Unique Components for Developing a State-of-the-Art Severe Behavior Program
There are many important characteristics of a severe behavior program to consider. First, the program should provide at least three levels of service:
- A day-treatment program provides a full day of services during weekdays to children whose destructive behavior prevents them from attending school.
- An intensive-outpatient program provides less-intensive, half-day services during weekdays or multiple times per week to children whose destructive behavior does not prevent them from attending school for at least part of the day.
- Finally, an outpatient program is the least intensive model and provides: (a) follow-up services for children stepping down from the day-treatment or intensive-outpatient program; and (b) weekly, bimonthly, or monthly services for children with less severe forms of destructive behavior who do not require admission to the intensive-outpatient or day-treatment programs.
The program should be:
- Data-based, meaning treatment decisions should be based on objective and ongoing measures of the individual’s destructive behavior
- Protocol-driven, meaning that the general treatment approach should follow standardized but flexible treatment protocols that are supported by empirical research
- Outcome-oriented, meaning that the program should have clearly defined outcome goals for each patient (e.g., reducing aggression by 90% in the clinic; training caregivers to implement the treatment with 90% accuracy; maintaining the reductions in destructive behavior obtained in the clinic when the treatment is transferred to the home and community settings)
The general goals of the program typically should include:
- decreasing the child’s destructive behavior
- replacing destructive behavior with appropriate behavior (e.g., functional communication)
- training caregivers to implement treatment protocols with high fidelity in the clinic and in natural environments such as the home and school
Other unique components to consider include:
- The professionals responsible for the program should have specialized, advanced training in the assessment and treatment of individuals with severe destructive behavior.
- The program should ideally include a clinical research component to advance knowledge and to provide feedback to professionals about the efficacy of individual assessment and treatment protocols.
- The program should have procedures for tracking and sharing primary outcomes (e.g., reductions in destructive behavior; increases in appropriate, alternative behavior) for individual children and for the entire program. They should summarize and share their outcome data with the public at least once a year.
- The physical space should be constructed such that the program can provide safe and effective treatment of children with severe destructive behavior (see section Characteristics of the Facility Needed for a Severe Behavior Program).
- There should be strict admission criteria that patients must meet, as well as a thorough medical evaluation prior to admission to the program.
