What strategy?
BT Kim is practicing the Premack principle that her supervisor taught her. She tells her client, North, "First homework, then tablet." North finishes her homework. Kim says "Now we can do flash cards." North throws her cup at Kim's head. What went wrong?
Follow-through!
Premack principle (first/then statements) should be met with consistent follow-through on the "then" that was contingent on completion of the "first" to maintain trust with our clients.
BT Spongebob is working with client Bluey on Receptive ID in the living room. Bluey's sister, Bingo, is watching their favorite YouTube videos, ASMR crushing videos. Bluey keeps looking at the tv and choosing whichever card is closest to her right hand. What is the barrier?
The environment. Bluey is never going to focus on work trials with her favorite YouTube video playing in the background. Spongebob can ask Bingo to pause the TV, or move Bluey to the kitchen table where she can't see the TV to maintain her attention.
BT Huggy Wuggy is playing soccer with client and his sibling. Client kicks the ball into his little brother's face and his little brother's nose starts bleeding. What is the crisis?
There is no "crisis." Document in your session notes and ensure you inform parents if they weren't present.
BT Joey has a client who struggles with eloping behaviors. Mom goes to get his client's brother from the school bus and leaves the client with BT. BT Joey updates his notes while his client gets a chair, unlocks the door, and runs outside. BT Joey looks up, but continues working on his notes. What should have happened?
BT Joey could have blocked the door, chased after client, yelled for mom to alert her.
BT Khloe is using timers to assist in transitions. Khloe's timer for break goes off, but client Kanye is not done with his numbers worksheet, he still has three lines. Khloe says "let's finish these three and then you can have a break." Kanye rips up the sheet. What went wrong?
When using a timer to show a client how long to engage, especially with non-preferred tasks, honor the end of that timer. It can destroy rapport if we only honor the time when it comes to their breaks ending.
BT Patrick is doing sessions in his client Peppa's room. Peppa and her little brother George have ALL OF THE TOYS. Every time Patrick holds up a card for Peppa's tacting goal, Peppa starts playing with one of the many toys in the room. What is the barrier?
When we say "sterile" environment, we don't mean Lysol and a hazmat suit. We mean an environment free of distractions. Patrick would have more success if they worked in a different room, or put the toys away first.
BT Catnap goes to his planned 4:00-8:00 session and finds out his client has diarrhea. Catnap says "that's okay, I'm not worried." The next day, Catnap has to cancel because he now has diarrhea too! What's the crisis?
We should never have session if the client is experiencing vomiting or diarrhea within 24 hours of session to ensure that it does not spread and that our clients get the rest they need.
BT Lance has a client who engages in climbing behaviors. His client's mom places their favorite candy on top of the fridge. While working on identifying household items, the client climbs onto the counter and on top of the fridge. Lance says "Jump to me" and client jumps, but Lance falls down and both Lance and the client are injured. What should have happened?
BT Lance could have immediately intervened when the client climbed onto the counter, redirected client to a preferred item and offered a break, used a safety huddle around client, yelled for mom to assist.
BT Kourtney has a client who is into sensory toys and recently started exhibiting the behavior of mouthing. Kourtney is not adding this into her notes, is not collecting ABC data, is not telling the supervisor. One day, she brings him Play-Doh and slime, which he keeps eating. Angry mom Kris calls the supervisor, screaming because the client has developed a GI blockage from eating the play-doh. Kourtney says it's okay because "it's vegan." What went wrong?
When we observe a new behavior, we should document the behavior, as well as what happens before the behavior and after, in our daily session summaries. When we notice it is frequently occurring, we should drop a message to our supervisor right away! Also... no eating the play-doh, vegan or not.
BT Sandy is practicing a new goal, safety instructions, with her client in their neighborhood. Every time they see Mr. Krabs walking his dogs, client runs to pet the dogs, even is Mr. Krabs is across the street. What is the barrier?
The dogs are adorable. But maybe this new goal should be practiced in the home or in the backyard until instructional control is demonstrated with the client to prioritize client safety.
BT Kissy Missy gets bit by her client on the arm. "Tis but a flesh wound," she says and keeps going to session, she doesn't tell anyone. Every day, Kissy Missy develops a desire to eat meat, then flesh, then brains. One day, mom calls the supervisor because Kissy Missy just took a bite out of the family dog. What is the crisis?
BT Kissy Missy should have reported the incident to her supervisor, completed an incident report, and called our Paradigm triage nurses to assess whether she would need an anti-zombie shot.
BT JC is outside with his 7-year-old client, who is playing with their scooter. BT JC says that he knows how to do a jump with a scooter and shows his client how to do the trick. While working on his session notes and debriefing mom, the client tries to copy the jump, falls on the pavement, and splits his chin open.
BT JC taught the client something dangerous. To make the scooter more interesting, BT JC could have drawn a race path with chalk, or played a different game not involving the scooter.
BT Kendall was told by her supervisor to collect ABC data for her client, Kylie, on her new climbing behavior. Kendall has never taken ABC data, so she writes in her session summary: "Kylie climbed today, but she didn't do her ABCs when I asked."
If Kendall was unsure about any procedure, she should ask her supervisor for help.
And for the record....
A - antecedent (what happened before the behavior)
B - behavior (the actual behavior of interest)
C - consequence (what happened after the behavior)
BT Gary (MEOW) has a client who throws anything and everything. When it's time to color, Gary gives his client a 64 pack of crayons. When Gary says "Coloring is all done, time for that goal you hate," his client throws the crayons. What is the barrier?
When a client engages in a behavior, such as throwing or climbing, it's best to limit access when we can. For Gary, this could be giving his client 3 crayons at a time and having his client return them for different crayons instead.
BT Pianosaurus is making crafts with his kiddo. Pianosaurus makes excellent crafts. Pianosarus runs to the bathroom because the Taco Bell he had for lunch just hit and he leaves his client alone. But don't worry!! Piaonosaurs told his client "do not touch the hot glue gun!" Shockingly, his client touched the hot glue gun anyway. What is the crisis?
Pianosaurus not only created an unsafe environment, he left client alone in that unsafe environment.
BT Justin has a 7 year old client who is aggressive. Client's younger sisters are the biggest trigger. BT Justin wants his client to practice the brand-new goal that the supervisor added that day, "Coping Skills," so BT Justin invites the younger sisters to play Uno with the client. After 3 minutes, the client begins punching his younger sister in the face when she makes him draw four. BT Justin yells "What can we do when we get angry, friend?"
Instead of involving sisters immediately, BT Justin should have worked 1:1 with his client on the new goal, coping skills. BT Justin could have modeled them, practiced them with his client, and controlled the environment by modeling the coping skills to the client whenever BT Justin lost, and prompting the client to engage in them whenever the client lost.