This case study concerned clinical safety and behavioral-pharmacological intervention with an 18-year-old man who had autism spectrum disorder and high-frequency aggression toward care providers at a specialized school. A multicomponent behavior support plan included antecedent, differential reinforcement, environmental modification, and physical management procedures subsequently combined with psychotropic medication (aripiprazole). Clinical safety components emphasized comprehensive care provider training, continuous supervision, function-based treatment, and prevention-focused strategies. The behavioral-pharmacological intervention eliminated implementation of aggression-contingent physical restraint and was associated with increased transition compliance during the school day. Throughout the 7.5 months duration of the study, there were no injuries to the participant or other students and a single injury was sustained by one care provider. Intervention effects were long-standing, and care providers rated their training, implementation fidelity, and therapeutic outcome favorably.

This study evaluated performance improvement interventions to increase and maintain data recording of activity completion with students by 9 educational care providers. Implemented in a multiple baseline design across 2 classrooms, activity completion data recording increased when the instructors received weekly written and graphic feedback from a supervisor. In a second intervention phase, the instructors maintained near-100% activity completion data recording through self-management without written and graphic feedback and with faded supervision contact. The classroom instructors positively rated all intervention components and recommended the type of supervision to other staff. Study results support written and graphic feedback, self-management, and supervision fading as practical methods for improving and maintaining performance competencies of care providers within education service settings.