HB Policies
Does the BACB expect you to follow Hopebridge's policies, even if they are not in the BACB RBT Handbook?
Yes, 2.02 - follow the direction of supervisors.
It's time to transition. Your patient has their PECS book, you have their schedule and tablet. They have been primed where you are going and told that a preferred item is available there to earn. Your patient drops in the hallway and starts crying....what do you do?
2. Remain with them and scan for nearby dangers. If any are present move them (NOT YOUR KIDDO) or call for assistance.
3. Begin data collection for tantrum or dropping if applicable. Provide empathetic statements and differential reinforcement of appropriate alternatives (reinforce what they are doing right) and prompt/reinforce incompatible behaviors (taking a drink instead of crying, sitting up instead of laying down).
4. Once de-escalation occurs/tantrum ends, probe for compliance if needed (patient is not showing you they are ready to go). Prompt simple compliance (high-five, say name, stand up) and then re-state where you are going/what they are earning ("We're going to the bathroom, first bathroom and then bubbles") - it is safer to have the behavior increase again where you know the area is safe/you are ready for them.
5. As soon as ANY prompt is met, reinforce! Use behavior-specific praise while walking to the next location, continue DRA.
6. Provide reinforcement when demand is met. If demand is no longer available/reasonable - find appropriate demands to reinforce so that your kiddo is still meeting frequent reinforcement.
7. CALL FOR HELP WHEN NEEDED - Call a float when you need an item, Call code green for behavior help!
Whose name goes into a session note?
Anyone with you during your session - BCBA, trainer, shadow, someone who provides a break, a parent if they come to observe part of a session.
What is behavior momentum?
Using easy or known demands to build up to a harder one to 'ease' into compliance and build momentum towards a harder task since you've given reinforcement/praise for easier tasks.
How do you establish assent for physical responding?
Your patient does not move away from physical prompts, they are relaxed, they do not engage in maladaptive behavior when prompted, they do not say 'no'.
True or False: You MUST hold hands with your patient when you are transitioning INSIDE and OUTSIDE (unless working on 'stop' or 'come here' goals per your BCBA)
True
What can you do if you know it's time to do something your kiddo doesn't like?
1. Preference assessment to know what is motivating and HAVE IT READILY AVAILABLE.
2. Establish that that reinforcer is available/prime you kiddo that it is almost time to move from reinforcement to 'work' - "In 1 minute we're going to earn bubbles!". Remember, this is individual - some kids love DTT and find the gym aversive. Use that minute to get materials/ReThink/reinforcers ready.
3. Build up throughout your session. Example: G struggles with transitioning from tabletop reinforcement -> DTT. Run pairing targets to accept relinquishing to an adult and maintenance DTTs first. This will allow you to establish yourself as a reinforcer (you give things back) and he can easily meet reinforcement with maintenance targets to establish that he can earn with you.
4. When a kiddo is struggling drop the demands for awhile - following directions like sit down can count towards their reinforcement schedule - not just the DTT targets. Once they are regularly complying, begin to increase the demand to only counting DTTs towards their reinforcement ratio.
5. Continuously use specific verbal praise and any token economy. Then, IMMEDIATELY provide reinforcement - we want a STRONG connection between completing work and receiving reinforcement.
Where else should times in and out be besides your session note?
When a kiddo engages in safe, but undesired behavior, how can you react?
1. Reinforce appropriate behaviors
2. Minimizing attention to undesirable behavior.
3. Prompting a functionally-equivalent desired behavior.
When do you use response blocking and physical redirection?
Your kiddo can potentially hurt themselves or someone else.
What happens if you are in a group and another kiddo asks you to play, run, or go on a wagon ride? How do you stay within arm's reach of your kiddo?
You will SWITCH places with the other kiddo's RBT for a few minutes to engage in these activities. They will remain in arm's reach of your kiddo and you will with theirs.
Your kiddo has been out sick for a week...what antecedent procedures can set them up for success?
1. Run a preference assessment - they may want different things if they don't feel well (comfort items) and may have gained a new preferred activity while at home.
2. Thicken the reinforcement schedule - provide specific praise and reinforcement for tasks that are typically easy for them (transitioning, sitting down, waiting, etc.).
3. Use NET to maximize engagement.
If you are pairing with a patient, or have a short session because they get picked up early, what is the minimum number of data points in your note?
3
What are some coping skills we teach?
1. Asking for help, asking for more time, asking to stop something they don't like, asking for a break
2. Taking deep breaths, starfish breathing, squeezing hands together, etc.
3. Problem solving/asking for an alternative
What do response blocking and physical redirection look like?
GENTLY preventing a behavior from occurring (kicking a wall) OR guiding them to a safer area. Children are NEVER CARRIED WHEN ESCALATED or held up by their underarms to walk.
What does active engagement look like?
Patient is engaged with you/what you are presenting, patient is following directions or you are following through prompt hierarchy, patient is engaging in the session - not just passively playing/watching tablet, patient is continuously communicating wants/needs, patient shows enjoyment throughout activities.
How can you stage the environment as an antecedent intervention to maladaptive behaviors?
Position yourself between your kiddo and the door, have preferred items unavailable unless reinforcement is earned, have necessary items readily available for your kiddo (PECS book in arm's reach, visual schedule, token board, etc.), have the table cleared.
When should you do your session note?
You can start and save during your session, during the last 15 minutes of your session while you are pairing with your patient, and at the end of your day at Hopebridge. Session notes are due the day you had the patient.
Your kiddo jumps off a stack of blocks in the gym. What is a positive way you can redirect them?
Trampoline. It is immediate, functionally equivalent (sensory input).
When do we use Crisis Management?
When the risk of not using it (allowing the behavior to occur) is a larger risk than using it. Examples: Head hitting that can cause concussions, physical aggression that can severely harm another person, property destruction that includes breaking windows/doors. WHENEVER YOU FEEL LIKE THIS IS A POSSIBILITY, CALL CODE GREEN, EVEN IF THE BEHAVIOR HASN'T OCCURRED YET.
How do you maintain active engagement?
Conduct frequent (at least hourly) preference assessments and use reinforcers based on them, Provide clear/reasonable expectations (make sure your kiddo can reach reinforcement), Adjusting tasks/Lowering demands temporarily and building back up if you can, use NET when you can, fine frequent opportunities to engage (stage the environment).
How can you stage the environment to promote NET?
Mand for missing items - remove the item and then ask patient to complete a task with it.
Social Play - arrange preferred activities near peers.
Peer imitation - have peers engaging with highly preferred activities
I had to cover a novel patient and there's no note in Hope Note. What do I do?
Teams the BCBA, Kathleen, and Amber on a single message to add a session note. If it is the end of the day, you can write the note just like you would in Hope Note and message it to us. You will still have to add it to Hope Note later.
Describe when we use non-contingent reinforcement (or JavCar's NCR program and why we run it).
NCR is usually used when a behavior occurs at high rates, and/or replacement behaviors occur at low rates, and it is unlikely that the kiddo will be able to earn reinforcement regarding that behavior. Example: JavCar would elope 50+ times a day (eloping before reinforcement could happen). NCR started at every 3 minutes we would prompt him to go on a walk. Elopement now occurs 2-3 times a day and NCR has been stretched to every 7 minutes.
When should you evacuate a room with your kiddo if another kiddo is upset?
If your child will engage in maladaptive behaviors or show signs of discomfort, if you are prompted to, if a code green is called, if you feel that your safety/your child's safety is at risk.