ABA and Older Adults: River Bend Adult Day Program, Edwin

River Bend Adult Day Program supports senior citizens with physical, cognitive, and/or mental health challenges. Participants attend day programs three to five days per week. The program provides opportunities to make friends and cook meals. They make arts and crafts, go on outings, and take wellness classes. Lunch and dinner service is also provided. The program’s goal is to support participants’ independence and peace of mind for their caregivers and families. Staff send home written notes for families/caregivers each week. They describe the loved one’s week, and they include activity highlights and social opportunities.

Staff use a survey to find out about each participant’s preferences and preferred activities. They use the results to create meaningful activities. These foster positive relationships between staff, participants, and families/caregivers. By understand participants’ favorite foods or preferred games, they try to connect participants. They ask about stories unique to them.

The principle of ABA below is represented in this example:

• Positive Reinforcement. Staff learn preferences of participants. They use those items or activities as reinforcers when needed.

A small group of people who work at River Bend Adult Day Program experience challenges during lunch and dinnertime. During these times, staff members are often assisting other people who have specific dietary needs or need functional modifications to eat on their own. Three of the people working in the day program have been yelling and swearing at each other. Staff members meet with families of each of these people. They learn that all of individuals involved enjoy conversation and story telling. The staff work with the group to create a seating arrangement that works for everyone. Each of the individuals who enjoy conversation and story telling are encouraged to sit by others who are also talkative and have good hearing. Once a week, these three people meet for their own story telling group. They talk about their experiences and ask questions to group members. Staff members share strategies for engaging other people who have hearing impairments and memory issues.

The following principles of ABA are represented in this example:

• Antecedent intervention. Seating chart and skills group.
• Teaching alternative behavior. Using different communication strategies with some residents.
• Positive reinforcement and verbal encouragement.

One participant, Edwin, has Alzheimer’s Disease. His behavior continues to cause challenges for him throughout the day. He yells loudly, swears and swings his arms at program staff. This happens most often when he is dropped off, picked up, and before or after lunch. These outbursts happen five to six times per day. Each instance typically lasts six to nine minutes.

The staff and administrators work with each other to implement and facilitate a Functional Assessment. This is a strategy for confirming the function that maintains a challenging behavior. The results suggest Edwin is engaging in these behaviors to communicate that he needs someone to pay attention to him. Program staff meet Edwin and his family to discuss supports that may help Edwin to make sure he can get attention from others whenever he wants. These supports would increase Edwin’s opportunities to participate in group activities and to talk with others. During the morning drop-off time, a staff member greets Edwin and asks what type of dessert he would like at lunch. Also, staff members remind Edwin that he can request preferred activities at any time. At lunchtime, staff members place a picture that represents the afternoon activities near Edwin. Throughout the day, a staff member asks Edwin about his day. As staff members monitor Edwin’s challenging behavior, they see that the challenges that use to occur are shorter in length and occur less often. Edwin uses appropriate ways to communicate with staff members more often.

The following principles of ABA are represented in the example:

• Functional Assessment. Collecting and looking at data to determine the function of a challenging behavior.
• Teaching Alternative Behaviors. Examples are the morning greeting, requesting information about the daily schedule, and appropriately requesting preferred activities.
• Antecedent Intervention. A staff member greets Edwin during drop off. They give him a reminder during transition times.
• Non-contingent Reinforcement. Edwin receives attention at a few points in the day.
• Data Monitoring