The ABA and PT Podcast

Time constraints are making it difficult for behavioral therapists to analyze the data they’ve collected. Bethan's goal is to bring charting to people in order to help them produce an efficient and measurable output.

Bethan Mair Williams has worked as a Speech and Language Therapist in the British public health sector for over 20 years. She has an amazing organization called the British Royal College Clinical Excellence Network for Speech Therapists. In today's episode, Bethan shares a very unique perspective on the ABA and Speech world, especially using Precision Teaching.

HIGHLIGHTS

00:35 Intro to Bethan Mair Williams

06:15 Teaching the methods of charting to classroom assistants: An efficient way in giving kids targeted measurable intervention 

10:04 Benefits of charting for Speech & Language Therapists  

18:07 How Bethan motivates teachers and Speech & Language Pathologists to do charting

25:14 The profound effects of charting to students

37:34 On the dark side of data collection

44:02 Is there still room for qualitative data?

SAFMEDS (Say All Fast Minute Every Day Shuffled) -  An assessment procedure that is useful for vocabulary acquisition 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

N/A

QUOTES

09:17 There's this huge push in our profession to take data but nobody teaches us how to do it effectively and efficiently given our time constraints.

14:20 "One of the really useful ways to use a chart is to measure the use of augmentative or alternative communication."

18:53 "You can't just give someone a book or a manual. The most important advice I have ever given when I trained as a speech and language therapist was, do not give the average person anything longer than a piece of paper one side because they will not read it."

27:50 "It is the biggest thrill ever to see that look in a kid's eyes when they're not relying on the adult to tell them all the time what it is to do, they are truly thinking for themselves."

32:45 "Our goal to show people how to measure, how to do it efficiently, and how to make sure that they get their work done as fast as possible so that kids, in particular, can be kids, get outside, play, do lots of fun stuff, and not sit trapped at tables for hours on end."

This episode is a continuation of the previous episode featuring Liz Lefebre and Amy Evans, both highly acclaimed practitioners of Precision Teaching. They highlight a thinking process of how to get precise when writing your goals. Combining measurable data in the SMART approach, practitioners can set even more attainable goals for the learners. 

HIGHLIGHTS

02:14 Being Specific on what you’re teaching and what the students are supposed to do

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Organization for Research and Learning 

Dr. Aditi the OT Website 

The Databased OT Facebook Group

QUOTES

09:13  When you’re using ‘percent correct,’ it could be anything and that leaves it up to the person that is in charge, whereas if you write a goal that says 8/10 across four days in a row, then it’s very clear what you’re looking for.

10:16   For these small things you might be able to get that learner to practice it much more often without you necessarily being there. So, once you’ve established a behavior then it’s just a matter of practice.

15:38  Part of the learner always being right is taking the right kind of data so that we can see if we’re making progress on a daily basis.

This episode is part one of a two-part series featuring Liz Lefebre and Amy Evans, both highly acclaimed practitioners of Precision Teaching, as they discuss how to write more accurately measurable goals and their benefits. 

SMART goals are more overarching while precision teaching uses a more fine-tuned approach. By observing a learner's component skills and using charts, teachers can come up with more accurate goals and develop tailor-fit interventions. This includes determining pinpoints and a student's fluency in behaviors.

HIGHLIGHTS

03:13 Introduction to Liz Lefebre and Amy Evans

08:20 Writing goals begin with observable behavior and the component and tool skills

13:48 Determining the sufficiency of component skills in task analysis 

22:53 Comparing observations: Precision teaching vs percent correct 

29:12 How to come up with pinpoints

36:28 How to figure out the aim of fluency

GLOSSARY

RESA - Retention, Endurance, Stability, and Application

REAPS - The five performance results produced by fluency (longer Retention, greater Endurance, greater generalization to Application, Performance aims for teaching, and Standards for aims and evaluation.

Discrete Trial Training (DTT) - Discrete Trial Training (DTT) is a teaching technique used in some therapies for autistic children. It involves breaking skills down to their most basic parts and teaching those skills to children, step by step.

Pinpoint - A specific way of describing what a single countable behavior is.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Organization for Research and Learning Website

Dr. Aditi the OT Website

The Databased OT Facebook Group

QUOTES

11:01 "Depending on where the learner is coming to you in terms of their current skill set, then that would definitely make me change how I word my goal based on the situation."

13:35 "It's almost like we would this overarching goal and then we would have all these little benchmarks that I might be working on simultaneously that will all move towards meeting that same larger goal."

24:13 "There's no way to get that information (correct responses) in terms of frequency or count per minute unless you're also measuring the time that it takes to do that."

35:34 "I'm still getting my data on whether I'm making progress on the larger goals but, by taking data on those smaller things, I get to celebrate at the end of the day even though I maybe didn't go from zero to a hundred."

39:13 "If I have a learner who I know has seizures or has something physical going on with their hands or something, then I'm going to look at their fine motor aims very differently than I would with somebody who doesn't."

The ABCs of behavior is an important tool to analyze whether a certain behavior is likely to happen again or not. The key here is that consequence matters. For OTs, it is possible to measure the effectiveness of interventions by hypothesizing and data-taking.

Discussed today is the case of Johnny's rocking and some antecedent (environmental) interventions that could usher in permanent change and affect the consequences of this action. Also discussed today are ways to get assent from clients to help ensure that interventions will have favorable outcomes. 

HIGHLIGHTS

02:18 Shoutout to the World Health Organization for developing Self-Help +

04:55 The ABCs: Is it reflexive behavior or is it sensory?

15:02 The consequence matters on whether a behavior will happen again

22:28 Hypothesizing can help OTs measure the effectiveness of interventions

29:20 Case study: Johnny's rocking and implementing antecedent interventions

36:02 Modifying ABCs to improve client progress

40:30 How to get assent from clients 

GLOSSARY

Operant behavior - This refers to behavior that can be modeled by its consequences. It often corresponds closely to behavior colloquially called voluntary or purposive. As this behavior is related to its consequences, it is said to be emitted rather than elicited.

Antecedent intervention - A strategy to manipulate an environment prior to the occurrence of a behavior. This is utilized to increase the likelihood of the desired behavior to occur and to decrease the occurrence of maladaptive behavior.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Scalable Psychological Interventions for People in Communities Affected by Adversity by the WHO

Dr. Aditi the OT Website

The Databased OT Facebook Group

QUOTES

15:00 "The consequence matters. So when you're trying to determine why is a student doing this thing? Why is this occurring? The first question to look at is what is the consequence? It's the consequence that matters."

15:25 "If the behavior is something we want less of or there is a behavior we want more of, we need to look at what is occurring after behavior to either strengthen or weaken it."

18:01 "If you're going to put interventions in place and look at their effectiveness, don't do it immediately in the presence of behavior you don't want more of if it's potentially a pleasant consequence to that student. Do it prior to the behavior."

29:03 "Are they deprived of something or are they satiated on something? This motivating variable before the behavior, looking at the environment is very important to determine why the student is engaging."

41:54 "Ensuring that you are strengthening and reinforcing behavior that has a student engaged, that it's a pleasant task that's involved, and that great things happen when the student is engaged and involved in the activity."

Using percent correct has become the industry standard in behavior analysis. Dr. Rick Kubina, CentralReach’s Director of Research and Professor of Special Education at The Pennsylvania State University, joins the show today to shed light on a more objective way of looking at data using precision teaching. 

Though percent correct is useful in coming up with ratios, it is not always the best measure because of the ease with which the results can be manipulated. Precision teaching looks at the numbers objectively, uses visual charts that document the processes, and provides data-driven context to determine whether interventions are effective or not.

HIGHLIGHTS

02:42 Introduction to Rick Kubina

06:45 How percent correct became the industry standard

10:49 Why fewer ABA's actually practice precision teaching

18:38 When percent correct is the right way to measure

27:40 The resistance to precision teaching is rooted in human behavior

33:29 How to apply precision teaching charts to your discipline 

45:31 Information on Standard Celeration Charts you can download and use

50:29 How Standard Celeration Charts determine when a goal is mastered 

GLOSSARY

Dead Person Test - A test that says if a dead person cannot do it, then it is behavior, and if a dead person can do it, it is not behavior.

Dimensional quantity - Something that has dimensional counts or numbers that tell you its characteristics (height, weight, etc)

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Greatness Achieved Publishing Company

Reflections on Precision Teaching book by Rick Kubina

CentralReach Institute

Standard Celeration Society Facebook Group

The Databased OT Facebook Group

Aditi's Website

QUOTES

16:11 "Let's say, Aditi you are 20 out of 20, Mandy was 1 out of 1, and I was 7 out of 7. You know, we have a pretty big difference Mandy, myself, and you, but it's all going to be 100% correct."

23:06 "We in precision teaching have a measure that's called celeration and this measure tells us how fast is the behavior changing. And guess how we report that? We report it in percentage of weekly growth. So someone's behavior is doubling, we say that behavior has a hundred percent growth each week."

24:26 "Here's what I would suggest. Just don't convert it to percent. Just use the count. So in this instance, if you have a checklist, having your actual counts even if you don't time it, that's always going to be more informative than when you convert it."

26:37 "All of you OTs, the good news is just don't take the step where you convert it to percent and just work with the counts because they'll be more informative to you and you'll be able to understand at a deeper level how well is your client responding to whatever intervention you're applying."

47:24 "When you get someone who's been in a system, you're starting from ground zero. What a waste of time for you to figure out. Oh, I have to do this and this again. Whereas, if someone just showed you, here's all the things we tried, then you can try new things."

52:23 "Mastery should not be measured in terms of percentage. It should be measured in terms of the frequency that we talked about before."

Taking data vastly improves the performance of both students and teachers alike. ABAs and OTs can determine the best course of action for increasing or reducing behaviors with data to back them up, while students also feel more motivated with their increased awareness. 

Discussed today are the practical reasons for taking data, specific steps you can take to start taking data, and the common barriers to taking good data. Data collection goals between ABAs and OTs may also be different, so Mandy and Aditi break down how they view these goals and how they can achieve them.   

HIGHLIGHTS

03:24 Shoutout to CentralReach Institute

04:20 Evidence-based interventions and why ABAs take so much data

08:49 OT barriers to data collection

11:23 How to begin collecting data 

15:30 OT data collection on goals and strategies to achieve that

25:48 Taking data increases motivation and improves performance  

28:30 Using standardized charts to measure fluency

35:13 Case study: Similarities and differences between ABA and OT goals

GLOSSARY

Dead Person Test - A test that says if a dead person cannot do it, then it is behavior, and if a dead person can do it, it is not behavior. 

RHUMBA - How Relevant is it, How long, Understandable, Measurable, Behavioral, and Achievable

COAST - Client, Occupation, Assist Level, Specific, and Time-bound

SMART - Significant, Measurable, Achievable, Relates to the person, and Time-based

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

Progress Monitoring and Documentation During Virtual School-based OT Service Delivery via Telehealth

CentralReach Institute

Rick Kubina: Using Precision Measurement to Derive Meaningful Performance Metrics and Analytics

Reading with Precision (Precision Teaching Aims)

QUOTES

04:33 "Ethically, we are required and therefore obligated to demonstrate that our interventions are effective and evidence-based and it's absolutely impossible to do that without data."

13:29 "In order to measure something, you must define first what it is that you're teaching or a behavior that you're trying to increase or some behavior that you're trying to reduce."

23:00 "If you use a Standard Celeration chart and you apply how many opportunities the student performed in a period of time, it'll give you a really good trajectory of how long it's going to take to master that goal."

25:48 "The sheer act of taking data with a student improved their performance. I was like oh my gosh because they are so much more aware of their own performance."

29:59 "It's got a fixed X and Y axes and it's always the same. As opposed to what I call a stretch to fill chart where you can alter the X and Y axes to make your data look better than it really is and data on those types of charts are not comparable."

Today's episode features Sasha Long, BCBA and Founder of The Autism Helper. There are areas for improvement in the relationship between ABA and OT, so Sasha shares her experiences and tips to help make the work more collaborative and effective. 

The differences in approach between the fields of ABA and OT present an opportunity to enhance both practices. By honestly touching on the pain points of this relationship, Mandy, Aditi, and Sasha recognize the benefits that each field brings to the table.   

HIGHLIGHTS

03:34 Shoutout to Jonathan Amey

04:14 Collaborating and misunderstandings with ABAs

15:35 Tools for collaboration for effective data collection

23:12 Tension, biases, and preferring ABA or OT over the other

40:28 Views on ABA and accountability 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

Sasha Long's Website - The Autism Helper

QUOTES

13:21 "My goal for this first meeting if I'm meeting a new clinician is not to sell them on my ideas. Because my goal meeting a client for the first time is not teaching a new skill. My goal meeting client the first time is to pair."

16:57 "I think asking people's opinion is always really helpful and just really keeping it super simple. Like what do I need to know, not what would I like to know. You got to go like need to know."

35:22 "You find connections. Like I tell behavior analysts this a lot, we're data people, when you go into a new meeting with a new parent, with an OT, with an IP team, you should be able to, in that session, find 3 connections with someone."

37:32 "The biggest thing, the biggest biggest biggest thing I think we can learn as OTs from ABA is learn how to take data because that's going to change the trajectory of our conversation."

42:38 "It can be collaborative, it can be fun, it can be safe, it can be televisable, it can be all these amazing things and that's, if we as a field can continue to move in that direction, I think collaboration will follow a lot more easily."

Spitting is a complex ADL that can be a real challenge to teach to kids in the spectrum. Especially when kids are nonverbal or have conditions like pica, ABAs and OTs have to use prompts as imitation and language are simply ineffective.  

They discuss the case of Andre and how strategies like TAG teaching and tools like straws were effective in teaching mouth manipulation. They also discuss the many advantages of video modeling as a standardized way of teaching, as well as the best way social stories can be applied in toothbrushing.

HIGHLIGHTS

02:33 Shoutout to OTs who want to include data collection in their practice

03:50 Spitting as an ADL: Challenges for ABAs and OTs

08:23 Evidence-based strategies: What works and what doesn't

13:09 Case study: Teaching Andre to spit  

26:46 How to effectively use video modeling, straws, and social stories 

GLOSSARY

Hyporesponsive (low proprioceptive awareness) - Not having as much awareness (like your mouth because you cannot see it) resulting in difficulty in imitation skills 

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

Dr. Kimberly Berens' Website

"How to Brush Your Teeth with Snappy Croc" Book by Jane Clarke

QUOTES

08:06 "Spitting is really important for so many things and it's also sort of a manipulation of the mouth that is important for other skills like speech, etc if you have a child that needs that type of oral motor movement."

23:28 "We have a range of whistles, about 12 different whistles with different intensities and we just ordered a lot of different ones and then we rated them. That is a way of measuring and breaking it down when you're getting increased force in order to make a sound out of a whistle."

25:37 "The great thing about using a clicker is... that when you tag the response, it's immediate and it's the same every time, so it identifies that that's the exact approximation of the skill that you're looking for."

32:44 "Why it is that child might be more proficient in one learning channel like seeing something and saying it or hearing it and doing it, as opposed to other learning channels, is not necessarily that they're better in that channel, they've just had more practice and more reinforcement in that particular area."

38:32 "Maybe where social stories can in is where we're teaching sort of consequences of not brushing teeth well or perhaps the effects of sugar without toothbrushing. So trying to do some education around oral hygiene as opposed to actually how to brush your teeth."

Habitual behaviors can be interruptive on a student's development. In this episode, Mandy and Adito discuss the case of Matt's detrimental nail biting and skin picking and the effective strategies they use to reverse it.  

Mandy shares her own struggles with nail-biting and her own personal strategies to extinguish this behavior. Mandy and Aditi also dive into the deeper reasons behind these automatic behaviors and how the differences between attention-maintained behaviors, habits, or something else can modify the best approach to replace them. 

HIGHLIGHTS

03:57 Shoutout to Dr. Rick Kubina

06:01 Matthew's nail picking: Strategies to address nail biting 

16:53 Mandy's strategies for nail-biting habit reversal

30:28 Applying reinforcement and environmental strategies

GLOSSARY

Comprehensive model of behavioral management - Has 5 categories: sensory, cognitive, affective (emotional), motor, and place and environment. 

Automatic escape maintained behavior - Any behavior that primarily happens to avoid, delay, or end something unpleasant. Over time, the behavior is maintained or persists because it was effective at escaping or avoiding the unpleasant thing in the environment.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

QUOTES

09:29 "We're talking about, in this episode, about behavior that is automatically maintained or habitual in nature which means they're not doing it for someone's attention or to get out of demands but it is repetitive and embedded behavior that the individual's no longer aware of."

12:28 "When you are engaging that behavior, it stops you thinking about something unpleasant for periods of time. That's one. So a behavior analyst would call automatic escape maintained behavior."

24:29 "If a behavior is not reinforced it will extinguish so having someone do something else that is a replacement behavior can result in extinction of that original behavior."

37:33 "His behavior was very much attention-maintained. So yeah, that's another thing to look at. Is the behavior maintained by something else occurring in the environment, not just habit."

38:43 "You allow the student to engage in a behavior and you provide different consequences so you run sessions of it being reinforced with escape from a demand or reinforced with attention. Or the student is just left on their own and you look at the rates of that behavior in that session time and you see where the rates are at their highest."

Telehealth consultations have unique problems that are magnified when addressing challenging behaviors in kids. From distraction to motivation to parent training, we discuss the most common problems and tangible tips to improve student engagement.

It is critical to first teach parents the basics of reinforcement for them to follow through with the necessary changes that make virtual consultations effective. Kids act very differently at home so learning how that environment is like is also necessary information for OTs and ABAs who have to maximize the effectiveness of telehealth.

HIGHLIGHTS

01:29 Shoutouts to the OT profession, Autism Awareness Month, and Dr. Jana Cason

07:28 ABA challenges with telehealth

10:27 Case study of Lena: Parent training and motivation

20:45 Strategies to create a motivating environment

27:27 Basic tips for reinforcement 

35:16 Virtual learning, environment, and scheduling 

GLOSSARY

Extinction burst - The phenomenon of a previously reinforced or learned behavior temporarily increasing when the reinforcement for the behavior is removed.

Behavioral momentum - Reinforce easier tasks followed by a harder task and then reinforce the completion of that harder task.

Variable-ratio schedule - A schedule of reinforcement where a response is reinforced after an unpredictable number of responses.

Behavioral contrast - A change in the strength of one response that occurs when the rate of reward of a second response, or of the first response under different conditions, is changed.

RESOURCES

Join our The ABA and OT Podcast Facebook Group to get access to the following resources:

Facebook group link: https://www.facebook.com/groups/397478901376425

EXTERNAL RESOURCES

Aditi's Website

Telehealthshare Website

"25 Tips to Increase Student Engagement in Telehealth" Ebook by Dr. Aditi Mehra

QUOTES

12:24 "Begin with parent training because you can put parents in a very, very difficult situation where they're going to strengthen and worsen behaviors because they don't have the skills to take instruction from a therapist over a computer screen."

15:27 "Motivation being something either a process of deprivation, in other words, to make a student more motivated is to deprive them of something that they like or to satiate which makes them less likely to want something."

21:27 "When you create an environment that the deprivation of that thing is contingent to doing a behavior then you can increase somebody's motivation. If they get it for free all of the time, then they're unlikely to want to do anything for it."

28:05 "Reinforcement is a process whereby something that has consistently been provided after behavior, some sort of change in the environment, has resulted either in a behavior increasing or reducing. So we know that consequence is functioning as a reinforcer."

39:24 "The first thing is really assessing that environment, parent interview, asking them what they normally do in that type of occurrence because work refusal over a screen, that's not the only time that student is going to be engaging in work refusal."