1
Functional Assessment Report
2
The Case of Luther
Luther is an 80- year old man, who has been diagnosed with Alzheimer's and now
resides in a Nursing Home. As a former farmer. Luther was accustomed to being independent
with zero restrictions. Luther still enjoys daily walks and having conversations with the staff and
residents of the nursing home; despite his medical diagnosis. The problem behavior presented
shortly after he moved into the nursing home. Luther began to take walks on his own around the
grounds which is a concern due memory issues. Luther has eloped during cold weather without
proper clothes as well.
The nursing facility five exits in which can use to escape, the main entrance near the
nurse’s station, an exit near the business office , and three unarmed fire exits along the sides of
the building. Additionally, the facility map shows four wings that form a square with a court yard
that is enclosed in the center of the building that has two doors that open to the courtyard.
Furthermore, there are four hallways, one in each wing of the buildings. (Miltzenburger, 2019)
Data from Indirect Observations
The staff at the nursing home was interviewed concerning the problem behavior. It has
been reported that Luther sometimes mumbles to himself, mentioning that he wants to go see his
wife before walking out the door. Other times he mentions before living that has some errand to
run or he wants to visit someone else. The duration of his elopement is less than five minutes, as
a staff member either catches him before reaching the door or brings him back in shortly after he
manages to exit the building. When asked what activity Luther was engaging in prior to eloping,
the staff responded that he is often alone walking the hallways or hanging around the door prior
3
to eloping. Additionally, after Luther is returned by the staff he is brought back into the facility
and taken to the break room. Once there is offered a cup of coffee, cookie and is given individual
attention by the nursing staff. However, if Luther manages to use one of the exits that leads out
into the courtyard staff allows him to stay outside by himself. Staff noted that Luther did not
receive attention after eloping into the courtyard and has used that exit again.
ABC Data
As a result of interviews with the staff, it has been determined that the antecedent to
Luther’s elopement is being left alone 100% of the time, without communication with the staff or
other residents. Furthermore, Luther also looks over that the nurse’s station 90% of instances
before attempting to walk out the doors. After Luther leaves the facility the staff immediately
provide cookies and coffee 50% of the time and individualized attention at least 90% of
occurrences of elopement.
Hypothesis
When Luther is left alone, with no one to talk -residents or staff, Luther will engage in
elopement in order to gain attention, therefore the function of the behavior is to obtain social
positive reinforcement. . Through indirect observation data obtained from the nursing staff,
Luther was a farmer who lived independently prior to being diagnosed with Alzheimer disease.
After being admitted to the Nursing Home, Luther would exhibit the problem behavior an
average of five times a day. As a consequence of the behavior, Luther would receive
individualized time with the nursing staff along with cookies and coffee at least 50% of the time.
4
( Miltenberger, pg. 270-271,2016). The individualized attention (social), added to (positive) and
reinforced the elopement procedure.
Using the steps for functional assessment I would collect baseline data which would
include direct observation of the behavior, indirect assessment through a follow up interview
with the nursing staff, to ask the following questions: (adapted from the FAST)
●Is there a certain activity that is happening in the Nursing Home when Luther walks off?
●Does the behavior occur in response to certain stimuli such as demands, noise level,
transition, or number of people in the room?
●What time of day does Luther elope?
●Does Luther engage in elopement after a visit from a family member?
●Could the behavior be related to a side effect of medication?
●Does the behavior often occurs when Luther has not received much attention ?
●Does Luther approach staff and/or initiates social interaction?
●Does Luther elope when you inform him that he cannot have a certain item or cannot
engage in a particular activity.?
Next I would manipulate the antecedent conditions by observing behavior in the
environment and conducting a secondary observation in a separate environment to test the
hypothesis. For example, if elopement occurs in the main visitation area, I would ask the nursing
staff to close off the main visitation area and allow Luther only into the Dining Area during the
time of day the the behavior usually occurs. “Baseline data on the interfering behavior are
gathered in locations and at times when the behavior appears to occur most often; however, it
5
also is sampled in other locations or at other times. Determining both when and where the
behavior occurs as well as when and where it does not occur will help therapist focus the
assessment on what happens before and after the behavior.” ( Nietzel et al., pg. 4, 2008) . The
baseline data collection period would last for at least two weeks. Since we have initially ABC
data from the current condition, I would make sure that the nursing staff can take ABC on the
manipulated condition as well. I expect that the baseline data would be similar in both the
Natural Environment as well as the contrived environment if the hypothesis is correct that Luther
elopes to receive attention from the nursing staff.
Treatment Procedure
An initial approach to treatment would be to create an antecedent based intervention.
Antecedent based interventions are used to replace the undesired behavior by changing the
environment in which the behavior occurs. Increasing opportunities for social interactions
and/or noncontingent attention for at least 10 minutes across 3 persons and 3 environments.
Accompanied by creating instance for Luther to use Functional Communication to ask for coffee
or attention.
Procedure for Non Contingent Attention (NCA) :
●When Luther is in the common areas, approach Luther making eye contact and Check in
with how is feeling and what activity he may be interested in participating.
6
●Give brief, specific praise about a project that Luther is working on or maybe what he is
wearing that day. (e.g. “ I really like how you completed the crossword puzzle” or “
Luther, you look really nice today”.)
●Set up a schedule for walks outside with staff
●Invite Luther to participate in shared activity with the staff such as distributing snacks to
other residents
●NCA should be given on a schedule on a thicker schedule of reinforcement and moved to
a thinner schedule of reinforcement to fade the intervention over time. (Miltzenburger,
2019)
After an additional assessment it is determined that random attention has reduced the elopement
behavior to 20% of elopement the intervention can be faded into Functional Communication
Training program(FCT). The FCT program would consist of Luther being reinforced to ask for
coffee and cookies or for time to share a story. If during the fading process, Luther regress in
behavior, the staff can increase the rate of positive attention into instances of elopement is
lowered again, including observation of desired behavior such as asking for attention or for a
snack. Then the staff can return again to fading the intervention.
Expected Outcomes and risk
The hypothesis suggests that the function of Luther’s elopement behavior is to obtain
attention and/or tangible, the expected outcome for using a NCA intervention is positive. The
anticipated risk to harm to Luther physically is zero, and harm to him psychosocially can be
minimized by ensuring that all staff is familiar with the Behavior Improvement Plan. Research
7
suggests that all staff includes front desk, security, housekeeping, maintenance, dining room
staff, etc. as well as direct caregivers. (Moore et al., 2009). In addition to ensuring all staff are
training, the intervention planned outlined in this FBA should be monitored and updated to
ensure that the plan is individualized to Luther’s behavior.
Strategy to Promote Generalization
There are three strategies that can be employed to promote generalization of behavior
change, training skills that contact natural contingencies of reinforcement, teaching a range of
functionally equivalent responses and incorporating a wide range of relevant stimulus situations
in the training. (Miltenberger, 2019). Successful generalization of Luther’s behavior change is
defined as an increase in Functional Communication to obtain Attention and decrease in
instances of elopement. To accomplish this goal all staff ( front desk, security, housekeeping,
maintenance, dining room staff, etc. as well as direct caregivers) will have to use Noncontingent
Reinforcement of Alternative Behavior consistently with Luther. If only some staff participate in
NCA with Luther there is a risk that his behavior will not enter the maintenance phase.
8
References
Carr, J.E., Bailey, J.S., Ecott, C.L., Lucker, K.D., & Weil, T.M. (1998). On the effects of
noncontingent delivery of differing magnitudes of reinforcement. Journal of Applied
Behavior Analysis,31, 313-321.
Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper
Saddle River, NJ: Merrill/Prentice Hall.
Jones, K.M., Drew, H.A., & Weber, N.L. (2000). Noncontingent peer attention as treatment for
disruptive classroom behavior. Journal of Applied Behavior Analysis, 33, 343-346.
Miltenberger, R. G. Behavior Modification: Principles and Procedures. [Capella]. Retrieved
from https://capella.vitalsource.com/#/books/9781285227924/
Moore, Helen D., Algase, D. L., Powell-Cope, G., Applegarth, S., & A., E. R. (2009). A
Framework for Managing Wandering and Preventing Elopement. American Journal of
Alzheimer’s Disease & Other Dementias®, 24(3), 208–219.
https://doi.org/10.1177/1533317509332625
Neitzel, J. & Bogin, J. (2008). Steps for implementation: Functional behavior assessment.
Chapel Hill, NC: The National Professional Development Center on Autism Spectrum
9
Disorders, Frank Porter Graham Child Development Institute, The University of North
Carolina.
Shibutani, M. (2017). The ABA Visual Language : Applied Behavior Analysis. San Bernadino,
CA: Rhinobook .
