H-6: Monitor client progress and treatment integrity. ©
Important note: Fictionalized clients are used to demonstrate the skill items in the second half of the task list, sections F-I. They make the most sense when read in order. Please remember that there is not substitute for real-life supervision and consultation. Get your case-specific advice from professionals – not from the internet! These examples are just that – examples of how behavior analytic skills might be applied.
Case example: Jada is an elementary school student. She experiences Level 3 Autism Spectrum Disorder (ASD). Level 3 is the severity level of Autism which is characterized by “requiring very substantial support.” Jada has also been diagnosed with a severe Intellectual Disability (ID). Jada has just transferred to a private school for individuals with global needs. She loves all kinds of play and messy activities, such as finger paint and water play. She also enjoys swinging on the playground, eating popcorn, and watching Disney movies. She loves to be read to, and laughs when staff make dramatic gestures while reading picture books. Jada does not use any vocal speech. She makes noises sometimes, such as humming. Jada engages in motor stimming, including upper body tensing and flapping her arms. Jada engages in severe challenging behavior, including self injury (hand to head and head to surface) and aggression (including hitting and biting). Jada has a mom, dad, and older brother living together in one home. Jada’s family has advocated for her to attend a private program, and they are excited for her to get high quality services. Jada’s new behavior analyst is Dr. Brown-Davis, who is a BCBA-D employed by the private program.
Example of Item H-6: Dr. Brown-Davis designs programming for Jada based on the results of relevant assessments. From there, he writes goals that are observable and measurable. Data are graphed on a daily basis, and progress is monitored on a daily or weekly basis, depending on the program. For example, safety and communication related programming is monitored more closely than adaptive skills related programming, because of the safety considerations and the expected rate of behavior change. Treatment integrity data are gathered on a weekly basis by Dr. Brown-Davis, and on an unpredictable schedule by clinical assistants or peer observers three times per week. Any dip in integrity below 90% for more than two sessions in a row involves additional observation and possible re-training using Behavioral Skills Training (BST) booster sessions.
Case example: Donovan is a high school student. He has been diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). He attends a public school and has been placed in a support program for students with social/emotional/behavioral needs. Donovan enjoys playing video games and drawing in his sketchbook. He would like to be a welder when he is an adult. Academic achievement and attendance have been challenges for Donovan historically, and he is currently not on track to graduate with his peers due to missed work and failing grades in several classes. Donovan’s team has identified challenges including frequent non-attendance to school, walking the halls during class times, non-attendance at expected guidance appointments, and non-completion of classwork. Donovan lives with his mother and older brother. Donovan’s mother is concerned about her son’s school challenges and expresses frustration about his “lack of commitment” to his education. She wants Donovan to understand how important it is to graduate from high school. Donovan’s behavior analyst is Ms. Bailey, who has just started contracting with Donovan’s school district through the agency she works for.
Example of Item H-6: Ms. Bailey monitors Donovan’s progress on a daily basis based on the data that his teachers enter into his electronic data collection form. Ms. Bailey also stops in weekly to monitor whether Donovan’s teachers are following his behavior intervention plan. During this time, Ms. Bailey uses a treatment integrity checklist to assess and make notes about the teacher’s performance. Ms. Bailey shares feedback with the teachers, based on her assessment of treatment integrity.