*This post is intended to be a guide to creating an ABA program book, also known as the skill book. The information in this post is not all-inclusive. The funding source and your employer may have their own requirements for what must be kept inside the program book.*
The program binder is an essential part of any ABA program, regardless of where therapy is conducted (home, at a center, inside a classroom). The programs tell you what skills to teach, and the programs are all compiled inside of the program book. The program book will remain a source of information, progress, goals, and data, throughout the duration of the therapeutic process. Many people may view or have regular access to the program book including all of the direct therapists, the Consultant, school staff, and the parents/family. Depending on the funding source, the information inside of the program book may be considered legal documents. For example, the data sheets could be used as evidence during an IEP due process, or submitted to insurance companies to receive reimbursement. It is important to keep the program book neat, organized, and accurate. As information becomes obsolete, it should be removed and securely stored elsewhere to keep the book neat and current. Old data sheets from 6 months ago shouldn’t be just jammed into the back of the program book.
The Consultant should be the only person removing programs or data from the program book after careful review, but sometimes the Consultant may share this responsibility with the Lead therapist or teacher. What’s important is that someone is in charge of the upkeep of the program book, and is reviewing the data regularly and closely. I have walked into some homes for consultation, and been handed huge, overflowing, program books and the reason why is usually because everybody helps to update and organize the program book. When its “everybody’s” job that usually means it’s “nobody’s” job. Everyone thinks someone else will clean it up, so one actually does.
For parents, it is important to store the program book (and all therapy materials) in a secure location, out of the reach of children. It wastes time and resources when a therapist arrives for a therapy session and finds that the children in the home have colored all over the data sheets, or spilled juice on the session notes.
Order of Program Book
- Sign In Sheet –The sign-in sheet is where anyone who will be running a session needs to record the time, date, and duration of the session. This could be the therapist team, or maybe Mom or Dad decide to do a Saturday morning session. Keeping a record of who worked with the child and when, is important for knowing how many hours of therapy the child is receiving. If the Consultant asks “How many hours of therapy did Lisa get last week”, can you answer that question? The sign-in sheet can also help to reveal concerning patterns, such as a line therapist who regularly leaves sessions 30 minutes early.
- Preference Assessment, ABLLS/ VB-MAPP Assessments/Behavior Checklists – During the intake process, an observation and assessment should have been completed. The results of this information should be kept in the program book to be easily accessible. Typically as the Consultant, I am the one to conduct the initial assessment and not the direct staff. However, the direct staff will be working with the child daily and the information contained in the assessment can be valuable to them. I also like putting the initial assessment and intake form inside the program book because it helps the direct staff know what the initial goals were, or why the parents sought treatment. This helps to remind all staff involved of the goals that are most important to the parents. The preference assessment is important to keep in the program book because it will tell the direct staff what is motivating to the child, what the child likes to touch, see, taste, etc.
- Current BIP, FBA, Protocols – The initial Behavior Plan or Functional Behavior Assessment should be kept in the program book, to be easily accessible. Any current protocols, should be kept in the book. The people who will be working with the child daily need to know what problem behaviors are being targeted, and what procedures to use. Everyone on the team needs to know how to handle (and collect data on) challenging behaviors.
- Data Sheets – The data sheets should be kept near the front of the book for easy access, and so they can be grabbed quickly at the start of the session. This could include trial by trial data sheets, Cold Probe data sheets, NET data sheets, behavior frequency data sheets, etc. Typically, the first therapist to work with the child at the start of the week should look over the program book and clean it up as necessary (print out more data sheets, replace pens, etc.)
- Manding/ NET Data Sheets – If Manding trials or NET sessions are being done, the data sheets should be stored inside of the program book. These sheets should be reviewed regularly by the Consultant, both to track progress and make programming changes as necessary.
- Graphs – If the data is being graphed either during sessions or after sessions, the graphs should be stored directly after the data sheets. Graphing helps to visually see progress and enables quick decision making. Downward trend graphs, or "flatline data" (that would look like 40%, 40%, 40%) need to be evaluated, so a determination can be made if the program needs to be changed or if teaching error is happening.
- Active Programs – The active, or current, programs are the meat of the program book. I typically will give a client more programs than they need, with most being active and some being put on “hold”. This way as the child begins mastering programs, the therapists can quickly move to a new program. The therapists should be keeping track of when a program begins, when it ends, and maintenance trial data. Sometimes the Consultant is the only one who can master or remove a program, and sometimes this task is shared with a Lead therapist or teacher. What is important is that anyone who is mastering out a program or choosing what to teach next is trained to do so. Selecting which programs to teach should not be an arbitrary process.
- Mastered Programs – As programs are mastered, or “closed out”, the active programs should be moved into the mastered programs section of the book. This way the therapists can easily go back and revisit old programs, as well as look and see what the child has recently mastered. The mastered programs are also necessary to fill out the ABLLS or VB-MAPP skill grid.
- Daily Session Notes – The direct staff should be taking session notes after each session, or however often the parents request. Daily session notes should include a brief summary of the child’s mood, behavior, and attending, as well as any particular areas of strength or deficit. It is important to use professional, objective language when writing session notes. Trust me when I say: you never know who will read the session notes. Avoid overly negative statements like, “He was so whiny today”. Focus on objective statements, and try to frame them positively. This is also where you can leave notes/suggestions for the next therapist, such as “Zoey may be getting a cold, appeared drowsy today and sneezed several times”.
- Supervision Notes – The Consultant should be writing supervision notes when they are on-site for supervision visits. This could include information about the programs, the data sheets, the staff schedule, etc. The Consultant should avoid using these notes to write specific comments or disparaging remarks about a therapist, such as “Carrie was 25 minutes late for the session today”. Again, try to use objective, positive language when writing notes, such as “Therapists: please be sure to arrive on time for sessions, and immediately notify the parents if you will be late”. When each therapist arrives for a therapy session they should review the daily notes from the last session, data sheets, and the supervision notes to see if any changes have been made to programs.
During the team meetings, the entire team should review the program book together looking over the data, programs, and session notes to discuss if any changes need to be made. Also, I suggest taking turns implementing programs and watching each therapist work 1:1 with the child. In a group setting, this can provide extremely valuable feedback and tips on how to improve. Team meetings are also a great time to get the parents involved and give them 1 or 2 programs to try with the child, so they can receive instant feedback from the professionals present. If you take notes during team meetings, those notes can also be stored inside of the program book for future review or as a record of what was discussed.