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2A.ANTECEDENT STRATEGIES

SCHEDULES

Description: A schedule will specify the tasks for (part of) the day or activity and will be publically posted in the living area

Implementation: The client will be reminded, possibly through rules, to verify the activities on the schedule, thereby learning how to follow necessary steps during daily or activity routines. A token economy may be used conjointly with the schedule

BEHAVIORAL CONTRACTING

Description: Behavioral contracting will be utilized to facilitate structured reinforcement, contingent upon various behaviors, over a long period of time. A contract must clearly pinpoint the behavior, must be positive, and must use generalized reinforcers. Sometimes visual schedules or behavior rehearsal may be used. A behavioral contract may allow the client to take an active role in selecting the reinforcers and criteria necessary to receive them.

Implementation: The client will create the behavioral contract, perhaps with the support of the parent/guardian. It is important that the parent/guardian and/or Direct Interventionist reinforce the client’s follow-through with the behavioral contract, especially if the client has selected to receive a reward contingent on certain target behaviors. Friends and extended family members should be encouraged to support the client’s commitment to the behavioral contract.

NON-CONTINGENT REINFORCEMENT

Description: Reinforcement will be provided, not related to the client’s behavior. Hereby the client is receiving attention regularly

Implementation: The client will be reinforced by the parent. This can be done on a fixed or variable interval. The client may become satiated with the reinforcement, hereby decreasing the possibility to use a tantrum or other challenging behaviors to request attention.

2B. CONSEQUENT STRATEGIES

DIFFERENTIAL REINFORCEMENT

Description: Differential reinforcement will be used to increase desired behaviors and decrease undesired behaviors. It consists of two basic operations: reinforcing a target behavior (replacement/desired behavior) and stopping the delivery of reinforcement contingent on a challenging behavior.

The different types of differential reinforcement include:
Differential Reinforcement of Alternative Behaviors (DRA): A reinforcement procedure usually designed to reduce a challenging behavior by increasing alternative behavior while withholding reinforcement for the unwanted response (e.g., a client who usually plays with food while the rest of the family is still eating is instructed to bring the plate to the kitchen or to get dessert)

Differential Reinforcement of Other Behaviors (DRO): Reinforcement is delivered when the inappropriate behavior is not exhibited during a designated time period (e.g., if the targeted behavior is interrupting, the therapist will provide reinforcement if the client waits to speak, even if other inappropriate behaviors are occurring)
Differential Reinforcement of Incompatible Behaviors (DRI): Reinforcement is delivered following a behavior that is incompatible with (cannot be performed at the same time as) the targeted inappropriate behavior (e.g., to reduce flapping hands, instruct the client to hold a preferred item in both hands and engage in an activity).

Implementation: The parent/guardian and Direct Interventionist will use differential reinforcement. During a board game, for example, the parent/guardian or Direct Interventionist may use social praise to increase the client’s social play skills. If tangibles are being used as reinforcers, they need to be prepared before the activity starts.

THINNING OF REINFORCEMENT

Description: Thinning is be used for the purpose of maintenance. The schedule of reinforcement will become more intermittent once the client meets criteria specified for the target behaviors. This consequence strategy is an important tool in contingency management and token economy systems

Implementation: The parent/guardian or Direct Interventionist may use this strategy. When the parent/guardian or Direct Interventionist observes that the client is making progress in the target skill area, he or she will systematically increase the ratio or interval schedule of reinforcement.

TOKEN ECONOMY

Description: A token economy will be used to increase wanted behaviors. A client will receive tokens when he/she displays desired behaviors and/or does not engage in inappropriate behaviors. The tokens can then be exchanged for a variety of reinforcers, depending on the client’s preferences. The number of tokens that are given to the client will gradually be reduced and then eliminated, as natural reinforcers for engaging in the target behaviors become strengthened

Implementation: A token economy is usually implemented by the parent/guardian or Direct Interventionist, or can be used as a self-management tool by the adult client. For example, a chart can be created showing the days of the week, the target behaviors, and the type of reinforcers to be earned. The client can self-monitor his/her own behavior and take part in selecting and delivering his/her own reinforcers and rewards.

2C. TEACHING STRATEGIES

VIDEO MODELING (VM) AND VIDEO SELF-MODELING (VSM)

Description: VM and VSM can teach long chains of behavior. Taped sequences of behaviors, such as bathing or toileting, are shown on the video. In VSM, the client observes him or herself performing a behavior successfully on video, and then imitates the targeted behavior

Implementation: The Direct Interventionist and the parent/guardian/client decide what chain of a behavior will be videotaped. Often, VM and VSM are used for teaching self-help skills or independent living skills while a task analysis is being followed. It is preferable if the client him/herself can be shown on the video while completing the steps in the process. While the client is watching the video, the parent/guardian will label the steps in the process and ask the client questions. When the client performs the steps in the process, the parent/caregiver or Direct Interventionist will provide feedback.

VERBAL BEHAVIOR TRAINING

Description: Errorless learning procedures are employed to lower levels of frustration, to facilitate mastery and to maintain high rates of reinforcement. During direct instruction, tasks are mixed and varied. This approach maintains a learner motivation and facilitates generalization. Material presented at an instructional level, with 70%-80% of the material known and 20%-30% of the material unknown. This facilitates acquisition. Much effort is devoted to teaching in the natural environment. Skinner points out the following verbal relations: mand, tact, echoic (and imitation), intraverbal, textual, transcriptive, and copying a text.

Implementation: For client’s with limited or no speech, mand training can be the focus at first. The Direct Interventionist creates natural situations in where the client is motivated to ask for something. For example, if the client is thirsty after eating salty chips, the client may want juice or water. The Direct Interventionist can place the water out of reach, and will prompt the client to say or sign for ‘water’. The Direct Interventionist will prompt and reinforce, so the client can receive the water immediately after the response.

For quick learners, the Direct interventionist can teach the client both manding and tacting simultaneously.

PROMPTING

Description: The purpose of using a prompt is to cue the client to engage in the target behavior. This creates an opportunity for the behavior to be reinforced, which increases the future likelihood of that behavior in similar situations. The ultimate goal is for the client to perform the behavior independently, without prompts. Prompts are provided prior to the desired behavior. They are often categorized in a prompt hierarchy from most to least intrusive.
There are several types of prompts:
Verbal prompts: Using a vocalization to indicate the desired response
Visual prompts: Using a visual cue or picture
Gestural prompts: Using a physical gesture
Positional prompts: Placing the target item closer to the individual
Physical prompts: Physically guiding the individual to produce the desired response. There are many degrees of physical prompts. The most intrusive level is hand-over-hand prompting, and the least intrusive level is a slight tap to initiate movement.

Implementation: The parent/guardian or Direct Interventionist will choose the least intrusive prompt and use this prompt to cue the target behavior. It is important that the client responds to the prompt and that the prompt occasions the target behavior. When the client shows progress, the Direct Interventionist will use less intrusive prompts, and eventually, fade the prompts. A client may also arrange environmental cues to prompt behavior, for example visuals (e.g., flashcards or an electronic device).

PROMPT FADING

Description and Implementation: There are different options for fading prompts. Prompts can be abruptly dropped, less intrusive prompts can be used, or part of the prompt can be removed gradually. The goal of prompt fading is for the client to engage in the target behavior independently. Before fading a prompt completely, it is essential that the behavior be maintained by natural consequences.

SHAPING

Description: Shaping is the development of a new behavior by the reinforcement of successive approximations and extinction of preceding approximations of the behavior. Small steps that lead towards the final goal are reinforced. Fading reinforcers requires that the individual respond in closer and closer approximations to the target behavior before reinforcement is delivered

Implementation: The Direct Interventionist may praise the client every time he or she makes progress towards the target goal. Thereby, the client becomes more motivated to perform the skills and eventually can perform the skill independently. It is important that the client’s progress be closely monitored, so once the client is making progress, the Direct Interventionist gradually thins the schedule of reinforcement.

CHAINING

Description: Chaining is used to teach tasks that are comprised of many discrete steps. Tasks are broken down into small steps, and then each step is taught within the sequence itself. A Task Analysis (TA) can often be filled out. A TA is a step-by-step breakdown of a task, such as toileting or brushing teeth, into smaller steps.
There are two forms of chaining:
Backward Chaining: The last step of the task is introduced first and then the Direct Interventionist works his/her way backwards to the beginning of the task
Forward Chaining: The first step in the chain is taught until it is mastered and then successive steps are added as competence increases.

Implementation: The Direct Interventionist may fill out a TA before he or she starts chaining. By breaking down the task into steps and working slowly towards the end goal, the client has more opportunities to master the task (e.g., bathing, buying groceries). It is important that, along with chaining, the Direct Interventionist uses modeling, feedback, and reinforcement.

BEHAVIORAL REHEARSAL

Description: The client will practice a response that has been previously taught. Usually, this takes place after the trainer has modeled the behavior.

Implementation: The Direct Interventionist will observe the behavior rehearsal and will provide feedback and reinforcement. Peers may be invited to participate in behavior rehearsal as well, so the situation may be more realistic.

GENERALIZATION TRAINING

Description: Generalization is the expansion of an individual’s performance ability beyond the initial conditions set for acquisition of a skill. Generalization training can occur across people, places, and materials. For example, once a skill is learned in one setting, with a particular person and with certain materials, the skills are taught in less restrictive settings and with more variation than the initial acquisition phase

Implementation: This strategy should be used across all skills. In order for a skill to be considered mastered, a client should demonstrate that he/she can perform the skill across people, places, and materials (e.g., the client is able to ask for assistance from his/her mother, his/her friends, and people in the community). A skill is considered mastered when the client can respond independently across contexts, such as the home, school/work, and community settings.

ASSISTIVE TECHNOLOGY

Description: This strategy may involve the use of an electronic tablet, or a Smart phone.

Implementation: Various apps are available, which may be used to assist the client in, for example, independently finding a street or bus station, expressively communicating with others (e.g., if a client is non-verbal) etc.

2D. TEACHING FORMATS

NATURAL ENVIRONMENT TRAINING (NET)

Description: NET capitalizes on establishing operations to build spontaneity. NET will be used to teach skills and target goals in natural settings and the client’s current motivation will be used to teach skills. The use of highly preferred materials (e.g., toys or materials that the client highly desires) and a focus on the client’s current interests are key factors in NET. Gradually, the schedule of reinforcement is thinned.

Implementation: The Direct Interventionist will make sure to arrange preferred activities that the client is motivated to initiate. For example, If a client likes to color, various markers will be placed out of reach so the client can be motivated for example to verbally request or to use sign language for other color markers. When the client requests, the Direct Interventionist will positively reinforce the request.

FLUENCY BASED INSTRUCTION (FBI)

Description: The distinguishing feature of FBI is the rate at which the client can demonstrate the skill. The client demonstrates the skill at maximum pace, with differential reinforcement and guidance from the Direct Interventionist

Implementation: The skill demonstration first occurs for brief periods of time (e.g., 10 seconds) and is gradually increased as performance increases. The client takes part in tracking his/her progress. A variety of instructional adjustments are made to increase the rate and/or reduce latency, such as guided timings where physical assistance is given, changes in timing lengths, or changes in the skill being addressed. The Direct Interventionist provides reinforcement.

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