Alternative Strategies and Multiple Outcomes in the Remediation of Severe Self-Injury: Going “All Out” Nonaversively

Abstract

This case study report describes the various treatments implemented over a 3-year period in an effort to reduce and eliminate multiple and severe self-injurious behaviors in a 45-year-old man who had been institutionalized and had exhibited these behaviors for the majority of his life. After baseline, an aversive procedure (contingent mechanical restraint) had been implemented and judged a failure by institution personnel. Subsequent intervention phases introducing community involvement and performance goals that emphasized functional activities in criterion environments and situations were associated with increasingly positive behaviors. Multiple outcome data are reported, including meaningful changes in targeted self-injurious behaviors, maintenance and generalization of those changes to integrated community environments at follow-up using available staff and resources, acquisition of new alternative skills, and placement in a supported apartment in the community with full-time work in a community job site. The procedures and the results demonstrate possible outcomes when nonaversive intervention procedures and community resources are utilized comprehensively as alternatives to aversive procedures focused upon only the immediate reduction of a single target behavior.