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Posts Tagged ‘Applied Behavioral Strategies’

It was another great FABA! I’ve made so many friends and I keep meeting more each year.

Nikki’s presidential address was definitely my favorite. I really enjoyed hearing about big data for the closing session as well. It gives me food for thought.

I enjoyed my workshop and my panel but I seriously thought our talk on assessment rocked. Too bad we were competing against big names like Merrill. None the less, we need to get this published!

If you missed FABA this year, hopefully you will make it next year in Jacksonville.

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We are registered to do business in Tennessee! We are so thrilled to be expanding and to soon be offering services to children with behavioral challenges and their families.doing-business-in-tn

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Parents and professionals working together

Parents and professionals working together

Hi and Welcome to What Works Wednesday! where the focus is usually the description of a successful case story. The general public is slowly beginning to learn and appreciate the fact ABA works. However, in an ongoing comprehensive ABA program for individuals, more than just good ABA is required. Parent and professional collaboration is an essential ingredient. In ABA teams at Applied Behavioral Strategies, the BCBAs work to ensure that every case has 4 hours of parent-professional contact at a minimum each month. Collaboration occurs in a variety of contexts.

Team Meetings

In a comprehensive program, it is important for the team to meet frequently to guarantee that the team is implementing programs correctly and that programs are modified so that the child will continue to make progress. In most cases, the team meets twice per month for 2 hours. The first order of business at every meeting: parent concerns. The team includes all therapists, the supervisor (BCBA), the parents, and other outside professionals.

Clinic/Team Meeting Notes

During the team meetings, detailed notes are taken so that team members may review them before therapy. Everyone receives a copy of the notes, including the parents. The notes are also placed in the child’s program book so they are handy for team members.

Communication Logs

In cases where the child receives therapy in a setting where the parent is not present, therapists and supervisors keep a detailed communication log that is sent home with the child each day. These logs keep the parents informed about the child’s day and serves as another way to build cohesive team communication.

Phone Consultation

Supervisors at Applied Behavioral Strategies make themselves available by phone. Supervisors are extremely busy but a great time to return calls is between appointments when driving from place to place (don’t forget to use your headset!). Parents, if you need to speak to your supervisor, let him/her know so that time can be made for the call.

Emails

Finally, email is another way to remain in close contact with parents. Emails can be returned at any time of day; especially when talking by phone is not possible. Emails also provide a written record of your requests and decision making.

In summary, professionals be diligent to ensure parent-professional collaboration. Parents, do not be timid. Partner with your BCBA and team to help propel your child’s progress to its maximum potential.

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graphHi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s question was posted on a list serve for parents and family members of individuals with autism. The mom wrote,

“As far as data collection, I hear about the BCBA doing it but I have never seen it nor heard specific results. I requested the data and the BCBA told me that as an outside consultant she is not allowed to provide it.

Having taught a course on Ethics and Professional Issues for behavior analysts, and in addition to offering on-going coursework related to ethical issues for Board Certified Behavior Analysts, hearing things like this really upsets me.

Guideline 2.0 Responsibility to Client

The Behavior Analyst Certifying Board (BACB) has developed a set of Guidelines that BCBAs and BCaBAs must follow. These guidelines are called the Guidelines for Responsible Conduct and they may be viewed here. One of the guidelines states that “the behavior analyst has the responsibility to operate in the best interest of the client“. When the client is a minor or incapacitated (i.e., unable to make decisions for him/her self), the client’s parents or guardians become the client.

In the case above, the BCBA is claiming that her responsibility lies with the school district who is paying her salary. Unfortunately, the school district is a third-party payer. While the BCBA has responsibilities to her employer, those responsibilities cannot override her primary responsibility to the client. In fact, the guidelines address this issues.

Guideline 2.05 Third Party Requests for Services

This guideline has two parts. First the guideline states that “When a behavior analyst agrees to provide services to a person or entity at the request of a third-party, the behavior analyst clarifies to the extent feasible, at the outset of the service, the nature of the relationship with each party. This clarification includes the role of the behavior analyst (such as therapist, organizational consultant, or expert witness), the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality.

The guidelines go on to state that “If there is a foreseeable risk of the behavior analyst being called upon to perform conflicting roles because of the involvement of a third party, the behavior analyst clarifies the nature and direction of his or her responsibilities, keeps all parties appropriately informed as matters develop, and resolves the situation in accordance with these Guidelines.

So, while the district is paying for the services, the client is the child and his/her guardian. When he client requests their data, the behavior analyst must make those data available.

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Teacher and SudentsHere at Applied Behavioral Strategies, the mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s research review continues the discussion this week on using principles of ABA to address ADHD. See Monday’s post and Tuesday’s post for additional information.

Researchers from a variety of institutions collaborated to author “Peer Tutoring for Children with ADHD: Effects on Classroom Behavior and Academic Performance“. Authors included: George DuPaul, Ruth Ervin, Christine Hook, and Kara McGoey. The Journal of Applied Behavior Analysis (JABA) published the study. Readers may download the entire article here.

Background

Children with ADHD need two types of intervention. First, teachers and parents must provide reinforcement for appropriate behaviors and research has shown this to be effective. However, reinforcement alone is not enough. Teachers and parents must also concurrently address academic behaviors. One method for addressing academic behaviors is peer tutoring. Peer tutoring consists of two or more students working together on an activity with one student providing assistance, instruction, and feedback to the other. Various models of peer tutoring have been studied by great educational researchers such as Charlie Greenwood and Doug and Lynn Fuchs.

ClassWide Peer Tutoring

One model of peer tutoring is Classwide Peer Tutoring (CWPT). Classwide Peer Tutoring is an evidence based instructional practice based on principles of Applied Behavior Analysis (e.g., prompting, reinforcement, modeling). In CWPT, students work together in pairs taking turns tutoring each other. Students address skills that have been previously taught by their teacher. The teacher also develops appropriate teaching materials for the students to use. This approach provides students with more opportunities for asking questions and getting answers.

Study Purpose

The purpose of the study was to examine the effects of CWPT on  the task engagement, activity level, and academic performance of children with ADHD and children without ADHD.

Study Methodology

Participants. Eighteen students with ADHD who were not taking medication participated in the study. Children ranged between 6 and 10 years of age. Additionally, 10 comparison children participated in the study. These children were matched to the other children on age, gender, and class (i.e., in the same class as one of the targeted students).

Measures. Researchers measured classroom behavior (on task, off task, and fidgety) using a 15-second partial interval recording. Researchers also measured academic performance using teacher-developed pre- and post-tests each week. Finally, researchers also measured social validity by asking teachers and students to rate the intervention at the end of the study.

Design. Researchers used an ABAB (or reversal) design to determine intervention effectiveness. In this design, researchers measure behaviors with no intervention. Then they measure behaviors during intervention. Then the intervention is terminated while researchers continue to measure behaviors. And finally, the intervention is reinstated while behaviors continue to be measured.

Study Validity. The researchers took two additional steps to measure the validity of the study. First, they monitored accuracy of implementation using fidelity checks. Second, the researchers measured inter-observer agreement to ensure that data collection was consistent and accurate.

Results

During baseline, students with ADHD were on-task about 29% of the intervals. This increased to 80% of intervals during intervention. When the intervention stopped, this behavior decreased down to an average of 21% of intervals but when the intervention was reinstated, it increased again to 83%. Changes in fidgety behavior were observed in some but not all students. It is important to note that even without intervention, the occurrence of fidgety behaviors was low (i.e. 6% of intervals). Pre-and Post-test scores improved with intervention for almost half of the students with ADHD. Finally, the intervention received high marks of satisfaction across both teachers and students.

Comments

In the discussion section of the paper, the authors note how the results of their study compared to the results of studies on stimulant medication. Essentially, effective instructional practices work just as well as medication without all the side effects. The authors also noted that anecdotal data suggested that student engagement increased as well. Use of stimulant medication does not necessarily result in increased engagement. Interestingly, the comparison peers also showed improvements in on-task behaviors and academic performance.

Readers, do any of your children engage in CWPT? Behavior analysts, is this an intervention that you teach others to use in classrooms? Teachers, how difficult is it to implement CWPT in your class?

 

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Last week, I (Missy) shared information about the Congressional Hearings on autism and I questioned why the news media had not picked up on the story. Clearly, they had more important things to talk about:

  • Lindsey Lohan getting arrested again
  • The lucky winners of the Powerball

Clearly, relying on television news media is not the best

Image representing Google Alerts as depicted i...

Image via CrunchBase

way to keep current on all things autism. For those of you who want to be in the know but who lack endless hours in front of the computer, I will share a few of my tricks with you.

RSS Feeds

One way to keep current, is to find your favorite webpages and set up RSS feeds so that you are alerted each time there is a change. I like to set up my RSS feeds right in my Outlook calendar so they appear like emails. You can also use Google to help you.

Google Alerts

I have several Google alerts set up including alerts for autism and applied behavior analysis. This is super easy! Visit this website and enter the term or terms that you are interested in. You will then receive alerts when those news items appear. Please note that you can set up weekly alerts and daily alerts and so forth.

Twitter Feeds

Several Twitter programs are available to assist you with information on Twitter. I tend to lean towards TweetDeck. I can set up columns on topics such as Step Parenting, Parenting, Autism, and behavior analysis. Within those columns I can read the twitter feed on that topic. You can also set up lists so that you organize your Tweeps by topic or content. I have a list on autism, GFCF, and behavior analysts. I have also written more in depth on Twitter and you can read about that here.

So, don’t feel overwhelmed as you try to keep up with the latest on your favorite topic. Many resources are available at your fingertips!

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We recently received the call for proposals for the upcoming conference in Dubai. If you will recall, we went last year and had a wonderful experience. The upcoming conference is going to focus on behavior analysis. We are super excited to submit something and we hope that our colleagues will as well. Here is the call for abstracts. Please share it with your colleagues! Due date extended to November 15th.

Abstract For Autism

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Here at Applied Behavioral Strategies, our mission is to improve the quality of life through effective intervention. One way we hope to do that is by reviewing research articles for our readers. Today’s article is titled “Brief Report: Increasing Verbal Greeting Initiations for a Student with Autism Via a Social StoryTM Intervention”. Brian Reichow and Edward Sabornie authored the article and The Journal of Autism and Developmental Disorders published the article.

Study Purpose

It is a known fact that children with autism spectrum disorders have social deficits. One intervention that has been used is Social Stories. While social stories are widely used, the research on the effectiveness has been limited. Thus, the authors set out to determine if a Social Story could be used to increase appropriate verbal greeting initiations.

Study Methods

The authors enrolled an 11-year-old male with autism in the study. “George” as he was called, had an average IQ and he had above average grades on his report card. While he attended a social skills group at school, his social skills did not seem to be improving.

The authors developed a story according the guidelines recommended by Carol Gray. We discussed some of the differences between Social Stories TM and social stories or social narratives earlier this week.

The authors used a withdrawal design to demonstrate experimental control. Basically, in this design, an intervention is implemented. If the intervention is effected, it is removed to determine if the behavior would return to pre-treatment levels.

The authors merely counted the number (or frequency) of verbal greeting initiations. Waves and gestures did not count, only verbal greetings (e.g., hi, hello, good morning).

In baseline, George reported to his home room, picked up his schedule, and went about his day.

During intervention, George picked up his schedule (which included “read your Social Story”) and then read his social story before heading out to classes. The authors faded the social story and moved to a simple “cue card”.

Results

During baseline, George had zero verbal initiations. During intervention, George had an immediate increase in verbal greeting initiations. Specifically, he initiated greetings between 2 and 6 times a day; including greetings to peers! However, when the intervention was “withdrawn”, George stopped initiating greetings. When the intervention was reinstated, his initiations increased again to 2 to 4 initiations per day; including initiations to peers. When the social story was faded and the cue card was taught, the verbal initiations continued.

Conclusions

As we have discussed, this intervention is effective. Also as we have discussed, all interventions should be developed on an individualized basis. This is not a one size fits all approach. This individualization means that teachers, behavior analysts, and other practitioners will need to spend time developing the materials that will be used to teach the skill(s).

 

 

 

 

 

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Hi! and welcome to What Works Wednesdays where we share a success story from our clinical files. We usually focus on the use of ABA and its effectiveness for our clients. Today, we are going to share a resource that works. The resource is the Office of the Health Care Advocate (OHA). We have one in Connecticut. Here is the website: http://www.ct.gov/oha/site/default.asp

Here is the contact information:

Mail To:
Office of the Healthcare Advocate
P.O.BOX 1543
Hartford CT,06144

Phone: Toll Free at: 1-866-HMO-4446

FAX:  (860) 297-3992

E-mail: Healthcare.advocate@ct.gov

On October 17th, the OHA held a public hearing on barriers to access to mental health and substance use services. I (Missy) went to testify. Here is my testimony:

Introduction

Hi and thank you for taking the time to listen to consumers, providers, and advocates. I am here today as a behavioral health provider. I am a Board Certified Behavior Analyst and my company, Applied Behavioral Strategies, LLC provides Applied Behavior Analysis (ABA) therapy services to children with autism under Public Act No. 09-115.

Autism Insurance Bill

Under Public Act No. 09-115, children under the age of 15 are eligible to receive ABA therapy if their parents have certain types of health insurance.

Success!

While I have only been in business 2 years, you will be pleased to know that all of the children on my caseload who receive services through mandated insurance coverage have made growth as a result of ABA therapy. For example:

  • “Matthew”
    • Learning to go on community outings without screaming when dogs pass
    • Learning to take a shower independently
    • Learning to shave
  • Casper
    • Used to request to avoid many school classes (specials), now participates in all instruction and specials
    • Before our therapy, he had no friends.  Now he has friends and makes play dates
    • Historically engaged in aggression with his parents and siblings, we haven’t seen aggression in many months
  • “Joanna”
    • After living off pureed food for 8 years, she learned to eat table food!
    • She is learning to wear different shoes, hats, gloves
  • “Sammy”
    • Learned to sit and relax by playing games on his iPad or watching music videos
    • Decreased self-injurious behaviors
    • Improving his spontaneous communication
  • “Charlie”
    • Decreased head banging
    • Learning to tolerate work at home
    • Learning to ride in the car without thrashing his head when his parents go a different route
  • “Clark”
    • After being restrained repeatedly in his public school, Clark attends a private school with support and only a few outbursts
    • In the past, cried because he didn’t want to do school work, now gets upset if he cannot finish his work

The “Unlucky” Ones

Those case studies illustrate how state policies improve the quality of lives for individuals with behavioral health challenges. But unfortunately, a group of clients exist who are not eligible for these services because they don’t have the right type of insurance, or their insurance originates from a different state, or even worse, they are too financially disadvantaged to have insurance and are covered by Husky.

It is for these clients, I am begging for your ear. These clients and their families will never share joys described to you previously because they will not receive the ABA therapy. They cannot afford to pay for it out of pocket so they do without.  Even as I write this, it feels like I’m writing about a different century or a third world country. How can this be? These clients and their families have just as many needs, if not more, than the clients who are receiving therapy. But as a result of not receiving therapy, their behavioral health needs worsen which only serves to exacerbate the mental health needs of their parents. And all of this costs more in the long run.

Provider Issues

But even worse than not having the appropriate insurance, are the clients who have the right insurance but cannot find a provider because there are not enough providers who accept insurance. Let me tell you why providers do not accept insurance:

  • The reimbursement rates are drastically reduced from fair market value
    • My highest rate of reimbursement is still 50% less than my billable rate
    • The insurance companies do not reimburse for services in a timely manner
      • Cigna currently owes me $18,000 on ONE client
      • The stress I experience at each payroll period is overwhelming because I am not sure if my cash flow is sufficient to pay my employees
      • The amount of administrative time that is needed to follow-up with insurance in order to get paid is almost a full-time position
  • The reimbursement for services does not cover my income and that of an administrative assistant (see rates above).

Amazing Resource

The Office of the Healthcare Advocate has been extremely helpful for me and my clients as staff (Vicki and Jody) have assisted my clients (and many others that are not my clients) in obtaining the coverage to which they are entitled. I am extremely grateful for their assistance over the past two years.

Summary

In closing, I feel fortunate that ABA services are available to children in this state. Thirty years ago, these services were not available to my brother. I cannot help but wonder where he would be today, had he received the services that my clients receive today.

Thank you for taking the time to listen to us today and please do not hesitate to contact me if you have questions regarding this testimony.

If you want to watch the entire hearing, you can do so here:

If you live in CT, be sure to use your OHA. If you do not live in CT, check your state’s resources to see if you have an OHA in your state.

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Hi and welcome to Ask Missy Mondays where I respond to a question from readers. Today’s post is in response to multiple requests and questions about social stories and visual supports. Common questions include:

  1. I thought the story had to be written in first person? (e.g., “I like” versus “Charlie likes”)
  2. I thought the story had to be just like Dr. Gray says (A specifically defined style and format: sharing accurate social information and affirming something positive about the child)
  3. Is there any research to support social stories or visual supports?
  4. We do ABA.  Social stories aren’t behavioral.
  5. My child cannot read so why should we have a story?

Overview

Social stories and visual supports serve a specific purpose of providing visual information to individuals so that they can be successful in difficult situations. Some examples of difficult situations include:

  • Non-preferred but required activities (e.g., shopping, haircuts, blood draws)
  • Changes to routine (schedule is disrupted, substitute teacher, different bus route, school cancellations)
  • Novel situations (first time to hospital, first time on an airplane, first time to a play or show, storms)
  • Special but routine situations (dr. appointments, dentist appointments, hair cuts)

 

Individualized

Social stories and visual supports should be individualized to the user. While it may  not be convenient for a teacher to create 12-15 stories/visual supports, what works for one person may not be appropriate for another. When developing stories and visual supports keep the following considerations in mind:

  • age of the individual (resources must be age appropriate for the user)
  • reading ability (adjust the text of the visual depending on the reading level)
  • visual acuity (content should be selected based on the individual’s vision and ability, 3D versus 2D, color versus black and white)
  • attention span (the length and detail of the story or visual support)

Content

While Dr. Gray has created a trademark, there are many options beyond what she describes. Because social stories and visual supports should be individualized, the content should be determined based on the individual’s needs. For example, a mom here in CT created a social story for her child regarding Hurricane Sandy. The story included information about the storm, how it would affect trees and power, and how power could be restored. The story was developed for her son because the issue of losing power is important for him. He becomes upset if he cannot turn on lights or play on computers. However, another child may be scared of the wind or scared of the heavy rain. That child would need a story that focuses on the wind and the rain and how to make the noise go away. And then another child may not fully understand why she cannot go to school. Because she cannot read, her story may show a picture of wind and rain and a picture saying “no school”. The story would end with a picture of the little girl at home working with her ABA therapist.

Research

We have written about visual supports before: here, here, and here. We recommend only evidence-based strategies for our readers. So obviously there is ample research to support social stories and visual supports. A research group has developed a list of evidence-based practices for individuals with autism. Social narratives and visual supports are both on the list. For additional information on those practices and to read the research visit here.

ABA and Social Stories and Visual Supports

ABA, applied behavioral analysis, is simply the application of behavioral principles, to everyday situations, that will, over time, increase or decrease targeted behaviors. For additional information on ABA, visit our website. Thus, the use of visual supports and social stories does not preclude someone from doing ABA. Similarly, implementing ABA does not preclude someone from using visual supports and social stories.

I hope this helps to answer the many questions about social stories and visual supports. If you have a behavioral question for me email me directly at askmissy at applied behavioral strategies dot com. Thanks!

 

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