ABA Journal Club #5: Caregivers as Interventionists

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.

There is a wealth of studies demonstrating that training caregivers to implement interventions is valuable for generalization of skills, improved learner outcomes, and decreases caregiver stress. While many teachers, behavior analysts, and other practitioners work to train caregivers; these practitioners are rarely given specific training on how to train caregivers.

In this month’s journal club article, behavior skills training (BST) is utilized to teach caregivers to be interventionists. BST is a model that involves instruction, modeling, rehearsal, and feedback. We hope this article will get you talking about your current level of training with BST and how your organization can improve in training practitioners to teach caregivers to implement behavior analytic strategies.

Loughrey, T. O., Contreras, B. P., Majdalany, L. M., Rudy, N., Sinn, S., Teague, P., … & Harvey, A. C. (2014). Caregivers as interventionists and trainers: Teaching mands to children with developmental disabilitiesThe Analysis of Verbal Behavior30(2), 128-140.

  • The researchers trained caregivers on a university campus using the BST model prior to home visits. In your current work, would this be a possibility for you? If not, how could you provide this type of training to caregivers? What obstacles can you predict, and how might you address them?
  • Discuss the multiple baseline design used in the study. How does it demonstrate experimental control? What can you determine from a visual analysis of the data?
  • Part of this study included a measure of whether a competently trained parent could teach their spouse how to implement mand training. Why is this important? Have you implemented similar strategies in your own work?
  • This study did include maintenance data. Why is this data valuable? Do you collect maintenance data on the caregiver training you provide?
  • Consider a particular skill you are teaching one or more clients. What would BST look like to teach caregivers how to implement the necessary procedures for teaching that skill?
  • The article states, “General instructions were provided prior to baseline, but parents were only able to implement the procedures effectively when full instructions, modeling, rehearsal, and feedback were used to train to mastery.” How can you change your current practice to ensure that you are providing the necessary steps to help caregivers master skills they have selected for parent training?

WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve 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.

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Common errors with token systems

I love token systems and use them frequently with my clients. Sometimes I use Velcro stars or stickers, or the Token Towers (which are great because you can hear the token going in the plastic tube.) It’s easy to vary the token system to fit the interests and age of a client I am working with. However, I see several errors in their use. Below are a few of the common ones:

• Inconsistent Use – The use of a token system should be predictable. When I am doing an ABA session, the token system is usually available throughout the session. But token systems may be specific to certain activities or certain environments. Using them only some of the time though doesn’t improve their effectiveness.
• Lack of Clarity – You should know what behavior you are focusing on for the token system. For example, I will write down for myself that I am providing tokens for a few specific behaviors (such as whenever a client responds correctly to a current learning target, when they remain in their seats for a period of five minutes, and when they greet a person who comes into the room.) It should be clear for you, as the person implementing the token system, what behaviors you are attempting to increase so you can provide tokens when those behaviors are exhibited.
• Lack of Differentiation – One of the things I love about token systems is that it allows me to easily differentiate reinforcement. For example, let’s say I’m working with a child to teach them to name items from different categories. Usually, when I ask them to name an animal, they name one animal and I provide a token for a correct response. But on this particular day, they name three animals. I can provide more than one token for the higher quality response.
• Not Allowing the Token System to Grow with the Child – Another benefit of token systems is that they can grow with the child. Once a child has mastered a certain behavior, I no longer include it in the token system. The child is always earning tokens for behaviors or responses that are difficult. If you have a client who has been receiving tokens for the same behavior for several months, then one of the two things is happening: (1) the client has mastered the behavior and you aren’t providing reinforcement for more challenging behaviors OR (2) the client has not mastered the behavior and for some reason your token system is not working. Either way, a change needs to be made.
• Fail to Provide a Motivating Reward – I have had some experiences in which the token was supposedly reinforcing on its own. In rare cases, this might just work. However, the tokens should be used to earn a known reinforcer for that particular client.
• Fail to Provide Choices in Rewards – There’s a great body of research on how choice improves motivation. Unfortunately, many children with developmental disabilities have fewer choices in their day-to-day lives than their typically developing counterparts. Allowing your client to choose from a selection of activities or toys for reinforcement will likely improve the quality of your token system.


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve 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.

Preparing For The Holidays

While the holidays can be a very fun and exciting time, they often tend to disrupt regular routines. A disruption in routines can frequently lead to added stress, anxiety, and behavioral difficulties for individuals with autism and their families. So how can you maintain the fun in holidays but also manage the major changes in routine? Here are a few ideas that may be helpful:

Use and/or modify tools your child already utilizes well. If your child uses an activity schedule, calendar, or some kind of app to prepare for transitions and upcoming events; be sure to include new icons, symbols, or preparation for the events related to holidays.
Practice the event. It may be possible for you to role play an event such as a larger family dinner, loud music, or the arrival of a someone dressed up as a character (such as Santa Claus.)
Take the time to list out what may be unique or new. While you cannot prepare for everything, it’s valuable to consider what your child may not have encountered in the past. For example, will there be lit candles within reach? Will there be appealing items your child is required to leave alone? Once you’ve brainstormed a bit, you’ll be better able to respond appropriately.
Enlist some help. If there is a family member or friend who will be present and can help if you need it, ask for their help beforehand and be specific. This might be asking them to engage your child in an activity for a short period of time, or running interference for you when your distant aunt approaches with a litany of rude questions about autism.
Make sure your child has an appropriate way to request a break. Whether your child is verbal or nonverbal, it’s helpful to teach them an appropriate way to exit a situation that is uncomfortable. This is a skill you can practice at home and use in other environments as well.
Recognize your successes. The holidays can be a stressful time, but they can also be a great indicator of just how far your child has come. Relatives you haven’t seen in a year are far more likely to see the difference in your child’s growth than you are, since you’ve seen that steady growth from day to day. It can be a wonderful time to step back and acknowledge just how hard you have all worked in previous months.

These are simple steps that may be helpful in reducing stress during the holidays. Do you have special tips for how you prepare?


WRITTEN BY SAM BLANCO, PhD, LBA, BCBA

Sam is an ABA provider for students ages 3-15 in NYC. Working in education for twelve 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.

3 Ways To Fade Prompts

Prompts are ways we help our learners demonstrate new skills. We use prompts to get our students to greet a peer, flush the toilet, name the color blue, and clap their hands. Prompts are something we add to the situation because the natural or teaching cue was not enough to cause the student to respond. The natural cue of being finished using the toilet was not a strong enough reminder to flush the toilet so we added the verbal prompt, “flush the toilet” and the student now responds. Prompts are important but fading them is just as important.  Prompt fading needs to be planned from the start and an integral and essential component to the plan. Unless you are committing to following that child around for the rest of his life and tell him to flush the toilet – prompt fading is essential.

Some rules for prompt fading:

* Plan it out from the start.
* Train your staff.
* Do it gradually.
* If incorrect responding begins, return to last prompt level.

1. Least to Most Prompt Fading

Like we discussed in Monday’s post, least to most prompting involves starting with the least intrusive prompts and moving up in the prompting hierarchy. This can be beneficial because it gives students to the opportunity to be independent and you are only providing as much prompting as needed. This is a strategy we tend to use naturally. When you meet a your friend’s toddler you put out your hand to give a high five. If she doesn’t respond you say, “give high five.” If she still doesn’t respond you move her hand to your hand to give a high five. This is a natural method of prompting. When using this method, ideally the prompts will be somewhat self fading. If you are always starting at the least intrusive prompt, your students will have the opportunity to demonstrate independence. As the student begins to learn the task, he will need less and less prompts to perform it correctly.

Some key tips for using this prompt fading procedure:

  • allow wait time; if you do not provide wait time you may be providing more prompts than needed and taking away the opportunity for the student to respond correctly
  • take data; data is key to track progress. Every time you utilize this prompting method – note the level of prompt you used. You want to see that your student is requiring less intrusive prompts as time goes on. This will help avoid prompt dependence.
  • use high powered reinforcers; use an item that is actually a reinforcer that your student wants to work for. The sooner he demonstrates the skills, the sooner he gets the reinforcer.

2. Most to Least Prompt Fading

 

Most to Least prompt fading is another effective method of using prompts. With this method you start the most intrusive prompts and gradually fade to less intrusive prompts. The prompt fading is build right in. However, sometimes people forget that and in their head rename this most to most prompting. The key to errorless learning and using the most intrusive prompts first is that you fade the prompts out. The idea behind most to least prompting is that students will contact reinforcement right away and you will avoid errors and the students developing any incorrect habits.

How to fade prompts in Most to Least Prompting:

  • set criteria for changing prompts; once your student hits a particular number of days or sessions or trials at a particular prompt level, fade to the next level; take data to track progress
  • once you hit the criteria move to the next type of prompt; refer to our prompt hierarchy or order that is in Monday’s post. Move up the list to less and less intrusive prompts.
  • fade magnitude than switch prompt type; before you switch from a gestural to a verbal prompt adjust the magnitude of the prompt. A dramatic point to an object is different that a nod of your head.

Data is critically important for avoiding prompt dependence. You want to set a criteria ahead of time and take data to make sure you are sticking with the criteria. The criteria you set will depend on the student and the task. Maybe you want 3 consecutive days with each prompt level. If you are taking data you can ensure that you are sticking to that schedule. If errors begin occurring, go back a prompt level. The data will guide your implementation of this procedure. If you are fading too quickly, your data will tell you!

Prompt fading isn’t scary. Plan ahead and make sure you train your staff. This is a group endeavor! 

3. Time Delay

 

One effective way we can fade prompts is using a time delay. A time delay inserts a set amount of time between the natural or teaching cue and our prompt. When utilizing a time delay, start with a zero second (i.e. no) time delay – so it will basically be like errorless teaching. For the first few trials, give the prompt right away so the student knows how to respond. Then after several trials, increase the time delay. For example, you may start with 2 seconds. If the student does not respond within 2 seconds – provide the prompt. If the student responds before the 2 seconds, provide loads of reinforcement. Once the student is successful and responding under the 2 seconds for several trials, increase the time delay. Now wait until 4 seconds to provide the prompt. Continue on. If the student does not respond with the 4 second time delay, move back to the 2 second time delay.

The key to time delay is planning and data. Set the criterion ahead of time. Plan how many sessions you will do at 0 seconds before moving to the first time delay. Determine what the mastery criteria is – how many times do you want the student to respond within the time delay before increasing the time delay length? Take data on this. It can easily and quickly get confusing if you don’t have a data sheet to track what you are doing. Write the plan in simple terms at the top of your data sheet. I like to track prompted correct (PC), prompted incorrect (PI), unprompted correct (UC), and unprompted incorrect (UI) using those abbreviations on my data sheet. If the student responds before the prompt it is counted as unprompted and if it’s after the prompt it is prompted!

There is no magic number of trials or days you should stay within the 0 second or 2 second time delay. It depends on the student’s level of functioning and the difficulty of the task. This is where data majorly comes in to play. If you’ve moved along too quickly, you will know and you can scale back.

Time delay works really well with verbal prompts. Another key component to time delay working successfully is making sure the reinforcement you give for the unprompted responses is better than the reinforcement for prompted responses. So if Johnny responds before the time delay and says the color blue on his own – give him 3 m&ms and praise but if you are using a 2 second time delay and he doesn’t respond and you provide the verbal prompt “bl…” and then he says blue only provide praise. You want the independent responses to be getting more reinforcement so your student is motivated to engage in those responses more!


About The Author 

Sasha Long, BCBA, M.A., is the founder and president of The Autism Helper, Inc. She is a board certified behavior analyst and certified special education teacher. After ten years of teaching in a self-contained special education classroom, Sasha now works full time as a consultant, writer, and behavior analyst. Sasha manages and writes The Autism Helper Blog, as a way to share easy to use and ready to implement strategies and ideas. Sasha also travels internationally as a speaker and consultant providing individualized training and feedback to parents, educators, therapists and administrators in the world of autism. She is currently an adjunct professor in the school of Applied Behavior Analysis at The Chicago School of Professional Psychology. Sasha received her undergraduate degree in Special Education from Miami University and has a Masters Degree in Applied Behavior Analysis from The Chicago School of Professional Psychology. Contact Sasha at sasha.theautismhelper@gmail.com.

Qualifications of Practitioners/Consultants who Practice ABA

This month’s ASAT feature comes to us from Sabrina Freeman, PhD, ASAT’s Consumer Corner Coordinator. 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!

It’s crucial to be a savvy consumer when it comes to one of the most important decisions you will make for your loved one with autism – choosing an ABA treatment provider for your child. Those of us who have already walked in your shoes know that all treatment providers are not the same. To the uninitiated, these professionals all look marvelous. From the slick websites, to the large numbers of associations of which these professionals are members, it is becoming increasingly difficult to differentiate between mediocre and outstanding treatment providers. Furthermore, publication of research in high quality journals is not synonymous with clinical expertise.

Fortunately, in this issue of Consumer Corner, we present a summary of consumer guidelines created by the Autism Special Interest Group (SIG) of the Association of Behavior Analysis International to help you make an informed choice when searching for ABA professionals to design, run and maintain your child’s program. A complete copy of the SIG guidelines are available here: https://3lvvdfmmeol12qpvw2c75ch6-wpengine.netdna-ssl.com/wp-content/uploads/2018/07/Final-Autism-Sig-Guidelines-Parent-Version-May-2018.pdf It is important to remember that your child’s future depends on highly quality consulting. Good luck!

 

  1. Certification:

Treatment professionals must all have advanced degrees, e.g., a Master’s Degree or a Doctorate in a relevant field of study, and be certified either by the Behavior Analyst Certification Board (BACB), or a board that has equal or higher level requirements than the BACB. To look up your consultant, visit: www.bacb.com and click on “Find A Certificant.” If the potential consultant is not on this list, ask where he/she became credentialed, and trained so that you can verify licensure and experience to determine whether it is equal to/or surpasses the standards of the BACB. If this individual responds to your inquiry in a defensive manner, then you may consider looking elsewhere as you are well within your right to seek clarification about certification status.

Find & Contact Certificants

  1. Extensive Hands-On Supervised Training:

Consultants are required to have extensive hands-on training treating children with autism in which they have worked at least one full year (1500 clock independent supervised hours or 1000 hours if taking a university practicum and 750 hours if taking an intensive practicum) under the supervision of a credentialed BCBA Certificant. In addition, they need to prove competency in many areas that cover the design and implementation of both individualized ABA interventions, and comprehensive ABA treatment programs. The partial list below was created by the Autism Special Interest Group (SIG) below. Your consultant should be competent in all the following areas:

  1. a) Design and implement individualized ABA Interventions
  • community living skills
  • functional communication skills (vocal and non-vocal)
  • “learning to learn” skills (e.g., looking, listening, following instructions, imitating)
  • motor skills
  • personal safety skills
  • play and leisure skills
  • pre-academic and academic skills
  • reduction of behaviors that jeopardize health and safety and impede successful functioning (e.g., stereotypic, obsessive, ritualistic, aggressive, self-injurious, disruptive, and other behaviors often described as “challenging”).
  • school readiness skills
  • self-care skills
  • self- management skills
  • social interaction skills
  • vocational
  1. b) Design and implement both comprehensive ABA intervention programs (using multiple ABA procedures to address multiple intervention targets) and focused interventions (using one or more ABA procedures to address a small number of intervention targets).
  2. c) Delivering ABA interventions directly to at least 8 individuals with autism who present with a range of repertoires, levels of functioning, and ages.
  3. d) Implementing the full range of scientifically validated behavior analytic procedures, including but not limited to:
  • reinforcement (including differential reinforcement)
  • extinction
  • discrete-trial procedures
  • modeling (including video modeling)
  • incidental teaching and other “naturalistic” methods
  • activity-embedded intervention
  • task analysis
  • chaining
  • activity schedules
  • scripts and script fading
  • prompting and prompt-fading
  • errorless training
  • error correction
  • motivating operations
  • stimulus control
  • preference assessments
  • choice
  • augmentative and alternative communication training procedures.
  1. Continuing Education:

Not only do behavioral consultants need to be trained as above, in order to maintain their certification, practitioners must also pursue continuing education in a variety of areas that may include, but are not limited to, Applied Behavior Analysis.

Red Flag

These practitioners should not be working collaboratively with professionals who implement an eclectic mix of interventions that are untested, discredited or experimental in nature. If the consultant you use endorses an eclectic approach, understand that this practice is inconsistent with the BACB Guidelines for Responsible Conduct for Behavior Analysis. This red flag is a particularly helpful way to be forewarned about a consultant who is not a good choice to design and maintain your child’s program!

 

Running behaviors? Tips for Making Your Class & School Safe

If you have a runner in your classroom, you don’t need a gym membership and have long ago put away those cute wedges. Every time the door opens you head jerks around to make sure it isn’t your little guy. The starbucks barista has your venti triple shot ready for you every morning before you get there. A lot of us have been there. From our kid’s perspective, running is effective. Whether it’s to get attention, escape a task, or find that keyboard in the music teachers room – it works most of the time. When looking at these behaviors, we of course want to analyze the function (or the why) behind the behavior when developing interventions. Interventions will definitely include teaching some type of replacement behavior. Today let’s also look at what else you can be doing while these interventions start to take shape.

Running is a scary behavior and potentially dangerous behavior because your student could get outside of the school. He could get lost, hit by a car, or walk into a stranger’s home. If your child or student has these types of behaviors, your mind has definitely gone to these worst case scenarios. I remember losing sleep regularly thinking about a student who had high frequency running behavior and stressing like crazy over what would happen if he ever got out of the school.

Keep them in your class. This is really the golden rule when it comes to runners. Do whatever you can to keep them in your room. Once that foot gets one inch outside your door, all bets are off. Once they are outside your room, you are chasing them and they are loving it. You’ve completely reinforced the inappropriate behavior but you had no choice. You had to keep them safe. Some schools may have systems set up with different staff at different spots in the hallway or building so you can avoid that. But unfortunately many of our classrooms don’t have that much staff to do that. The number one goal is keeping them safe, so do whatever you have to do to get them once they leave your room. But the goal is avoiding that. The goal is keeping them in your room where you can be teaching replacement behaviors.

In the effort to keep them in your room, think obstacles. Go through your student’s schedule and make sure that at every single point of the day there is not a direct pathway to the door. When I do behavior consults, the teacher and I literally do this together. We walk around the room and go to every single spot the student will be at. Sometimes you forget about a specific center or time of day when the student is very close to the door. You classroom may look like a maze. That’s okay. That’s actually good. A maze means it will take your student 4 seconds instead of 2 seconds to get to the door and the extra 2 seconds may be enough to prevent that escape. Use furniture and dividers to create zig zag pathways around your room. I know it’s tempting to do something potentially unsafe like put a lock on the door – but it’s majorly breaking fire code so steer clear of that. If you have two doors in your room, block one up completely so you only have to worry about one.

Have a super clear and straightforward schedule of who is in charge of this student at all times of day. Make sure the transition handoff is clear. Clarify with staff what they should do if they need to go to the bathroom or get up to get a pencil when working with this student. Make sure the goal is clear to everyone – keep him in the room.

If they do get out – minimize the attention component. Sometimes we are doing everything right, working on analyzing the function of the behavior, teaching a replacement response, added in loads of preventative interventions keep the student in your classroom – and life happens and you blink and your student is halfway down the hallway. As we talked about, yes you are going to run after him to get him because above everything safety is important. But minimize the attention that goes into this. Picture two scenarios: 1 – Johnny runs down the hallway. Three adults start running after him, one of them yelling. They catch up to him. One adult yells to the other, “got him.” Another adult, starts lecturing Johnny on we he shouldn’t be running. The three adults walk him back together talking amongst themselves about how fast they are getting. They re-enter the classroom and announce to everyone in the room loudly, “he one got to the end of the hallway.” Basically it’s a circus. I see this ALL the time. And it’s unintentional. None of those adults wake up thinking let’s turn Johnny’s behaviors into a parade today, but it happens. We get scared, adrenaline is rushing, and we don’t have a clear plan in place. Let’s rework this scenario. Johnny runs. One adult makes eye contact with another adult in the classroom and says, “I’m on it.” One adult runs after him, another waits in the doorway of the classroom to watch. When the adult gets him, she says nothing and walks him back to the classroom. He goes back to the exact task he was doing before without any eye contact or talking/lecturing. Attention was minimal. Attention may be a function for many of these behaviors so even though we have to give attention by chasing we can minimize the magnitude of the attention. 

Know where all the school exits are. Seems obvious but I worked in a school for ten years and honestly still didn’t know where all of the exits are. Really old buildings have a seemingly endless amount of hidden doors to the outside. I finally had the school engineer walk me around the basement so I could find them all. Once you know where the main exits are, you can divide and conquer with staff. If your student is running the direction of an exit, one staff member can run ahead to that door or go meet him where the door opens outside. #themoreyouknow

Have a plan with the security guards for the worst case scenario. You guys know I’m all about having an emergency plan in place and you likely already have one with your classroom staff (if you don’t – make one!). But take that emergency plan beyond just your classroom staff. Work with your school’s security guards to get them in the loop. If that horrible worst case scenario happens and your student does somehow get out of the building, what is the plan? We tend to avoid making a plan for this because we think it never will happen. Agreed, plan for it never happening. But just in case at the rare, rare, rare chance it does – you will be much better off with a plan in place.

Use Walkie Talkies with key people through the school. Walkie talkies can be your saving grace here. Many schools already have a system of walkie talkies in place and if you aren’t part of – get part of it. If you student has left the classroom, you will be much more efficient getting him back to the class if you can alert 8 people throughout the building of it versus doing it yourself. If you school doesn’t use walkie talkies, approach your admin about getting a set for your classroom staff and a few key people through the building (security guards, secretary, etc.).

This piece was originally posted at The Autism Helper


About The Author

Sasha Long, BCBA, M.A., is the founder and president of The Autism Helper, Inc. She is a board certified behavior analyst and certified special education teacher. After ten years of teaching in a self-contained special education classroom, Sasha now works full time as a consultant, writer, and behavior analyst. Sasha manages and writes The Autism Helper Blog, as a way to share easy to use and ready to implement strategies and ideas. Sasha also travels internationally as a speaker and consultant providing individualized training and feedback to parents, educators, therapists and administrators in the world of autism. She is currently an adjunct professor in the school of Applied Behavior Analysis at The Chicago School of Professional Psychology. Sasha received her undergraduate degree in Special Education from Miami University and has a Masters Degree in Applied Behavior Analysis from The Chicago School of Professional Psychology. Contact Sasha at sasha.theautismhelper@gmail.com.