*Recommended Reading:

Discrete Trial Teaching
Pre-Requisite Skills to Group Instruction
"Learning to Learn" skills 


One of the most important components of quality instruction, in addition to accurate assessment, ongoing data collection, and an individualized system of reinforcement, is the understanding of how Pre-Requisite Skills impact learning and progress.

Think of any skill you are trying to teach like a ladder. For some clients, moving from rung 2 straight to rung 5 is fairly simple, and for others that is nearly impossible. What is a logical mastery progression for one client, could cause another client to derail any progress gains. Skill acquisition is an art, and requires some serious fine-tuning at times in order to ensure the client continues to progress.

What cannot be left out of this conversation is the pre-requisite skills to what you are working hard to teach. Or, what is underneath what you are teaching. Have you broken the skill down as far as you can? Are you sure?

Some examples:

Teaching playing with toys according to function --> How many toys can the client interact with for more than a few seconds?

Teaching motor imitation --> Does the client attend? If not, how will they see the action to imitate?

Teaching a listener responder instruction ("sit down") --> How many adult demands does the client currently follow/Who else in the client's life is requiring sitting behavior?

Teaching play behavior through coloring/drawing --> Does the client interact with crayons/markers ever? Do they have any idea what to do with a crayon?

Teaching a vocal manding repertoire --> How many sounds does the client currently make per hour, if any? 



When designing intervention it can be quite overwhelming to decide where to start first, what skills should be prioritized, and which deficits are impacting the client the most on a day-to-day basis. BUT, once you start to examine the underlying skill deficits that are causing many responding errors, it gets much easier to streamline/maximize therapy sessions by focusing on those pivotal areas of learning that will positively impact other areas. 

When progress on a particular program or target stalls, regresses, or is inconsistent, beyond modifying prompt levels, reinforcement, or changing the stimuli, along with the suggestions below, it's a good idea to also focus on the skill(s) underneath the skill you are teaching:


  • Examine the data closely, what kind of progress has the client made on the specific program/target over time?
  • Are all the programs demonstrating need for troubleshooting, or just one particular program?
  • Is it necessary to return to some previously mastered concepts? 
  • Is therapy happening frequently enough/is the program being taught frequently enough?
  • Is the teaching method consistent across the team?
  • Watch the client carefully during teaching trials to learn about the types of errors that are occurring (or if non-responsiveness is occurring)
  • (Super helpful tip) Observe a typically developing peer perform the specific target or skill. Compare that to how the client performs the target or skill. What's different/missing? 



Reference: (2005). A Model for Problem Solving in Discrete Trial Training for Children with Autism


Value1) the regard that something is held to deserve; the importance, worth, or usefulness of something.; 2) a person's principles or standards of behavior; one's judgment of what is important in life.

"Value" is currently a hot buzzword with employers/recruiters looking to fill ABA positions, and if you haven't been on an interview yet and heard the "We value our team" speech.... you will.

Employers will tell you how much they VALUE their team, value their employees, "couldn't do what they do without them", and value the contributions of the clinicians, but without observable action steps does this word actually mean anything?


I can't count how many times I've heard employers go on and on about how much they value their team/staff, and see the importance of each team member. Yet when talking with the staff, they are often overworked, underpaid, and frustrated. So it would seem there is a disconnect somewhere, or ABA companies would not have such high turnover rates.


What's going on here?


Let's look at both parts of the definition of Value, to shed some light on the problem:

1) The importance or usefulness of something: This is basically how the employer values YOU. Are you viewed as a unique individual, possessing specific talents and unique perspective, as someone who would benefit the company, and a much needed addition to the current team? No? Well then what kind of "value" is that? To quantify value, yes, we do need to touch on the financial aspect. As an ABA provider, are you being paid a reasonable wage based on average salaries in your area, your education, and your experience? Are you working somewhere where you can give feedback to management, have a say in how you perform your job, and receive the level of support you need to grow? If you are truly an important part of the team, what happens when you disagree with a decision from management? Is your viewpoint heard and respected, or dismissed? Worse yet, does management simply pacify you (pretend to hear your concerns), but no change actually happens?Employers far too often focus on their bottom line, without intentionally working to put together a team of highly-valued ABA clinicians who will approach their work with passion and excellence. I've been in this field for a long time, and trust me: passion will take a person much farther than just talent. 

2) A person's principles/standards of their own behavior: This is basically how YOU value you. Have you truly sat and considered all that you bring to the table as a RBT/BCaBA/BCBA? It's probably much more than you realize. No 2 clinicians are exactly the same, so even though you may have the same educational background and certification as every one else applying for the position, you possess a unique personality, perspective, and style, that would be hard to replicate. What is most important to you about a position? Do you value income the most? Or flexibility? Or not being micro-managed to death? Or working for ethical professionals? Or a family-like atmosphere? Or cool perks and paid vacations? What really matters to you? And here is the tough part---> Once you learn what your values are, don't toss them out the window just because an employer approaches you with a really good offer. You won't thrive in a position that cost you your values. To put this another way, if you apply for a company that seems FAR more interested in your certification than who you actually are as an individual: run. Do not walk, run from places like that.


*Resource:

Know what your core values are, and hold firm to them: Personal Values Assessment




*Recommended Posts:
ABA & Professionalism
ABA & Informed Consent


Dear Parents/Caregivers,

I'm talking to you, and only you, with this post.

There are specific expectations we have of the professionals we regularly interact with (doctors, teachers, attorneys) based on the professional and ethical standards of their field. Even if we don't know exactly what those standards are, most of us have a good idea of what SHOULD happen, and how we should be treated.

For example, most people expect their child's teacher to not belittle, or curse at their child.
Most people expect their doctor to protect their private medical information.
Most people expect a police officer to help you during an emergency.

If someone is presenting themselves as a professional, then they should act like a professional in their demeanor, words, and practice.

So let's talk about ABA providers specifically--

Did you know that the professional field of Behavior Analysis has specific ethical standards just like any other profession? If this is news to you, please peruse our ethical guidelines.

As a parent, you may be wondering how to evaluate the quality of the ABA provider you receive services from. I hear many, many variations of this question from parents all over the world: "How do I know if this company is any good or not??".

This handy resource may assist you with knowing what to look for.

But more important than a resource, is knowing for yourself what makes a quality Registered Behavior Technician, Board Certified-Assistant Behavior Analyst, or Board Certified-Behavior Analyst.
To help you with that, I've included a simple list below, and also a visual reminder. Print it. Tape it to your fridge. Share it with your friends. Call a meeting with your current ABA provider and review it together.


EZ ABA Ethical Guidelines:

Your ABA provider must work within the boundaries of their expertise. Unless they have access to resources/a supervisor who can train them on what they don't currently know, they should refer you to someone else if they don't know how to help you. Guidelines 1.02, 2.01

Your ABA provider should strive to be truthful and honest, and to avoid engaging in unethical or illegal actions. Guideline 1.04

Your ABA provider should communicate with you in an easy to understand manner, explaining any clinical terms simply, so that you fully understand what is happening in therapy. Guideline 1.05

Your ABA provider should not accept gifts from you, socialize with you outside of therapy sessions, babysit your children, attend your wedding anniversary party, or be considered a "friend". Guideline 1.06

Your ABA provider should explain your parent rights to you when services begin, and should also provide you with information about how to report them/file a complaint about them if you have any issue with the quality of their services. Guideline 2.05

Your ABA provider should strive to protect your confidentiality. Legally, there are specific circumstances under which we have to break confidentiality, and ethically, your ABA provider should tell you what those circumstances are. Guideline 2.06


Your ABA provider should keep accurate records about treatment, and use them to evaluate if treatment is effective, if the pros outweigh the cons, and if treatment should continue. As the parent, you also have the right to speak up if YOU think treatment is not effective/beneficial. Guidelines 2.09, 2.11

What you will pay for services, and when you will pay it, should be upfront and transparent when services begin. When you open the first invoice, there should not be an ugly shock. Guideline 2.12

ABA providers do not just abandon clients. If services need to discontinue, you should know why, be given a timeline of transition, and the provider should help connect you to another provider (as possible). Guideline 2.15

You should know your child's ABA goals. You should know the behavior strategies being used. You should know how your child is progressing. ALL of this should be simply explained to you, and you must agree with how treatment occurs. If you do not give consent, then it should not happen. Guidelines 3.01, 3.03, 3.04, 4.02, 4.04, 4.08

Your ABA program supervisor only takes on as much work as they can handle, and is responsible for training the direct care staff. The supervisor is also responsible for training you, and if needed, collaborating with your child's teacher, Speech Therapist, etc. Guidelines 5.01, 5.02, 5.06

ABA providers do not solicit clients through manipulative advertising, or glowing testimonials on their website. We also should not walk up to you in public and thrust a business card at you. All of that is unethical. Guidelines 8.05


I hope it helps you!

The I Love ABA Blog




It's just about that time again, for Hallmark Christmas movies, baking, and wrapping presents. 

Be safe and I'll see you in 2019!



*Recommended Reading: Selecting an ABA Employer




For individuals seeking to work as a RBT, BCaBA, or BCBA, part of the journey is to receive direct supervision, oversight, and/or training from a Board-Certified Behavior Analyst.

This supervision relationship can (at times) be challenging to find, and it can be even more challenging to find a good fit. Like anything else related to working in this field, Goodness-of-Fit should be prioritized over just meeting minimum requirements.

A low-quality supervision experience will not yield a clinician who is ready for the rigorous demands of succeeding in this field.
The decision to initiate a supervisee-supervisor relationship should be carefully evaluated, and must be approached similar to a job interview.
On a job interview, the applicant is not just looking to impress an employer. There is also a need to gather information about company culture, pay, benefits, evaluation of performance, company vision, etc.

Okay....so then why do so many of us treat the supervisee-supervisor relationship more casually than we would starting a new job??? The selection of an ABA Supervisor can have far-reaching implications on your effectiveness as a clinician one day, which if you ask me, is FAR more important than a simple job interview.

See below for some general guidelines to help you select a Mentor for the supervisee-supervisor experience. I hope they're helpful!

YES, this person should be a Mentor: I use the word Mentor intentionally, because the supervisee-supervisor relationship (ideally) should continue far after certification. Your first big interview post-BCBA certification, your 1st conference attendance or presentation, your 1st promotion or exciting leadership opportunity…all of these events should be discussed and shared with the ABA Supervisor. After all, this person has invested heavily in your future success, shouldn’t they care about how you do once you pass the exam?? It would be odd if they didn’t care.
Similar Career Aspirations & Goals: I get contacted on a regular basis by people seeking BCBA supervision, and I always ask about their future career aspirations. I primarily work in-homes, with children under the age of 5. If my supervisee wants to eventually work as an animal trainer, that is something I need to know about. Obviously, the science is the science. But beyond the science, it is important as a supervisor that I have the experience and expertise to be a valuable resource for my supervisee. Otherwise, a more well-matched supervisor would be a better choice.
Availability to Supervise: This point is critical for anyone receiving BCBA supervision through their current job. Just because you were matched with a supervisor does not mean that person actually has the availability to properly train and mentor you. If the only time you see or speak to your BCBA supervisor is during a therapy session twice a month àYikes. I am not saying to quit your job, but just know that you will very likely need to supplement the supervision you are receiving through work (hire an additional external supervisor), and probably at your own expense.
Suitable Experience Supervising: Yes, the BACB has added more guidelines to ensure that BCBA's who supervise others have the proper qualifications to do so. Which is great. However, it is still important as the supervisee to do your diligence and ask questions about your supervisor’s background and experience supervising. Again, this person will have a far-reaching impact on your career in this field. Wouldn’t you want to know how experienced they are as a supervisor in advance? Or what their supervision style is? Or what their expectations of you are? These are all critical questions to ask, right up front.
Approachable: Lastly, in my experiences even available, highly qualified, and similarly matched BCBA's, can have a cold, overly formal, or condescending demeanor that makes them seem highly unapproachable to supervisees. It’s sad, but it does happen. Just because someone has 30 years’ experience in the field, and has published tons of research, that does not automatically mean you will enjoy being a supervisee to that person. As a supervisee, you should feel comfortable asking your supervisor questions (which many of the RBT’s I talk to are terrified to ask their supervisor questions), stating your opinion, or asking for more help.  If you can’t depend on the supervisor to respond respectfully to your questions, suggestions, or complaints, then you may be working with the wrong supervisor.



* Resources:

'Recommended Practices for Individual Supervision of Aspiring Behavior Analysts'

For more information about obtaining the RBT credential, or  BCaBA/BCBA certification, see www.Bacb.com




Some of my BEST decisions were born in failure.
Let it motivate you, not devastate you.

*Recommended Post: Preventing Burnout (practitioner tips)


If you're an ABA peep working in this field and you haven't experienced burnout yet, it's likely that you will at some point in your career.


The way I see it, there are 2 main prevention strategies when it comes to professional burnout:

  1. Proactively prevent it at the employee/practitioner level
  2. Proactively prevent it at the business owner/employer level
Let's talk about option #2.


People who work in human service fields such as counseling/mental health, psychology, social work, in general often report high levels of stress, mental strain, and burnout, but there are also multiple factors outside of the direct control of the practitioner that can worsen this issue.

In my position, I regularly recruit, hire, and onboard new staff. I regularly observe that many of the new hires are seeking a position with quality supervisor/management support, clear channels of communication, and a liveable wage, which were all lacking in their previous positions.

I also regularly observe that multiple applicants come to me from a handful of agencies in my local area. I refer to this as places that are "bleeding staff". Meaning, their employees are quitting in droves
Ever wonder why some companies/agencies seem to have a revolving door when it comes to ABA staff? Glad you asked.


There could be pervasive, unresolved issues with:

  • Inconsistent hours which = inconsistent pay
  • Hard to reach or chronically unavailable supervisors
  • Lack of goodness-of-fit (company culture is lacking)
  • Insufficient program eligibility requirements (clients being accepted are not on board with treatment/abrasive to staff/highly resistant to change, etc.)
  • Lack of variety in your role/position or Lack of advancement opportunities beyond your position
  • Lack of proper training and/or low-quality training

For employers or agency owners, what can we do to ensure that we put systems in place to help prevent burnout from occurring, and also to quickly identify and address burnout that is already occurring?
PLENTY.

Focus on quality right from the start - Quality recruiting practices, quality training, quality onboarding. Ensure that people are properly prepared for their role, understand the demands of their position, and have been trained to competency to perform their role with excellence.

Leadership training yields professionals, not workers - When leadership training (accountability, initiative, critical thinking skills) is built in to the staff training process, what this produces is future leaders who will produce high-quality work. Leaders add value to organizations, versus just holding a position.

Create company policies and procedures of operation ... and actually enforce them - Speaking from experience, the only thing worse than working for an employer that lacks appropriate policies, is working for an employer that has policies but never enforces them. This may sound odd, but a lack of appropriate operating systems can hinder effective employee performance. For example, when the illness policy is not enforced, clients get sick. When clients get sick, employees get sick. When employees get sick, they cannot work. When employees cannot depend on reliable, consistent income, here comes job dissatisfaction and stress. 



To put it simply, the work that we do is far too important to approach it from a space of frustration or mental fatigue. We have to guard our own emotional well-being, as well as hold low-quality employers accountable for consistent business practices that contribute to lowered levels of job satisfaction. It's NOT okay.



* Professional Burnout Resources:






Recommended Post: Parent Resource: When you're waiting to access ABA


Inevitably (sorry, but it is somewhat inevitable), somewhere on your Autism treatment/therapy journey you will suddenly and unpleasantly find yourself wait listed.

A company or provider may explain that while they may accept your insurance, accept clients the age of your child, and serve the area you are located in, at the moment they are going to have to wait list you.

So why does waitlisting happen? And how should a parent/caregiver respond?


First, let's look at some reasons for being placed on the dreaded wait list:

  • If a provider is in the process of credentialing (securing relationships with funding sources), they may have to temporarily wait list clients until the set up process for billing is completed
  • If the provider/company is brand new, then there could be renovations to the physical location, staffing needs, or legal red tape on the part of the company that is causing a wait list
  • If a provider is expanding into serving new areas, there can often be a wait list for services because they would need a certain amount of clients in the new area to be able to hire staff
  • If a provider is going through significant unforeseen changes (e.g. a critical member of management abruptly quits), this will absolutely cause a temporary wait list situation for all new clients
  • If a provider is new to your particular funding source (i.e. a grant or waiver for therapy), you could be temporarily wait listed while they go through the process of securing funding, and completing any documentation the funding source may require

As you can see from the list, there are varied, and very understandable reasons why a provider may say, "We can help you, but just not right now". If a company does not have enough staff to cover your case, or is in the process of properly training or onboarding a new hire, then there will be a delay before you can access services. Being placed on a wait list is not always a bad thing, although it may feel like it is.

What many, many parents want to know is what they are supposed to be doing while on that wait list. For that and other common parent questions, please see below.


"Is there anything I can do to prevent being wait listed?" - To a degree, yes. Keep in mind that the service you are trying to access is probably in very high demand, with a a limited supply of clinicians/professionals. This is true for ABA therapy, Speech therapy, Occupational therapy, etc. Across the board, we need more qualified professionals serving Autistic populations. But, as a parent you can request parent/family training by a BCBA (this doesn't require RBT level staff), just to complete the Initial or Functional Behavioral Assessment, or ask if you can start as private pay to speed up the process. Depending on the reason for the wait list, any of these options may get things moving more quickly.

"How long will I be wait listed?" - This is the absolute wrong question to ask. I don't say that because there is something wrong with you asking. I say that because the reality is the answer will be a guess. The problem is, people drop off and get added to the wait list constantly. Add to that unforeseen challenges or road blocks, and that "2 month wait" someone promised you could easily stretch to several months long. Also asking "Well how many people are on the wait list?", is typically a question providers won't answer.

"Okay...then what should I ask instead?" - Instead of asking, try telling. Decide how long you will give this provider/company to be available to you, and inform them of your decision. For example, "Yes, please add us to the wait list but after 6 weeks we will be reaching out to other providers". This way you already have a plan B ready to go, but just in case a spot becomes available you still have plan A.

"What should I be doing with my child while we are stuck on this wait list?" - Something. Yes, that's intentionally vague. I couldn't possibly know what your child needs to do while you sit on a wait list, but I do know the absolute last thing they need to do: NOTHING. The worst mistake you can make is to be placed on a wait list, and then just go back to life as normal. Obviously, you are requesting therapy services because you need help. So still pursue ways to get help, while you are waiting for the professionals to step in. Especially with the technology options today, you could consult remotely with a BCBA, take online courses in ABA or behavior change, attend conferences to learn, join an Autism support group, etc. What you will be able to do while you are on the wait list is going to vary depending on your local area, and the resources available to you.

"How long should we remain on a wait list for treatment?" - And this is the #1 question I hear from parents/families. I don't have a specific answer for you, but instead I would emphasize the importance of treatment. Think of this way: If you arrived at a restaurant and were told there wouldn't be any tables available for 3 months, would you just sit in the waiting area and not eat for 3 months? No, right? Well, the treatment you are trying to access for your child is as critical as food and water. You do not have time to waste. If you have been idly sitting on a waiting list, not hearing from the provider, and not receiving any updates, it may be time to move on.





* Further Reading:



For a variety of reasons (some preference based, some due to circumstances) many parents today are choosing to homeschool their ASD child.

Thanks to technology, if you are a parent considering taking the often scary step into not just being Mom or Dad, but also Teacher, then there are websites, apps, and all sorts of tools that can help you. Which is great.

So is homeschooling all great, ALL the time? Hmmmm.....not really.
Just like any educator, every day will not be sunshine and roses. However there's a huge difference between an occasional rough day, and ending each homeschooling lesson sobbing at your kitchen table. Let's avoid that 2nd scenario, when at all possible.

Many of my clients are homeschooled by one or both parents, so I get an upfront view of the difficulties these parents have when it comes to teaching their own children.

This post isn't about answering the question "to homeschool, or not to homeschool", as that's a decision parents should make. But, I do hope to give some helpful tips for making the homeschool process a bit easier and less frustrating.


Moving from Amateur to Master

“Adapt” is now your favorite word
 If you have spent any amount of time inside a Special Education classroom, or speaking with a Special Education teacher, then you should know that Adaptation is the name of the game. Most purchasable curriculum does allow for  customization (some more than others), but if your child is not progressing well with the curriculum/can't keep up, or isn't understanding the material, the beauty of homeschooling is that you can adapt the material to fit the child. I know some parents who don't even teach certain skills/certain subjects because in the grand scheme of things it just isn't functional for their child. When I say "adapt", I mean the materials, the tests/quizzes, the textbooks, the lesson plans, EVERYTHING! What you are teaching should be functional for your child, and presented in a manner they find interesting, and clear to understand. If it isn't, then you have some adapting to do.
Reinforcement is key
 Life is about reinforcement. The quicker you accept that, the easier teaching will become. Using a combination of visual/auditory supports, and tangible rewards, embed frequent, powerful, doses of reinforcement into teaching. Ideally, you want your child to be a willing and compliant learner who enjoys learning, right? Well, the way to get there is by breaking tasks down (see the previous point) and wrapping up demands in a thick layer of reinforcement.
Knowledge is your strongest weapon
 Knowledge of subjects? Nope. I mean knowledge of your child. If you have a teaching background that's great, but many parents who choose to homeschool do not. But you definitely do have knowledge of your child :-) Use what you know about your child (temperament, motivation, personality, etc.) to design instruction. I know of a family where the mom created lesson plans focused around the movie "Zootopia", as that was a special interest for her daughter. So they used "Zootopia" to learn about history...math...science....etc. Use what you know about your own child to your advantage.
“Prompting” & “Teaching” are not synonymous
 See my Prompting post if you are unfamiliar with this word. Here is a common error I see many parents make when homeschooling: child responds incorrectly, parent delivers prompt, child responds incorrectly, parent delivers prompt...repeat 500 times. The problem with confusing a prompt with teaching, is "What is the child learning"?? A prompt is always intended to be lessened, or fully removed, so we can reach independence. If you stop prompting your child, and they suddenly have no idea what to do, then you have been over- prompting. Which will slow down the rate of acquisition (it will take longer for the child to learn).
Masters seek help when they need it!
 The most important tip is not to try and do everything on your own. Educators working for school systems know when to reach out for assistance, and so should educators working around their kitchen table. If your child has significant behavior issues, attention problems, or their academic performance is far below their age (a 7 year old working on Kindergarten level assignments) then you need some professional assistance to design intervention. Reach out to an educator, the support available through the homeschooling curriculum/website, or a qualified BCBA so they can help you learn the best ways to teach your child.




*Resources:

If you aren't already familiar with TPT (Teachers Pay Teachers) it's an awesome site full of resources made by and for educators

"The Value of Homeschooling"

"Homeschooling Your Child with Autism Spectrum Disorder"

*Recommended Reading: Therapy Intensity/How Much Therapy


Behavior analytic research as well as best practices for ABA treatment recommend robust/intensive treatment for the most significant results. Typically, "focused" treatment would require at least 15 hours a week of therapy, while more "comprehensive" treatment would require at least double that. 

There are many reasons why therapy hours could be low. Maybe the funding source only approved half of the service authorization (e.g. BCBA asked for 30 hours per week, the insurance company approved 12). Or sometimes the family isn't available for therapy very often, or the child has multiple other therapies and a full day at school.

Regardless of the reason, if treatment hours will be low does that mean its pointless to pursue ABA therapy at all?

No. It does not.

BUT, it does mean that the goals selected for treatment and the modality of treatment need to be super, super realistic and practical.

It's hard to know in advance how long it will take a client to progress through goals, or to reach mastery with a specific skill, but for the most part complex or multifaceted goals are going to take lots of repetition and time. So during intake, when I meet a family and they are discussing goals like toileting, language acquisition, severe problem behaviors, school refusal, etc., I explain very clearly that these goals will need a more comprehensive approach. ABA therapy every Tuesday for 2 hours, is not going to make much of a dent when it comes to comprehensive goals.
However, if the family is requesting help with more focused goals such as shoe tying, eating with utensils, or following instructions, then such comprehensive treatment may not be necessary.

So to parents: If your child has been receiving ABA services for some time with minimal progress, the problem could be that treatment is not intensive enough (doesn't occur at a high enough frequency).


Beyond keeping treatment goals highly realistic/practical, if a client receives minimal therapy hours I also recommend the following:

1. Intensive parent training: If the ABA professional is only going to see the client once a week, what is the best use of that time? Working directly with the child, or the parent? If the professional works with the parent, then outside of session time (and when services end) the parent is now equipped to teach their child, handle challenging behavior, and modify the home environment to help the child be successful. To me, it just makes the most sense to teach the parent as much as you can during the time you have together so they can keep the demand on when you leave.

2. Self-management/Coping skills: If appropriate for the client, teaching using more self-management strategies and less of an instructor-led format is very beneficial when therapy hours are low. I am a huge fan of implementing activity schedules/checklists/task analyses with clients, and showing them that they control their own reinforcement (not me). As long as they are doing what authority figures need them to, they will always be able to access what they want. Also, if behavioral issues are occurring and there is inadequate time for implementation of a comprehensive behavior plan then teaching replacement behaviors, or coping strategies, could be very helpful for the client. For example, when the client escalates and gets upset instead of the adults present reacting to that, the client can be taught how to independently de-escalate. 

3. Self-help/Adaptive functioning: Think of adaptive goals as those daily living skills that are non-optional. You either do them, or someone has to assist you/do them for you. Examples: getting dressed, feeding, toileting, cleaning up after yourself, etc. I have *sadly* had some clients with therapy hours far-r-r below what they actually needed. In situations like that, at a bare minimum I need to know from the family what day- to- day issues are causing the MOST difficulty in the household. Then we start to tackle those, being sure to take small bites of the problem rather than try to squeeze multiple goals into a 1 hour therapy session. For example, if the client fights the morning routine everyday before school and it's causing them to regularly be late to school, that is an awesome place to start. Just helping the parents tackle that one problem with clear strategies, visuals, and support, will make a huge impact in the day- to- day stress levels for the household. 


With low therapy hours, the focus should zoom in and get very practical and answer the question, "What can we do today, to make a difference in this family's life".


Resource: BACB Practice Guidelines for Applied Behavior Analysis
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