What is Compassionate Care, Today’s ABA, PFA and SBT?

You have undoubtedly heard the terms Compassionate Care, Today’s ABA, PFA and SBT all around you in recent times. If you’re lost, let the bitches help you find your way, SNABA style!

Dr. Greg Hanley: Dr. Greg Hanley is a BCBA who has published articles and protocols about a learner led approach in ABA that he refers to as compassionate care and Today’s ABA. He has developed tools for the assessment of problem behavior and intervention of skill instruction. This approach is much different than the ABA described and sometimes modeled to us, that often jumps to most intrusive prompts and extinction as easy fixes.

This Rad BCBA

Compassionate Care: the individuals we work with are just like us, human! Compassionate Care strives to give autonomy and kindness back to the people we work with and consider how they feel at all times. Pat Friman gives an inspiring talk on this kind of approach below.

“No such thing as a bad boy” Ignite compassion for problematic behavior | Dr. Pat Friman | TEDxOmaha

Real World Example:

While driving someone cuts you off. #rudeAF Instead of flipping them the bird, you engage in compassion and assume that they are late to a meeting and give them some space. BUT then they start driving 5 miles per hour. Instead of losing your shit you assume that maybe they like to have the lead while driving and it calms their nerves. This is being compassionate, in an otherwise difficult situation.

Clinical Example:

A four year old is in crisis and is crying and thrashing on the floor. Instead of removing all objects, you offer some things that you know that they like such as a warm blanket, stuffy toys and squishy balls while wiping their snots and tears away.

Today’s ABA: Some argue that today’s ABA is not different than “yesterday’s” however, what we believe Greg is trying to urge us to do is listen to the learner through their vocalizations and their behavior, teach them by using joy and things that they like to do, empower them to advocate their desires and feelings, and for us as clinicians to learn by teaching. Today’s ABA is trauma informed, meaning we should assume that our learners have experienced some trauma in their lives and adjust our approach accordingly to create happy, relaxed and engaging environments for them to flourish in.

Practical Functional Assessment (PFA): This is a specific assessment process that Dr. Hanley has developed. It starts with an open-ended interview that allows for personalized analysis of the problem behavior. Hanley suggests that this yields more socially meaningful treatment outcomes.The interview is usually followed up with the interview-informed synthesized contingency analysis (IISCA) which is a version of functional analysis that safely and quickly identifies classes of problem behavior and their relevant contingencies in which they naturally occur. Identifying the classes or levels of problem behavior become useful in the intervention process. The IISCA typically functions as a baseline to help treat problem behavior.

Skills Based Training (SBT): After the completion of the PFA, practitioners move on to immediately teach the learner an appropriate more effective way to obtain the same outcomes as they do with their problem behavior. Often functional communication training (FCT) is used to teach a phrase like “My way” and it is reinforced immediately with the same things that problem behavior was reinforced with and problem behavior goes on extinction (no longer receives reinforcement). Once this is mastered, practitioners begin to shape more complex and appropriate language such as “Excuse me” or “Can I have it please” and varied delays and denials to reinforcers are introduced. The learner is also taught a tolerance response to these denials such as a high five or a phrase “ok” and is immediately given the denied item to reinforce acceptance. Once the concepts of functional communication, delay and denial tolerance and compliance with reasonable tasks have been mastered you can then start to teach individual skills in the same format (leisure skills, academics, daily living etc.).

A Visual