Therapeutic Staff Support In-Service Training

Therapeutic Staff Support In-Service Training
Practical & Applied Skills © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Sensitivity to the Client’s Family
Building a Relationship with the Client’s Family RESPECT Respect is an ATTITUDE of Acknowledging the Feelings, values and interests of the family in a Therapeutic Relationship Affording your Client’s Family Respect, you are not Passing Judgment on the Manner that they live, OR Interact, OR the Values that they Hold CASSP principles- child centered, family based, community-based, multi-system culturally competent least restrictive/least intrusive © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

© 2007 The Institute for Behavior Change, Inc.
Rapport Is one of the Most Important Features or Characteristics of Unconscious Human Interaction The Ability to enter the Family’s World View It is Commonality of Perspective, being in “sync”, being on the same wavelength as the person you are talking to Positive Communication Skills Trust The basic Foundation of every Relationship: Honesty, Caring, Integrity Compliance Boundary Setting up Parent and Teacher Boundaries- Allowing Intervening Caregiver to Finish Intervention before Approaching unless asked by the Attendee ( Teacher, Parent, TSS) Talk to BSC first, then Deal with it Appropriately These are basic skills and understandings that all BHRS providers, especially TSS providers, must have. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Sensitivity to the School and School Environment
© 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws. Sensitivity to the School and School Environment Building a Positive Working Relationship with the Teachers Positive Communication Skills Respecting the Role of the Teacher with your Client Respecting the Rules of the School Discussing with the Teacher the need for pairing with Child Working in the classroom can sometimes be difficult. Make sure that you understand the classroom rules and the school rules. Paperwork is not to be shown to the teacher unless specified by parent and BSC. The teacher only needs to sign your CRF and Progress Note. Any problems should be forwarded to the BSC ASAP © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Restraining Clients PA Laws Pertaining to Restraint of Children
Personal Restraint is the Application of Physical Force on a Person’s Body without the use of any Device for the Purpose of Restricting the Free Movement of a Person’s Body. The Term Personal Restraint does not include Briefly holding without Undue Force a Person in Order to Calm or Comfort him or her, or Holding to Safely Escort a Person from One area to Another. BHRS staff may not be involved in the Application of a Restraint Procedure under Any Circumstances even if they have been trained within the past year. Open hand assist Stress the reason why we do not place our hands on the clients © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Physical Assistance and Guidance
What are the Limitations? Physical Assistance and guidance is an intervention that is utilized when a client puts him/herself at risk for harming self and/or others. Physical Assistance is NEVER utilized as a general intervention. Examples of “do’s” and “don'ts” of physical guidance. Examples of do’s and don’ts: When a child has thrown themselves to the floor and is kicking and screaming When a child runs out in the middle of a street and a care is coming. The caregiver has another child that she is already holding onto/ there is no caregiver around….. Child is throwing things in the classroom and is endangering self and others Child refuses to get up out of their seat when it is time to transition to another activity © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Restraint Cont. Exclusion (Federal term: "exclusionary time out") is the removal of a child from the child's immediate environment and restricting the child alone to a room or area. (See 55 Pa. Code § ). PERMITTED Exclusion is similar to the Federal "time-out" which is the restriction of a person for a period of time to a designated area from which the person is not physically prevented from leaving, for the purpose of providing the person an opportunity to regain self control. (See 42 CFR § and .368). PERMITTED Seclusion is NOT PERMITTED by PA State law (55 Pa Code § ), in that the person cannot be confined to the room by any form of locking the room, blocking egress by standing in the doorway, or otherwise preventing a person from leaving the area. Which one is the one a TSS can use? What does time out mean? © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Professionalism on the Job
Keeping Personal Distance What are your Personal Boundaries when Working with a Family Disclosure Gifts Mealtime In the Community TSS Role Limitations What are the Limitations to your Role as a TSS Provider? You are a Direct Provider of Services to the Client You may make suggestions as to the Course of Treatment, However, any suggestion must be Discussed with the BSC before the Intervention is Implemented. You may be in Direct Contact with the Parent, However, there are Limitations to what you may be in Direct Contact about: Check with your BSC Keeping personal distance: 1.Do not discuss personal life with the clients family. Do not get involved in their personal life as well. If the family is having difficulties that effect the client have them discuss or relay that information to the BSC. They can set up some kind of other service if needed. 2. We do not except gifts from the clients family. If the family is persistent on giving you something, you can always donate it to the office for all staff to use. 3. Bring your own food if you are working with a client during mealtimes. This will reduce the family in thinking they have to offer you anything. 4. Be aware, especially in school, that people will see you with your client. Try not to make it obvious that they have services. This could cause the client, if they are aware enough, to feel that they are different then others and stand out TSS Role limitations: It is better, when presented with a concern of the parent, to discuss with BSC FIRST before offering any opinion on how services should be given. TSS’s are only to use interventions prescribed by BSC. Any ideas on treatment or how interventions are not working should be discussed with BSC. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

What is this packet the BSC gave me?
The Psychological Evaluation The Client’s Full History Client’s Demographic Information Psychiatric evaluation and Diagnosis Who the treatment team is History of medication Allergies and Sensitivities (sensory issues) Past Services Current Services This information is important to better understand your clients needs. This can better help you deal with problems that your client has and might help you understand the behavior they are displaying and why. If you do not understand the clients diagnosis, ask your BSC to explain. Medication, allergies and sensitivities could all be factors in the clients behavior. Be aware of all these things. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The Importance of the Diagnosis
What is your Client’s Diagnosis? Why is it Important to Understand your Client’s Diagnosis? How the Diagnosis affects the Manner in which you Work with your Clients Understanding the Medication your Client is Taking © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Increasing your Knowledge of your Client’s Diagnosis, Treatment, and Appropriate Interventions Accessing Resources: Resources are available at the Office, Talk to your BSC, Internet, Parent, other TSS providers, Teachers, PT/OT, Speech, etc. It is Important to keep the Lines of Communication going to ensure that All Treatment Team Members are on the Same Page Regarding the Client’s Progress © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Client Treatment Outside of BHR Services What treatment has your Client had in the past? Has the treatment outside of BHRS been successful or unsuccessful? Why? What treatment outside of BHRS does your client receive at the current time and how does it affect the work you do with the client? © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The Treatment Plan Working Treatment Plan
Goals for the Client What are the short-term and long-term goals for the client? Always positive and always focus on increasing the client’s skills and abilities for positive behavior Target and Replacement Behavior Target Behavior– negative behavior you are targeting to assist the client to reduce Replacement Behavior – a preferred behavior that replaces the target behavior Methods of Achieving the Goals The interventions that you are expected to utilize when working with the client to achieve the short-term and long-term goals !. Set your client up for success. Reinforcement is the best intervention for behaviors. 2. Target behaviors are the behaviors we are striving to have. We use the interventions prescribed to help us accomplish that. 3. Replacement behaviors are the tools we use to reach those target behaviors © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

If Your Goal is to Document Behavior….. You first have to Understand Behavior © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Technically Speaking….
What is Behavior? Technically Speaking…. Behavior is defined as any Observable and Measurable act of an Individual Behavior always has an Antecedent and a Consequence (A-B-C which will be explained later) Behavior is also a Response to what is Occurring in the Environment at any given Time, and that response will determine future behavior There is Positive and Negative Behavior- How you Handle the Behavior will Determine what will Reinforce that Behavior Behavior is anything that can be observed in response to the environment around us. Use the dead man test, if there is a reaction, it is behavior. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Analyzing the Behavior
How is the Behavior Analyzed? There are several different methods to analyzing behavior…. The method most often utilized is through direct observation and documentation… 1. Functional Behavior Analysis The process of gathering information about the antecedent and consequence that are functionally related to a problem behavior and teach alternative behavior instead of suppressing the behavior using punishment A Functional Behavior Analysis helps to assess how the client learned the behavior and how it has been maintained The data collected during a Functional Behavior Analysis is used to select interventions that will assist the child in replacing the problem behavior This collection of data is helpful to the BSC to help create an accurate treatment plan. Our job is to constantly be aware of how the client interacts with the world. If we see patterns forming, the BSC can help create interventions to help the clients better deal with their environment. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

How we Assess the Problem Behavior
Through Direct Observation in the Child’s Environment, We: Identify the Problem Behavior Define the Behavior in Concrete Terms Identify the contributing Factors to the Behavior Create a Hypothesis about the function of the Behavior The Contributing Factors are discovered through an A-B-C analysis (Antecedent-Behavior-Consequence) assessment techniques- INDIRECT ASSESSMENT - Structured interviews, review of existing evaluation info. DIRECT ASSESSMENT- standardized assessment or checklists or observing and recording situational factors surrounding the behavior DATA ANALYSIS- a comparison and analysis of data to determine whether or not there are patterns associated behavior FUNCTIONAL INTERVIEW- w/ at least two people who have been present at the time problem behavior occurs DIRECT OBSERVATION- ABC data, frequency, duration, latency rate EXPERIMENTAL MANIPULATIONS- setting up test conditions to identify function of behavior © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

A-B-C Antecedent The event that happens before behavior occurs Behavior What the Client says and does Consequence The event that occurs directly after the Behavior The use of the A-B-C chart will assist you in determining what preconditions are causing the behavior and what interventions could be applied to prevent the behavior from reoccurring. Create scenarios and have them write out A,B,C info. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Antecedent The setting or event that occurs before the behavior happens Examples: People that are present in the environment Time of day The activity the child is doing or asked to do Physical and medical variables (hunger, tired, medications) The instructor/parent tone of voice © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Behavior: Form Anything observable that the child does – it should be specific and concrete What the TSS actually observes not your opinion If you were talking on the phone to your BSC how would you explain what the child did A behavior should be described without opinion: not that the child had a “bad attitude”, but the child “pushed his paper on the floor and said no” © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Behavior: Function Behavior occurs due to 2 functions: To get: attention, activities, objects, sensory stimulus To escape or avoid: attention, activities, objects, sensory stimulus © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Consequences Any event that follows a behavior This will either increase or decrease the behavior Examples: Verbal praise Redirect to a replacement behavior Attention or the lack of attention to the behavior © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

What Creates Behavior? Definition of Reinforcement
Reinforcement Creates Behavior Reinforcement is the key to learning “ everything you have learned is a result of reinforcement” Definition of Reinforcement Any event that INCREASE the likelihood of that specific behavior in the future Positive Reinforcement In an attempt to increase the likelihood of a Behavior Occurring in the Future, a preferred stimulus is ADDED to the environment Negative Reinforcement In an attempt to increase the likelihood of a Behavior Occurring in the Future, an aversive stimulus is REMOVED from the environment Any event that follows a behavior and increases the rate of that behavior. Positive- increase a behavior to get good things Negative- increase a behavior to remove aversive stimulus ( escape, avoidance) improvement of the environment. Discuss primary rein forcers to help them understand. Water, food, sex, sleep, sensory stimulation Have them work out scenarios of positive and negative reinforcement in groups: After her second grade teacher yells at her, Linda’s misbehavior in class increases- positive reinforcement 2. After her finger got infected last month, Dawn quickly took out a splinter today.- negative reinforcement 3.Johnny wanted to play his video game when he got home from school. Mom told him he needed to go his homework first. Johnny screamed and cried until mom gave in. Now Johnny screams and cries whenever this scenario presents itself. – positive reinforcement for Johnny , negative reinforcement for mom 4. Whenever Chris raised his hand in class, he would get a look of approval from the teacher and a smile. Chris raised his hand more often in class.- Positive reinforcement 5.Whenever Sam did not do his homework, he had to stay in for recess and do it. The teacher would lecture him and tell him that he needed to do his work to do well in his courses. Sam did his homework more often. Negative reinforcement © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The Importance of Using Reinforcement
Negative Reinforcement- Why Does it Happen? Escape has occurred when behavior has led to a reduction of the aversiveness of the present environment. In other words, something unpleasant is currently going on, and the person does something to terminate or lessen it. Avoidance has occurred when behavior has prevented the onset of an impending increase in the aversiveness of the environment. Escape and avoidance are both instances of behavior leading to an improvement in the environment (hence reinforcement) by removing some amount of the aversiveness of the environment (therefore negative). As is always the case with reinforcement, life is better for the behavior having occurred, therefore increasing the probability of the behavior in the future under similar circumstances. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Reinforcement Cont. You should: Identify Reinforcers that will work with your Client Reevaluate Reinforcers daily 3. Apply on a variable schedule 4. BE PREPARED-Reinforcers will change constantly (reevaluate reinforcers daily) ****VERY IMPORTANT**** The Reinforcers should be given to the Client WITHIN 3 SECONDS After the Appropriate Behavior Occurs. The Client will then begin to Associate the Reinforcer with the Appropriate Behavior. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Reinforcement Cont. Example of positive reinforcement of cooperative play: Martha was a five-year-old girl who attended preschool. She seldom played with the other children. Workers at the preschool began praising and admiring Martha when she engaged in cooperative play with other children. As a result of this procedure Martha's level of cooperative play with the other children increased. Example of positive reinforcement of disruptive classroom behavior: Research was conducted in elementary school classrooms to study the effects of teacher behavior on student behavior. During one phase of the study, the teacher began disapproving of the students' disruptive behaviors when they occurred. This resulted in an increase in the level of disruptive behaviors. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Reinforcement Cont. The Nudist Decide if the following item is an example of positive reinforcement. Focus on the highlighted target behavior to determine if it was positively reinforced. Provide a reason for your answer. Martha had a three-year old son named Noah. For reasons that Martha could not understand, Noah would sometimes take all his clothes off and run about the house. Every time Noah did this, Martha gave Noah a stern lecture telling him about the dangers of not wearing enough clothing. As a result of this, Noah took his clothes off and ran about the house more often than he had previously. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Reinforcement Cont. Analysis of Noah and his need to be naked: This is an example of positive reinforcement because the lectures were consequences dependent upon removing the clothes and because this caused clothing removal to become more frequent. As illustrated in this example, sometimes stimuli that are painful and seemingly unpleasant can act as positive reinforcers. When a child is being lectured, that child is also receiving attention, and especially among attention-deprived children lectures of this kind can function as reinforcers. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Importance of Reinforcement
It is Difficult to Apply the Treatment Plan with a Client Until you Know what is Reinforcing to that Client Understanding What is Reinforcing could take Time. Be Patient and Learn in order to Pair Yourself with the Reinforcer Using a Reinforcer Checklist Go over reinforcer check list with the group. It is a good tool to help them to start pairing with the client. Explain that when they first start with a client a time of observation is needed to help understand some of the behaviors the child may be displaying. Make sure that everyone knows what you are doing. Caregivers may think that you are not doing your job. This should happen within the first week of working with the client. Observe how others interact with the client and take note what is reinforcing for that child. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Schedules of Reinforcement
Fixed Ratio: A reinforcer given after a fixed number of responses Fixed Interval: The first correct response after a set amount of time has passed is reinforced Variable Ratio: A reinforcer is given after a varying set of correct responses Variable Interval : The first correct response after a varying amount of time has passed is reinforced Get examples from print out. Split into groups and have them label what schedule of reinforcement. Discuss which schedule of reinforcement would be most effective in maintaining skills after TSS has reduced or stopped services At this time hand out pink scenario cards and have them break up into groups. This will help you figure out how much they know about the interventions they are doing. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

End of Day 1 Tomorrow, we’ll explore treatment methods, strategies and tactics that are especially relevant for children with Autism Spectrum Disorders. We’ll start on time, so please don’t be late, so you can receive full credit for the program. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Pairing Positive Pairing is one of the Most Important Interventions that the therapist will Utilize. If the therapist Does Not create a Positive Relationship with the client, the Client may not Respond to the therapist or the interventions. The Result of not pairing Positively with the Client is Potential for Refusal to Engage with the therapist in order to Reduce the Target Behavior. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Pairing Continued Definition of Pairing
Building Positive Rapport with the Client: Pairing begins with Noncontingent Reinforcement, first Reinforced without having Demands placed on the Client Once the Client is taking Reinforcers from the Therapist, they can gradually introduce demands Once paired , everything associated with the Therapist will become Reinforcing. Noncontingent reinforcement. "A response-independent or time-based delivery of stimuli with known reinforcing properties," and its possible advantages over the use of differential reinforcement of other behavior (Vollmer, Iwata, Zarcone, Smith & Mazaleski (1993, p. 10) © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Pairing with Reinforcement
The Goal of Pairing with Reinforcement “Become the M&M” Steps for Pairing with the Client Identify the Reinforcers: Identify Objects, food items and Activities that are Reinforcing to the Client Approach the Client with Something Fun: Approach the Client with a Reinforcer in an Outstretched hand Make it Obvious that you are Approaching with something Fun Make sure that what you have is More Desirable: Don’t interrupt the Client’s fun to do an Activity that is Less Reinforcing © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Pairing with Reinforcement Cont.
Make Activities More Fun: When the Client is Playing with a Toy or Engaging in an Activity, do things that make it more Enjoyable Pair your Voice with Reinforcement: While Pairing with the Client’s Reinforcers, say the Client’s name and use Short Phrases to Describe what you are doing You will Pair not only Yourself but also your Voice with the Reinforcement Limit the Availability and Visibility of other Reinforcers: Every time a Fun Item Appears, it Appears Because you make it Available, Therefore Making you more Valuable Pairing is an ongoing Process © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Interventions How to help your client change non-preferred behavior to PREFERRED behavior utilizing effective intervention techniques The Intervention must be “Least Restrictive/Least Intrusive” The interventions that you Utilize are documented in the treatment plan. Communicate with the Treatment Team for appropriate Implementation of all Interventions © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Interventions Continued
The Hierarchy of Prompts Why Use Prompts? When teaching, we Usually want to prompt because we want to be able to Reinforce the Behavior -However- We also want to be able to get rid of prompts (fade prompts) because we want the Client to learn to Demonstrate the behavior without help © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Prompts Continued 1. Full Physical Prompt Hand over Hand assistance to complete the Targeted Response. Hand over Hand is typically used when the Target Response is motor in nature. For Example, a full Physical assist Might entail putting your hand on the Client’s hand and moving the Client’s hand through the action of writing his or her name OR If the Client is learning to Jump up and down, Providing a full Physical Assist would mean Physically lifting the client up and down in a jumping motion. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Prompts Continued 2. Partial Physical Assist (PPA) As the name Suggests, a partial Physical assist is less intense or Intrusive than a full Physical Assist. If full physical Assist is hand over hand, the Partial Physical assist can be visualized as providing minimal supportive Guidance- For example - touching the Wrist to Stabilize handwriting or encouraging the Client to jump without actually lifting his or her body off the ground If the Client doesn’t need hand over hand assistance, Start here. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Prompts Continued 3. Direct Verbal (DV) Prompt: This is a direct Statement of what we expect the Client to do or say. Example: “come here.” “Put the glass on the counter.” This level of Prompt requires that the Client be able to follow your Direction. 4. Indirect Verbal (IV) Prompt An Indirect Verbal Prompt tells the Client that something is expected but not Exactly what. Example: “What Next?” “Now What?” 5. Independent The Client is able to perform the Task on his or her own with no Prompts or Assistance from you. Prompt levels can change form moment to moment when Teaching. Prompt if necessary to keep the Response Effort low and Reduce Frustration. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Modeling Modeling is simply showing the Client what you want him or her to do. You do not Physically touch the Client. In order for modeling to work, the Client must Know how to Imitate another person’s actions. If a Client has good imitation skills, start here. Gestures Pointing, Facial expression, Mouthing words silently or otherwise indicating with a motion what you want the Client to do. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Redirection Providing Client alternative choices and redirect the client away from inappropriate Behavior to the preferred behavior Backstep Taking the Client back to the original place that they last followed direction. Overcorrection/Positive Practice Procedures involve having the client engage in repetitive behavior as a penalty for having displayed inappropriate action Social Stories Presents Appropriate Social Behaviors in the form of a story If the client is capable of helping to write the story, then he/she does so. If the client is not capable, the parent or TSS writes the story with the client’s involvement. Break them into groups and have them each write a social story based on the topic given to them. Line leader, expressing anger, sharing toys, raising your hand in class, crossing the street, going to the toy store, taking turns when playing games, washing hands, when my teacher talks to someone else, asking others to play, what is lying?, saying hi © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Planned Ignoring A variation of timeout in which social proximity and attention are consistently withheld for a specific length of time immediately contingent on a client’s undesirable behavior. Contingency Contracting A Contingency Contract is based on an “if…then” statement. Token Economy A token economy is based on delayed reinforcement. A system of behavior management in which tangible or token reinforcers such as points, plastic chips, metal washers, poker chips, or play money are given as rewards and later exchanged for back-up reinforcers that have value in themselves (e.g., food, trinkets, play time, books); a miniature economic system used to foster desirable behavior Goal Charts Visual Reward of a delayed reinforcement which allows the client to see his/her progress Contingency. The relationship between behavior and its consequences; contingencies are often stated in the form "if-then" © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Behavioral Rehearsal/Role Modeling Rehearsing the requested behavior before the Client is exposed to the Social Situation. ( TSS model the behavior with Parents). Walk and Peel (Home Version) Walk - Disengaging from the client – walking away when the disruptive behavior occurs Peel - if the Client tries to grab you. Peel him/her as soon as possible. Before you leave the area, make sure the client is safe from danger and no property has the potential to be destroyed. Once the behavior has stopped (about one minute), then redirect Client to an activity. If the problem occurs again then, reroute through the above procedure. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Intervention Continued
Walk and Peel (Non Home Version) This behavior should be handled differently in school or public as compared to home which is described previously. If problem behavior occurs, tell Client “No” and provide a SHORT rational. If Client accepts, reinforce Immediately but not with the item you just refused. If the client is still displaying disruptive behavior, Immediately place a demand on them to do something else. Example: “Walk with me, sit in this Chair, etc.” At this point the client should complete the demand placed on them without further behavior. Once the Client has completed the demand without disruptive behavior, allow them to continue what they were doing before behavior or redirect to the next activity. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Counting Procedure A distracter from inappropriate behavior Utilizing Time- Out and Chill- Out Time-out/ Chill out- A procedure for the reduction of inappropriate behavior whereby the child is denied access, for a fixed period of time, to the opportunity to receive reinforcement Seclusion – is different from time- out and is not permitted by TSS providers Counting procedure is a form of time-out. It just helps clients visually see how long they need to be calm and quiet. Mainly used with children on the spectrum. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Interventions continued
Shaping A Behavior change process in which a new or unfamiliar behavior is taught through reinforcing successive approximations of the behavior, progressing step-by-step toward a terminal objective Forward Chaining Forward Chaining is a Procedure that begins with the first element of the chain and progresses to the last element. (A to Z) In this procedure you start with the first task in the chain. You Do Not move on until the Client can perform the element Satisfactory. Each element of the chain is performed in this manner until it is completed in its entirety Backward (Reverse) Chaining A Chaining procedure that begins with the last element in the chain and proceeds to the first element. As in Forward Chaining, Do Not move on until the Client can perform the element Satisfactorily. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Differential Reinforcement
Differential reinforcement of alternate behavior (DRA). A procedure in which reinforcement is delivered for behaviors that are alternatives to the target behavior Differential reinforcement of incompatible behavior (DRI). Systematically reinforcing a response that is topographically incompatible with a behavior targeted for reduction Differential reinforcement of low rates of behavior (DRL). A procedure in which reinforcement is delivered when the number of responses in a specified period of time is less than or equal to a prescribed limit; encourages maintenance of a behavior at a predetermined rate lower than the baseline or naturally occurring rate Differential reinforcement of other behavior (DRO). A procedure in which reinforcement is delivered when the target behavior is not emitted for a specified period of time; behaviors other than the target behaviors are specifically reinforced; also referred to as differential reinforcement of the omission of behavior. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Applied Behavior Analysis
Definition of Applied Behavior Analysis (ABA) ABA is the Study of human Behavior, the pattern of a Client’s Behavior to understand and Predict the Client’s Future Behavior ABA Utilizes Specific and Comprehensive Theories of human learning, Operant learning, or Learning Theory to Change Behavior ABA Enhances the Development, Abilities, and Self direction skills of Clients with Disabilities, and to enhance the Productivity and Abilities of the Client in Regular Education Implementation of ABA will Produce practical Behavior change in the Client. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

WHAT!!!!!! Ahh… can someone please Explain what was just said…..
Simply put: ABA is a Behavior-modification-type Approach to learning based on the work of Dr. B. F. Skinner This Approach is based on: 1. Careful study (analysis) of each behavior. 2. Breaking down each problem Behavior into even smaller Behaviors (Task Analysis). 3. Gradually teaching each small desired Behavior one at a time, using Rewards in Specific ways (shaping). © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Applied Behavior Analysis Continued
While uniquely adapted to each child, ABA is a highly structured, rigorous, systematic and consistent teaching Approach throughout all of the client’s environments which is organized around: 1. The Specific way a Request is made of the Child (antecedent) 2. The Child’s response to Requests (Target Behavior) 3. How Adults React to the Child’s Correct/Incorrect Responses (Consequence) © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

How to help children with ASD
The following interventions were designed specifically for helping children with Autism Spectrum Disorders © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Verbal Behavior (VB) What is Verbal Behavior?
Verbal Behavior is Programming Based on the Principles of Applied Behavior Analysis incorporating B.F. Skinner’s Analysis of Verbal Behavior ABA/VB in this context Addresses difficulties in the Development of Communication seen in most individuals with Autism and other related Disabilities, in part by emphasizing Functional language and tying it to Motivational Variables Verbal Behavior is Based on Language The Focus is teaching Verbal Behavior to children with Autism within a program of Applied Behavior Analysis (ABA). It is the study of functions of language over its forms, and numerous Verbal Operants, or units of language. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The VB Curriculum Based on B.F. Skinner’s book VERBAL BEHAVIOR (1957) which proposes that language is a behavior, which is influenced primarily through reinforcement, and on establishing and maintaining the motivation to learn. Emphasis is on teaching the function of language. Teaching procedures focus on transferring the child’s ability to respond across all functional categories. A “word” is not considered “learned” until it can be used across all functions. Intensive one-on-one therapy immerses the child in a “language-learning environment”. The Mariposa School 2006 © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

VB continued - Teaching Manding
What is Manding? The request of an Item, Event, Information or Removal of an Aversive; response is Specific to Motivative Operation The Request is made through Sign, PEC’s, or Verbalization Please note that our goal is to assist the child to become as verbal as possible and to reduce or eliminate the need for PEC’s Motivative operation- an event or stimulus that affects an individual by momentarily changing the reinforcing effectiveness of other events. Using what is highly reinforcing to get the child to ask for items. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Why Mand? Manding is what teaches the Client that Talking or Signing is Useful It helps Clients avoid Frustration in Communicating their needs and wants It is Relatively easy to do because you Are using the Clients own Motivation as a tool The Mand is usually the First Form of Verbal Behavior to be Acquired since it may produce Immediate and the Specific Reinforcement Requested © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Teaching how to Mand What do they want? Label the item give them the item Say the name of the item Try to have them repeat use sign, PECS, vocalization If the item is really reinforcing they will try to request for it again! © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

***Manding only works if the item is highly reinforcing
to the client *** How do we know what is Reinforcing? Through Motivative Operation How motivating is the item? Find out through direct Exploration with the child Reinforcer Inventory Differential Reinforcement- Reinforcement of one form of Behavior and Not another, or the Reinforcement of a Response under one condition, but Not Another. Differential reinforcement. Four strategies that involve reinforcement applied differentially to reduce undesired behaviors while increasing desired behaviors; see DRL, DRO, DRI, and DRA Differential reinforcement of alternate behavior (DRA). A procedure in which reinforcement is delivered for behaviors that are alternatives to the target behavior Differential reinforcement of incompatible behavior (DRI). Systematically reinforcing a response that is topographically incompatible with a behavior targeted for reduction Differential reinforcement of low rates of behavior (DRL). A procedure in which reinforcement is delivered when the number of responses in a specified period of time is less than or equal to a prescribed limit; encourages maintenance of a behavior at a predetermined rate lower than the baseline or naturally occurring rate Differential reinforcement of other behavior (DRO). A procedure in which reinforcement is delivered when the target behavior is not emitted for a specified period of time; behaviors other than the target behaviors are specifically reinforced Differential reinforcement of other behavior (DRO). A procedure in which reinforcement is delivered when the target behavior is not emitted for a specified period of time; also referred to as differential reinforcement of the omission of behavior Refer to examples on printout sheet problem behavior and DR techniques © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Natural Environment Training (NET)
Unstructured teaching that uses the learner’s motivation and not teacher selected set of materials as a basis for learning NET aides in the development of functional and generalized communication Occurs in the context of fun activities, use reinforcing items and materials that are of interest to the learner to teach skills, teaching motor imitation- ability to imitate or do what others do during play or other activities is an important skill to acquire © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Natural Environment Training
Characteristics of NET Learner initiated activities Tasks and activities vary frequently Preferred items /activities chosen by child Serves as basis for learner- teacher interaction © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Early Learner NET Put very few demands on the learner and pair yourself with reinforcers Have learners take reinforcers from you Gradually increase response requirement Begin errorless teaching of mands with full complement of prompts and then fade prompts Intersperse a few instructional demands for easy tasks to develop compliance Fill in the blank intraverbals with songs, nursery rhymes and other fun activities © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Intermediate Learner NET
Teach within the context of the activities which are reinforcing and motivating for the child Teach mands, simple tacts, receptive, and simple intraverbals Transfer across operants © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Advanced Learner NET Teach within the context of the reinforcing or motivational activities of the learner Complex VB modules that are conversations within non-verbal contexts Include answers to “WH ”questions (Intraverbals) as well as manding for information (asking “WH” questions) Have similar but less complex conversations in the intensive teaching settings Break them up into groups and have them practice with the objects given. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The DIR Model The DIR Model is : An integrated Understanding of Human Development A more Advanced intervention than Past Models that looked only at surface Behaviors and isolated Cognitive Skills © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The DIR Model continued
Three Areas of Insight: D- Functional Developmental Level Where is the child at in his/her Development? I- Individual Differences in Processing What is the Processing Profile of the child? *Auditory *Visual *Spatial *Sensory *Motor © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The DIR Model continued
R- Relationships What are Relationships Like? What is the interactive use of Affect in the family Now? What are the Ideal Patterns to Support enhanced Development? © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

What is Floor Time? Time set aside for Unstructured Play with Child ( Minutes) Spontaneous Play on the Floor led by child Encourages two-way interaction while Continuing to let Child Lead the Play Sessions should happen 6-8 times a day © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

What is the Purpose of Floor Time?
The Purpose of Floor Time is to Assist a Child in Climbing the Developmental Ladder and to Achieve the Six emotional milestones of Communication © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Six Emotional Milestones of Communication
1. Self Regulation, Shared Attention, and Interest in the World Take interest in the World and not Be Overwhelmed Shared Attention is the most important component 2. Intimacy Child Gains the Ability to engage with other 3. Two-way Communication Beginning of Communication Through non-verbal gestures to Create Dialog Opening and closing circles of Communication Increased affect © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

6 Emotional Milestones Cont.
4. Complex Communication Creating complex gestures Child now has a means of expressing needs Problem Solving Patterns( i.e. Child takes mom by hand, knocks on fridge and points to juice) 5. Emotional Ideas Formation of Ideas and Language acquisition begin Child puts stories together with toys Emotional Themes are Played out by the Child with a Momentarily desired Toy Begins to understand Symbols stand for things Imaginary play begins to take place 6. Emotional Thinking Building bridges Between ideas as a basis for Logical Thought Ideas are Linked together in a Logical Sequence of Play Symbolic level of Thinking © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

The Five Steps of Floor Time
Step 1: Observation Facial Expressions Tone of Voice Gestures Body Posture Verbal Ability Step 2: Approach Open Circles of Communication using Gestures Expand on Interests of the child Step 3: Follow the Child’s Lead Be a Supportive Play Partner Assist the child as he/she Leads Play © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Floor Time Continued Step 4: Extend and Expand Play Expand Themes of Play while Continuing to let the child Lead the Play Making Supportive Comments about the Play Ask Questions to Stimulate Creative thinking Step 5: Child Closes the Circle of Communication Adult opens the Circle of Communication Through a Gesture Child closes Circle of Communication by Building on that Gesture and in turn providing one of his/her own Again, break them into groups and have them practice play. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Documentation Documentation of BHR Service delivery must be: A thorough, accurate & complete record, in ink, of service delivery (with date and start & stop times) Contemporaneous (completed in written form within 24 hours after services were rendered) Legible, including the signature of the provider, with the provider’s Signed by the provider Signed by the parent, guardian or teacher who was responsible for the child while the provider delivered services Handed-in promptly after work has been performed © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Documenting the Client’s Behavior The Purpose of Documentation
To record the client’s target and replacement behavior throughout your shift To document any new behavior that might shift the focus of treatment To provide data that will determine if any changes are necessary with regards to the treatment plan that will increase your client’s chances for success To monitor the progress or lack thereof that your client has made throughout the authorization period For legal purposes © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Do’s and Don’t(s) of Documentation
Document on CRF in the Notes Section any Missed Hours with the Client and explain fully why the hours were not utilized. Turn in the CRF each Week, Whether or not you saw the client. Turn in your progress notes and CRF for the days that you did see the client Use AM and PM when Writing Time, write your degree. Have Parent, Caregiver or Teacher sign CRF and Progress Notes DAILY Establish with BSC how Tick Marks Should be Documented according to the Client’s Behavior and make sure Tick Marks on Page one of Progress Notes Match Page Two Ensure Interventions Match with Target Behavior Use Quotation Marks if you are Quoting someone else Document who else was with with your Client that Day Write in third person (“TSS used verbal praise when Johnny independently used replacement behavior”) DOCUMENT EVERYTHING The Network for Behavior Change (NBC) uses a “Contact Record Form” (CRF) to allow providers to make private comments about the billing process to the appropriate staff at NBC. Other providers do not use the CRF. NBC Progress Note forms are pre-printed with the title of the staff (BSC, TSS, MT) but this information must be included beside the provider’s signature on other providers’ forms. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Documentation of the Client’s Behavior
Do Not Do Not Write in Start and Stop Times if you did not Work with the Client Do Not Leave any blank Lines or Spaces Do Not Write your Opinions in your Notes Do Not Use “I” or “We” © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Discuss ticking of behaviors. Always be documenting through out the day -- not just at the end of your shift. Make sure you note all people that have worked with your client. Ex. BSC, OT, Speech, etc. Make sure your average distance from the client is recorded. If you are positioning yourself farther away from the client, you are “titrating” the intensity of your service delivery and the child will be less-dependent on you as a provider of support. This will be important when it comes time to renew the authorization for services. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Using A,B,C as a guide, write situations in which you encountered during the day. What happened before the behavior, what intervention was used to redirect the behavior, and how the child responded to the intervention. Tally all numbers at the end of the session. Be sure to circle the level of prompting you delivered during the session. If you are delivering less intense prompting over time, you are “titrating” the intensity of the service you are providing. This will be important when it comes time to renew the authorization for services. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

NBC has added this third page to the mandatory two-page TSS progress note to allow staff additional space to capture their service delivery “thoroughly, accurately and completely” to satisfy all relevant DPW and Medicaid regulations concerning documentation of service delivery. Other providers are welcome to adopt this practice. Write any information about how the day went. Write any problems you encountered or any observations. This is not a place for opinions. Discuss only what was observed and if comments were made by others or yourself, use quotations. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Other Interventions COLLAGE provides socialization groups and opportunities for clients to acquire new social skills. Devereux CARES offers training in the Picture Exchange Communication System (PECS). SibShops offers sibling assistance. © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Support for Teens and Young Adults with ASD
Adolescence (13 to 17 Years) Family and Community Issues Peer rejection, reducing social isolation New parental roles in education planning Transition planning in school for employment at the end of High School Emerging sexuality Estate/Trust planning (how to find responsible advisors from the legal community) © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Adolescence (13 to 17 Years) Educational Focus Academic achievement Vocational training Domestic skill acquisition Self-care skills in the home Expanding community awareness (the Communi-Teen program, for example) Improving reading & writing skills Social Skills with siblings and parents Expanding recreation opportunities © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Late Adolescence (17 to 21 Years) Family Issues Adjusting emotionally to having an adult son/daughter with special needs Developing advocacy skills for adults Financial and guardianship planning Residential issues © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Late Adolescence (17 to 21 Years) Educational Focus Vocational education and work support Domestic skills training for independence Self-care skills training for independence Expanding awareness of community Communication skill enhancement Social Skills enhancement Expanding recreation opportunities Functional reading, writing & math skills © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Hands-On Training SCENARIO You will be given a specific scenario Expectations: Utilize the specific interventions that you have been given. What intervention did you choose? Why did you choose that intervention? Detail your reasoning for utilizing that specific intervention. Use orange cards and create groups © 2007 The Institute for Behavior Change, Inc. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Therapeutic Staff Support In-Service Training

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