SBT Extensions: Enhanced Choice Model

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What is the Enhanced Choice Model (ECM) anyways?

This video with Melisa Santacroce provides an overview of the rationale and application of ECM:

How do I use ECM?

Maximizing Safety by Embedding the PFA and SBT into an Enhanced Choice Model

ECM Hangout

ECM Case Studies

Does ECM lead to meaningful outcomes?

Reflections on procedural changes with ECM principles – Melisa Santocere

I was just spending some time reflecting on some ways that my colleagues and I have implemented some adjustments across the board with our learners in the past year that I think has resulted in some really meaningful outcomes, and I’d like to share them for others to consider and use.

1) Directly teaching and reinforcing multiple ways of withdrawing assent for interaction – this is a piece I’ve been thinking about for many years with my Enhanced Choice Model clients, but my group has really put into practice with clients across the board in the past year, and I’ve come to believe it might be the single most important aspect of what we are doing to improve safety. This takes time – we may spend a month or mor focusing in on this while developing and learning about HRE and implementing Universal Protocols before moving into the first steps of SBT. We have been working on this the last year and have seen multiple times now that dangerous problem behavior can abruptly stop once the learner grasps how to withdraw from the immediate situation/demand without being pursued.

2) Any time there is an R1 behavior in a session we take the time for analysis before we send anyone back in. For us this means the next therapy session on the tech’s schedule that day gets cancelled to give them time to debrief with the supervisor and consider all the factors. The supervisor takes the time to analyze the situation – to the degree that it may be like another PFA. Sometimes an interview with caregivers is part of this. We may put sessions on hold for a couple days if that is the time we need. We promise not to try to change a behavior until we understand it – and understanding takes time and resources. It also gives staff time and space for self care.

3) Allocating both an implementer and a data collector for all SBT sessions, at least the first 3-6 months. We have been doing this for more than a year ever since I first saw it mentioned in the FTF implementer course. This has allowed the implementer to be present with the learner without the need of looking at an iPad or a piece of paper and recording things. They are present and they are available, and they are not distracted. The data collector is typically on video, and we utilize Apple AirPods in the air of the implementer as needed to guide the next trial. This has helped substantially with timing, and being able to observe things that a single person may not observe on their own as well as problem solve.

4) SBT training for all staff – at my agency we have every RBT go through the 12 hour implementer training from FTF. We also have them do the Boundaries training from the Thinkific page of this group. The business invests in paying for these trainings as well as the time of the person doing the training. We have each of these people observe SBT sessions over video multiple times before sending them in person. When we send them in person, we have them overlap with a confident implementer. We have them take on implementer duties or data collection when they tell us they are confident.

I wanted to share these because we’ve been messing around with these different aspects for awhile now and I think we have a good combination. There is not a single one of these pieces I would change as of right now, and all have lead to increased safety, rapport and televisability. This is the concerted effort of many great minds that work with me – RBTs and BCBAs, and of course our learners who teach us so much. My hope is a year from now I will have more improvements on the technology to share. Feel free to ask questions about how we came to decide these different things, and how we implement it.
-Melisa Santocere

What other trainings and resources do you have?

Podcast

The Behavioral Observations Podcast with Dithu

Our CEUs & videos!

What are some FAQs about ECM?

Check out these threads in our FaceBook group!

Here is a great general thread about what ECM can look like

Is there a way to signal that he is in “hang out” without it being a separate physical space?

I use two different signs that say “Hangout” and “Practice.” Also for that same learner, who was getting annoyed, we really slowed our pace. Right now he has a minimum of 10 minutes HRE between trials and we cap at 10 per day. Ideally we will work up to more trials, but this is what works for us right now!
-Kayln Danielle

Tell me more about reinforcement in ECM — what are examples? How do we modify it? Should they be different or rotate? Should the quality differ?

So here are some of my thoughts having used ECM for a few years now across several clients and what they have taught me. I work only in home and schools and community, no center so that may influence my thinking. First and foremost I think of ECM as an “anti-coercive” system, meaning that in response to many of your questions, I will give the answer that is the most opposite of coercion. When I am trying to decide what to do, I think of the potential for coercion and the impact on this learner – and try to move away from that. Here are some thoughts:

1) What are some examples of reinforcement in practice mode? Or is reinforcement supposed to be just the removal of the aversive instruction and access to hangout?
If we have developed a good relationship with the learner, then the reinforcement of the encouragement and that awesome relationship is available across all conditions. Think of some of your favorite teachers from your past. Did they act one way when they were trying to teach you something and another way when they were enjoying their time with you without trying to teach something? Likely not. They were their authentic selves across all of these conditions. It makes teaching look effortless when teachers have accomplished this.

I think this should be the goal here. The person implementing this system and supporting the person in ECM should not act differently according to the “door” they chose. That means that we are not thinking of instructions as aversive, or practice as aversive. It’s just that likely hangout is more desirable initially (or even leave) because that is where they KNOW they can have all of that reinforcement. Once they develop that relationship, they know that they can take that reinforcement (the relationship) across all contexts without fear of punitive action.

2) If so, do we allow them (or prompt them) that they can go back to hangout after engaging in the specified practice task (s)?
We find it to be useful to do this in a naturalistic way. Usually at first while they are learning the “rules” of the game they need more reminders. Some learners benefit from a visual as well. These are concurrently available and since it is not a coercive system (and likely this learner is very sensitive to that) they may desire to try out all of the conditions many times before they really trust that it works. I think reminding them naturalistically about all of their choices in a way that is supportive (and not annoying) is a good idea.

3) In the presentation it was shared that if precursor or BX occurs in practice mode, immediately allow access to reinforcement. But if there is no bx in practice, should we stay in practice mode until the learner emits an FCR?
I would answer “it depends” on this one. How long have you had the relationship with this learner? How fluent are they at moving between the conditions and signaling that they need to move? Usually learners need extra insight on this at first – “looks like this is getting kind of challenging and you are pushing through – are you feeling like giving yourself a break yet? because that is totally cool” or “need some self-care?” or even a surprise shorty by definitively saying the task is done “well that’s good enough for today, nicely done lets hang out some more”

4) What dimension(s) should we consider for modifying reinforcement in practice mode versus hangout mode?
I do not modify reinforcement according to mode. In fact, I believe that any attempt to do so will be perceived as coercive and the whole thing falls apart. Just my opinion/experience. Let go of control. This is a system of shared governance. You will not be able to even guess sometimes which condition the learner will land in that day. That’s okay. You have set it up so that whatever condition they are in, everyone is safe. It’s not about the destination.

5) For instance, should both modes have highly preferred but DIFFERENT reinforcers?
Should QUALITY of reinforcers differ slightly between modes?
Should we rotate reinforcers in both modes to prevent satiation?
I feel that expanding a person’s circle of activities, people, places, things, etc that provide reinforcing value to them is always a socially valid pursuit. In ECM I make extra effort not to “require” a person’s participation. Sometimes I might just have an activity nearby and say “hey is it cool if I mess around with these legos over here while you play Mario?” and then respect their decision. I might place something in view that they could ask about if they wanted. I might consider expansions on current reinforcers that they are interested in without requiring a change – “ah I noticed you like Michael Myers…have you seen the new M3GAN preview yet?”

However the QUALITY of reinforcers should only be as FANTASTIC as you can make them across all conditions. All appetitive all the time.
-Melisa Santocere

Do learners actually choose the work condition?

I will be real. It is stressful to try this and to put your faith in the yearn to learn. And I think it does take longer than say universal protocols or SBT but with some learners it is the only way to go. These are learners that have had so many experiences with therapist, teachers, and everyone else trying to manipulate them or rapport them or reinforce them into doing what the adult thinks is best that truly the only way forward is to sincerely let go of all expectations and contingencies and let them see you are there for them equally when they do what you want versus when they do not do what you want. This takes time. and not all insurances/stake holders will be willing to hang in there.
–Taylor Johnson

This is inherently not a coercive system which can really confuse people. However, we do know a lot about coercion and its fallout as a field right? (Or we should). Once a person builds a relationship and feels safe that there’s not going to be an excessive number of expectations that they can fail at, they can relax a bit. At this time they might be more willing to accept some encouragement to try something a little bit more difficult. Actually had an hour long phone call with Mom today because she was worried that her son was spending too much time giggling with my therapist. She wanted to see that he was working. I think she has this impression that therapy should be difficult and you should be exhausted afterwards. There are other ways to do things and when we do things in these other ways, there are benefits. Finally got this mom to see what I was talking about was when I said that when her son has to do something hard and the next few months and he looks around at his support team, who would he choose to go try to do that hard thing with? Probably my staff member that spent time building a genuine relationship that was not based on coercion.
–Melisa Santacroce

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