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The main difference between these approaches is that the functional analysis looks beyond the diagnoses and labelling of behaviour problems and emphasizes functional relations in order to make a client's problems and other behaviour problems understandable—the main goal of the functional analysis is to explain behaviour problems and suggest the best treatment focus.

Although diagnosis can be useful in case formulation, there are several limitations when using diagnoses in clinical practice see review of the role of diagnosis in behavioural assessment in Nelson-Gray and Paulson A diagnosis is often helpful when communicating information between professionals within the healthcare system. However, because a particular diagnosis can reflect many different combinations of symptoms, a diagnosis is often insufficient for understanding and effectively treating a client's behaviour problems. The descriptions of a disorder, such as deafblindness, give little information on specific behaviours of a particular client, the unique aspects of a client's situation, his or her goals and strengths, or the variables that may be affecting them.

When developing an individualized psychological intervention such as cognitive behavioural approaches, more specific information on specific problems, causal variables, and their functional relations is necessary. A diagnosis provides no information about how problematic behaviours vary across situations and contexts, and how different psychological problems and external events may interact with each other.

Further, a diagnosis may not address psychological problems that can have significant impact on the quality of life of a deafblind person. We were interested in understanding the psychological problems faced by many deafblind persons.

The purpose of this article was to describe deafblind persons who have multiple psychological problems and apply the functional analysis and FACCD to better understand these problems. We give examples of how a functional analysis model and FACCD can aid the rehabilitation and treatment of persons who are deafblind. The cases were collected during behavioural assessment training provided for professionals working with persons who are deafblind.

First, the professionals were trained to use the functional analysis and FACCD and instructed in how to apply the model for their own client cases. Behavioural assessment training was provided to 69 professionals staff members, rehabilitation workers, nurses, psychologists, social workers, teachers, etc. The training was done during three two-day workshops and using home assignments. During the training, client case examples were analyzed using the functional analysis model of case formulation.

The staff members were instructed to bring information of one client case—with multiple problems—to the workshop. They were also instructed to gather information about their client from different sources, e. The staff members did not use any validated instruments for assessing psychological symptoms because that was not part of their profession. The first workshop included lectures on general issues of functional analysis and neurocognitive issues related to deafblindness. Between workshops the trainees were instructed to begin applying functional analysis with their clients.

Workshop two dealt with physical and psychological issues in well-being. The trainees were instructed to finish the behavioural analysis cases after workshop 2. Workshop 3 concentrated on short and long term interventions. The functional analysis model learned during the workshop was as follows: 1 background information about the client is collected; 2 the problems and strengths of the client are listed; 3 problems are classified according to different forms of behaviour i.

Robert A. DiTomasso, Stacey C. Cahn, Susan M. Panichelli-Mindel, and Roger K. McFillin

Briefly, the rectangle indicates a behaviour problem; a circle indicates a causal variable an antecedent variable, consequence, moderator variable , and a diamond indicates a historical causal variable that cannot be modified. These symbols illustrate a client's problem areas as well as contextual and situational variables, moderator variables, and contingencies that affect them. The functional relations between the variables are depicted by arrows and lines that indicate the strength, direction, and form of functional relation.

The overall goal of the functional analysis and the FACCD is to estimate the relative magnitude of effect of each causal variable. That is, the degree to which a treatment focus on the causal variable would be expected to result in benefits for the client. Although effects can be calculated mathematically, this estimate can often be done through visual inspection of the FACCD. Clinical judgments from the FACCD can be more precise by adding judgments of the importance of a problem by using numbers or, as in this model, graphic illustration.

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The strength of the connection between variables can be estimated by using different line thicknesses. Haynes, O'Brien and Kaholokula There were altogether 38 deafblind or deaf clients analyzed using the model by the trainees who attended the training. Some of the case formulations were made by one staff member whilst others were constructed by pairs or small groups of participants. Of those 38 analyses, 26 complete analyses were chosen for this article. These cases selected included all the steps of the model as presented above Haynes, O'Brien, and Kaholokula actually propose 21 steps in the functional analysis of clients.

Twelve clients were omitted from this article as their case formulations were incomplete because of limited time during the workshops. The 26 complete cases were divided into three groups according to hearing and vision impairment and time of onset.

The number of men and women in each group was as follows: Group 1. Deafblind clients with acquired deafblindness: 4 men, 10 women 14 ; Group 2. Congenitally deafblind clients: 4 men, 3 women 7 ; Group 3. Deaf clients with or without additional impairments, no vision problems: 4 men, 1 woman 5. Because the main interest was on groups of individuals with deafblindness, groups 1 and 2 persons with acquired deafblindness and congenitally deafblind persons were chosen for more thorough data analysis.

The two groups of persons with acquired and congenital deafblindness were defined as follows. Within this group, persons could have a been born visually impaired and their hearing weakened later; b been born with hearing impairments and their vision weakened later, or c become deafblind as adults or as older adults. The mean age of the persons in the group with acquired deafblindness was In the acquired deafblindness group half of the subjects used speech and half Finnish Sign Language as a primary communication method.

Of sign language users approximately half used signing in free space and half used tactile signing. In the congenitally deafblind group most of the subjects had multiple means of communication based on sign language, gestures, objects, and pictures. In the acquired deafblindness group 12 subjects were unmarried. In the congenitally deafblind group all subjects were single. Five subjects with acquired deafblindness lived alone. Consistent with the results of past research, and on the basis of assessments done by the staff members, the most common difficulties within the both groups were problems with communication.

Both groups reported an average of about seven psychological problems per person ranging from 3 to The main problems of the subjects with acquired deafblindness were communication difficulties, traumatic or distressing experiences e. In addition to the main problems, the subjects with acquired deafblindness reported having problems such as negative thinking, fear of losing control in life, problems with nutrition e.

Within the group of congenitally deafblind persons, the most common problems were communication problems, aggressive or self-injurious behaviours e. Additional problems reported were as follows: life was too structured and restricted because frequent changes in everyday life cause, for example, anxiety , problems associated with puberty and sexuality, problems associated with nutrition and health, constant changes in medication or neurological problems. Since the literature e. Many of those having traumatic experiences reported sleeping difficulties, aggressive behaviour, and severe mental health problems including psychotic behaviour, delusions, and personality disorders.

More specific analysis of trauma experiences would be needed in order make appropriate treatment plans but because of the design of the study we were not able to collect these data. An important finding, with implications for individualized case formulations and treatment, is that there were important differences among person in the types of problems experienced.

In order to illustrate both the complexity of the individual cases and the benefits of the functional analysis model two case examples are presented. These case examples were done during the workshops. The background information has been modified in order to protect the identity of the subjects. The client was a deaf man of about 50 years with Usher Syndrome. He was born deaf and had gradually been losing sight so that he had only a narrow visual field left.

His native tongue was Finnish Sign Language although Finnish had been the language of his childhood family. This and oral method at school had effected his mastering of sign language. The client used an old-fashioned type of sign language which caused some communication problems.

The Transdiagnostic Road Map to Case Formulation and Treatment Planning |

Young staff members and interpreters in particular had difficulties understanding his signing. He used little Finnish, for example, and he fingerspelled words. He had stopped work because of his vision deterioration and was on a pension. He lived at a residential centre which provided housing facilities and communication through sign language.

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He received help for his house chores and other domestic chores when needed. His main problems were difficulties in communication because of language deficits, lack of skill in managing his money and a severe drinking problem. Approximately twice a month, he had a heavy drinking period which would last for 4—5 days and which sometimes caused vision and sensory delusions with consequent anxiety. He also had difficulties with social relationships because of violent behaviour and bothering people with asking for money during drinking periods. This led to fear and avoidance among some of the other residents as well as frequent conflicts between him and other residents.

It indicated the strong association between language deficits and drinking problems. Drinking, on the other hand, influenced several other problems like violent behaviour. Conversely, his deficits in communication and fear of losing his sight affected his drinking, so drinking would be used to reduce this anxiety and feelings of distress. The case formulation suggested that there was a behavioural chain leading to violent behaviours and problems in relationships.

As illustrated in Figure 1 , deafblindness due to Usher Syndrome leads to a fear of losing vision this fear probably includes specific thoughts and emotional reactions that we were not able to describe in this study. The fear of losing vision causes anxiety, and anxiety increases the probability of excessive drinking of alcohol.