Gentle Teaching Evaluation Network
G-TEN
International Alliance to Produce
Evidence – Simple Yet Scientific
James W. Conroy, Ph.D.
The Center for Outcome Analysis
www.eoutcome.org
Outline
Purpose
Why Measure and Measure What?
Paradigms and Resistance
The Scientific Literature – Paradigm War
Things are Changing, Especially in the Americas
Now is a Very Good Time to Seek Evidence in a
Cooperative International Venture
Dimensions We Must Measure
– Interactions, Qualities of Life (including feeling safe
and loved), Behavior, Person-Centeredness
How to Move Forward: Pilot Studies, Home,
COA Nations,
Funding,September 2007 Studies 2
Purpose
Today – to share our thinking about how to
get new, reliable, valid scientific evidence
Aiming toward publishing studies
And obtaining serious funding from USA
organizations – government and
foundations
GTEN – what is our best strategy toward
production of good evidence across our
nations?
COA September 2007 3
Why Seek Evidence?
We have a common belief in Gentle Teaching
We all hope that it will spread, and negative
approaches and aversives will end
We will need more evidence to bring the skeptics
and the “undecideds” along
Yet we must overcome powerful past rejection by
behavioral scientists
GTEN – is there hope of achieving this?
COA September 2007 4
The Controversy in the “Scientific”
Literature, 1980s and 1990s
Why all the resistance, skepticism?
Because GT threatens established thinking
and funding?
Look at this title from one of the critics:
Bailey, J.S. (1992) Gentle teaching: trying
to win friends and influence people with
euphemism, metaphor, smoke, and mirrors.
J Appl Behav Anal. 1992 Winter; 25(4):
879–883.
COA September 2007 5
The Controversy in the “Scientific”
Literature, 1980s and 1990s
McGee, J. J., Menolascino, F. J., Hobbs, D. C., &
Menousek, P. E. (1987). Gentle teaching: A non-aversive
approach to helping persons with mental retardation. New
York: Human Sciences Press.
McGee, J. J., & Gonzalez, L. (1990). Gentle teaching and
the practice of human interdependence: A preliminary
group study of 15 persons with severe behavioral disorders
and their caregivers. In A. C. Repp & N. N. Singh (Eds.),
Perspectives on the use of nonaversive and aversive
interventions for persons with developmental disabilities
(pp. 237-254). Sycamore, IL: Sycamore.
– Caregiver’s Interactional Observation System (CIOS) and the
Person’s Interactional Observation System (PIOS)
COA September 2007 6
1989 JABA
J Jordan, N N Singh, and A C Repp (1989). An evaluation
of gentle teaching and visual screening in the reduction of
stereotypy. J Appl Behav Anal. 1989 Spring; 22(1): 9–22.
Extremely complex behavioral research design with just 3
“subjects”
“…gentle teaching was found to be more effective than
task training for 2 subjects but less effective for the 3rd “
Published anyway – because their Discussion conclusions
were negative about GT
Footnote on Singh – Therapy Malls in big institutions and
DOJ witness history
COA September 2007 7
1992 Review of the Controversy
A J Cuvo (1992). Gentle teaching: on the one
hand ... but on the other hand. J Appl Behav Anal.
1992 Winter; 25(4): 873–877.
Perhaps the most balanced review of the early
controversy.
This would be worthwhile reading because it
explains the harshness of the attacks on GT.
COA September 2007 8
Most Recently, 2003:
Polirstok, Susan Rovet EdD; Dana, Lawrence PhD; Buono,
Serafino Dot.; Mongelli, Vita Dottssa.; Trubia, Grazia
Dottssa. Improving Functional Communication Skills in
Adolescents and Young Adults with Severe Autism Using
Gentle Teaching and Positive Approaches. Topics in
Language Disorders. 23(2):146-153, April/May/June 2003.
Described positive findings, both for individuals and
workers.
Working with 18 young people in Sicily.
COA September 2007 9
More Recent Rigorous Study in England
Cullen C. & Mappin R. (1998). An examination of the effects of
gentle teaching on people with complex learning disabilities and
challenging behaviour. Br J Clin Psychol. 1998 May;37 ( Pt
2):199-211.
13 students, 7 staff observed
13 weeks “pre” and 23 weeks “post”
45 hours direct observational data on handheld computers, 75
hours of video
“Wherever there were differences between gentle teaching and IEP
these were in favour of gentle teaching, although they were generally
relatively minor in terms of clinical (rather than statistical)
significance.” NOTE the disclaimer
Conclusions: all effects of GT unimportant, may be “useful adjunct”
But who did the training, and how was it reinforced?
COA September 2007 10
Scientific Revolutions
Thomas Kuhn’s “The Structure of Scientific
Revolution” 1963
The source of the phrase “Paradigm Shift”
When the prevailing “model” or “paradigm” fails
to explain something – an anomaly
Sometimes a new worldview is required
But there will be powerful resistance
The thinking which was the cause of our success
in the past often becomes the reason for our failure
in the future.” - Einstein
COA September 2007 11
1. Current paradigm does not “work” for some observations – anomaly and
crisis. Not all in the community will care about anomaly – too
comfortable
2. The proponents of the “new” are reviled, criticized, distrusted – Threat!
3. Competing camps form
a. One camp seeks to defend the old institutional constellation.
b. One (or more) camps seek to institute a new paradigm
4. Polarization: civil scientific discourse fails – Demonization, stridency,
desperate defense – paradigm wars
5. Circular arguments - Each group uses its own paradigm to defend its
paradigm – circular discussions
6. Finally, the new does replace the old, and the guardians of the old
“suddenly” embrace the new as though they had thought of it themselves
7. Gentle Teaching has been immersed in a paradigm war
8. But this paradigm shows every sign of success – allies have sprung up –
we will live to see it become the established belief system
9. COA September within
To speed this up, evidence developed 2007 the scientific method will 12
help
Is the Paradigm Changing At Last?
There’s reason to believe so
Look at the insurgencies into the bastions of
resistance
Look at the organizations that have embraced
positive approaches (not the same thing but
emerged from GT thinking) e.g. Herb Lovett
Look at the rise of aversive regulations, concerns,
surveys, government requirements
COA September 2007 13
Even the ABA (Association for
Behavioral Analysis)…..
Now has a Special Interest Group, the PBS
ABA International Newsletter
– Volume 29 | 2006 | Number 2
Positive Behavior Supports
– The Positive Behavior Support (PBS) SIG addresses
the interests of members engaged in experimental and
applied analyses of behavior who are proponents of
positive behavior support. Established in January 2005,
the goals of the SIG are to promote and disseminate
positive behavior support within ABA, and to ensure
that PBS is aligned with the science of behavior.
COA September 2007 14
PBS - SIG
The PBS SIG currently has approximately 40 formal
members….electronic listserv with over 70 recipients,
many of whom belong to both ABA and the Association
for Positive Behavior Support (APBS).
Goals of the PBS SIG are to:
– Increase the number and visibility of PBS presentations at the
ABA convention
– Disseminate accurate information about PBS to ABA’s
membership
– Promote methodologically sound, data-based PBS research
– Encourage open dialogue among behavior analysts and proponents
of PBS
www.pbsaba.org
www.pbsaba.org/newsletter
COA September 2007 15
Association for Positive Behavioral
Support, APBS.org
http://www.apbs.org/main.htm
Affiliated with TASH
TASH has 20 years of commitment to
positive approaches
Should GTI interact with the new emerging
groups with similar values?
Or should GTI simply be aware that the
world is changing toward our values?
COA September 2007 16
USA – Nationwide Awareness
Is Finally Emerging
Aversives Survey3.pdf
COA September 2007 17
Old Paradigm, New Paradigm
Old – Behaviorism New – GT & Positive
– Mechanistic – Humanistic
– Ghost in the machine – Presumes humanity
– We can shape any – We can make a real
person’s behavior connection with any
person
– All means are fair, if – The process is often as
justified by ends important, sometimes
more important, than
the outcomes
COA September 2007 18
Dual Dimensions of Measurement
Individual Caregiver
Feeling Safe Protecting –
Confidence in Ability to Offer Safety
While Avoiding Negatives
Feeling Loved Assisting Warmly –
Feeling of Offering Unconditional
Love
Enjoying Interactions Enjoying Job
Self-Control (less challenge) Feeling of Success in Job
Self-Control (choicemaking) Pride in Sharing Power
Self-Actualization – Self-Actualization –
Becoming More Authentic Becoming More Authentic Human
Human
COA September 2007 19
Simple Rating Scale:
The Person Being Supported
Very Neutral Very
Cold, Warm,
Negative Positive
Response to Caregivers' Presence
Response to Caregivers’ Words
Response to Touch
Response to Food, Drink
Acceptance of Doing Things with Caregivers
Acceptance of Doing Things with Peers
Self-Esteem
COA September 2007 ? 20
Simple Rating Scale:
The Caregivers
Close Distant
Warm Cold
Heart Head
Warm Protection Restraint
Engagement Disengagement
Colleague/Friend “Boss”
Unconditional Love Conditional Rewards
New Memories Old Memories
COA September 2007 21
Input, Process, and Outcomes
Measure
GT Here?
Input Process Outcomes
Effort, Resources, Safe, Loving, Relationships,
Time, Emotional Positive, Qualities of Life,
Investment, Hope Supportive, Behavior Change
Persistent, Patient
(Or is GT Here?)
Feedback After Success/Failure
COA September 2007 22
We Have Good Measures for the
Collateral Outcomes
Control of one’s own life (DCI)
Person-centered planning (EPP)
Qualities of life (QOL Then & Now)
Family perceptions of quality life and service
Qualities of work life for the caregivers (QOWL)
If we can get decent measures of Safe and Loved
from both perspectives, these other outcomes will
make a very strong case.
COA September 2007 23
Paradigm Shift – What It’s Like
What Animal is This?
Duck? Or Rabbit? The switch is what a Paradigm
Shift feels like.
COA September 2007 24
I’ve Already Seen….
Two and a half paradigm shifts
I came in at the end of the Medical Model in 1970
I witnessed and studied the decline of belief in a need
for segregation – deinstitutionalization
I took part in the self-determination movement from its
inception, studying and demonstrating
And now the largest system of grants ever given from
the USA’s major funding source, “Money Follows the
Person,” $500 million, is aimed at individual control of
resources (SD) in community settings.
I believe that the time of GT’s ascension is coming fast.
COA September 2007 25
We Are Going to Live to See it
Happen
The signs are clear
Our task is to gently develop and offer the
evidence
People have begun to want to believe
Gentle nudges and good solid science are all
that’s needed
Our international cooperation via GTEN
will be very important – and FUN!
COA September 2007 26
We Need Partners
This idea is now a year old
We’ve been studying and thinking
Siddhartha’s motto:
– I can think, I can wait, I can fast
I think the time is right to move forward
with real data, real pilot studies, and plans
for large-scale evaluative research.
Cross-nations: GTEN
COA September 2007 27
Comments and Ideas
All ideas welcome
Testers of these instruments needed
Critiques needed
Thank you for your attention and
for the honor of appearing before
you at this conference
COA September 2007 28
COA September 2007 29
Perceived Qualities of Life:
“Before S-D and Now”
Running own life
Privacy
Happiness
Treatment by staff
Comfort
Getting out/getting around
What he/she does all day Then
Overall quality of life Now
Relationship with friends
Food
Health care
Health
Relationship with family
Safety (NS)
COA September 2007 30
0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5
How “Person-Centered” is the
Planning Process?
4.43 Are meetings held as needed?
4.29 Emphasis on cooperation in meetings?
Are meetings comfortable for focus
4.20 person?
Does respondent consider plan to be
4.06 Person-Centered?
Does process allow and deal with
4.02 conflicts?
Is the planing process flexible, trying
4.02 other ways?
Strong efforts to understand person's
3.86 hopes and dreams?
Does process emphasis creativity, new
3.78 ideas?
Are the person's relationships
3.75 considered?
Does the person have ultimate
3.71 authority in disagreements?
Is process governed by formal rules and
3.65 regulations?
Does the planning process take money
3.63 into consideration?
Does group have control over money
3.35 supporting the person?
Do the unpaid group members have the
3.11 real power?
COA September informal support
Are community and 2007 31
3.07 networks emphasized?
How Many Friends?
12
10
10
8
8
6
6
5
4
4 4 4 4
3 3
2
Count
2 2 2 2 2
1 1 1 1 1
0
0 1 2 3 4 5 6 7 8 9 10 12 13 15 18 20 25 30 45 90
# OF FRIENDS
COA September 2007 32
Who Are Your
Closest Friends?
NEIGHBOR 16
OTHER PAID 23
HOUSEMATE 29
STAFF OF DAY
35
PROGRAM
STAFF OF HOME 43
c
RELATIVE 43
OTHER 45
CO-WORKER OR
47
SCHOOLMATE
0 5 10 15 20 25 30 35 40 45 50
COA September 2007 33
One Wish in 1994 One Wish in 1996
None More contact with family
None Meet Garth Brooks, go to Disney world, walk
None Enjoy better health
None Friends
None Hair
None To go on a plane to FL to see sister, make more $
None To always be happy and grow into independence
Ham sandwich More friends
To be finished work Motorcycle
To be sleeping Ride a bike, go to Disney with Steve
Bill Clinton To be healthy, to be safe and alive
Get out of house and go to Keene (Accomplished)
Go to Disney World (Accomplished)
To go to California Would like to visit FL + CA
To live near my parents Go horseback riding
Vacation in Florida Good health
Have a brain Want to have a little boy baby
Get away from Keene housing authority To meet celebrities, to live in warm climate
Not to have a roommate To live like royalty, a queen with loyal subjects
A friend Go visit Maine someday, maybe have more money
That my father was still alive I'd like to see Richard C
To be married September 2007 34
COATo have Keene fully accessible, live in dream house