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3282 Starting off on the Right Foot: One Year of Behavior Analysis in Practice (1.5 BCBA continuing education units available)


Thursday, July 10, 2008: 2:15 PM-3:30 PM
Sanibel 2 (Gaylord Palms Resort & Convention Center)
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This data based presentation reviews one year of data from an Early Intervention (EI) center-based program using applied behavior analysis special instruction. One-to-one instruction was provided in individual and in group formats. Instruction was provided within a combination of discrete trial training and natural environment training formats. Program data are reported for 24 EI children diagnosed with PDD. Ninety-five percent of the children who participated in this program for one year progressed to lesser restrictive environments. Applied Behavior Analysis (ABA) program models have been effective in the remediation of learning problems for young children with pervasive developmental disorders (PDD) and language deficits for decades (Cooper, Heron, & Heward, 1987; Lovaas, 1987; Greer, McCorkle, & Williams, 1989; Twyman, 1998; Greer, 2002; Greer & Ross, 2008). Early intensive and behavioral interventions have been established as one of the most effective treatments for children with an autistic spectrum disorder (ASD)[1].
Many public and private schools that serve students with PDD provide instruction in a one to one format which has been the hallmark of many ABA programs. Under these conditions 0-3 students with disabilities may have few, if any, opportunities to learn in a group setting with their peers. The Children’s Center for Early Intervention (CCEI) comprehensively aims to enhance language and communication, social/play, pre-academic and daily self-sufficiency skills of young children. CCEI provides ABA services in an environment which combines discrete trial training and natural environment training by delivering learn units across these settings. This allows each student to benefit from the one to one programming while also including group program instruction.  "Group" refers to the students attending within a group of  three or more peers, however each child still continues to receive one to one individual consequences for all responding. All program intervention methodology is based on the science of the principles of ABA.  For example, one teacher reads a story, or sings a song with imitation opportunities to the group of children, while the assistant teachers will sit behind the children and prompt and reinforce as well as record data in real time. Progress is recorded immediately, and then graphed daily.  Decisions are made on the graphs based on a data decision protocol (Greer, 2002; Keohane, 1997), and research based tactics are applied as needed (Greenberg, 2007).   
This paper presents a report of one year of data from a center-based early intervention (EI) class at CCEI.  We will highlight the programs behavior analytic components and include a cost benefit analysis.

Population

The EI children enrolled in the home-based program for the given year ranged in age from twenty-three months to 42 months of age. The verbal behavior, social and cognitive repertoires of each child varied however all children had severe delays across these domains. Specifically, verbal behavior functioning ranged from pre-speaker and pre-listener to speaker and listener behaviors. However, about 80% of the children had severely limited speaker as well as listener skills.  Social skills were also severely delayed as is characteristic of children having PDD.  

Interdisciplinary model

CCEI provides services in an interdisciplinary model using ABA, speech and language therapy, occupational therapy, and physical therapy as well as sensory integration, natural environment training, and family support.  Our model of ABA is applied to young children with disabilities in preschool and EI programs by professional staff that collaborate about effective treatments on a daily basis.  The teams work together with a focus on the individual child. Parents are a central part of our interdisciplinary team. We provide family training and family support groups monthly. Parents are encouraged to be active members of the treatment team. Their input is necessary with regard to individual child deficits, family situations, and cultural issues. In addition, parents receive training regarding specific behavioral techniques to foster the generalization of skills in their home and communities.

CCEI is not a CABAS® school, however the program was based on the that model and incorporated the following CABAS® components in its’ program: LUs[2], PSI modules[3], TPRA’s [4]and data decision analysis[5].

 ABA special instruction

CCEI provides home-based and center-based services. The data reported within this study are limited to the center-based program. Each of the 24 children targeted were enrolled in a 10-hour weekly ABA program. A majority of the children’s programs were supplemented by ten hours of homebased ABA special instruction. The specific components of the center-based program only were as follows.

Discrete trial training and Learn Units

Discrete trial training (DTT) using learn units (LU) is an intensive, structured teaching program. Each skill taught was broken down into its simplest elements and smallest step possible for initial acquisition.  The skills taught follow a developmental progression with a strong emphasis on the generalization of skills to more natural learning environments. The child was presented with an antecedent stimulus. The child’s response (if correct) is reinforced by giving positive reinforcement (e.g. verbal praise, a book, toy, edible). The child’s response (if incorrect) is given a correction, and appropriate responses are modeled or prompted.  Prompt levels may vary from verbal or physical guidance to repeating the instructional antecedent. Prompts are faded as correct responding increases. As new behaviors are learned to mastery, acquisition tasks are added to each individual child’s programs. DTT is generally therapist directed. Target goals will include attending skills, non-verbal and verbal imitation, self-help skills, academic and social skills. The LU is a three-term-contingency that may occur in a scripted, automated, discrete, captured, dispersed or massed form (Greer, 2002).

Natural environment teaching

The natural environment teaching (NET) component relies on naturally occurring opportunities in the environment (e.g., group instruction, captured learn units) to promote learning.  Addition of this component emphasized child-directed activities (choices) while still incorporating the stimulus-response-consequence paradigm. Target goals included language, play and social skills. During NET, antecedents that may be child initiated were paired with multiple cues interspersed by the therapist. All goal directed attempts by the child were reinforced to strengthen appropriate responding. The reinforcers were the natural consequences of the desired  behavior.  This approach began as a small component of a given child’s two hour session per day. NET was expanded as they mastered skills, and increased the generalization opportunities.

Verbal behavior

Skinner (1957) presented the framework for the functionally independent verbal operants which has proven to be invaluable to practitioners setting out to teach communication skills to early learners.  The verbal behavior (VB) approach and VBA is a

focus on teaching the specific components of expressive language (e.g., echoic behavior, mands, tacts, intraverbals) by emphasizing the function of a word as opposed to the form of a word.  This approach has been effective in rapid skill development, functional communication training and reduction of inappropriate behaviors (Greer & Ross, 2008).  Group instruction
DTT, LU delivery and NET procedures continued during group instruction. The main difference is that students were not isolated into specific one to one settings. A group program or group setting consisted of a child engaging with generally three or more of his or her peers during an instructional period (two hours). During the group instruction, teachers may have positioned the children to be seated in a semi-circle arrangement facing the teacher who led the group.  Teacher assistants (TA) sat behind each child to prompt, praise, reinforce, and record data throughout the group activity.  Group instruction formats may have also occurred in a rectangular seating arrangement around a table for art activities, or on the floor, for music activities using various instruments.  Therefore, the children continued to receive LUs parallel to their peers in an approximation of a typical group setting.

Teacher training (PSI)

Staff instruction consisted of treatment packages with decision analysis protocols, direct instruction of research based tactics and frequent observations by the supervisors.  Staff received training by completing PSI modules.  Supervisors presented

content and modules that were completed weekly which included reading specific chapters in assigned texts, passing written exams on the content of the reading, and the clinical application of the subject matter. Training sessions were scheduled weekly and consisted of the delivery of instruction. Staff also received formal observations of their teaching procedures using the TPRA observation procedures mentioned above.

Data decision protocol
The data decision protocol allowed us to monitor student progress and to make timely data based decisions regarding the next step in instruction,  by analyzing the trends in the child’s data.  Based on the landmark dissertation by Keohane (1997), the decision analysis protocol enables teachers using ABA to teach 2-3 times more objectives.  This is a critical component to best practice ABA programs.

Both instructional formats at CCEI are individualized and involve data collection, graphing, data decision analysis, and the application of scientifically based tactics to ensure optimum instructional effectiveness and efficiency (Greer, 2002; Keohane 1997; Greenberg, 2007).

Supervision

The instructional systems at CCEI are established and maintained using techniques from the science such as the Teacher Performance Rate Accuracy (TPRA) observation procedure (Ingham & Greer, 1992).  Teacher performance/rate and accuracy (TPRA) measurements were administered through direct teacher and teacher assistant observation by supervisors who are board certified behavior analysts. The child’s instruction is measured in LU by dividing the number of three term contingency trials by the rate of instruction. In addition correct responses and incorrect responses are monitored daily to measure response accuracy and learning. Teachers and assistants made graphic displays and analyzed the data daily using the Data Decision Analysis Protocol. Data decisions regarding interventions for decreasing trends or stable rates of responding were accordingly scripted. All data were graphed daily. 

Results

The results for 24 children across 44 weeks of instruction are shown in Figures 1, 2, 3, 4, & 5.  Visual graphic displays were established and maintained weekly and posted in the classroom each week.  Figure 1 shows the total number of learn units presented and correct for each of the 24 children who attended the classroom throughout the year across 44 weeks of instruction. The trends are highly variable due to the variation in the number of days per week of school.  Most weeks of school were five days; however, due to holidays and the school calendar some were two, three, or four days.           

Figure 2 shows the mean number of learn units correct and presented for each child per day, across each of 44 weeks.  The mean number of correct learn units per child per day across the year was 86 with a range of 60, 104.  The mean number of learn units presented per child per day across the year was 134 with a range of 100, 168.  The trends are variable due to the variation in allocated instruction time which ranged from 30 minutes per two-hour session (one day of school), to 90 minutes (based on related service delivery).   

           

Cumulative objectives met were counted weekly as the total number of programs that each student mastered (90% accuracy across two consecutive sessions). Instructional sessions were 20 LU each (see Figure 3).  Objectives met were counted as the sum of all instructional programs across all instructional areas.  The objectives met were counted as short term objectives and long term objectives.  Prompted and unprompted responses resulted in the sum of all objectives met for each week.  The total cumulative objectives mastered for all 24 children across the year was 2561.  The average per child (N=24) resulted in 107 objectives met per child across the year.           

Learn units per objective was a measure of the average number of learn units needed to be presented by the teacher to move a child to perform at the predetermined level of mastery (90% accuracy across two consecutive sessions).  The mean for the year resulted in 213 learn units per objective with a range of 103, 750.  The trend started off high due to the nature of baseline conditions of instruction which occurs at the start of the new school year.  The trend was relatively stable throughout the year (see Figure 4).           

Supervisors conducted TPRA observations on the head teacher and teacher assistants each week.  These observations resulted in a measure of interobserver agreement calculation (Cooper, et al., 1987).  The number of agreements was divided by the sum of the number of agreements and disagreements.  Vocal and written feedback resulted from each TPRA as well. The total number of TPRA observations conducted by one supervisor was 183.  There were nine staff assigned to work in the EI class.  The mean number of observations per staff was about 20 (see Figure 5).  Results are summarized in Table 1.  

Learning Objectives:

  • Participants will learn how to utilize discrete trial instruction within a group setting effectively.
  • Participants will learn how to increase individual student mand repertoires within the natural environment.
  • Participants will learn how to use the natural environment to increase instruction.

Content Area: Early Intervention

Presenter:

Rosa C. Martinez, Ph.D., BCBA
Educational Director
The Chldren's Center for Early Intervention

I have been working with individuals on the autism spectrum for approximately 25 years. I have a doctorate in Behavioral Disorders from Columbia University and am also a Board Certified Behavior Analyst. I have taught Education courses at the College of Staten Island, Long Island University and Touro College.