Skill Building Program
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Apr 3, 2024
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Clinical Project 2: Assessment and Intervention Plan Western University
Introduction This assessment and intervention plan focuses on a 5-year-old girl who was diagnosed with ASD at the age of 3. This client has been observed to engage in stereotypy behaviour such as scripting and self-stimulation. The client was referred to ABA services two years ago to increase receptive and expressive language, daily living skills, social skills, and communication. The client’s skill repertoire has been assessed at three different time periods over the last two years, using the Verbal Behaviour Milestones Assessment and Placement Program (VB-MAPP). As per assessment results, the client has well-developed play skills, receptive skills, and continues to work on expanding their expressive and communication skills. The client currently attends 1:1 sessions within a clinical ABA setting for 9 hours a week. Over the past 2 months, it has been observed by staff members that the client’s speed and accuracy of responding has decreased while tacting maintenance targets at the table. This assessment and intervention plan has been developed to further investigate the client’s rate of responding. The ethical codes involved in conducting this assessment and intervention plan were: 2.01 Providing Effective Treatment, 2.03 Protecting Confidential Information, 2.11 Obtaining Informed Consent, 2.13 Selecting, Designing, and Implementing Assessments, 2.14, Selecting, Designing, and Implementing Behavior-Change Interventions, 2.16 Describing Behavior-Change Interventions Before Implementation, and 2.17 Collecting and Using Data, (Behavior Analyst Certification Board, 2020). Code 2.11 was the first requirement that needed to be met, as consent for participation from the client’s caregivers was required. The signed consent forms were submitted to the Clinical Supervisor for documentation and storage. Throughout the intervention and assessment plan, confidentiality was maintained as described in code 2.03, by refraining from using any identifying or confidential information in the report. Code 2.01 was involved by focusing
on a meaningful skill for the client and by only suggesting assessments and intervention strategies that are based on evidence-based literature. Looking at codes 2.13 and 2.14, the writer and Clinical Supervisor met to discuss appropriate methods of assessment and possible intervention strategies that focused on ABA principles and best fit the target behaviour to maximize benefits to the client. Then, prior to implementing the assessment or intervention plan, the writer was required to describe in writing the details of the plan following the guidelines of code 2.16. Lastly, code 2.17 was included by collecting and graphing data on the target behavior using the selected measurement system, and by analyzing baseline and assessment results to determine next steps within the intervention plan. To determine the social significance of the target behaviour, the social significance tool suggested by Cooper et al. (2021) was modified (see Appendix A). This tool was modified to incorporate relevant factors that may influence the social significance of the target behaviour. The results of the social significance tool show that the client can experience increased interaction with family members, access to reinforcement in their natural environment, and opportunities to generalize and maintain the skill after treatment is complete. This skill has also been deemed age appropriate and is a pre-requisite skill that is required in order to continue working towards caregiver goals. The results also indicate that the current behaviour has interfered with the client’s progress in service, as their responding is not consistent and therefore progression through skills is slow. Baseline The behavioural objective is to increase the clients rate of responding. Responding is defined as an independent vocalization emitted by the learner in response to an instruction within 10 seconds of the demand. The frequency of correct responses was recorded across maintenance
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targets from a tacting items program to calculate the percentage of correct opportunities. Baseline data collection with maintenance targets was selected because a decrease in responding was observed with these targets in recent sessions. Recording the frequency of correct responses was selected as the most suitable measurement system for this skill because the behaviour of responding is observable, discrete, countable, and the behaviour can only occur when the learner is provided with an opportunity to respond (Leblanc et al., 2016). Leblanc et al. (2016) suggest frequency data is most beneficial with behaviours that have a clear beginning and end, and that do not occur at a high frequency so that the observer is able to accurately collect the data. In this case, responding does have a clear beginning and end, and the observer should be able to achieve accurate data collection as they record the total number of correct responses only when they present opportunities to the learner. Some limitations to frequency data include more room for error because the observer must constantly record responses as they occur, and that the data does not provide any information surrounding the latency of responses. Baseline data was collected during the maintenance phase of a tacting items program for 15 items, across 5 treatment days (see Figure 1). All trials were run with the client using discrete trial training (DTT) while seated at the table in their treatment room, however no error correction procedures were delivered if an incorrect response was observed. The client was expected to tact each item independently and did not receive reinforcement for a correct response. The baseline data shows the frequency of correct responses produced by the learner when presented with the target item and asked, “what is it?”. The results of the baseline show variable percentages of correct responses across each session, with a slight increasing trend in the last 2 sessions. However, the level of correct responses is low, and falls well below the mastery criteria for the program of 80%. It should also be noted that many of the incorrect responses that were recorded, were due to the
learner failing to respond. The baseline data indicates that the learner is no longer responding at the program mastery criteria of 80% or higher, across all sessions and their rate of responding has decreased in the maintenance phase. Figure 1 Percentage of Correct Responses to Label Items Note. The percentage of correct client responses when presented with the instruction to label various maintenance target items. Assessment Plan A staff interview was completed with one of the client’s therapists to collect information regarding the clients responding during sessions (see Appendix B). The interview was delivered by the writer in a private room, where the therapist had the opportunity to provide their written answer to each question. The interview resulted in staff sharing that they have noticed a lower frequency of responding while targeting the tacting items program, and higher rates of no responses have also been observed despite using strategies to gain the client’s attention. The staff also reported that they believe the learner responds better while targets are run using natural Labeling Items Baseline 100 90 80 70 60 50 40 30 20 10 Session Percentage of Correct Responses
environment teaching (NET), compared to DTT at the table. Conclusions that can be drawn from the staff interview are that the client has a lower frequency of responding to expressive tasks such as the tacting item program and responding has been particularly low during the maintenance phase of this program. It has been reported that a variety of general attending strategies have been tested with the client, but there is no consistent strategy that works to increase their responding. A direct assessment in the form of a forced choice preference assessment was also conducted, to assess the learner’s preferred edible items (see Appendix C). The preference assessment was completed with the client by the writer. The writer presented two edible items at a time and instructed the client to choose one. The chosen item was provided to the learner and indicated on the data sheet. This was repeated for all combinations. The results of the preference assessment show goldfish crackers as the most highly preferred item, as they were selected three times. Smarties were selected two times, ranking as the second highest preferred item, marshmallows were selected one time, ranking as the third highest preferred item, and the animal crackers were not selected by the learner, ranking as the least preferred edible from the available options. Next, an alternating treatment design was developed to compare four different conditions in which the method of stimuli presentation was manipulated. The main methods of teaching used at this ABA centre are DTT and NET, therefore a comparison between the two were important to see if one method resulted in higher rates of responding than the other. Parenteau (2011) discussed the opportunity to explore stimuli presentation through methods other than a typical DTT presentation. This raised the idea of comparing the presentation of targets on a computer screen and on an upright scan-board. Therefore, the alternating treatment design compared four conditions: DTT presentation, scan-board presentation, laptop presentation, and NET presentation. The alternating treatment design was selected because the presentation methods could be
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manipulated to see which one resulted in the highest frequency of correct responses, pointing to the most effect teaching method for this client (Cooper, et al., 2021). This experimental analysis was conducted throughout various rooms in the treatment centre and focused on maintenance targets from the tacting items program. This program was selected due to the results of the indirect assessment and baseline phase. Although the client’s responding was reported as variable depending on the day, the client had at one point demonstrated that they knew the name of the maintenance targets because they had been previously mastered. As the baseline results show a decrease in accurate responding, the experimental analysis aimed to further investigate this relationship to see how responding could be manipulated depending on the condition. The DTT condition was run at the table in the treatment room, the scan-board condition was run at the table but targets were presented on an upright scan-board, the laptop condition was also run at the table using pictures of target items presented on the computer screen, and the NET condition was run in the play-room where the learner had free access to different toys. The materials required for the experimental analysis were selected target items, a laptop with pictures of target items, a scan- board, various toys and reinforcers, a choice board with preferred items, and a first-then visual. The results from the experimental analysis are presented in Figure 2 and display variable outcomes from conditions. The DTT condition resulted in a low level of correct responses, with significant changes in level of correct responses each day resulting in variable data. For the first four sessions, responding increased, but then decreased in the final two sessions. The scan-board condition resulted in highly variable responding, as the level of correct responses fluctuated between low to high each session and no trend could be observed in the data. The laptop condition resulted in a low to moderate level of correct responses, with a decreasing trend in responding for the last four sessions. As a result, the data can be described as variable within the laptop condition.
The NET condition resulted in the most consistent level of responding with a moderate level of correct responses. It is also noted that limited variability in the NET condition is observed, resulting in a stable trend across sessions. The results from the experimental analysis indicate that the learners responding is the most stable and consistent within the NET condition. This condition also had the highest average of correct responses at 58%, deeming this condition as the most successful. Figure 2 Percentage of Correct Responses when Measuring Client Responding Intervention Plan Using the results of the experimental analysis, the tacting item program will be targeted within NET with the goal of increasing client responding. Responding is defined as a correct independent vocalization emitted by the learner in response to the instruction within 3 seconds of the demand. The client will achieve 90% accuracy across three sessions, in at least two NET locations, with two different therapists to move to the next step of the program.
Antecedent Strategies Antecedent strategies that will be used to help increase the likelihood of responding are preference assessments and choice boards. A forced choice preference assessment will be completed daily to assess the client's preferred edibles, which will be used to reinforce the learner when they correctly engage in the target behaviour. The forced choice preference assessment will be implemented at the beginning of every session, following the same method as discussed within the assessment plan section. Miltenberger (2015) discussed the importance of providing choices as they increase the reinforcing value and probability that the learner will complete the task. Therefore, a choice board of available edible items will be provided to the learner upon entering a NET location, so they can choose which edible they will be working for. A choice board will also be provided to the learner to display available locations where NET sessions can occur (e.g., activity room, play room, gym, playground), which they will have the opportunity to choose from every 15 minutes during the session. Choice boards will be available within each NET location to display all available toys and activities within that location. These visuals will prompt the learner to choose a reinforcing edible, location, and appropriate toy or activity to engage in while in the location, to help maintain client motivation to engage in the target response. Behaviour Teaching Strategies The tacting item program will be targeted through NET, as the client freely engages in activities and with toys. This program will use a shaping procedure to decrease the amount of time it takes for the learner to provide a correct response to the instruction. Cooper et al. (2021) explain that shaping can be successful in changing a target response through the differential reinforcement of successive approximations, that work towards the final skill. The first step of the program will include presenting the target item and instruction “what is it” to the learner while in NET. The
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therapist will provide a 10 second delay, if no response is emitted by the learner, they will then provide a full verbal prompt to tact the item. The learner is required to tact each target item within 10 seconds with 90% accuracy, across three sessions, in at least two different NET locations, and with two different therapists. The next step of the program will include presenting the target item and instruction, the same as previous step, to the learner while in NET. The therapist will provide an 8 second delay, if no response is emitted by the learner, they will then provide a full verbal prompt to tact the item. The learner is required to tact each target item within 8 seconds with 90% accuracy, across three sessions, in at least two different NET locations, and with two different therapists. The third step includes presenting the target item and instruction in the same way as previous steps. The therapist will provide a 5 second delay, if no response is emitted by the learner, they will then provide a full verbal prompt to tact the item. The learner is required to tact each target item within 5 seconds with 90% accuracy, across three sessions, in at least two different NET locations, and with two different therapists. The final step of the program involves presenting the target item and instruction, as done with previous steps. The learner must independently tact the target item within 3 seconds 90% accuracy, across three sessions, in at least two different NET locations, and with two different therapists. After the last step of the program has been mastered, the skill will be maintained every session for 12 weeks, where the learner must maintain 90% accuracy across the entire week. Consequence Strategies Consequence strategies that will be used to strengthen the client’s responding are edible reinforcement, descriptive praise, and error corrections. After each correct response, during any step of the program, the therapist will reinforce the learner with a highly preferred edible item, as determined by the daily preference assessment, and
descriptive social praise on an FR1 schedule. It will be beneficial to provide modulated reinforcement to the learner to provide a larger piece of edible and more excited social praise when they provide a faster correct response. This will help to build the contingency with the learner that they are being reinforced for a quick, correct response. If the client errors and does not respond to the instruction within the time frame designated in the step, a 2-step error correction will be used to prompt the response as a consequence strategy. The therapist will represent the item along with the instruction and provide a full verbal prompt to the learner, to elicit the correct response and provide neutral social praise. During the 12-week maintenance phase, the schedule of reinforcement will be faded. The first week of maintenance, the client will receive reinforcement on a VR2 schedule, the following week they will receive reinforcement on a VR3 schedule, and during the third week it will be faded to a VR4, which will remain the same for the duration of the maintenance phase.
References Behavior Analyst Certification Board. (2020). Ethics code for behavior analysts. https://www.bacb.com/wp-content/uploads/2022/01/Ethics-Code-for-Behavior Analysts-230119-a.pdf Cooper, J. O., Heron, T. E., Heward, W. L. (2021). Applied behavior analysis (3rd ed.). Pearson Education. LeBlanc, L. A., Raetz, P. B., Sellers, T. P., & Carr, J. E. (2016). A proposed model for selecting measurement procedures for the assessment and treatment of problem behavior. Behavior Analysis Practice, 9
, 77-83. Miltenberger, R. G. (2015). Behavior modification: Principles and procedures. (6
th
ed.). Cengage Learning. Parenteau, R. E. (2011). Comparing the acquisition rates of stimulus presentation in discrete trials: Table-top vs. scan-board (1497745) [Master’s thesis, Northeastern University]. ProQuest Dissertations Publishing.
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Appendix A Evaluating Social Significance of Target Behaviour Date: February 27, 2023 Person Completing Worksheet: ZT Relationship to Client: Therapist Target Behaviour: Responding Considerations Assessment Rationale/Comments Will changing this behaviour increase the client’s interaction and engagement with family members and others in their environment? Yes No Not sure Create more opportunities for exchange of communication with people. Is this behaviour a necessary prerequisite skill for more complex and functional skills? Yes No Not sure Necessary for teaching any skill to the client. Will changing this behaviour work towards client/caregiver goals? Yes No Not sure Communication and expressive language are big caregiver goals, client responding must be increased. Is the current behaviour interfering with the client’s progress in service? Yes No Not sure Client’s progress is slow because responding varies daily and we do not see consistent correct answers. Is this behaviour likely to produce reinforcement in the client’s natural environment after intervention ends? Yes No Not sure Promotes further engagement with people and other items in environment. Are there opportunities for the client to generalize and maintain this skill over time after the intervention? Yes No Not sure Client will learn to use this skill with variety of people in the natural environment, and will continue this after intervention.
Is this an age-appropriate behaviour? Yes No Not sure Responding within 5 seconds is appropriate. Note. Tool for evaluating the social significance of target behaviour. Appendix B Staff Interview Date: March 1, 2023 Interviewer: DG Staff Interviewed: ZT 1)
What are the learners' most preferred items? Edibles (smarties, goldfish crackers, marshmallows), iPad, kinetic sand, dolls, play food set, car ramp set. 2)
What type of programming does the learner have? Receptive identification of items, selecting adjectives, visual performance, labeling items, self- help skills. 3)
Does the learner respond more frequently while running certain programs? Yes, I find the learner responds more consistently while completing receptive programs such as visual performance skills, selecting items, and adjectives. While running labeling programs, the learner often does not respond and appears to not be paying attention while at the table. 4)
Does the learner respond more frequently during DTT or NET? I think the learner responds better in NET, but it also depends on the day. 5)
Does the learner respond more frequently during acquisition or maintenance targets? I believe the learner responds more frequently during acquisition targets. 6)
What are some strategies you’ve used in the past to gain the learners attention?
Sweeping items in front of the learner, displaying an attending card, and instructing them to “look” at items, allowing the learner to touch or hold the item as I give the instruction, playing an iPad video to gain attention and then instructing. Appendix C Forced Choice Preference Assessment Date: March 6, 2023 Therapist: DG Item Number of Times Selected Rank A) Goldfish cracker 3 1 B) Smartie 2 2 C) Animal cracker 0 4 D) Marshmallow 1 3 Present items in order presented, circle the chosen item: A or B C
or A D
or A B
or C D or B C
or D
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