The Behavioral Assessment and Treatment (BAT) program was developed in the Child and Adolescent Psychiatry outpatient clinic at Harbor-UCLA Medical Center to address the overwhelming preponderance of children and adolescents presenting with disruptive behavior disorders (DBDs). Diagnoses of:
- Attention-Deficit/Hyperactivity Disorder,
- Oppositional Defiant Disorder,
- Conduct Disorder, and
- Disruptive Behavior Disorder Not Otherwise Specified
all fall under the disorders of childhood domain of Disruptive Behavior Disorders. The behaviors demonstrated can be challenging to parents, families, and therapists alike; the majority of treatment providers rely on a multitude of eclectic techniques, often times with limited results.
Current research indicates that the best treatments for DBDs include intensive home-, school-, and community-based supports (See Multisystemic Therapy for more information). Unfortunately, these treatments are few and far between and are typically only utilized with severe presentations. Those families seeking treatment for their children and adolescents presenting with less severe forms of the diagnoses are left with few choices, usually once-a-week outpatient therapy and/or medication. It was my belief that a successful treatment approach for these children, adolescents, and families would bridge intensive multi-environmental supports and once-a-week outpatient therapy.
Before treating behaviors, it is imperative to obtain a full assessment on all aspects of the behavior. Behavior topography, frequency, severity, and function should be included in a comprehensive assessment as well as antecedents to, and consequences maintaining, each behavior. Also known as a Functional Behavior Assessment, this information provides an environmental snapshot of the child’s behavioral functioning. Treatment then, should include environmental supports tailored to target each behavior of concern. Of importance to the assessment and treatment process is the dissolution of diagnosis. When clinicians become embroiled in diagnosis, the environmental snapshot of the child is lost. Effective treatments for DBDs should target behaviors, not diagnoses. Please follow the links in the left panel to learn more about the BAT Assessment and Treatment process.
BAT Assessment Process
The BAT program involves a multi-dimensional assessment process, assessing behaviors across multiple settings and gathering information from multiple sources. Typical BAT program assessment includes:
- Parent interview
- Teacher interview
- Additional persons of interest interview
- Parent- and teacher-report behavioral assessments
- Behavioral observation in school and home environments
- Behavioral observation data collection and analysis
- Additional psychological assessments, as needed
BAT Treatment Process
From the comprehensive behavioral assessment, both a Functional Behavior Assessment (FBA) and Behavior Intervention Plan (BIP) are created. These documents provide the specialized treatment plan for the child/adolescent, targeting those behaviors of concern in both school and home environments. Caregivers and education providers then provide implementation of these supports directly to the child/adolescent.
BAT program treatment typically entails one collective feedback session to all those involved in the treatment of the child/adolescent. At this point, treatment shifts into a phase-based delivery of individualized behavior strategies, derived from both the FBA and the BIP.
- Phase 1 of treatment entails weekly meetings with caregivers for training in the FBA and BIP and to ensure fidelity of implementation, with the goal of safety, structure, and caregiver-child relationship enhancement.
- Phase 2 of treatment includes individual treatment with the child/adolescent, addressing skill enhancement in such areas as: anger management, emotion regulation, social skills, conflict resolution, as well as other areas of notable deficit.
- Phase 3 of treatment addresses behavioral functioning in school settings and includes consultation with school personnel.
It should be noted that this phase-based treatment is not always sequential; effective treatment for DBDs requires a flexible, balanced approach incorporating a variety of supports.