Bridget Knights

Lojic

Abstract:  Improving quality of life and reducing restrictive practices is a cornerstone of effective behaviour support services (Carberry et al., 2024; Leif et al., 2024). Achieving these outcomes, however, is often met with resistance from diverse stakeholders (Fisher et al., 2024; Leif et al., 2023). In such instances, innovative organisational behaviour management (OBM) approaches are necessary (Konstantinidou et al., 2023).

This case study presents a constructionist OBM approach to eliminating seclusion for a 14-year-old in out-of-home care, where restrictive practices were endorsed by Child Safety. Initial data-driven recommendations failed due to stakeholder resistance, implementers’ concerns about managing behaviour without restraints, and systemic barriers. As such, these challenges prompted a shift to a constructionist approach, focusing on identifying systemic obstacles and collaboratively building implementers’ skills (Goldiamond et al., 2002; McGill et al., 2018).

Through targeted training, collaborative problem-solving, and a gradual shaping process, seclusion was eliminated, PRN chemical restraints were reduced, and the child’s engagement in daily activities and community participation improved. This approach also facilitated a plan for school and peer re-engagement after four years of disengagement, thereby demonstrating the value of a collaborative constructionist OBM approach in achieving meaningful change in complex behavioural support contexts.

Target Audience: Practitioners working in or will be providing systemic support/approach

Learning Objectives: At the conclusion of this presentation:

1. Participants will learn how to transition from traditional, data-driven behaviour management methods to a constructionist organisational behaviour management (OBM) approach, with a focus on reducing restrictive practices in care settings.
2. Participants will understand the importance of targeted training, stakeholder collaboration, and a gradual shaping process in fostering long-term behaviour change, increasing stakeholder buy-in and overcoming resistance to new approaches.
3. Participants will gain an understanding of the ethical principles underpinning the constructionist OBM approach and how this framework supports increased quality of life and reduction of restrictive practices.

BACB CE Instructor: Oliver B. Roschke

Oliver B. Roschke & Bridget Knights

Lojic

Abstract: High drop-out rates, reports of discomfort and trauma, and evidence of new side effects following treatment all suggest that a new approach to exposure therapy is needed (Moritz et al., 2015). Although exposure therapy is currently considered the "gold standard" for treating anxiety, obsessive-compulsive disorder, PTSD, and other related conditions, it often focuses on reducing presenting concerns by increasing tolerance to distressing stimuli (Abramowitz et al., 2019), thereby relying on the prolonged exposure to aversive events.

This presentation examines a promising alternative to traditional exposure therapy, based on Goldiamond’s constructional approach, and Rosales-Ruiz’s pioneering research in constructional exposure therapy (CET) (Goldiamond, 2022; Katz & Rosales-Ruiz, 2022). A key difference in CET is that the procedure reinforces the avoidance or escape of the aversive stimulus, rather than increasing exposure to it, therefore allowing the participant increased choice and control over the progression of treatment. This case presentation will compare traditional and constructional exposure therapy, summarize the evidence base, and show how targeted CET training and gradual shaping helped a 14-year-old in out-of-home care transition from avoiding medical professionals and exhibiting harmful behaviours toward emergency services to willingly engaging with healthcare providers.

Target Audience: Mental health and behavioral therapy professionals supporting individuals with aversion

Learning Objective:  At the conclusion of this presentation, participants will be able to:

• Identify key conceptual and practical differences between Constructional Exposure Therapy (CET) and traditional forms of exposure therapy and desensitization training.
• Identify key differences between constructional- and pathological orientations and how these apply to the delivery of Positive Behaviour Support (PBS).
• Critically evaluate current exposure therapy methods and the ethical implications of utilising negative reinforcement rather than positive reinforcement.
• Describe key steps involved in Constructional Exposure Therapy (CET)

BACB CE Instructor: Oliver B. Roschke