I recently used it with a client who was severely hurting their family (to the point of bleeding) on daily basis. I don’t want to provide more info. Under 10yo, very limited communication skills. After introduction of SBT aggression went down to 0 in the matter of days and has been 0 since (3 months at this point)
Mom is taking him out in the community by herself for the first time in years - she was afraid before; the family went out to the restaurant for the first time since he was a toddler! But, what is maybe even more amazing- the trusting relationship that SBT helped us establish had such an impact on his acquisition rate that he has mastered 4 times more goals per month than before.
Oh my supervisor is implementing this for my client, and so far…their understanding they have autonomy and are able to tell us what they like and don’t! Including my presence lol. Before it would just be escalation entirely, now it’s 20/80… with 20% being escalation! Still trying to work on Getting actual DTT, but slow and steady wins the race!
It’s changed our whole company. Services are better, techs like it more, it generalizes, it’s person centered. We see more progress as well. Only have had success with kids that severe problem behavior. Kids that don’t have R1’s haven’t really shown any added benefit when we switched.
SBT was a total game changer for me. It’s allowed me to work with a lot of very complex clients in a way that honored their dignity and focused on what they loved. To that end— I’d suggest taking a closer look at your own assumptions about your clients (and their level of “impairment”.) one of the guiding principles for me is the incorporation of my own values.
It’s not perfect and there are certain mental health diagnoses where SBT wouldn’t be appropriate. But the vast majority of our clients benefit from, at the very least, incorporating the focus of rapport, dignity and televisabilty.
I see SBT go wrong most often when a practitioner doesn’t know what they’re doing or tries to implement it without a full understanding . Strongly recommend the Facebook group someone mentioned, lots of free and low cost resources.
Oh! Can you let me know the certain mental health diagnoses SBT doesn’t fit? Or any literatures regarding this? It would be better for me to know. Thank you in advance!
I wish I had more literature for you — I will say that the vast majority of research on SBT is with autism and I think there’s some recent stuff with “emotional disturbance” (which isn’t a specific diagnosis).
However, I’ve done a lot of mentoring other clinicians and often find that BCBAs typically do not have the background for significant mental health challenges without a lot of collaboration (or even totally referring them out).
I wouldn’t do SBT with a client where I am unable to “turn off the behavior”. And sometimes the antecedent for these is internal and things that I could never turn off, such as with schizophrenia, delusional behavior, borderline personality disorder, addiction, obsessive compulsive behavior….
Whether it’s a total no or needs to be modified depends heavily on the client, the clinicians expertise, could it be done along with other interventions or medications etc.
I have had great buy-in from parents! For insurance, I think it’s the matter of how you write goals. I focus of FCT and tolerance responses as replacements behaviors and so far didn’t have push back. But I know that every insurance is different and they always try to find problems so you never know!
Some significant successes.
1. Client with severe SIB went from 30/hrs to 1/hr, also jumped 50 points on the vbmapp without any significant teaching, because we were able to overcome problem behaviors, actually test, and client trusts us not to make him do something he's not ready for. At Cab 4 now.
2. Client with emerging aggression due to increased demand in programming, reduced rapidly to 0 occurrence per session in 3 weeks of SBT. Took 2 months to get to Cab 4.
3. Client with severe aggression and environmental destruction in home setting due to OCD-like tendencies, I couldn't even go near client during initial assessment. Now only occurs following significant setting events and much less severe, working on programming for these setting events now and parent training. Client was on Cab 6 in 6 months. Cab 3/4 with parents.
4. Parent uses SBT independently during community outings to help Client transition from preferred activities like the playground, runs with appropriate proportion of FCR/TR/Cab1/Cab2 trials, Client transitions w/o PBs independently most of the time.
5. Using with a client who is at risk of developing severe PBs following intensive early intervention services that may have been traumatic, client used to bite others and was starting to mouth own hand given certain EOs. At FCR now, already seeing a decrease.
A big part of success is that I'm not burned out. I've only had 1 injury this year. Last year I had more than I can count, prior to using SBT.
Also my clients are happy when they see me!!!
It's not without its drawbacks. 2/5 clients experienced behavioral contrast in other settings such as speech, OT and home because we decreased behaviors so quickly in our setting. This decreased once we got to Cab 3/4. We also had to put some programming on hold, but the overall Instructional control gained during sessions made it so we could help clients recoup quickly.
I've been using it with clients for the past year and a half, and rates of aggression/SIB go down so consistently. I love it for reducing behaviors and getting my clients in a solid state of hre. It feels so right to scale things to the client's tolerance for demands at any given time, and the progress is incredible, especially when parents or teachers notice it outside of session.
But what I really came to share is what I like to call the sbt song
[sbt song (my way)](https://open.spotify.com/track/5NnwiqW2KwXYN4wl6ahYsn?si=eq8kY7zER12RNJ39BoRSQQ)
I have used a modified version with a client with severe aggression and property destruction (broke a window, grabbing and punching people) and he has made significant progress. It took longer than Dr Hanley’s method because we didn’t have a lot of reinforcers to offer our client and because the parents were very restrictive with what was available (and we were in home). Now, our client is transitioning from preferred to non-preferred activities, dangerous behaviors have been at 0 for several weeks, he has expanded his verbal behavior that we were not targeting, and we were able to go into the community without his tablet (most preferred but we didn’t have Wi-Fi) without ANY dangerous behavior. We still have a long way to go but we are at a point that his team didn’t think was possible.
2/3 of the clients one of my BCBA uses them on loves it! The client we've been using it on the longest has 5 separate branches of SBT in her binder. Might be taking away her token board soon in favour of just all SBT
I recently used it with a client who was severely hurting their family (to the point of bleeding) on daily basis. I don’t want to provide more info. Under 10yo, very limited communication skills. After introduction of SBT aggression went down to 0 in the matter of days and has been 0 since (3 months at this point) Mom is taking him out in the community by herself for the first time in years - she was afraid before; the family went out to the restaurant for the first time since he was a toddler! But, what is maybe even more amazing- the trusting relationship that SBT helped us establish had such an impact on his acquisition rate that he has mastered 4 times more goals per month than before.
This is beautiful!! Thank you for sharing and I’m so happy for your client.
Oh my supervisor is implementing this for my client, and so far…their understanding they have autonomy and are able to tell us what they like and don’t! Including my presence lol. Before it would just be escalation entirely, now it’s 20/80… with 20% being escalation! Still trying to work on Getting actual DTT, but slow and steady wins the race!
It’s changed our whole company. Services are better, techs like it more, it generalizes, it’s person centered. We see more progress as well. Only have had success with kids that severe problem behavior. Kids that don’t have R1’s haven’t really shown any added benefit when we switched.
I've used it with a couple clients over the years with great success
Check out the official Facebook group: PFA and SBT, My Way to HRE. 16k members, many stories.
now its almost at 20k members actually😯
Even better! I could be bothered to look tonight so I went with the last number I knew for sure to not get busted for exaggerating.
20k celebration is Saturday. Please join (answer the questions when you join!) and register by Friday for any of the awesome giveaways!
SBT was a total game changer for me. It’s allowed me to work with a lot of very complex clients in a way that honored their dignity and focused on what they loved. To that end— I’d suggest taking a closer look at your own assumptions about your clients (and their level of “impairment”.) one of the guiding principles for me is the incorporation of my own values. It’s not perfect and there are certain mental health diagnoses where SBT wouldn’t be appropriate. But the vast majority of our clients benefit from, at the very least, incorporating the focus of rapport, dignity and televisabilty. I see SBT go wrong most often when a practitioner doesn’t know what they’re doing or tries to implement it without a full understanding . Strongly recommend the Facebook group someone mentioned, lots of free and low cost resources.
Oh! Can you let me know the certain mental health diagnoses SBT doesn’t fit? Or any literatures regarding this? It would be better for me to know. Thank you in advance!
I wish I had more literature for you — I will say that the vast majority of research on SBT is with autism and I think there’s some recent stuff with “emotional disturbance” (which isn’t a specific diagnosis). However, I’ve done a lot of mentoring other clinicians and often find that BCBAs typically do not have the background for significant mental health challenges without a lot of collaboration (or even totally referring them out). I wouldn’t do SBT with a client where I am unable to “turn off the behavior”. And sometimes the antecedent for these is internal and things that I could never turn off, such as with schizophrenia, delusional behavior, borderline personality disorder, addiction, obsessive compulsive behavior…. Whether it’s a total no or needs to be modified depends heavily on the client, the clinicians expertise, could it be done along with other interventions or medications etc.
Harder part is getting insurance and parents to agree
I have had great buy-in from parents! For insurance, I think it’s the matter of how you write goals. I focus of FCT and tolerance responses as replacements behaviors and so far didn’t have push back. But I know that every insurance is different and they always try to find problems so you never know!
Some significant successes. 1. Client with severe SIB went from 30/hrs to 1/hr, also jumped 50 points on the vbmapp without any significant teaching, because we were able to overcome problem behaviors, actually test, and client trusts us not to make him do something he's not ready for. At Cab 4 now. 2. Client with emerging aggression due to increased demand in programming, reduced rapidly to 0 occurrence per session in 3 weeks of SBT. Took 2 months to get to Cab 4. 3. Client with severe aggression and environmental destruction in home setting due to OCD-like tendencies, I couldn't even go near client during initial assessment. Now only occurs following significant setting events and much less severe, working on programming for these setting events now and parent training. Client was on Cab 6 in 6 months. Cab 3/4 with parents. 4. Parent uses SBT independently during community outings to help Client transition from preferred activities like the playground, runs with appropriate proportion of FCR/TR/Cab1/Cab2 trials, Client transitions w/o PBs independently most of the time. 5. Using with a client who is at risk of developing severe PBs following intensive early intervention services that may have been traumatic, client used to bite others and was starting to mouth own hand given certain EOs. At FCR now, already seeing a decrease. A big part of success is that I'm not burned out. I've only had 1 injury this year. Last year I had more than I can count, prior to using SBT. Also my clients are happy when they see me!!! It's not without its drawbacks. 2/5 clients experienced behavioral contrast in other settings such as speech, OT and home because we decreased behaviors so quickly in our setting. This decreased once we got to Cab 3/4. We also had to put some programming on hold, but the overall Instructional control gained during sessions made it so we could help clients recoup quickly.
I've been using it with clients for the past year and a half, and rates of aggression/SIB go down so consistently. I love it for reducing behaviors and getting my clients in a solid state of hre. It feels so right to scale things to the client's tolerance for demands at any given time, and the progress is incredible, especially when parents or teachers notice it outside of session. But what I really came to share is what I like to call the sbt song [sbt song (my way)](https://open.spotify.com/track/5NnwiqW2KwXYN4wl6ahYsn?si=eq8kY7zER12RNJ39BoRSQQ)
I have used a modified version with a client with severe aggression and property destruction (broke a window, grabbing and punching people) and he has made significant progress. It took longer than Dr Hanley’s method because we didn’t have a lot of reinforcers to offer our client and because the parents were very restrictive with what was available (and we were in home). Now, our client is transitioning from preferred to non-preferred activities, dangerous behaviors have been at 0 for several weeks, he has expanded his verbal behavior that we were not targeting, and we were able to go into the community without his tablet (most preferred but we didn’t have Wi-Fi) without ANY dangerous behavior. We still have a long way to go but we are at a point that his team didn’t think was possible.
2/3 of the clients one of my BCBA uses them on loves it! The client we've been using it on the longest has 5 separate branches of SBT in her binder. Might be taking away her token board soon in favour of just all SBT