While most of the Rehab Without Walls® locations across the country provide similar neurorehabilitation services—customized, of course, to individual patient goals and capabilities—some locations provide additional services that reflect the needs of their community or are tied into state funding. One such program is Behavior Management for Adults and Children (BMAC), which provides skilled behavior consultation and staffing services for people with autism and intellectual disorders in the Puget Sound, Washington, area.
This highly specialized program pairs a BMAC field staff member with a child who has been identified with behavioral issues that interfere with education, social integration and productive work and who already has an Individualized Education Plan (IEP). The staff member works one-on-one with the child throughout the school year, attending classes, partnering with teachers, consulting with parents and even riding the school bus daily if the child’s behavior interferes with that activity. The BMAC staff member helps the child focus, develops behavioral modification techniques, supports the teaching objectives and helps integrate children into the school environment. This, in turn, allows them to realize their potential and learn enough to become productive and independent adults.
Serving a Wide Range of Diagnoses
Up to 85 percent of children and teens in the program have been diagnosed with an autism spectrum disorder. However, the program works with other diagnoses such as Smith-Magenis, Angelman Syndrome and post-birth injuries like traumatic brain injury that manifest in cognitive/behavioral impairments that interfere with learning.
Typically a child partners with a field staff member for the length of the school year. In some cases, the relationship will last over several years, but more often than not, as the child’s needs change, the appropriate staff member with the appropriate skills will be assigned to him or her. The program currently has 55 field staff who work one-on-one with a child. Their background may include a bachelor’s degree in psychology or social work, special education certification or school counseling certification. All have experience with behaviorally challenged children and teens—for example in group homes or camps—and undergo highly specialized training that teaches them to bring a high level of focus and intensity to the population. For backup with the more difficult cases, Rehab Without Walls® also has a support team that includes a behavior analyst and a core staff with more than 50 years of experience with this population.
An Intense One-on-One Approach
“These are children who have been engaging in challenging behaviors for years with no modification,” explains BMAC Program Director Michael McCormick. “Let’s say the problem is that Johnny hits other kids. This may not be viewed as a major problem until he reaches adolescence, is strong enough to cause serious damage or is too big to control. At this point, the child is already in an IEP program but the teacher is still having difficulty with the child. This often is when we step in. With our specialized training, we can address the specific behavioral issues of the child within the educational setting. We work side-by-side with the child so we can see the behaviors firsthand, intervene immediately and track progress.” McCormick continued, “In addition, since we are typically dealing with very challenging kids an important part of our job is safety—keeping the patient, the other kids, the teachers and even property safe.” Progress is defined, tracked and measured toward functional goals. The BMAC program takes a pragmatic and scientific approach. In this case, it uses the science of applied behavior analysis to:
- Operationally define each challenging behavior
- Establish a data collection process to track the circumstances of the behaviors
- Develop a plan to respond to the negative behaviors that will change the behaviors or decrease the patient’s tolerance to triggers
- Selectively reinforce appropriate behavior (which science shows is more effective than creating consequences for inappropriate behavior)
- Track data over time
- Graph and share data with parents and the teaching team so they have a clear picture of the child’s status and progress toward goals
“What we have found,” says McCormick, “is that often kids make progress for the first time. Teachers are pleased, parents are thrilled and everyone wants us to remain with the child for the duration of their school years. Actually, for the district, it is a good business decision to hire us. Our model allows us to fit in and fill into the existing system, keep a child in school, change disruptive classroom behaviors and ensure these children get the help they need to reach their potential.”