discuss how you would approach Kaitie’s parents as resistant clients. What barriers would prevent the development of an effective rapport, and what strategies would you suggest to use as a means to establish a therapeutic relationship

Consider that you are a Behavior Analyst that has been assigned to work as a supervising BCBA for a home program for Kaitie, a 4-year-old girl who has been diagnosed with autism.  She attends a special education preschool program for students with ASD and Communication Disorders in a self-contained classroom, where she receives Physical Therapy, Speech Therapy, Occupational Therapy, and Discrete Trial Teaching (DTT) as part of her half-day program. Kaitie is mostly non-verbal, emitting only a few basic words such as “no”, “more”, and “I-Pad”.  Most other times, Kaitie will engage in squealing noises, crying, or whining as a way to express herself.  Occasionally, she will engage in tantrum behaviors such as hitting, kicking, and flopping on the floor if her needs are not met quickly enough.  Kaitie’s parents have heard about Facilitated Communication as a “miracle”, and ask you about implementing a plan to include it into her program since they are eager to increase her language development.  You explain that Facilitated Communication is not an evidence- based practice and therefore, you cannot recommend it as a treatment option. Upon hearing that, Kaitie’s parents become a bit resistant to your recommendations, and seem doubtful about her developing home program.

Kaitie’s home program is contracted for 15 hours of services per week, most of which are to be provided by two Registered Behavior Technicians (RBTs).  There is also a parent-training component, in which you, as the BACB, provide to parents for 2 hours per week to assist with supporting parents to become active participants in Kaitie’s program, particularly to enhance the maintenance and generalization of skills learned during her therapy with the RBTs.

Part One: Develop a Rapport

First, discuss how you would approach Kaitie’s parents as resistant clients.  What barriers would prevent the development of an effective rapport, and what strategies would you suggest to use as a means to establish a therapeutic relationship?

Part Two: Verbal Behavior Assessment & Intervention

Next, outline the process that you would use to establish Kaitie’s verbal behavior program, including the specific assessment and teaching methods, providing a clear rationale for your decisions.  Present an overview of your assessment instrument and the hypothetical results related to the existing and target verbal operants in Kaitie’s case.  Based on the results, discuss how you would set up a treatment program using Discrete Trial Training and how you would provide effective management and supervision to the RBTs who will be facilitating the DTT program.  Then, discuss how you would consider maintaining and generalizing Kaitie’s behavior as part of the parent-training program.  Choose a naturalistic approach in which parents can be taught to implement procedures that will generalize Kaitie’s language skills into the natural home and community environments. Finally, explain the facets of Performance Management that you would adopt to support your RBTs and Kaitie’s parents with the successful implementation of the intervention plans.

Part Three: Evaluate the Program

Describe how you would assess the overall effectiveness of the home program, and what steps you would take if (a) goals were not being achieved in a timely manner or teaching procedures were not effective and (b) steps you would take when behavioral and instructional goals are met.

Part Four:  Important Considerations

Throughout your discussion, specifically, outline each of the key ethical considerations that will support the necessary steps in the assessment and intervention process. Be sure to use the BACB Professional and Ethical Compliance Code (2014) as a framework, and take careful thought in supporting your discussions with specific codes and relevant rationale. Also, include a discussion to address any potential legal, cultural and social validity issues (10 – 15 pages).

Effective use of replacement behaviors will result in a decrease in the associated behavior targeted for reduction.  The use of these replacement behaviors should be prompted as necessary across various settings and with various caregivers to ensure generalization.

 

Maintenance will be ensured through weekly probes of mastered skill items.  The supervising behavior analyst will use contrived situations to ensure the maintenance of skills and the generalization of those skills to novel situations.

Fading behavioral services when goals are met. Behavior Analysis services will be faded as services providers and family members are trained to successfully implement procedures and target behavioral objectives have been met.  Services are requested at a frequency of 1 hour per week, to provide ongoing monitoring and training of caregivers and the supervision of Behavior Assistant services.

 

Upon attainment of a 50% reduction in the frequency of Behavioral concerns, Behavior Analysis services will be reduced by 50% per week.  This will allow for extended observations in the family home and community, for revisions to program procedures, and for the supervision of Behavior Assistant services.  This level of supervision will be required until the frequency of target behaviors falls below 95% of baseline, and remains stable as the Behavior Assistant services are faded.

 

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