By Sam Blanco, PhD, LBA, BCBA-D

I’ve been working with families with autism for over 25 years, and have witnessed firsthand the major shifts in provision of ABA services. We’re living in a time where far more families have access to services, but as the services have become more available the human connection seems to have gotten lost.

I’d like to take a little time to consider how you can approach your work as a BCBA given the very real barriers in place to building strong connections with parents and caregivers. Whether you’re working in a center where parents drop their kids off for services, working to provide in-person parent training once every week through in-home services, or trying to build a rapport via telehealth, there are strategies you can put in place to address the challenges discussed above.

• Start off with a clear explanation of expectations. You need buy-in from the parents and caregivers to engage with parent sessions. Discuss with them their role in the provision of services. And ask them about why they sought out ABA services in the first place.  It can be useful to create your own simple parent contract that you go over and sign together about everyone’s expectations and roles.
• Understand your parents. What are their priorities? Their values? Their concerns? An open dialogue should be occurring in which parents can share concerns about potential interventions as well as ideas they may have. Some ideas for structuring this might include, introductory parent surveys about their expectations and wishes for surveys, having parents write a mission statement about their overall goal for services, or sitting down to align on priorities for all the skills they may want to focus on.
• Identify where you and the parents align. You need to ensure you and the parents are on the same page about expectations across the board, as well as treatment priorities. By now, you’re probably seeing that all of this is about communication communication communication. When you’re discussing an intervention, you should be checking for alignment on the goal itself, prompting, the timing of interventions, settings for interventions, and reinforcers. Be detailed!
• Lead your team with intention. Think beyond insurance requirements and IEPs. Considering the values and priorities of the parents, what do you need to focus on for each session. Be clear about the goal of each session. It’s not simply a parent training session or supervision session. There should be one or more goals you can clearly define and understand how you intend to achieve those goals in each session.
• Check in. Once you have established expectations and alignment, check in on a regular basis (monthly or quarterly) about expectations, priorities, values, and concerns.

About the Author

Sam has been working with children with autism for 25 years. She loves working with new BCBAs and students pursuing their BCBAs. She is the Chief Clinical Officer at BK Behavior.

By Sam Blanco, PhD, LBA, BCBA-D

There’s a famous quote from W. Edwards Deming that says “Without data, you’re just another person with an opinion.” While Deming wasn’t a behavior analyst, this statement aligns closely with how BCBAs approach their work.

Most BCBAs will report how much they love data. But as workloads for BCBAs continue to increase, it’s unfortunate that some BCBAs aren’t looking at their client’s data more than once a month, and some aren’t looking until the authorization period ends after 3 to 6 months. It’s true that the system has drastically increased the response effort to review graphs weekly, but BCBAs are ultimately responsible for adapting their behavior in sessions in order to ensure they are completing those consistent reviews.

Our Ethics Code requires that we provide effective services, and a key component of this is ensuring our decisions are driven by data, not by opinion. If you’re feeling rushed and have a big caseload, there are some practical changes you can make to your day-to-day routines to help embed daily data review in your practice. These might include:

• Ten minutes prior to a supervision session, select five targets to review. Look at the data, and then focus on those targets during the session.
• Ask your clinical director if there are specific prompts within your data collection platform to help you organize data review better. For example, some platforms will have a visual indicator if data should be reviewed, while more sophisticated platforms might have flags or ways to sort out targets in which progress is not being made.
• Organize a system with your behavior technicians so they can tell you in advance of supervision sessions what targets they would flag.
• If your client has Behavior Treatment Modification hours (97155) or Treatment Planning hours (97151) utilize that time weekly to review data and make treatment modifications. This is what these hours are for!

Remember, we are collecting all this data for the purpose of making treatment decisions. This data is crucial to our work, and it is meant to inform our plans and ensure we are providing effective services. Here are some considerations to keep in mind as you review data:

• For any targets that have been mastered, move them to Mastered. If you keep mastered targets in Acquisition, you will lose out on having an accurate understanding of your client’s general rate of acquisition.
• For any mastered targets, add in additional targets if necessary. This will give you a more accurate picture of your client’s general rate of acquisition, and also improve variety and continued growth!
• If you see a target that has not been mastered after several weeks (or after a time longer than the client’s general rate of acquisition), consider possible changes, such as changes to the prompt level, the materials, or the need for mastering prerequisite skills. Adjust to what the data is telling you.
• For any targets you’re uncertain about, run them as-written with the client on your own. Then observe your BT to ensure they are running the program with procedural fidelity.
• Identify if there are any targets without data. You will need to review with your BT to understand barriers to implementing the target.
• If you see that an increase in challenging behaviors occurs during specific targets, evaluate what changes you may need to make. Again, adjust to what the data is telling you.

This isn’t a comprehensive checklist, but it’s a good start. Ultimately, reviewing all data should be a weekly practice for each client you work with. Otherwise, we’re not providing the full scope of behavior analytic services our learners rely on to make meaningful progress.

About the Author

Sam has been working with children with autism for 25 years. She loves working with new BCBAs and students pursuing their BCBAs. She is the Chief Clinical Officer at BK Behavior.

By Sam Blanco, PhD, LBA, BCBA, Originally Posted October 11, 2018

Recently I was working with a parent who was using a Time Timer with her son to help him recognize when it was time to get ready for bed. Our plan was to start the timer every night while he was engaged in an activity, show him the timer and have him repeat how many minutes left, then have him tell his mom when the timer went off. For the first couple of weeks, this plan worked beautifully. The boy could see the time elapsing, brought the timer to his mother when it went off, and then started the process to get ready for bed without engaging in tantrum behaviors.

I went in for a parent training session after a month of the intervention and the boy’s mother informed me the timer just wasn’t working any more. As we started talking, I realized that the mother had drifted from our original plan in a way that is quite common. As her son experienced success, she used the timer less frequently. Then, if he was struggling, she would introduce the timer. In effect, she started only using the timer when he was misbehaving, instead of using it as a consistent tool to help him with the bedtime routine.

This type of procedural drift (when there is an unintentional or unplanned change in the procedure outlined for the intervention) is very common for parents, teachers, and ABA therapists. It’s important to understand this type of drift so it can be corrected when it occurs.

Here are a few things to remember when implementing an intervention

• First, any intervention should include a clear plan for fading the intervention. In the example above, the Time Timer was an appropriate tool for this particular child, who was only four years old. But we don’t want him to rely on the timer for the duration of childhood! A plan should include how to fade the intervention with specific steps and specific requirements for mastery.

• The use of the Time Timer is considered an antecedent intervention. This means that we are implementing a change in the environment prior to any problem behaviors to help the child contact reinforcement and experience success. Antecedent interventions should be implemented consistently as part of a routine, not ONLY when a problem behavior occurs. If it is only implemented when the problem behavior occurs, it is no longer an antecedent intervention.

• If we implement a tool (like the Time Timer) only when problem behavior occurs, it’s possible the tool will become aversive to the child and possibly result in an increased magnitude of the problem behavior.

• Consider using tools for the people implementing to intervention to remind them of the specific steps. For example, you might create a video model and instruct the parent (or other adult implementing the intervention) to watch it every couple days. Or you might post the steps in a clear space to be reviewed regularly.

• Finally, we have to remember that a couple of good days in a row without any instances of problem behavior does not mean that the problem is solved. This is why the first step outlined above is so important. We want to teach the child replacement behaviors and give them lots of opportunities to be successful with it.

Ultimately, we were able to re-implement the procedure with this parent and see more continued success with this particular case. We also decided to post the steps to the intervention on the back of the Time Timer for easy review on a daily basis.

However, in some cases, you might have to create an entirely new intervention using different tools. The goal is to be clear about the steps of the intervention, and to maintain those steps when implementing the intervention.

About the Author

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.

BY SAM BLANCO, PhD, LBA, BCBA

There is a common misconception that individuals with special needs require a slower pace of instruction. While they may require a slower pace through a curriculum, this does not mean that individual lessons should be taught at a slower pace. In fact, slowing the pace of instruction not only wastes precious instructional time, it may increase the occurrence of problem behaviors.

Higbee (2009) writes that “appropriately paced instruction helps students to maintain attention to the instructor and instructional materials. Though student attention can be lost when instruction is happening too rapidly, it is most often lost when the pace of instruction is not rapid enough” (p. 20).

So how can you maintain a fast pace of instruction that is appropriate for your student? Here are some things to consider:

1. Prepare! Set out your materials in such a way that they are easy to access quickly. I keep all the mastered skills on index cards so I can easily add maintenance questions into instruction. Organization is often the simplest way to increase efficiency in your session.
2. Take data. You want to increase attention and decrease problem behaviors. Try different paces of instruction and measure the behaviors you are wanting to change. For instance, if I have a student who is often grabbing for my shirt during a session, I may try a pace of instruction that includes 15 questions each minute, then try a pace of 20 questions per minute, another of 25 per minute. Next, I will compare the rates of grabbing for my shirt with each pace of instruction. Remember, these aren’t 15 questions for the target skill; some mastered skills will be intermixed.
3. Record a session. By taking video of yourself working with a child, you may see opportunities for increasing efficiency on your own. You may also observe specific times at which problem behaviors tend to increase, then be able to target those specifically. For instance, perhaps problem behaviors occur when you turn to write data in a binder, but didn’t recognize that pattern until you watched a recording later.
4. Use reinforcement effectively. Usually, pace of instruction in and of itself will not change behavior. Instead, pair it with reinforcement and be systematic with how you implement reinforcement. We’ve talked about reinforcement here on the blog a lot, so you can read about that in more detail here.
5. If possible, get input from supervisors or the individual you are working with. Supervisors may be able to observe your session and provide insight on how to increase your pace of instruction. And the individual you are working with may be communicating that they are bored through misbehavior, stating “I’m bored,” or nonvocal behaviors such as yawning. This may be an indication that you need to provide more challenging material or increase the pace of instruction.

REFERENCES

Higbee, T. (2009). Establishing the prerequisites for normal language. In R. A. Rehfeldt, Y. Barnes-Holmes, & S.C. Hayes (Eds.), Derived relational responding applications for learners with autism and other developmental disabilities: A progressive guide to change (7-24). Oakland, CA: New Harbinger Publications, Inc.

About the Author

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

Over the years, I’ve seen several behavior intervention plans written and implemented. Typically, these plans include reinforcement for the desirable behavior, but I see the same mistakes crop up again and again. Here are a few common mistakes in implementing reinforcement to look out for:

Fail to identify individual reinforcers.

Hands down, the most common error I see is identifying specific activities or items as reinforcing. For instance, many people love gummy bears, but they make me want to puke. Presenting me with a gummy bear would not increase my future likelihood of engaging in the appropriate behavior! You must account for individual differences and conduct a preference assessment of your learner, then make a plan based on his or her preferences.

Fade reinforcement too quickly. 

Let’s say you’re working with a child named Harold who draws on the walls with crayon. You implement a reinforcement plan in which he earns praise and attention from his parent each time he draws on paper. The first few days it’s implemented, Harold’s rate of drawing on the wall greatly decreases. Everyone claims that his behavior is “fixed” and suddenly the plan for reinforcement is removed… and Harold begins drawing on the wall once more. I see this sort of pattern frequently (and have even caught myself doing it from time to time). After all, it can be easy to forget to reinforce positive behavior. To address this issue, make a clear plan for fading reinforcement, and use tools to help remind you to provide reinforcement for appropriate behavior.

Inconsistent with reinforcement plan. 

Harriet is writing consistently in a notebook, to the detriment of her interactions with peers. Her teachers implement a DRO, deciding to provide reinforcement for behavior other than the writing. However, the teachers didn’t notify all the adults working with her of the new plan, so Harriet’s behavior persists in certain environments, such as at recess, allowing her to miss multiple opportunities for more appropriate social interaction. To address this issue, make a clear outline of the environments in which the behavior is occurring and what adults are working in those environments. Ensure that all of the adults on that list are fully aware of the plan and kept abreast of any changes.

Don’t reinforce quickly enough. 

This one can be quite challenging, depending on the behavior and the environment. Let’s saying you’re working with a boy named Huck who curses often. You and your team devise a plan to reinforce appropriate language. You decide to offer him tokens that add up to free time at the end of the school day. However, sometimes as you are handing him a token for appropriate language, he curses again right before the token lands in his hand. Though it was unintentional, the cursing was actually reinforced here. Remember that reinforcement should be delivered as close to the desired behavior as possible. To address this issue, consider your environment and materials and make a plan to increase the speed of delivery.

Fail to make a plan to transfer to natural reinforcers. 

Ultimately, you don’t want any of these behaviors to change based solely on contrived reinforcement. Making a plan for reinforcement of appropriate behavior is essential, but your ultimate goal is to have the behavior be maintained by naturally occurring reinforcement. To address this issue, the first thing you need to do is identify what that naturally occurring reinforcement might be. For Harold, it might be having his artwork put up in a special place or sharing it with a show and tell. For Harriet it might be the interactions she has with peers on the playground. Once you have identified those reinforcers, you can create a plan for ensuring that the learner contacts those reinforcers over time. This might include pairing the naturally occurring reinforcers with the contrived reinforcers, then fading out the latter.

Ultimately, it’s important to remember that reinforcement is not as simple as it seems. Taking the time to plan on the front end will help with long-term outcomes.

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.

By Sam Blanco, BCBA

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 or 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!