the hair, spinning objects and playing with coins among others. ii. Antecedents/Motivating Operation 1. McNeal’s depressed state triggered by his wife’s death causes his stimulatory actions. i. Consequences 1. Might increase depression as a result of idleness iv. Hypothesized Function 1. By dealing with the behaviors and depressed feelings that defined his relationship with his wife prior to his death, McNeal is likely to resume to optimal functioning characterized with her renewed interest in living. Behavior #2 Physical Aggression i. Operational Definition This type of behavior involves inflicting pain or harm that is physical in nature. ii. Antecedents/Motivating Operation His depressed state makes him to be physically violent iii. Consequences Physical aggression may result in physical injuries such as body harm iv. Hypothesized Function Social interaction would provide McNeal with an opportunity to share his experiences and avoid physical fights Behavior #3 Property Destruction i. Operational Definition Property destruction is the process through which personal or other people belongings are damaged. The damages could involve the use tools such as hammers to destroy property Antecedent/motivating operation His depressed can make him destroy his property. Consequences Property Destruction may result in destruction of valuable property. Additionally, it could result in destruction of other people’s property. Hypothesized Function Avoiding property destruction is essential in dealing with McNeal’s state of depression. Behavior #4 Self Injurious Behaviors Operational Definition Self injurious behavior is the process through which an individual inflicts pain on himself or herself. This behavior could involve the use of things such as razor blades or sharp needles and knives to inflict pain on the body. Antecedent/motivating operation McNeal state of depression makes him think that by inflicting pain on his body could help reduce the stress he has. Consequences Self injurious behavior could lead to extensive damage of the body or pose of health problems. This behavior can also result in suicidal ideation. Hypothesized Function By McNeal engaging in his research activities, this behavior can effectively be controlled. Functional Analysis Screening Tool This is a type indirect assessment method for data analyzed (Shumate & Wills, p 28). It has individual report lists that are designed to identify variations in maladaptive behaviors. This behavior can be identified through pain attenuation, sensory stimulation or attention. This type of behavioral analysis tool is divided into two main sections. Problem behavior information and information client relationships are the main subsections of this analysis tool. Problem behavior information usually contains eight queries that relates to severity, frequency and topography of targeted behaviors. The Information client information usually contains questions related to interaction situations and client relationships (Talen & Valeras, 87). On the other hand, the checklist section questions are usually marked by a yes or no. In this list, items marked with a yes are then categorized into possible rein forcers. Functional Analysis Interview (FAI) This type of tool also uses duration, frequency and topography to analyze behavioral patterns of people (Larue, p1351). For example, it can analyze behavioral data by looking at the intensity or frequency by which an individual portrays unsocial behaviors. The unsocial behaviors could involve the frequency at which a person avoids family members or friends. FAST analysis Results from FAST: a. Behavior #1 Self stimulatory behavior- idleness as a result of depression b. Behavior #2 Physical Aggression- physical body injuries c. Behavior #3 Property Destruction-destruction of other peoples property. d. Behavior #4 Self Injurious Behaviors may involve suicidal ideation or posing of health risks. Graph frequency date 1 1 2 2 3 3 4 4 6 5 7 6 The graph above shows a stable trend during the first six days McNeal is expected to respond to behavioral correction. For example, the first day McNeal is expected to have a response that is equated to a single unit. Impression McNeal’s state of depression is mainly attributed to psychological factors. From the case study, McNeal does not have any history of disorder heredity in his family. Therefore, his problems arise from the psychological state of his mind and not from family. The psychoanalytic model can be used to explain the causes if his psychological problems. According to the psychoanalytic model, various behaviors contribute to this type of disorder. The model presumes that unconscious motives and childhood experiences are significant in the later behavioral patterns. Moreover, traumatic memories usually recur. The death of McNeal’s wife is the main cause of depression and anxiety. The death of his wife creates mixed emotions. The acceptance rejection theory also explains the reasons for McNeal’s socialization issues. This theory emphasizes on the need for acceptance in cases of traumatic experiences such as death. The death of his wife triggered depression considering the fact the he was previously divorced. Summary and findings McNeal suffers from post traumatic stress disorder and generalized anxiety disorder. His wife’s death which occurred few months ago has significantly contributed to his depressed state. This was noted by his neighbor who saw him exhibit strange behaviors such as isolation. He cannot clearly recall when he lost his interest in his most liked research jobs and playing football during his free times. Mr. McNeal admits that the tragedy affected him a lot. However, he is unable to understand why that traumatic event affected him that much. Before this, McNeal sought psychiatric help after close friends noticed he no longer liked his research activities and hobby of playing football. He was diagnosed with post traumatic stress disorder and generalized anxiety disorder. He was then given medication by the psychiatrist to help deal with his depressed state. Recommendations Psychotherapy Psychotherapy and medication are some of the ways that post traumatic stress disorder can be treated and controlled or reduced (Kasckow et al., p 371-375). People are different, so a specific type of treatment may for one individual may not work for the other. Therefore, it is important to administer treatment using different types as prescribed by professional mental health officials. Psychotherapy involves talking to mental health professionals about the psychological disorder. There are various types of psychotherapy that can be used to help people with this type of disorder depending on the symptoms. Cognitive Behavioral Therapy is one of the main talk therapies that can be applied in this type of disorder (Ochsner &Kosslyn, p 10). It involves cognitive restructuring, exposure therapies and stress training. Exposure therapy helps individuals to face and control fears. This technique uses safe exposure tools such as mental imageries or visits to help people control their feelings. Cognitive restructuring technique helps individuals with this disorder to make sensible meaning of traumatic events (National Institute of Mental Health). Sometimes affected individuals remember traumatic events differently than the way they occurred causing a sense of shame or guilt. Therefore, therapists help such individuals to view disturbing events more realistic ways. For example, McNeal can be helped using this type of therapy to view the death of his wife as something that can occur to anyone. Grief Therapy Grief Therapy will definitely help McNeal to deal with the death of his wife. He can move from a denial state to acceptance if the therapies are properly administered on him. His wife’s death will stop triggering of the memories and depressions faced. Physical aggression and property destruction will be stopped if such therapies are used. This means he can engage in meaningful activities that add value to his life (DiTomasso et al., p110-20). For example, encouraging Mr. McNeal to continue with his hobby of research work will help him reduce depression. Service Recommendations Therapist sessions- 5hours per week BCBA- 2 hours per week. Differential reinforcement Intervention This is a type of reinforcement intervention that involves the use of only one type of response or condition (Behavioral Intervention Guide, p1). This type of intervention usually takes time to be effective. Moreover, intrusive methods should be used in cases where inappropriate behaviors are dangerous. For example, McNeal can be helped through differential reinforcement by ensuring he does his hobby every weekend. This ensures he is busy and reduces his idle time. Punishment Intervention This type of intervention ensures that an individual is punished for any wrong doing. For example, McNeal can be offered punishment whenever he destroys his property or other persons’. Therefore, this type of intervention will help McNeal in avoiding physical destructive behaviors. Token economy This type of intervention utilizes tokens when appropriate behaviors are portrayed by individuals. These tokens can later be exchanged for rein forcers. Stickers are one way in which tokens can be used in this case (Behavioral Intervention Guide, p1). The stickers can be used on McNeal’s house to encourage him avoid self injurious behavior. Tolerance skills This type of intervention involves teaching the individual on ways of dealing with acceptance issues. It will help the individual to understand that death is part of life. Functional Communication Training This type of intervention involves the use of appropriate forms of communication to address inappropriate behavior. For example, asking for time during therapy lesions instead of avoiding such sessions. The therapist can give McNeal a break upon request. This will facilitate smooth and effective administration of therapy sessions (Behavioral Intervention Guide, p1). Goal setting This type of intervention involves breaking down tasks into smaller parts. This means a behavior like physical destruction should first be addressed in terms of its consequences. Group reinforcement contingency This involves the use of groups such as friends to address the behavioral patterns. Friends can be used to effectively reduce behaviors such as physical destruction. Friends of McNeal can actively help him through encouragement. Increased frequency recognition This type of reinforcement involves provision of feedback concerning behavioral patterns. McNeal can improve if he constantly provides feedback to therapists (Behavioral Intervention Guide, p1). Graphs frequency week (s) 1 1 3 2 4 3 5 4 8 5 10 6 The graph above shows how McNeal is expected to positively respond to the various interventions. For example, after 6 weeks, a significant change is expected from McNeal in terms of positive response of his depressed state. The graph shows increasing positive response trends expected from McNeal.  Staff Training will be done through various means. There will be training forums that will run for a period of two weeks. The forums will teach involved individuals on the best ways of implementing programs. Moreover, online training programs will also be available. This would enable people concerned to access data necessary for program implementation Data Collection: various data collection methods will be used. Questionnaires, face-to-face interviews, medical reports are some of the data collection methods that will be used. Medical reports will involve information found from psychiatric institutions. The collected data will be analyzed by professional data analysts. The analysts can be found from government analytical centers. Fading Fading will be applied once the patient shows positive recovery signs. The signs could include: lack of physical aggression, destruction or self harm. Skills Communication skills, recognition skills and functional skills would help in reduction of behaviors. The main objective of fading will be done once very positive results shall have been achieved. For example, when McNeal does not show destructive, self injurious or self stimulatory behavior, then the interventions can be withdrawn.  Works Cited Behavioral Intervention Guide. Conducting Functional Behavioral Assessments and Developing Positive Behavior Intervention Plans. Web. 24 November 2014. Castella, MD., Sidener, TM., and Sidener, Dw. “ Response interruption and redirection for vocal stereotypy in children with autism: A systematic replication.” Journal of Applied Behavior Analysis, 29 (2011): 519-533. DiTomasso, Robert, Golden, Barbara., and Morris, Harry. Handbook of Cognitive Approaches in Primary Care. New York: Springer Publishing Company, 2009. Print Kasckow, J., Morse, J., Begley, A., Anderson, S., Bensasi, S., Thomas, S., Quinn, S.C., & Reynolds, C.“Treatment of post traumatic disorder in emotionally distressed individuals.” Psychiatry Research, 220 (2014): 370-375. Larue, Robert. “Functional Analysis Screening Tool.” Encyclopedia of Autism Spectrum Disorders, (2013): 1351-1352. National Institute of Mental Health. Post-Traumatic Stress Disorder (PSTD). Web. 24 November 2014. Ochsner, M. and Kosslyn, S. The Oxford Handbook of Cognitive Neuroscience, Volume 2: The Cutting Edges. Oxford: Oxford University Press, 2013. Print. Psych Central. Generalized Anxiety Disorder Symptoms. Web. 24 November 2014. Shumate, Emily and Wills, Howard. “Classroom based functional analysis and intervention for disruptive and off-task behaviors.” Education and Treatment of Children, 33, (2010): 23-48. Talen, Mary., and Valeras, Aimee. Integrated Behavioral Health in Primary Care: Evaluating the Evidence, Identifying the Essentials, New York: Springer Science & Business Media, 2013. Print. Read More