gentle teaching evaluation network g-ten

Gentle Teaching Evaluation Network

G-TEN

International Alliance to Produce Evidence – Simple Yet Scientific

James W. Conroy, Ph.D.

The Center for Outcome Analysis

www.eoutcome.org

2COA September 2007

Outline Purpose

Why Measure and Measure What? Paradigms and Resistance

The Scientific Literature – Paradigm War Things are Changing, Especially in the Americas Now is a Very Good Time to Seek Evidence in a

Cooperative International Venture Dimensions We Must Measure

– Interactions, Qualities of Life (including feeling safe and loved), Behavior, Person-Centeredness

How to Move Forward: Pilot Studies, Home, Funding, Nations, Studies

COA September 2007 3

Purpose

Today – to share our thinking about how to get new, reliable, valid scientific evidence

Aiming toward publishing studies And obtaining serious funding from USA

organizations – government and foundations

GTEN – what is our best strategy toward production of good evidence across our nations?


Why Seek Evidence?

We have a common belief in Gentle Teaching We all hope that it will spread, and negative

approaches and aversives will end We will need more evidence to bring the skeptics

and the “undecideds” along Yet we must overcome powerful past rejection by

behavioral scientists GTEN – is there hope of achieving this?


The Controversy in the “Scientific” Literature, 1980s and 1990s

Why all the resistance, skepticism? Because GT threatens established thinking

and funding? Look at this title from one of the critics: Bailey, J.S. (1992) Gentle teaching: trying

to win friends and influence people with euphemism, metaphor, smoke, and mirrors. J Appl Behav Anal. 1992 Winter; 25(4): 879–883.


The Controversy in the “Scientific” Literature, 1980s and 1990s

McGee, J. J., Menolascino, F. J., Hobbs, D. C., & Menousek, P. E. (1987). Gentle teaching: A non-aversive approach to helping persons with mental retardation. New York: Human Sciences Press.

McGee, J. J., & Gonzalez, L. (1990). Gentle teaching and the practice of human interdependence: A preliminary group study of 15 persons with severe behavioral disorders and their caregivers. In A. C. Repp & N. N. Singh (Eds.), Perspectives on the use of nonaversive and aversive interventions for persons with developmental disabilities (pp. 237-254). Sycamore, IL: Sycamore.– Caregiver’s Interactional Observation System (CIOS) and the

Person’s Interactional Observation System (PIOS)


1989 JABA

J Jordan, N N Singh, and A C Repp (1989). An evaluation of gentle teaching and visual screening in the reduction of stereotypy. J Appl Behav Anal. 1989 Spring; 22(1): 9–22.

Extremely complex behavioral research design with just 3 “subjects”

“…gentle teaching was found to be more effective than task training for 2 subjects but less effective for the 3rd “

Published anyway – because their Discussion conclusions were negative about GT

Footnote on Singh – Therapy Malls in big institutions and DOJ witness history


1992 Review of the Controversy

A J Cuvo (1992). Gentle teaching: on the one hand ... but on the other hand. J Appl Behav Anal. 1992 Winter; 25(4): 873–877.

Perhaps the most balanced review of the early controversy.

This would be worthwhile reading because it explains the harshness of the attacks on GT.


Most Recently, 2003:

Polirstok, Susan Rovet EdD; Dana, Lawrence PhD; Buono, Serafino Dot.; Mongelli, Vita Dottssa.; Trubia, Grazia Dottssa. Improving Functional Communication Skills in Adolescents and Young Adults with Severe Autism Using Gentle Teaching and Positive Approaches. Topics in Language Disorders. 23(2):146-153, April/May/June 2003.

Described positive findings, both for individuals and workers.

Working with 18 young people in Sicily.


More Recent Rigorous Study in England Cullen C. & Mappin R. (1998). An examination of the effects of

gentle teaching on people with complex learning disabilities and challenging behaviour. Br J Clin Psychol. 1998 May;37 ( Pt 2):199-211.

13 students, 7 staff observed 13 weeks “pre” and 23 weeks “post” 45 hours direct observational data on handheld computers, 75

hours of video “Wherever there were differences between gentle teaching and IEP

these were in favour of gentle teaching, although they were generally relatively minor in terms of clinical (rather than statistical) significance.” NOTE the disclaimer

Conclusions: all effects of GT unimportant, may be “useful adjunct” But who did the training, and how was it reinforced?


Scientific Revolutions

Thomas Kuhn’s “The Structure of Scientific Revolution” 1963

The source of the phrase “Paradigm Shift” When the prevailing “model” or “paradigm” fails

to explain something – an anomaly Sometimes a new worldview is required But there will be powerful resistance The thinking which was the cause of our success

in the past often becomes the reason for our failure in the future.” - Einstein


1. Current paradigm does not “work” for some observations – anomaly and crisis. Not all in the community will care about anomaly – too comfortable

2. The proponents of the “new” are reviled, criticized, distrusted – Threat!

3. Competing camps form

a. One camp seeks to defend the old institutional constellation.

b. One (or more) camps seek to institute a new paradigm

4. Polarization: civil scientific discourse fails – Demonization, stridency, desperate defense – paradigm wars

5. Circular arguments - Each group uses its own paradigm to defend its paradigm – circular discussions

6. Finally, the new does replace the old, and the guardians of the old “suddenly” embrace the new as though they had thought of it themselves

7. Gentle Teaching has been immersed in a paradigm war

8. But this paradigm shows every sign of success – allies have sprung up – we will live to see it become the established belief system

9. To speed this up, evidence developed within the scientific method will help

13COA September 2007

Is the Paradigm Changing At Last?

There’s reason to believe so Look at the insurgencies into the bastions of

resistance Look at the organizations that have embraced

positive approaches (not the same thing but emerged from GT thinking) e.g. Herb Lovett

Look at the rise of aversive regulations, concerns, surveys, government requirements


Even the ABA (Association for Behavioral Analysis)….. Now has a Special Interest Group, the PBS ABA International Newsletter

– Volume 29 | 2006 | Number 2 Positive Behavior Supports

– The Positive Behavior Support (PBS) SIG addresses the interests of members engaged in experimental and applied analyses of behavior who are proponents of positive behavior support. Established in January 2005, the goals of the SIG are to promote and disseminate positive behavior support within ABA, and to ensure that PBS is aligned with the science of behavior.


PBS - SIG

The PBS SIG currently has approximately 40 formal members….electronic listserv with over 70 recipients, many of whom belong to both ABA and the Association for Positive Behavior Support (APBS).

Goals of the PBS SIG are to: – Increase the number and visibility of PBS presentations at the ABA

convention – Disseminate accurate information about PBS to ABA’s

membership – Promote methodologically sound, data-based PBS research – Encourage open dialogue among behavior analysts and proponents

of PBS www.pbsaba.org www.pbsaba.org/newsletter


Association for Positive Behavioral Support, APBS.org http://www.apbs.org/main.htm Affiliated with TASH TASH has 20 years of commitment to

positive approaches Should GTI interact with the new emerging

groups with similar values? Or should GTI simply be aware that the

world is changing toward our values?


USA – Nationwide AwarenessIs Finally Emerging Aversives Survey3.pdf


Old Paradigm, New Paradigm

Old – Behaviorism– Mechanistic

– Ghost in the machine

– We can shape any person’s behavior

– All means are fair, if justified by ends

New – GT & Positive– Humanistic

– Presumes humanity

– We can make a real connection with any person

– The process is often as important, sometimes more important, than the outcomes


Dual Dimensions of MeasurementIndividual Caregiver

Feeling Safe Protecting – Confidence in Ability to Offer Safety While Avoiding Negatives

Feeling Loved Assisting Warmly – Feeling of Offering Unconditional Love

Enjoying Interactions Enjoying Job

Self-Control (less challenge) Feeling of Success in Job

Self-Control (choicemaking) Pride in Sharing Power

Self-Actualization – Becoming More Authentic Human

Self-Actualization – Becoming More Authentic Human


Simple Rating Scale:The Person Being Supported

Very Cold,

Negative

Neutral Very Warm, Positive

Response to Caregivers' Presence Response to Caregivers’ Words Response to Touch Response to Food, Drink Acceptance of Doing Things with Caregivers Acceptance of Doing Things with Peers Self-Esteem

?


Simple Rating Scale:The Caregivers

Close Distant

Warm Cold

Heart Head

Warm Protection Restraint

Engagement Disengagement

Colleague/Friend “Boss”

Unconditional Love Conditional Rewards

New Memories Old Memories


Input, Process, and Outcomes

InputEffort, Resources, Time, Emotional Investment, Hope

ProcessSafe, Loving,

Positive, Supportive,

Persistent, Patient

OutcomesRelationships,

Qualities of Life, Behavior Change

Measure GT Here?

Feedback After Success/Failure

(Or is GT Here?)


We Have Good Measures for the Collateral Outcomes

Control of one’s own life (DCI) Person-centered planning (EPP) Qualities of life (QOL Then & Now) Family perceptions of quality life and service Qualities of work life for the caregivers (QOWL) If we can get decent measures of Safe and Loved

from both perspectives, these other outcomes will make a very strong case.


Paradigm Shift – What It’s Like

What Animal is This?

Duck? Or Rabbit? The switch is what a Paradigm Shift feels like.


I’ve Already Seen…. Two and a half paradigm shifts I came in at the end of the Medical Model in 1970 I witnessed and studied the decline of belief in a need for

segregation – deinstitutionalization I took part in the self-determination movement from its

inception, studying and demonstrating And now the largest system of grants ever given from

the USA’s major funding source, “Money Follows the Person,” $500 million, is aimed at individual control of resources (SD) in community settings.

I believe that the time of GT’s ascension is coming fast.


We Are Going to Live to See it Happen

The signs are clear Our task is to gently develop and offer the

evidence People have begun to want to believe Gentle nudges and good solid science are

all that’s needed Our international cooperation via GTEN

will be very important – and FUN!


We Need Partners

This idea is now a year old We’ve been studying and thinking Siddhartha’s motto:

– I can think, I can wait, I can fast I think the time is right to move forward

with real data, real pilot studies, and plans for large-scale evaluative research.

Cross-nations: GTEN


Comments and Ideas

All ideas welcome Testers of these instruments needed Critiques needed

Thank you for your attention and for the honor of appearing before

you at this conference


Perceived Qualities of Life:“Before S-D and Now”

0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5

Safety (NS)

Relationship with family

Health

Health care

Food

Relationship with friends

Overall quality of life

What he/she does all day

Getting out/getting around

Comfort

Treatment by staff

Happiness

Privacy

Running own life

Then

Now


How “Person-Centered” is the Planning Process?

4.43 Are meetings held as needed? 4.29 Emphasis on cooperation in meetings?

4.20Are meetings comfortable for focus person?

4.06Does respondent consider plan to be Person-Centered?

4.02Does process allow and deal with conflicts?

4.02Is the planing process flexible, trying other ways?

3.86Strong efforts to understand person's hopes and dreams?

3.78Does process emphasis creativity, new ideas?

3.75Are the person's relationships considered?

3.71Does the person have ultimate authority in disagreements?

3.65Is process governed by formal rules and regulations?

3.63Does the planning process take money into consideration?

3.35Does group have control over money supporting the person?

3.11Do the unpaid group members have the real power?

3.07Are community and informal support networks emphasized?


How Many Friends?

11

22

4

1

2

11

4

2

4

3

5

10

8

6

3

4

2

# OF FRIENDS

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Cou

nt

12

10

8

6

4

2

0


Who Are YourClosest Friends?

47

45

43

43

35

29

23

16

0 5 10 15 20 25 30 35 40 45 50

CO-WORKER ORSCHOOLMATE

OTHER

RELATIVE

STAFF OF HOME

STAFF OF DAYPROGRAM

HOUSEMATE

OTHER PAID

NEIGHBOR

c

34COA September 2007

One Wish in 1994 One Wish in 1996

None More contact with familyNone Meet Garth Brooks, go to Disney world, walkNone Enjoy better healthNone FriendsNone HairNone To go on a plane to FL to see sister, make more $None To always be happy and grow into independenceHam sandwich More friendsTo be finished work MotorcycleTo be sleeping Ride a bike, go to Disney with SteveBill Clinton To be healthy, to be safe and aliveGet out of house and go to Keene (Accomplished)Go to Disney World (Accomplished)To go to California Would like to visit FL + CATo live near my parents Go horseback ridingVacation in Florida Good healthHave a brain Want to have a little boy babyGet away from Keene housing authority To meet celebrities, to live in warm climateNot to have a roommate To live like royalty, a queen with loyal subjectsA friend Go visit Maine someday, maybe have more moneyThat my father was still alive I'd like to see Richard CTo be married To have Keene fully accessible, live in dream house

gentle teaching evaluation network g-ten

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