What's Wrong?
Tantrum:
Any instance of 1 or more of the following behaviors for longer than 20 seconds: screaming/crying, yelling, kicking, hitting, throwing on floor, ignoring directions, and occasionally throwing up.
Tantrum needs 2 or more bx to be considered a tantrum!
20 seconds- too long of an interval. If it happens from 1-19 seconds, is it disregarded? Not best practice.
"Throwing on floor"- not objective, clear. Throwing what? self? items?
"Ignoring directions" - does not pass dead mans test, not a behavior
When are H codes used? Try to name a few!
H codes are recognized by Beacon.
H2012- in-vivo supervision
H2019- direct therapy by BT
S5111- PT w/ client present
H0032- reassessment/ data entry
Your client is a high functioning 8 year old who attends public school from 8-4 5 days/week. His parents would like support with social skills, but otherwise note he is very independent and smart. What is the appropriate recommendation for hours based on medical necessity?
Given availability and skills level, 10-12 per week
Teaching an early learner to engage in art activities:
Whats the best first goal to target?
1) imitating art sequences
2) attending to art for a 5 minutes
Imitation is the precursor!
Program Description:
What are focused based vs comprehensive based programs?
When are they to be used?
Focussed: increasing socially appropriate behavior (for example, increasing social initiations) or reducing problem behavior (for example, aggression) as the primary target. Even when reduction of problem behavior is the primary goal, it is critical to also target increases in appropriate alternative behavior, because the absence of appropriate behavior is often the precursor to serious behavior disorders. Therefore, individuals who need to acquire skills (for example, communication, tolerating change in environments and activities, self-help, social skills) are also appropriate for Focused ABA.
Focused ABA plans are appropriate for individuals who (a) need treatment only for a limited number of key functional skills or (b) have such acute problem behavior that its treatment should be the priority.
Comprehensive: treatment of the multiple affected developmental domains, such as cognitive, communicative, social, emotional, and adaptive functioning. Maladaptive behaviors, such as noncompliance, tantrums, and stereotypy are also typically the focus of treatment. Although there are different types of comprehensive treatment, one example is early intensive behavioral intervention where the overarching goal is to close the gap between the client’s level
of functioning and that of typically developing peers. These programs tend to range from 30-40 hours of treatment per week (plus direct and indirect supervision and caregiver training). Initially, this treatment model typically involves 1:1 staf ng and gradually includes small-group formats as appropriate. Comprehensive treatment may also be appropriate for older individuals diagnosed with ASD, particularly if they engage in severe or dangerous behaviors across environments.
Training family members and other caregivers to manage problem behavior and to interact with the individual with ASD in a therapeutic manner is a critical component of this treatment model.
Client will mand politely to gain access to preferred items, toys, activities, and routines. Client will also mand politely to terminate an aversive and will ask for a break, more time, etc. (90% across 2 consecutive sessions).
Should be separated into 2 different manding goals:
- request to access preferred items
- measurable? How many words, phrases?
- request to terminate
What are CPT codes and when are they used?
Anthem BC (commercial), Cigna, Tricare, and Magellan cases.
When summarizing Vineland reports, how many paragraphs should be written?
5:
Communication
Daily Living Skills
Socialization
Adaptive Behavioral Composite
Summary
What skill should be taught first?
1) asking WH questions
2) answering WH questions
Answering questions is the precursor to asking
Focussed or comprehensive based programs?
ZN
AS
DL
HS
LL
CGS
EIR
DD
PG
BK
MY
RJ
KV
ZN- focussed
AS- comprehnsive
DL- focussed
HS- focussed
LL- comprehensive
CGS- comprehensive but could transition to focussed
EIR- focussed
DD- comprehensive
PG- comprehensive
BK- focussed
MY- focussed
RJ- comprehensive
KV- transition to focussed by summer
Goal #1: Client will sit in a small group for 10 minutes, attend to the teacher or material for 50% of the period, and respond to 5 teacher SDs (i.e. instructions) (90% across 2 consecutive sessions).
-difficult to track accurately
- technically they just need to attend for 5 minutes?
- too broad, not behavior analytic in nature
- opportunity to respond to 5 teacher SD's consistently for data collection?
Which insurance(s) require RBT's?
Magellan and Tricare
With an EI learner, whats the most appropriate assessment tool?
VB-MAPP
When working with a non-verbal child, what are the first 3 steps/goals to target teaching communication?
1) pointing
2) eye contact, joint attention
3) PECS
You have a new client who is 13 years old with a mild/moderate diagnosis of ASD. She attends a SDC and is independent for the most part, she doe snot require an aid or special assistance. She has great communication skills and enjoys interacting with others. You conduct an assessment and fill out the VB-MAPP. Her FBA has 3 target behaviors, all defined appropriately following BCBA guidelines. You select 17 program goals and 2 parent goals based on assessment and skill level. The report is denied, why?
VB-MAPP is not appropriate for her age and skill level! What assessment method should be used?
What should the following be used for? What codes are these?
- ABPM
- ABCS
- BIA
- FAT
ABPM: "adaptive behavior treat protocol modification" in-vivo supervision
ABCS: "adaptive behavior treatment by clinical sup" aka direct as a supervisor
BIA: "behavior identification" assessments, reports
FAT: "family adaptive behvaior treatment" parent training
For general knowledge, name some assessment tools that are commonly used within the field. PP may or may not use them!
VB-MAPP
ABLLS
Vineland
MAS
You are working with a child who has minimal verbal skills (ex: approximates some single syllable sounds) and they are approaching 8 years old. Until this point, you have spent he last 3.5 years working on PECS, pointing and vocal imitation. What is the best plan of action for next steps?
Introduce AAC device!
Why?
In addition to PECS or as a replacement?
In addition to vocal imitation or as a replacement?
A client has very minimal social skills and the BCBA on the case added the following social goals. Are they appropriate?
- imitate others actions
-greetings
-sustained peer play
Typically, you would want to teach parallel play before sustained peer play. To engage in sustained peer play, the child would need to have independent play skills with peers.
What insurance(s) use their own format for reports?
Magellan
Typically 2-3 total.
Parent interview (sometimes in addition with 1 observation and sometimes separate)
2 observations of child in 2 different locations. 1 observation requiring assessment
When is the Social Thinking Model appropriate to use with our clients? Is this based on age, skills, parent requests?
When the child is able to cognitively process/understand these skills. EX: moderate -high functions kids, typically older with some precursors social skills.
Is the Social Thinking Model widely accepted in the ABA community? Why or why not?