Monthly Archives: September 2019

Encouraging Parent Participation in Home-Based Intervention

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This month’s ASAT feature comes to us from Alice Walkup, MS, BCBA. To learn more about ASAT, please visit their website at www.asatonline.org. You can also sign up for ASAT’s free newsletter, Science in Autism Treatment, and like them on Facebook! You can read more of our ASAT featured posts here.

How does a behavior consultant who is invested in the child’s best outcome encourage parents to actively participate in home-based intervention?

Answered by Alice Walkup, MS, BCBA

For many parents of children with autism, participation in a home-based behavioral intervention program may seem overwhelming. In addition to managing and advocating for the child’s various services, parents may find it difficult to attend to the needs of other family members, their spouses, and their jobs. Participating in their child’s home-based program can certainly seem like one more responsibility for which there simply is not enough time. It is important to appreciate that other commonly-endorsed autism therapies, such as occupational or speech therapy, do not usually require the same level of time, energy and parental involvement that an intensive behavioral intervention program does.

Understanding And Assessing Barriers To Participation

When you conduct the intake interview (and likely throughout the consultative relationship), it is important to take note of any potential barriers to the parents’ participation. Education level, socio-economic status, competing responsibilities, other family members in the home, cultural beliefs, and beliefs about autism and autism treatments are just a few factors to consider. It is also important to keep in mind that parents may be unaware that the skills of children with autism (e.g., communication, compliance) do not automatically generalize from therapists to parents. As such, it is important for consultants to gauge the willingness and motivation of family members to be active participants in their child’s intervention program (Taylor & Fisher, 2010).

From the outset, it is important to explain to parents that they will be a critical part of their child’s learning and will be shown how they can help the child practice what they’ve been taught during therapy sessions. Parents may also hold misconceptions regarding behavioral intervention, such as a belief that behavioral techniques are based exclusively on punishment. Explaining the intervention process at the outset will help eliminate such concerns. A final point to consider is that many parents of children with autism experience their own psychological challenges, such as depression and anxiety. Some research suggests that mothers with depressive characteristics do not acquire as much information and skills during parent training as mothers without depressive characteristics (Gelfand, Teti, Seiner, & Jameson, 1996; Cicchett, Rogosch, & Toth, 2000). Such issues may present challenges for consultants but once identified can be taken into consideration when individualizing consultation and the scope of the home-based intervention. It may also become clear during the intake process that referral to other services or resources are warranted.

Setting The Stage For Success

When working with a new family, there are many strategies you can employ to build a collaborative, open relationship from the outset. These include:

  • asking questions that will help you better understand the parents’ experiences as they relate to supporting their child with autism. Such questions may include asking what other services/therapies the child has received (or is still receiving), what supports (community, family and individual) are available to the parents, and what they see as their biggest challenges related to parenting a child with autism
  • being an attentive and compassionate listener
  • minimizing “behaviorspeak,” including clinical terms and acronyms with which the parent is unfamiliar. When explaining behavioral principles, it may help to use simpler, every-day examples to illustrate the concepts
  • explaining the intervention process and what a typical session may look like
  • using language that fosters a cooperative spirit; for example, saying, “we as a team” instead of “you” when discussing the home-based intervention

Goal Selection

When meeting with parents for the first time, encourage them to identify the hopes and fears they have for their child as doing so will help guide intervention planning and goals. It is equally important to identify goals that are most relevant to the family such as eating, sleeping, and community-based goals (Taylor & Fisher, 2010). This conversation should address both short- and long-term goals for the child, such as playing with friends, sitting appropriately in church, or attending college. With this knowledge, the consultant can assist parents in identifying their top three most important goals. One strategy for longer-term goals is to give each a name, such as “Project Friendship” for a socialization goal, as it will serve as a reminder to focus on the big picture. Once these are identified, the shorter-term goals and associated skills to be taught can be more easily defined, and the parents can see how they are supporting the longer-term goal. After selecting initial teaching targets and determining appropriate instructional strategies, the behavioral team will begin implementation. Keep in mind that some parents may challenge your typical approaches to behavior change, such as finding it difficult to tolerate extinction bursts, appreciating the need for direct teaching of desired skills, or using edible reinforcers. This again highlights the critical importance of discussing the intervention process and teaching strategies with parents at the outset. You can also explain their potential roles as teachers and that they will be included in their child’s teaching at the appropriate time. Doing so will help foster a more collaborative relationship and help parents better anticipate and understand their roles in the behavioral intervention process.

Promoting Enduring Participation

Once parents agree to be involved in their child’s home-based intervention, many factors can potentially influence their adherence to behavioral programs and their participation. Continued parent participation can be impacted by parental perceptions of themselves as effective in behavior change, confidence in the treatment approach, and by the degree to which the child is accepted in the family and community, among other variables (Moore & Symons, 2011). When engaging parents in the teaching process, the key is setting them up to be successful. Start with a smaller goal that the child has already mastered with the in-home therapists so that parents leave the teaching interaction feeling effective in promoting behavior change in their child. Utilizing best practices for training that incorporate modeling, rehearsal, and feedback will provide parents with valuable opportunities to both observe and practice teaching the targeted skill to their child. Tracking and graphing their progress in addition to the child’s, then taking the time to review it with them regularly, is a good strategy to provide encouragement throughout the intervention process.

Parents and consultants should also consider whether or not the funding source for child’s in-home services requires parent participation (and to what degree). Currently, some funding sources place a significant emphasis on training the parents to be effective at-home therapists and require behavior consultants to teach parents therapeutic skills to a level of mastery that they can do so. Parents can be asked to implement programs and collect data, and the consultant must report the level of parent involvement to the funding source. In extreme cases, in-home services have actually been terminated due to a lack of parent participation. While it is often more effective to appeal to parents on a more personal level when encouraging their involvement, this requirement and the potential loss of services should be discussed.

Behavior consultants providing in-home services are tasked with addressing a child’s needs within an existing, and sometimes challenging, family dynamic. The ideal in-home behavioral intervention program would include extensive and high-quality parent participation during therapy sessions; however, this may not always be possible. As such, we must individualize the type and extent of parent involvement on a case-by-case basis and employ our skills as consultants to encourage and maintain active parent participation, where possible. Despite the challenges that may accompany our efforts, it’s important to remember that, at the end of the day, we are all working towards the same goal: ensuring the best possible outcomes for the child.

References

Cicchetti, D., Rogosch, F. A., & Toth, S. L. (2000). The efficacy of toddler–parent psychotherapy for fostering cognitive development of offspring in depressed mothers. Journal of Abnormal Child Psychology, 28, 135-148.

Gelfand, D. M., Teti, D. M., Seiner, S. A., & Jameson, P. B. (1996). Helping mothers fight depression: evaluation of a home-based intervention program for depressed mothers and their infants. Journal of Clinical Child Psychology, 25, 406-422.

Moore, T. R., & Symons, F. J. (2011). Adherence to treatment in a behavioral intervention curriculum for parents of children with autism spectrum disorder. Behavior Modification, 35, 570-594.

Taylor, B. A., & Fisher, J. (2010). Three important things to consider when starting intervention for a child diagnosed with autism. Behavior Analysis in Practice, 3, 52-53.

Citation for this article:

Walkup, A. (2012). How does a behavior consultant who is invested in the child’s best outcome encourage parents to actively participate in home-based intervention? Science in Autism Treatment, 9(4), 4-6.

About The Author

Alice M Walkup, MS, BCBA currently resides in Los Angeles, CA where she practices behavior analysis with clinical populations. 

Posted in ABA

ABA Journal Club: A Response from Dana Reinecke

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A quote from this week's ABA Journal Club response from Dana Renecke

Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. The following week another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

Check out last week’s discussion questions here!

Behavior analysts engage in many different professional activities, many of which are more or less likely given specific clinical or research settings. For example, some behavior analysts who work with individuals with disabilities are likely to conduct preference assessments and use token economies, while those who work with organizations are less likely to use these technologies. One part of the behavior analyst’s repertoire that is always important, however, is the careful and accurate collection of data. This skill set is necessary for understanding and assessing behavior, as well as for ongoing monitoring of the effectiveness of behavioral interventions. 

It is important to understand not just how to measure behavior, but when to use each type of measure.  LeBlanc, Raetz, Sellers, and Carr (2016) describe some of the critical questions that should be considered when choosing a measurement procedure and offer a clinical decision-making model to guide behavior analysts in making these choices.  This article is useful for helping trainees to practice choosing measurement procedures, and reminding more experienced behavior analysts about the considerations involved in measurement. 

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice, 9(1), 77-83.

Why is this article important for practitioners to read?

Measurement of behavior is one of the most important activities that a behavior analyst engages in.  Without accurate, meaningful measurement, assessment of both behavior and intervention effectiveness is impossible.  Trainees should read this article to learn about the important variables involved in choosing appropriate measurement systems, and more seasoned behavior analysts should read it to remind themselves about those variables.  Even though the article is focused on the measurement of problem behavior, the same principles can be applied to the measurement of behavior targeted for increase.

The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?

Length of observation period might be a relevant factor in choosing a measurement procedure.  Consideration of the availability of resources may be influenced by the goal for how much observation is desired.  To use the case example provided by the authors, Joey’s teacher and aide might not be able to continuously record his work engagement throughout the day, but one of them might be able to do so for a limited sample of each day.  They could choose to conduct continuous measurement during a sample interval, and compare it to the longer period of discontinuous measurement to ensure that the discontinuous measure does not result in an over- or under-estimate of behavior. 

Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.

As a consultant, I need to measure behavior based on limited samples when I can observe, and I also need to design data collection plans for the staff who are there for the rest of the week.  Staff are often responsible for more than one student, and may not have the resources to conduct continuous event recording.  Behavior is also often not discrete (e.g., crying) or occurs too frequently to count (e.g., stereotypy).  I often use partial-interval recording when I consult in school programs.  This allows for a very easy, non-intrusive overview of the pattern of behavior across the school day.  Another common measure is duration of behavior, because it is also relatively easy to start a timer when behavior begins, and stop it when it ends.  Frequency data are pretty rare in my practice, and reserved for low-frequency behavior that only occurs under specific circumstances.

In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?

When training staff to collect data, it’s important to acknowledge any unintended bias.  Depending on the staff member’s level of experience, I will conduct more or less frequent IOA to reduce the risk of observer drift, and will also regularly review behavioral definitions to ensure that we are still talking about the same thing.

In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?

The importance of each dimension of the behavior will depend on the situation, the behavior, and the target or goal for the behavior.  For example, if a student is able to answer social questions but only does so after a delay, we would want to target, and therefore measure, latency to respond instead of frequency.  Or, a learner might engage in several very brief tantrums throughout the day.  In that case, I would expect that duration would be less important, and frequency a more meaningful measure.  By contrast, if a learner engages in one or two very long tantrums per week, we would want to measure duration and possibly intensity, rather than highlighting frequency.

One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

One possible way to validate this model would be to provide several experienced behavior analysts with some case studies, and ask them to use the model to recommend measurement procedures for each case study.  High levels of agreement between the behavior analysts might indicate some validity for the model.  Further validity could be achieved by using the model to select measures, and then conducting those measures and comparing them to true values (e.g., permanent products or continuously-collected event recording).

About The Author

Dana Reinecke, Ph.D., BCBA-D is a doctoral level Board-Certified Behavior Analyst (BCBA-D) and a New York State Licensed Behavior Analyst (LBA).   Dana is a Core Faculty member in the Applied Behavior Analysis department at Capella University.  She is also co-owner of SupervisorABA, an online platform for BACB supervision curriculum, forms, and hours tracking.  Dana provides training and consultation to school districts, private schools, agencies, and families for individuals with disabilities. She has published her research in peer-reviewed journals, written chapters in published books, and co-edited books on ABA and autism.  Current areas of research include use of technology to support students with and without disabilities, self-management training of college students with disabilities, and online teaching strategies for effective college and graduate education.  Dana is actively involved in the New York State Association for Behavior Analysis (NYSABA).

ABA Journal Club: Clinical Decision Making

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Welcome back to ABA Journal Club! One of the tenets of ABA is to provide evidence-based practice. The best way to help us do this is to keep up with the literature! Each month, Sam Blanco, PhD, LBA, BCBA will select one journal article and provide discussion questions for professionals working within the ABA community. Next week, another ABA professional will respond to Sam’s questions and provide further insight and a different perspective on the piece.

One of my favorite parts of my job is training people who are working to become BCBAs. There is an immense amount of content for my supervisees to learn, and one of the key aspects of this is to understand how to implement all of the new concepts they’re learning within the context of an actual case. This is often far more challenging than it might appear at first blush. I frequently supervise students pursuing their BCBA, and I require each one of them to read LeBlanc, Raetz, Sellers, & Carr (2016) because it provides a clear model for clinical decision-making.

This month’s article:

LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior analysis in practice, 9(1), 77-83

This month’s questions:

  • Why is this article important for practitioners to read?
  • The model proposed by the authors incorporates several variables (such as observability of behavior and personnel resources.) Are there any other variables you might consider when selecting a measurement procedure?
  • Table 1 clearly outlines each form of measurement along with strengths and limitations. Discuss the forms of measurement you frequently use and the limitations to incorporating other forms into your current practice.
  • In Figure 1, the authors provide a flow chart for easily selecting the most appropriate form of measurement. Many of the questions are directly related to observer resources. In this article, the term “resources” relates directly to the ability of personnel to continuously monitor the behavior. Are there any other factors you would consider in relation to personnel? If yes, how do you typically address those factors?
  • In discussing the behavior being measured, the authors write: “If the behavior can occur at any time, consider all dimensions of the response and select the ones that are most critically important to fully capture the important features of the behavior and the potential change in the behavior that may occur due to intervention” (p. 81).  How do you determine which dimensions of the response are the most critically important? Can you think of an example?
  • One of the limitations of this paper is that the model it presents has not been empirically tested. What might such an empirical study look like?

Check back next week for our ABA Journal Club response post from Dana Reinecke. Let us know what your thoughts are on Facebook and Instagram!

About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services.

VB-MAPP vs ABLLS-R: Understanding The Differences

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Assessment is the cornerstone of creating appropriate and effective interventions. Two common assessments used for youngsters with autism are the Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) and the Verbal Behavior – Milestones Assessment and Placement Program (VB-MAPP). You’ve likely heard of both the ABLLS-R and the VB-MAPP. While these two assessments are similar in many ways, there are also some big differences that might make one more appropriate for you than the other.

ABLLS-R

The ABLLS-R is made up of two components: the ABLLS™-R  Protocol and the ABLLS™-R Guide. The protocol is comprised of a skill-tracking system, assessing items ranging from listening and language skills to academic and ADL skills. The scoring system is simple, in that each specific skill is broken down into 2-4 levels. You simply mark the level that matches your client’s current skill. The simple organization allows for you to easily track your learner’s progress.

It is important to recognize that the ABLLS-R is more than just the protocol. It also includes the ABLLS-R Guide, which provides instructions for scoring as well as strategies for using the information to develop appropriate goals. Over the years, I have seen many practitioners simply using the protocol without referring to the guide. This is an error that should be corrected, as the guide is a useful resource for parents, teachers, and practitioners. Finally, the ABLLS-R assessed skills that typically develop between approximately ages 2-6.

VB-MAPP

The VB-MAPP is composed of five components.

The Milestones Assessment is comprised of 170 measurable milestones, all based in B.F. Skinner’s analysis of verbal behavior. It focuses primarily on language and social skills, but does include some skills related to academics.

The Barriers Assessment provides a way to assess and measure common barriers to learning experienced by children with language delays. These include barriers such as prompt dependence, impaired social skills, and failure to generalize.

The Transition Assessment provides a way to assess and measure progress towards the child’s ability to move to a less restrictive environment. This portion of the VB-MAPP includes items such as the rate of acquisition for new skills, adaptability to change, and ability to learn from the natural environment.

The fourth component of the VB-MAPP is the Task Analysis and Supporting Skills. This portion goes hand-in-hand with the Milestones Assessment. It is comprised of hundreds of skills that are often directly related to the milestones. It shows the skills that should be taught prior to each milestone and can provide additional information into the child’s current skill level.

The final portion is the VB-MAPP Placement and IEP Goals. This is an in-depth guide for developing IEP goals and identifying interventions based on the results of the other portions of the assessments.  As with the ABLLS-R, I’ve seen many practitioners utilizing the VB-MAPP without referring to the Placement and IEP Goals in the VB-MAPP Guide. This is an error that should be corrected to best use the assessment. The VB-MAPP assesses language skills that typically develop by age 48 months.

VB-MAPP vs ABLLS-R?

It is valuable to receive training in both of these assessments. They are important tools for assessment, especially if you are working with young children.

No matter what assessment you choose, we’ve got you covered! Head to our website and check out our full line of ABLLS-R and VB-MAPP supports, including our exclusive full assessment kits!

About The Author

Sam is an ABA provider for school-aged students in Brooklyn, New York. Working in education for over 15 years with students with Autism Spectrum Disorders and other developmental delays, Sam utilizes strategies for achieving a multitude of academic, behavior, and social goals. She is also an assistant professor in the ABA program at The Sage Colleges and the Senior Clinical Strategist at Encore Support Services. You can read more of Sam’s posts for Different Roads To Learning when you click here!