Category Archives: Education

Resource Wednesday: How do you document risks?

02 Wednesday Aug 2017

Posted by in adults, Behavior Analysis, Community, Education, ethics, job aids, risk assessment, supervision, teaching behavior analysis, teaching ethics, Uncategorized

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Many behavior analysis supervisees, students, and even young Board Certified Behavior Analysts (BCBA’s) have not yet obtained proficiency communicating with their clients and agencies about risk assessments, and may even lack the experience or training to use or document them in their own practice. Yet, a risk assessment is required by our Compliance Code (for example, see related items 2.09 c and d, or items 4.06-4.07), and the need for this skill is evident in the Task List (see C-01, C-02, and C-03).

As a consultant and an instructor for a university’s course sequence toward certification in Behavior Analysis, I use the Bailey and Burch text on ethics as a resource both for my students and for my practice. Several editions of this text mention and describe a Risk Assessment Tool which is not only necessary and required, but can also be a powerful decision making tool for teams, supervisors, agencies, and even families. When services are discontinued after barriers to service have been repeatedly encountered, supervisors and the court systems value evidence that the behavior analyst documented and discussed the risks and barriers with a family or team. Also, lives might be saved by considering the short and long-term risks before moving forward with an intervention that is at best, inappropriate, and at worst, dangerous. Risk assessments can facilitate otherwise difficult conversations about risks (or benefits) to a client, family, team, agency, system, or even a consultant’s reputation and credentials.

So what tools do YOU use, and what are those used by your team? Kolu and Winn (2017) presented tools for our work, based on something developed in our consulting practices. First a Risk versus benefit flowchart helps walk a supervisor, team, agency or family through a sequence of questions. Then the Risk Assessment Tool helps keep track of the answers, and can be used to facilitate a discussion with families and teams. When making a tough decision, it helps to ask about the short- and long-term risks of doing “the current option” or doing “something else”, and weigh these against the potential benefits. Should my family pull our child out of a school where he is not really benefiting from education but has immense social interaction opportunities? Should I stay with this employer billing in a confusing and possibly unethical way, or start my own practice? What should I consider when approached by a long-distance supervision client whose client caseload doesn’t really match my skillset?

And as the Compliance Code makes clear, we should be continuously asking, what is the best treatment recommendation, given the possible options, the current environment, resources, and the risks and benefits?

With these questions and more, a risk versus benefit assessment can be extremely informative, helpful, and may even be required. Know the requirements, and then assess, document and communicate about the risks. It might just save your credibility one day when you are called to testify. (We all think it won’t happen to us, until it happens to us.)

Need a tool to document your risk versus benefit results? Download this Risk Assessment Tool and let us know your suggestions or what kinds of decisions you use it for.

Email us if you’d like a word version of the form that you can use to fill in with your team or agency. And if you’d like to share, let us know what YOU use to document risks.

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New blog series: Treating trauma from a behavior analytic perspective

28 Friday Jul 2017

Posted by in adults, Education, ethics, trauma, Uncategorized

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A new series on trauma and behavior analysis  

By Dr. Teresa Camille Kolu, Ph.D., BCBA-D

chalk_teddy (2)Behavior analysts are tasked with doing no harm. Like other professionals who adhere to a rigorous code of ethics, they are responsible for working only in their defined areas of competence, while seeking supervision and training in other areas as appropriate if needed to grow their expertise.

A new training is available from Dr. Kolu on the ethical and behavioral treatment of cases related to “trauma” (e.g., adverse childhood experiences or variables related to early disrupted caregiving). See some of the learning objectives below, check out our related blog series, and contact us today if we can support your team.

SAFE-T model Continue reading →

I’m done with this; now where do I put it?

13 Wednesday Feb 2013

Posted by in Behavior Analysis, Behavioral Cusp, Early Intervention, Education

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This is a story about a little girl, about five years old. Before she learned where things went, she learned where they DIDN’T go.

(First, a note to the teacher or student in all of us: Do you notice that adults often tell us what NOT to do? Sometimes it’s easier for adults to think about what NOT to do than what TO do.

But do you also notice that when little children hear what NOT to do, they don’t automatically understand what TO do?

This makes sense!

If it’s hard for US to articulate, it’s even more difficult for children or students to understand.

It takes practice, but you can learn to give almost ALL instructions or requests, in a way that lets the person know exactly what to do.

It’s the first lesson of being a great therapist, and it’s better than wishing a significant other could read your mind.

And you can do it. These stories show two different ways this strategy could be used.)

Carlie was a little artist and avid reader, and with alone time, loved nothing better than taking out ALL the art supplies, all the stuffed animals who needed to watch, and surrounding herself in the bedroom with piles and piles of STUFF. She changed clothes often, and changed shoes just as often, and the piles grew every afternoon.

Often at night, before getting tucked into bed, she scrambled to push the piles to the corners, and artfully arranged pillows over the piles. Other piles she pushed under her bed, where a perfectly positioned bedskirt hid them from mama’s eyes during a bedtime story or conversation about kids at kindergarten that day.

And it worked for a while. But one rainy Saturday morning, her other chores were all finished, and Mama said the dreaded phrase: “Why don’t you clean your room? I can help if you need me to.”

No! Not the offer to help! And sure enough, the little girl sat sobbing on the floor for what seemed like hours, as Mama lay on the bed, sometimes only her feet showing, as she pulled out pile after pile of clothing, moldy bowls and cups, ruined art projects and half-eaten cereal science projects. And the little girl was embarrassed, for now Mama knew her messy (somewhat naughty) secret.

But wait!

Now that Mama knew the secret, Mama could solve the problem. Now she knew that the REAL secret was this: The little girl, even after all this time, had no idea where to put things! At least, it hadn’t “stuck”. Now, Mama and the little girl organized the room TOGETHER. The little girl decided where everything went. Mama helped her make places for things: they hung up a net for stuffed animals, Carlie made colorful signs labeling spots for books, art supplies, and even “things to take to the kitchen”! Now she had a place to put everything. And Mama had a much more specific way to help. Saying “clean up your room” hadn’t usually resulted in a clean room. Instead, saying “put everything back where it goes” somehow made a huge difference for Carlie.

It’s not that hard, unusual, or impressive. 

But if you’re not already helping kids figure out where they CAN put things, try it: it’s a lot easier to clean up when you do!

It’s true for their behavior too.

A couple of years ago, three year old Carlie had just graduated to a “big girl seat” but was kicking at the breakfast table. Every day mom threatened to put her back in her “little girl”seat and every breakfast ended in tears with Carlie back in her “little girl” seat.

But wait, thought Carlie’s mom. She’d just enrolled in a parenting course, and remembered to apply a strategy from class. “Where CAN Carlie kick? When can she kick? Who will play with her? And most importantly… what can Carlie do at breakfast, INSTEAD?”

Fast forward 1 day. Carlie’s mom has purchased a tiny stool. Carlie’s feet rest there. Each breakfast begins with a happy discussion of what she can do with her feet. She can put them on the stool! Then they discuss what they can do after breakfast. We can go outside in the yard and play ball! We can practice our kicks, we can bring our dolls, and we can have fun!

Fast forward 2 minutes. Usually, Carlie starts kicking about 3 minutes after breakfast started. So today, Mom said “Wow, Carlie! Your feet are safe on the stool! I love it. It’s fun having breakfast with you in our big girl chairs!”

Now, this was just one example, with a minor behavior. The behaviors some parents think are problematic are not priorities to other parents. Find what will work for YOUR family or team. Cusp Emergence offers family empowerment coaching. Contact us for more information or to share your story!

Bottom Line: Give clear instructions and involve learners in creating and enjoying supportive structure or alternative behaviors, the way Carlie learned to enjoy active playtime after her breakfast, or participated in creating her bedroom’s “places to put things”.

Note: Did you wonder why this post is in the “behavior cusp” category? Giving clear instructions is so important a skill for caregivers and teachers, that I have often observed them able to access new levels of teaching and instruction when they learn how. Mastering a strategy like this can be a “cusp” for teachers and parents, making it easier to promote appropriate behavior and engagement in their families and teams.

HELP- There’s a monster in my toybox!

06 Wednesday Feb 2013

Posted by in Autism, Behavior Analysis, Community, Early Intervention, Education, play, Rett's, Social Interaction

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Part 1 of Series: Helping caregivers and teachers support children to meet fearful challenges

Shannon’s Story

Shannon and Gina sat in a free play area near their preschool teacher. “SQUAWK!” came the loud animal sound when Gina pushed the button on a new toy. As the toy noise grew louder, Shannon’s eyes opened wider and wider until she froze, a look of sheer terror on her face. She started to back away and wailed, sinking onto the floor and crying.”Oh no,” gasped her teacher. “Put that toy away!” While Shannon cried, their teacher pulled Gina aside and said “I’m sorry, but Shannon is afraid of that toy. Next time we will remember to play with it when she’s in another room.”

Devon’s Mom’s Dilemma

Devon and his mom Jenny walked down the sidewalk with their next door neighbors. As they neared the playground, Devon suddenly grabbed his mother’s skirt tightly and shrieked. “NO BIRDIES! NO DOGGIES!” At this, Jenny’s face grew red as she picked up Devon and held him tightly. She looked at her neighbor helplessly and apologized: “I’m just so sorry… We can’t go any further with you. He’s been doing this every time. He has this issue with ducks and dogs and birds now. I think even if we don’t see one he’ll be afraid one might get him.”

Toward more supportive, long term strategies

At first, it may seem supportive to shield a child from their fears.

But both teachers and parents want and need solutions that will ultimately help children face and overcome challenges. So when there is a question, especially when a particular strategy feels good or soothing or produces relief in the short term, it’s a good idea to ask ourselves, “is this procedure also supportive in the long term?”

If not, how can Shannon’s teacher and Devon’s mom learn a more therapeutic approach? And why is that important? Let’s review these scenarios again, to better understand why and how to take a supportive long term approach. What might Shannon’s interaction with the toy, and Devon’s interaction with park creatures, have in common?

First, these scenarios are similar in how they are resolved.

In both interactions, a pattern is being established: the child first encounters a fear, or “fear inducing stimulus”, and then others respond by helping the child to escape or avoid it.

Second, these scenarios are similar in how they affect other people.

From the perspective of Shannon’s peers, her inability to play with that toy meant that they couldn’t either, at least not when she was around. From the perspective of Devon’s neighbor, the neighborhood kids couldn’t play with Devon in a park. This concept, the idea that Devon can’t play in the park, and that Shannon can’t play with toys that make animal sounds, limits interaction opportunities. It also risks changing the way peers think about approaching Shannon and Devon.

Third, these scenarios have similar “reductive” effects on the children’s “repertoire” or world. Have you ever met a family member or caregiver who says, “we used to love to do ___” but we can’t anymore”? Perhaps a family used to go to the movies, or out to dinner, or have friends over, or go to museums, or go hiking. During the initial conversation with families, that blank is filled in by all the things they need to avoid now because of fears of how people will react, fears that it won’t go well, fears that it will be too difficult, embarrassing, or noisy. Often those fears are REAL at the time! Perhaps people DID stare and talk at church when a family’s child loudly refused to stop standing on the pew. Perhaps all the teachers and mothers DID stare and talk in the parking lot as a child disrobed in public and threw a tantrum before leaving the store. Perhaps it WILL be difficult, embarrassing, or noisy. But keep reading. We can do this together.

Fourth, understand it’s a cycle: handling scenarios by allowing “fear habits” to persist, allows learners to skip learning opportunities and continue to repeat old harmful habits instead.

If Shannon and Devon can’t play with certain toys or in certain places, they have reduced opportunities to learn about those things and places, and no opportunity to learn that they are NOT scary.

Fifth, if these scenarios become habits, they make it more difficult for the child to handle or face similar or other fears in the future. These situations do not teach the child how to be more successful in coping with scary, new or different events.

Bottom Line: Instead of stopping or thwarting learning opportunities, we can expand them.

Come back Friday to learn how!

School of Play

04 Tuesday Dec 2012

Posted by in Autism, Behavior Analysis, Early Intervention, Education, play, Social Interaction, Uncategorized

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School of Play ©
Our school of play division provides one-time, brief, or long-term play or leisure skill-based individualized client supports, training, and education.

WHO can benefit?
Groups: Schools, classes, churches, businesses (gyms, pediatric doctors or dentist groups, therapists)
Families: Families affected by behavioral, developmental, social, emotional, or other challenges
Individuals: Children, staff, teachers, administrators

WHEN?
Our clients can benefit from School of Play © services whenever:
-A child gym owner sees staff struggling to help young mothers engage their children in play, interaction, or language, and enjoy the gym activities at the same time
-A community or church member runs a play group in a church or gym, and is not sure what to do differently to support new students with autism
-A community or church play group is not sure how to support children with language delays
-A parent needs the babysitter to manage behavior more effectively when supporting the family’s children
-A parent’s child with autism doesn’t know how to play with his siblings
-A family’s two year old with autism doesn’t like to play with his parents
-A family’s or organization’s group of therapists is great at 1:1 instruction, but they need help getting children to interact with each other
-An organization’s therapists are highly skilled at discrete teaching, but provide less effective naturalistic teaching

WHY does it work?
Cusp Emergence provides play and leisure skill support that is:
-Compatible with IFSP or IEP goals
-In some cases, able to be funded by a state’s early intervention services if the client qualifies
able to improve family or team interaction
-supportive of social, emotional, or behavioral wellness
-provided in the community or home setting
-consistent with research proven methods with demonstrated effectiveness
-administered by qualified, educated, trainers with extensive experience collaborating with parents, educators, therapists and community members

HOW can clients benefit?
-Learn to arrange environments to make appropriate effective language and communication more likely
-Learn to arrange environments to support play
-Learn to teach staff, babysitters, community, or family members to provide supportive environments
-Learn to arrange environments that prevent behavior challenges
-Receive support from our School of Play division in your group or home

HOW does it work?
-An initial consultation takes place to discuss the family’s or group’s needs
-Next, a workshop or future education is planned based on individual needs
-Follow up support is available for families or groups on a schedule determined together with the client

(click here to check out Building Your Workshop)

Build-Your-Own-Workshop

04 Tuesday Dec 2012

Posted by in Autism, Behavior Analysis, Community, Education, Uncategorized

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Cusp Emergence is excited to offer a Build-Your-Own-Workshop feature to families, groups, and communities.

1. Consider what your workshop will address, and why you need a workshop.

  • Need to learn general ways to provide social, emotional, and behavioral support?

  • Need to practice behavior management for specific behavior challenges?

  • Need to teach your family or group about managing a particular behavior challenge?

  • Need to support a student or family or community member with cognitive or developmental challenges?

  • Want to know more about how social-emotional and behavioral wellness relate to physical health?

  • Want to learn a particular technique (for example, for teaching skills or shaping language, appropriate behavior, play, or social interaction)?

    2. Think about who will participate, where you’d like the workshop, and how long your group would like the workshop to be

    3. Contact Cusp Emergence!

CONTACT CUSP EMERGENCE:
720.263.CUSP

The Behavior Cusp: A special instance of behavior change

30 Tuesday Oct 2012

Posted by in Behavior Analysis, Behavioral Cusp, Community, Education, Emergence, Social Interaction, Uncategorized

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“a cusp is a special instance of behavior change, a change crucial to what can come next”

~ Rosales-Ruiz and Baer, 1997

Behavior analysts define behavioral cusps as changes that have special features and special effects. Experiencing a behavioral cusp (examples to follow) exposes the learner to new reinforcers, new reinforcing environments and relationships, and gives rise to “generativeness”. In other words, after a learner has experienced a behavioral cusp, she may have access to richer experiences that may become enjoyable themselves or simply make it possible to access even more experiences and environments.

Learner example: A child experiences a behavior cusp

Timmy is a learner with communication delay and limited gross motor skills. He was two years old before he could use purposeful movements with his hands; it was frustrating for him to wave and gesture without others understanding “what he meant”. His mother often wore a desperate expression as she wondered what he needed or wanted, and as he screamed for hours on end she often exhausted her ideas and ended up holding him tightly and rocking him, still unable to understand but too tired to work on it anymore that day. One day, Timmy was able to extend his finger to point, and his mother understood exactly what he pointed at! She provided it immediately, and Timmy relaxed and smiled. They went around the apartment together, his mother joyfully exclaiming to name the things Timmy pointed at. A barrier was broken! A behavioral cusp, pointing at objects, had occurred and Timmy was now able to communicate with much less frustration. From there, he progressed within months to being able to point at different pictures on the same page. Timmy’s mother is thrilled to understand what he needs, and Timmy’s inconsolable screaming for hours at a time no longer occurs on a daily basis.

Learner example: An adult provider experiences a behavior cusp

Jean is a daycare provider. She has struggled with behavior management in her private daycare classroom, as children hit and bite each other at least weekly and often daily. Her management team has a no tolerance policy for these behaviors, but Jean and her co-workers in the classroom still wonder how to stop the behavior without constantly reprimanding the children. One weekend, Jean attended a seminar on positive parenting. She had planned to use the techniques with her teenage son, and was surprised when she listened to the instructor describe that the “attention pivot” technique was also useful in the classroom when children were motivated to acquire the attention of teachers. Jean implemented the technique in her daycare the next day, and by changing just one thing- the timing of when she began talking and turning toward a child – the everyday behaviors of pushing, whining, climbing on tables, and throwing toys diminished. Even more exciting to Jean, they diminished in less than an hour, and Jean’s classroom helpers easily saw what had changed in Jean’s technique. When she saw a child looking at another student who had a toy, Jean used to observe and wait until she needed to intervene (or stop the student from yanking it away). She used to say “stop!” or “No! We need to SHARE!” multiple times per day. After Jean changed her timing, she now turns to a child BEFORE “misbehavior” and she catches the child doing the right thing. When the other teachers noticed what had changed, they began trying it themselves, and soon the number of hitting and biting episodes had decreased to a rare few times per month, instead of daily.

The point of the story:

Sometimes behavior cusps occur on their own, during development. Other times, it becomes important for someone to assist a learner experience a cusp. In Timmy’s example, the cusp was engineered by providing many, many opportunities to practice the steps needed before pointing, and the behavior analyst used fluency training and shaping to provide this practice and make it enjoyable for Timmy.

DISCLAIMER: The preceding stories, and others on this site, are simply examples or vignettes; they do not constitute training, supervision, or a behavior plan. The resources on this site are not developed for a specific individual. It is recommended that before implementing any technique described here or in resources available on this site, a reader consult a qualified behavior analyst with experience related to the appropriate field and population.

RESOURCE: Check Imagine!’s calendar often for upcoming trainings.
Dr. Jeff Kupfer, Ph.D., BCBA-D, provides “Building Cooperative Behavior” class free to the Boulder and Broomfield communities on a monthly basis. Locations, times and contact information can be found on the Imagine! calendar (search for “Building Cooperative Behavior”).

http://www.imaginecolorado.org/Calendar.htm