Weeks 7-8:
Caregiver Support
Components
Sheri Kingsdorf, Ph.D., BCBA-D
Our goals:
▸ Identify different models of parent
training.
▸ Write goals that align with parent training.
▸ Translate the written goals into
technological programming.
▸ Select strategies that best align child and
parent needs with the goal of progressing
ABA programming.
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What is the current state of?
Intake Report
▸ What is missing?
▸ What is unclear?
▸ How can I help?
...the caregiver support section is missing- before we look
there… a quick activity
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Caregiver Support… What’s going on now?
▸ Are you making them accountable?
▸ Putting formal goals in place to ensure
that targets are being addressed with the
parents?
▸ Being contingent in your own actions?
▸ Including requirements in the:
○ Initial contract
○ Initial report
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There are different options, let’s look at a few:
▸ Formal instruction
○ As in the CABAS model
▸ Self instruction
▸ Self monitoring
▸ Structured curriculum
○ As in the RUBI-PT
▸ Acceptance and Commitment Training
(ACT) for parents
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Before starting… remember to make the LTOs
easy to use
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▸ Use easy to understand language when defining ABA
terms.
▸ Remember the importance of baseline.
▸ Keep shaping in mind.
▸ Be collaborative in your efforts to train (to get more
buy-in).
▸ Create user-friendly materials.
○ That can be followed systematically in your absence.
Caregiver support from the CABAS model
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▸ Goals on formal instruction in ABA terminology
▸ Goals for parent behavior change, using:
○ Modeling
○ Corrections
○ Prompting/cueing
▸ Goals associated with the child's behavior
○ Goals related to the awareness of the childʼs
behavior.
Caregiver support from the CABAS
model
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▸ Formal instruction
○ Materials to read.
○ Assignments.
○ Quizzes.
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Instructions to Write Parent LTOs
Formal instruction LTOs: MODEL
(can we find some of the needed components?)
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Formal instruction LTOs: MODEL
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Parent Behavior Change: Consequation
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▸ Parent rate of contingent and noncontingent
consequations
○ What does this look like?
Consequation
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▸ Contingent consequation
○ Contingent consequation may be any discrete verbal or physical (e.g., a
hug) positive response which the parent delivers to the child for beginning
to comply within five seconds of a command. Any positive correction or
prompting (e.g., pointing while saying, "It goes there."), modeling (e.g.,
demonstrating how to place a toy gently in the toy box), physical guidance
or follow-through (i.e., fully physically assisting the child to pick a toy after
the command was given and not followed), and planned ignoring
procedure that is contingently emitted by a parent may be considered a
contingent consequation.
Consequation
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▸ Non contingent consequation
○ Non-contingent consequation may be considered any
verbal disapproval, physical punishment, absence of
correction, failure to respond appropriately to the child
for non-compliance, the absence of positive
reinforcement for compliance, and any verbal or
physical reinforcement for non-compliance to both
flawed or unflawed commands.
Consequation LTOs: Model
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The previous LTO
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▸ The wording could also be changed in the
previous LTO to be more specific, and look
only at:
○ Approvals vs disapprovals
○ Contingent vs non-contingent behavior (following
through)
The operational definition is important here, you can define it more clearly in the
LTO if needed.
Parent Behavior Change: Antecedent commands
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▸ Parents rate of flawed and unflawed
antecedent commands
○ What does this look like?
Antecedent commands
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▸ Flawed antecedent commands
○ Any command not understandable to the therapist including (a) an
omission of an observable, active, and imperative verb with a specific
object or an adverb, (b) a rhetorical question, (c) an unflawed command
confounded by a lengthy explanation, (d) a statement or question which
left a particular response in doubt (e.g., "Stop doing that!"), (e) words such
as "please" or "okay?" at the end of a command, and (f) any sentence with
a rising inflection at the end of the statement making it a question.
Antecedent commands
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▸ Unflawed antecedent commands
○ (a) linguistically it consists of a phrase with an
observable, active, and an imperative verb with a
specific object or an adverb, (b) the above phrase was
not followed by a lengthy explanation, and (c) it was
spoken in a normal volume of voice.
Antecedent based LTOs: MODEL
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Antecedent based LTOs: Model
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Parent Understanding of Behavior: Child
compliance
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▸ Rates of child compliance
○ Any appropriate behavior (e.g., touching sister gently,
walking to the toy box) emitted by the child within five
seconds of the parent's flawed or unflawed command
including the child's correct or incorrect vocal
responses to parental questions.
▸ Tracking of verbal operants
▸ Tracking of antecedents
▸ Tracking of frequency of SIB
Child compliance LTOs: Model
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Think….Delivering Feedback to the parents
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▸ Goals that involve implementation by parents in your
presence, or result in a permanent product, may require
your delivery of feedback to the parents. It is important
that the parents receive such reinforcement or
corrections, but be careful of how this is done.
▸ Consider…giving verbal feedback to parents in the
presence of their young children during in vivo training
may undermine parental authority and efficacy.
How can this be addressed?
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Instructions to Write Parent LTOs
Look back at the
instructions & Models
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Then...PRACTICE!
Another idea: Video feedback
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▸ Procedures to put in place during video feedback
○ IOA (parent and you/therapist) data collection on
three-term contingencies between the parent and
child.
○ Identifying select pieces of the contingency (setting
events, motivating operations, A, B, Cs).
○ Specific look at reducing/increasing parent behaviors.
○ Discussion.
LTO incorporating video feedback: MODEL
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Parent training, RUBI-PT
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▸ Parent training curriculum.
▸ 11 core sessions, 2 supplemental.
▸ Data can be collected on parent goals, parent activity
during the session, behavior change, social validity.
▸ Focus on A-B-C relationship with trainings on various
concepts (e.g., reinforcement, schedules, compliance,
FCt, etc..).
▸ Uses: direct instruction, video vignettes, role-play,
feedback, and homework.
Parent training, self instruction
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▸ Use of a self-instructional manual/course.
▸ Mastery test for each section.
▸ Role-play and self–rating for each section in
the manual.
▸ Self viewed brief instructional video.
Have you seen this?
▸ How could self-instruction be incorporated into parent
training goals?
Possible use of a self-rating checklist
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▸ A parent self-instruction (PSI) packet can be developed
and an LTO developed surrounding that.
○ Think about the formal instruction LTOs looked at
earlier.
▸ The self-rating checklist can also be used outside of the
self instruction piece.
○ Bringing more awareness to behavior, as in some of the
other LTOs (e.g., video feedback).
Parenting “self” checklist/Assessment
Instructions
Parent Training Checklist
➢ Think about your current case, and the needs of
the parents and the child:
◻ Create a checklist that could be used for
the parent to self-assess/self-rate his or
her own behavior. The checklist could be
used to create later goals/LTOs or as part
of a goal/LTO itself.
◻ Make sure that the items on the checklist
are measurable, clear, and concise.
◻ Make the checklist targeted to one
specific need.
◻ Make the checklist brief.
◻ Use everyday language.
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Example (model)
LTO surrounding the checklist: Just one idea
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Another idea: DC of child’s behavior
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▸ A number of studies on PT have incorporated data collection of childʼs
behavior.
▸ Perhaps consider such an ongoing method to help the parent see the
progress.
▸ We have looked at a few of these pieces already.
▸ But remember to make it:
○ Ongoing.
○ Check for IOA.
○ And consider more data collection and public display options.
MORE ideas for parent training..
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▸ Modifying the environment.
▸ Implementing programs when you are there, or not
there.
▸ Participating in a certain portion of the sessions- consider
self monitoring here.
▸ Being present for a 15 minute debriefing at the end of the
session.
▸ Using a token economy during the weekend .
▸ REMEMBER- you may need to shape the parentʼs behavior
ACT for Parents
▸ Acceptance and Commitment Training (or
Therapy)
○ General goal: The goal of ACT is to learn more flexible and adaptive ways for parents to
respond to their own inner thoughts about their child and his/her behavior. The result of
learning this skill set is that as their inner responses to the behaviors of their child change,
so do their outward responses, and therefore their child's behavior.
○ A method of implementation: In a direct instruction format, the behavior analyst delivers
6-10 tailored sessions to teach parents to use strategies to facilitate these changes.
Individualized sessions involve discussion, examples, practice, and feedback. The child is
not present during the sessions. However, the parents are expected to later apply these
strategies on their own outside of session times. Parents are expected to collect data, set
goals, and practice expectations. All of these activities are related to their actions and
thoughts, not the behavior of their child.
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Parent Training: ACT
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Example of
targeted parent
behaviors
Going Back to the report
▸ You need a
paragraph about
your initial caregiver
training plan.
▸ Caregiver data.
▸ Caregiver support
goals.
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Writing the initial parent Goals
Instructions
Parent Goals
➢ Think about your current case and the LTOs that you
have created/are thinking about creating to:
◻ Write at least 2 goals and objectives that align
with those pieces.
➢ Goal
◻ Make the goal just a statement about the
target behavior and the direction of
change.
➢ Objectives
◻ Describe the target behavior in a clear and
observable way.
◻ Describe the antecedent condition under
which the behavior should or should not
occur.
◻ Include a criterion for success.
◻ Break the goal down to include objectives
(smaller steps toward the larger goal), as
needed.
Model
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Writing the initial parent plan paragraph
Instructions
Parent Training Plan Summary
➢ Think about your current case, the needs of
the client, and the family, then write a short
summary paragraph about your parent
training plan:
◻ Including a few sentences about the
general plan for parent training (e.g.,
who, where, when, how).
◻ Stating the expected level of parent
participation (e.g., sessions,
workshops, etc..).
◻ Outlining the general time
commitment expected of parents.
◻ Making mention to the use of specific
goals and training procedures (look to
your LTOs/goals).
Model
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PRACTICE!
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Final considerations: What is needed?
Traditional Program Model
▸ Emphasis on session time
between the BT and child.
▸ Between 10-40 hours a week of
session time.
▸ Child always present.
▸ Limited parent involvement.
▸ Limited emphasis on
generalization.
▸ Ability to target numerous skill
acquisition goals.
▸ Can close learning gaps quicker.
Parent Training Only Model
▸ Parent as the BT.
▸ Focus on the parent “running” the
sessions in a naturalistic manner.
▸ Less hours where the BT is present .
▸ Less can be targeted/slower program
progress.
▸ More of a focus on challenging behaviors
than skill acquisition.
▸ Generalization targeted more naturally.
▸ Results should yield parent and child
changes in behavior.
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Parent Training Only
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One idea for
running this type
of case…
Before NExt Time
▸ Continue with the intake report.
▸ Complete the caregiver support section with at least 2 goals.
○ Include the baseline data statement and support plan
summary.
▸ Create program sheets for caregiver LTOs (suggested only).
▸ If you do not have a current case, please complete all of the
pieces with another person who can pretend to be a caregiver
of a child in need of services.
*** Remember, telehealth is an option.
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Before Next Time
▸ View all of the week 7 and week 8 materials.
▸ Watch this recording, if needed.
▸ Complete the assessment.
○ Do your best to complete sections 1-4 what we
have worked on already. You can copy and paste
your past section pieces/upload, if you are happy
with them.
▸ Be prepared with parts 1-4 of the intake report and any
collected data/questions for the next live class.
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