A Successful Behavior Intervention Model
By Dr. John M. Guercio, Ph.D., BCBA-D, LBA, CBIST
Benchmark Human Services (Benchmark) began providing residential services in the state of Missouri in 2007. The upstart was a slow and measured one and in the summer of 2010, Benchmark served about 10 individuals in the state. Many of these individuals displayed extensive physical aggression or property destruction and had not been successful in multiple prior placements. Benchmark recognized that existing service models were not sufficient to successfully support them to thrive in the community. To meet this need, Benchmark was one of the first programs in the state to design an intensive behavioral setting.
Our brand of behavior intervention and therapy in these settings is deeply rooted in Applied Behavior Analysis. Benchmark Missouri uses a tiered model of clinical support and a team of Board Certified Behavior Analysts (BCBAs) and Registered Behavioral Technicians (RBTs). The team is comprised of several Board Certified Behavior Analysts (BCBA/BCBA-D) that oversee the clinical programs and staff training for the clients that they serve. Each BCBA has a Registered Behavioral Technician (RBT) that is charged with making sure that staff are completing data collection in the homes and following the programs that the BCBAs put in place. They are the main source of contact with the staff in the homes and the BCBAs that serve the clients across each of the homes in Missouri. The interventions that are employed evolve to fit the needs of the clients. Over 75% of those that we serve have a dual diagnosis, thus presenting a more complex clinical picture. We have put in place extensive Dialectical Behavior Therapy (DBT) programming to address the needs of those individuals with Borderline Personality Disorder and other psychiatric conditions that are amenable to the approach. All of this is done without abandoning the behavior analytic nature of our interventions. We blend Acceptance and Commitment Therapy (ACT) with the DBT approaches to present information and treatments that are the best fit for the individual that we are working with.
All clinical interventions are presented in both the home and community settings to better foster the generalization and maintenance of behavioral gains. Close to 30% of the individuals we serve are actively employed in the community. There are also weekly group sessions that are presented according to the functioning level and gender identity of the attendees in order to individualize the material being presented. The topics range from vocational activities, anger management, dating and sexuality to host of other topics.
Through this model, we are able to enhance the autonomy of individuals we serve while providing needed therapeutic and residential options for those that historically have not had them. Since the inception of this model, Benchmark has placed an exclusive focus on the care and treatment of persons with significant behavioral challenges, and Benchmark has become a go-to provider to assist the State with their deinstitutionalization efforts and for individuals with very complex needs whose placement options had been exhausted. Many individuals we supported have ultimately transitioned from these intensive behavioral setting to community based settings with much more freedom and autonomy. The clinical approaches and Benchmark’s dedicated leadership in Missouri has allowed us to experience great success working with a population that many other providers do not have the expertise and capacity to support, and we are honored to support these individuals to thrive.