If just reading the words "The Report" gave you a migraine headache and some unpleasant stomach cramps, then sounds like you are already familiar with the report writing process ;-)

If you had no reaction, then let me introduce a part of the job description for a supervisor/BCBA: Report Writing.


In most scenarios, when you begin working with a new client there is an assessment process that concludes with writing up a formal report. Depending on the funder, this report needs to be updated at specific intervals, such as every 6 months.
The purpose of the report is to summarize the treatment plan, and justify the need for services (or with a progress report, to continue to justify the need for services).

For newly certified clinicians the learning curve of report writing can be quite steep (I know it was for me). The report may need to include specific sections such as: Client Demographic Information, Client Diagnosis, Current Medication, Current & Former Therapies, School Schedule, Assessment Results (complete with grids/graphs), Functional Behavior Assessment, Coordination of Care, Transition Planning, etc.

Having strong written communication skills helps, as does being adept at Case Conceptualization, and compiling the report from strong assessment results. If the assessment process was rushed, skimpy, or otherwise flawed, then don't expect to write a stunning report from that data. The data collected during the assessment process are the foundation for the report to come. Don't neglect to gather important information during Intake/Assessment, as this will cause problems down the road.

But first, a quick disclaimer: The clinical report is not a one-size-fits-all document. Your employer and/or the funding source will have specific requirements for how reports must be written. It's also important to consider the target audience: who is going to read the report? Reports are often written in very technical language that may be difficult for laypersons to understand, which means that someone needs to interpret the report to laypersons and review each section in detail. When in doubt, follow the report guidelines communicated to you by your employer, or the funding source.


So let's jump in to some very generalized tips to clinical report writing:

• I already mentioned above, but before even starting the report the assessment data are KEY. Having organized, accurate information (including any graphs or data sheets) at your fingertips will save SO much time when sitting down to write the report. Random pieces of paper scattered all over your desk? Not so much.
• Follow the template provided to you. Your employer should have given you a report template to use (which can often vary from one funder to the next). Following the template saves time, and decreases the chances you will have to make tons of edits later. If your employer embedded drop down menus into their template? Gold star for them. If you work for yourself, make a template. It saves time. 
• If possible (because this may not be your choice), use an electronic data management system for reports. An electronic system will store collected program data, and generate its own graphs, so when it comes time to update the initial report you will save SO much time by not having to enter all this information in yourself. Oh and by the way, the amount of time you can bill for report writing will be a drop in the bucket compared to how much time it takes you to write it. So saving time in this process will be suuuuuper important.
• Always, always, always, always --> read your completed report multiple times before submitting. Be on the lookout for spelling errors, referring to a graph and then forgetting to include the graph, weird formatting glitches, dropped words/missed words, correct client name, etc. Trust me when I say you don't want to hand off a completed report to a family, school, or supervisor, and have them notice a really simple error that you missed. It's embarrassing. 

A well written report presents a full snapshot of the client, and thoroughly lays out a plan of action (including the clinical reasoning for choosing the plan of action). Selected goals are developmentally appropriate for current abilities, behaviors targeted for reduction are identified and described, and any barriers to instruction/progress are clearly stated with a specific plan for how to overcome these barriers during the period of authorization for services.

*Resources:

Best Practices in Client Documentation

BACB Practice Guidelines

Papatola, K. J., & Lustig, S. L. (2016). Navigating a Managed Care Peer Review: Guidance for Clinicians Using Applied Behavior Analysis in the Treatment of Children on the Autism Spectrum. 

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Tameika Meadows, BCBA, Blog Author

If you are a clinic/business/agency owner, is it important to you that your team looks forward to coming in to work?

If not, then you have no idea the kind of harmful impact a miserable employee can have on their team members, on their superiors, and on the consumers being served.

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Tameika Meadows, BCBA, Blog Author

"How ABA can help a child be successful in a classroom setting"

Guest post written by: How To ABA

Many children start out their ABA journey with an intensive individualized ABA program.  This means that they can be receiving 20-40 hours a week of one-on-one ABA support with a skilled Instructor Therapist and oversight by a Behavior Analyst.  

I say this is a journey because it is not always the end goal for a child to have this level of support – both financially and educationally.  However, it doesn’t have to be all or nothing.  There is a misconception that ABA is all about the one-on-one model but in reality, ABA principles can do so much more to support a child in different settings and environments so that they are successful.

When children transition from 1:1 ABA into a classroom environment, the outcome can either be fantastic or disastrous.   With the right amount of thought and planning, using ABA principles can help a child transition to a classroom and away from needing 1:1 support.  

Here are some tips and strategies to keep it on the more fantastic side in the classroom:

Visual Schedules

If I was sent into work one day without my calendar and appointment book, I’d be lost!  I can be told what my meetings are and where I need to be but if it’s not written down, I’m likely to forget.  This is similar for our students in the classroom.  Visual schedules make the words more meaningful and permanent.  I’ve heard so many times from teachers, “But he knows what to do!” and that may or may not be true.  But why are we expecting more of our students then we would want for ourselves? We can make it easier on our students by having the visuals available for them and this also makes the prompting less intrusive.  Instead of needing to verbally remind them, we can direct them back to their schedule and thus removing the need for constant reminders.  

Tip: A visual schedule is something that can always be available to a student in an age appropriate way.  While a younger student can use pictures, an older student can be following a text-based to-do list.

Classroom Setup

In ABA we’re all about the interactions between the environment and behavior.  So wouldn’t it make sense to set up the environment for the behavior we want to see?  In a classroom, this means using the physical space to set your students up for success.  You can use dividers to block off areas that become distracting.  You can create an area in the classroom that is used for calming down and regulation.  Strategic planning can be as simple as making sure that your student’s materials are easily accessible to minimize traveling around the room (which can result in unwanted behaviors).  Is the student having difficulty transitioning from circle time back to his desk? Put his desk as close as possible to where circle time occurs.  Does the student need frequent breaks? Put his desk near the door so it can be less disruptive. 

Reinforcement Systems:

Reinforcement is a proactive way to set our students up for success.  Instead of waiting for the problem behavior to occur, we want to set up ways for the student to access all the good stuff by showing the appropriate behaviors.  Don’t wait!  The first thing to do is to make sure that the behavior expectations in the classroom are clear.  Review rules like, “Keep your hands to yourself” and “Use an indoor voice” so that student understands what they mean.  Then, reinforce, reinforce, reinforce.  If you want the rules to be followed, there has to be something in it for the student to follow them!  Reinforcement can be immediate (e.g.: getting a favorite toy every time they show the desired behavior) or delayed (e.g.: collecting points toward a treat at the end of the day). If your student is new to the classroom environment, you can tweak the system to be individualized for that student’s goals.  If your student is working on “greetings” then have a reinforcement system in the classroom that rewards appropriate greetings with adults and peers.  The more we reinforce a skill, the more we’ll see it and then we can build on it in the classroom. 

Tip: Sometimes reinforcement systems take some time and some tweaks to find what works.  Don’t give up!  Keep trying until you find the right combination of time, effort, and reward for that student.

Peer Leaders:

Using other students as leaders is another great strategy.  If your student is going into a classroom with peers who are at a higher level, you can choose one of those peers to act as the peer model or leader. Give that peer jobs such as holding all the crayons and waiting for your student to ask for one.  If the teacher gives an instruction and your student hasn’t followed it yet, have the peer go and get that student instead of you.  Pair up your student with an appropriate peer model for structured lessons such as turn-taking or group work.

Tip: Reinforcement can be for everyone! Did the peer do a really great job waiting for your kiddo to say hi? Offer a small sticker or reward to both!

Priming

Priming is another great ABA strategy that can be applied in a classroom.  If you know that your student struggles with a certain subject, ask for the materials beforehand so that you can pre-teach or prime some of the content.  That way, when the teacher teaches the content during class, it makes it easier for the student to pay attention and follow the instructions in a group.  You can also use this strategy for a difficult time of day, like gym or recess.  Prime your student before going into the gym with what the rules are in the gym.  Remind your student about the behavior expectations and what’s in it for him to follow the rules.  Some role-play and modeling might also be helpful in acting out the specific scenarios before they happen.

Is it Working?

How do you know if any of these systems are working? DATA!  Keep ongoing data on the behaviors you want to increase and the behaviors you want to decrease.  Is the child having LESS tantrums when transitioning inside form recess?  Is the child becoming MORE independent with self-help skills?  Is the child able to request for what she wants MORE often?  Watching for the trends in these behaviors will let you know if what you’re doing is working or if something needs to be changed.  As the child becomes more successful and more independent, slowly fade the amount of support and prompting they are receiving in the classroom. 

Guest Post Authors: 

We’re Shira and Shayna and we started How to ABA as a way to share and collaborate with other ABA professionals.  We know how overwhelming and lonely it can be in this field, especially when first starting out.  We’ve taken our resources and materials that we’ve collecting over many years of ABA practice and we’re sharing them all in one place! How to ABA and The Bx Resource offers programs, downloads, community, support, and CEU’s  - so you can help your clients and save more time!  With our combined strengths of teaching, program development, and finding the practical application of ABA to real-life situations, we love helping other professionals help their clients and feel supported along their journey!

You can find us at www.howtoaba.com.

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Tameika Meadows, BCBA, Blog Author