DRA/I/O is often implemented as a stand-alone intervention but can also be implemented as part of a wider treatment package. This approach to intervention includes two components. In their initial implementations, DR-based interventions included one component that scheduled reinforcer delivery following alternative/incompatible behavior or omission of challenging behavior, and a second component that specified extinction for challenging behavior.

As mentioned, implementation of DR procedures has been more recently described to still include two components, with the second component being scheduled delivery of a reduced amount or quality of reinforcer following challenging behavior, relative to the reinforcer scheduled for alternative/incompatible behavior or omission of challenging behavior.

DRA/I/O can be implemented with the extinction component when challenging behavior poses minimal risk to the individual or implementer. Care may need to be taken when implementing DRA/O/I with the extinction component when challenging behavior is moderate or severe. Extinction-based interventions can result in temporary increases in frequency and/or intensity of challenging behaviors. This side effect of extinction can be mitigated by the inclusion of reinforcement for alternative behavior.

Implementation requires observation and monitoring of at least two behaviors, and its implementation requires high procedural fidelity to maximize efficacy. DRA/I/O have been demonstrated to be effective for challenging behavior with social functions. Some limited demonstrations of effectiveness exist for DRA/I/O related to behavior with a non-social (i.e., automatic) function (see, Berg et al., 2016 for an example). However, in these implementations it should be noted that the extinction component is not possible, given that the challenging behavior directly produces access to the maintaining reinforcer.

Thus, when arranged for treatment of automatically maintained challenging behavior, DRA/I/O establish two competing reinforcement schedules in an attempt to shift responding away from challenging behavior.

Caregivers/implementers with wide-ranging responsibilities (e.g., teachers in classrooms with large numbers of students; caregivers with multiple children or overlapping household responsibilities) might struggle with implementation, regardless of challenging behavior intensity. Initially, a dense schedule of reinforcement (i.e., reinforcers are delivered frequently and/or after each occurrence of the target response) will likely be required to change behavior.

This initially dense reinforcement schedule can result in disruption to ongoing activities, such as academic learning. However, successful strategies to thin the schedule of reinforcement delivery have been described in the literature, including delays to reinforcement, increasing the response requirement, and specifying time intervals during which reinforcement is available using schedule-correlated stimuli (i.e., a multiple schedule).