Goals and Objectives

Goals:

          Goals represent where you want to go.  MBOs represent the steps needed to get there.

Goals should be:

          Positive, well supported, logically tied to both formal and informal assessments---and developed/gleaned from desired outcomes.

Goals should always be set in full partnership with family members, the participant, and/or guardian.

MBOs should be:

1.     Contextualized within natural routines and/or desired natural routines.

2.     Some MBOs can lead (or provide logical steps) to MBOs which are contextualized within natural routines, and/or desired natural routines---IF there is a clear, parsimonious, path to the natural routine.  (For example: a pilot may spend many hours in a simulation responding to various potential situations.  Those simulations mirror the actual situation as closely as possible, while the pilot is not actually flying the plane.  Someone with ASD (autism) may practice making a purchase in a simulated or practice store and speaking with the practice cashier before going to the actual store and making the purchase.  A common mistake of some interventionists is incessant practice without actual implementation.  For many, modeling or coaching, in the actual natural setting, making a purchase the child or adult may want or need to make, is the more practical intervention.  This may also include some pre-coaching for the cashier and include prompting.)

This may also require going to the store at optimal times when the store is not as busy and when the individual is neither tired nor stressed.  It may require some adaptive equipment or clothing to reduce difficult stresses or stimuli.  Sometimes something as simple as a hoodie, sunglasses and/or headphones can be helpful depending upon the individual needs of the person.

What???

          MBOs should be contextualized within the natural routine and environment; however, sometimes one must take steps to get to this point---as quickly as possible.

MBOs should:

          Use… as much as possible, Natural Reinforcement In lieu of Contrived Reinforcement.

For example: if a child asks for a hug, the natural reinforcement is a hug.  The contrived reinforcement (and an unhealthy substitute) might be a piece of candy.

Another example: someone makes a desired (based upon their current expression of the desire) peanut-butter and jelly sandwich after work or school and then gets to eat the natural reinforcement, the sandwich.   

As a child, you may have received a contrived reinforcement for cleaning or keeping your room clean.  Today; hopefully, you have a different and more natural reinforcement for keeping your home or apartment clean.  This natural reinforcement may be an internal feeling and/or social responses from visitors and/or permission from your landlord to continue to rent or lease your apartment.

While you may feel a sense of accomplishment and purpose for doing the work you do, in most cases, you will also expect a paycheck.  The paycheck, is a natural reinforcement.  It is something that naturally flows from the work you do.

You may think of it this way.  A contrived reinforcement might be considered a bribe.  A natural reinforcement may be considered a logical payment, consequence, outcome, or product for your efforts.  Both bribes and payments come in many forms.  Both can be monetary, social, physical, edible, etc.

A well written MBO will:

1.     Identify the learner (target of the intervention) [WHO]

2.     Identify the target behavior in measurable terms (what is the person supposed to do) [WHAT]

3.     Identify the Target Stimulus or Cue that will clearly tell the person it is time to do the target behavior. [WHEN]

4.     Identify the criteria for acceptable performance. [HOW] will we know the objective has been accomplished. 

Why are Measurable Behavioral Objectives (MBOs) so important?

When well written, and based on a functional behavioral assessment, correctly implemented, and adjusted as needed (no longer than every six weeks), they simply provide:

BETTER OUTCOMES!

So… Why else are MBOs so important?

They, with well written goals, provide:

A clear, unambiguous map to the desired destination (outcome).

To test this on your objectives, write a practice MBO and give it to a group of people without any additional explanation and see if they all carry it out the same… as each other, and as you had intended.  You may want to try something silly and different from what you might typically write.  For example, write an objective on making a peanut butter and jelly sandwich, or some other very simple food preparation.  You may want to try writing a measurable behavioral objective on tying a shoe in an unusual way, or some other fairly-simple task done in an unusual way, so the person must follow your directions, not just do what they have always done.

A measurable behavioral objective is the core of the intervention plan.  The goal is where you want to go.  Objectives are the steps or path to get you there.  You may have a goal to travel to Katmandu or Timbuctoo.  You may have a goal to travel to Brussels Belgium or Paris France, or Paris Idaho (USA).  However; if you have no plan on how to get there, no map, no GPS, no means of travel, no resources; are you likely to ever arrive at your desired destination.  Such things are very unlikely to occur, just by chance.

A quality MBO is parsimonious!

1.     As short as possible.

2.     As simple as possible.

3.     Succinct.

For additional clarification (of your MBO) attach:

1.     Charts.

2.     Visual: Schedules or Cues.

3.     Operational definitions.

As needed.

          Keep your MBO parsimonious.  If additional clarification is needed, attach clarification to the plan, but also keep the additional clarification as simple as possible.

A well written MBO and plan will:

1.     Be written in full partnership with primary care providers, such as parents, grandparents, other family members, foster parents, etc.

2.     Be written in full partnership with the intended recipient of services, to the extent possible.

3.     Always protect the safety and dignity of the intended recipient and all others involved.

Start with OUTCOMES!

1.     What does the individual want to be able to do or do differently?

2.     What does the family want the individual to be able to do or do differently?

3.     What does the individual need to do or do differently to be able to function better or well, within his or her natural routine?

4.     What are the current and desired natural routines for the individual?

5.     (Within the family and non-clinical natural environment, without the presence of a therapist or interventionist… with family and/or typically developing peers, what is the person doing now?  What is the desired change?  How will the behavior look differently?  What will the individual be doing differently when the objective has been achieved?)

Write this out.

What is the current situation?

1.     What is the current routine?  What is the environment of that routine?  Is this the natural environment for the routine?  Is this where a person would/should typically be doing or performing this routine?

2.     What are his or her current skills and behaviors?

3.     What are the current baselines (according to objective data) for the desired behavior, task, and/or response?

Write this out.

WHY?

1.     Why is the individual doing what s/he is doing now?

(The answer to this question may be best learned from a thorough, professional, Functional Behavioral Assessment, which includes a Functional Analysis of Behavior.  This is often conducted by a Board-Certified Behavior Analyst, BCBA.  The answer may also be due to the stages of development, not attained or skills which have not been learned.  It may be caused by setting events as will be discussed later.)

There are ALWAYS reasons for behavior, (appropriate or inappropriate) an underlying need has often been met through or because of the behavior.  IF the behavior is inappropriate, are there other ways for the individual to meet the underlying need?   If the behavior is basically appropriate, is there need for improvement?  Is the child capable of doing the desired behavior?

Write this out.

Well written objectives are… almost always:

1.     Measurable (ALWAYS)

2.     Observable (Almost always.  On occasion, they are observable only by inference or ancillary information or observation.)

3.     Repeatable (Almost always. On occasion, they may only occur once. An example would be the flower girl at a wedding.  There may be many practices, but only one final application of the desired activity/behavior.)

Measurement (of an adjective) must be:

1.     Valid (measure what it is intended to measure.)

2.     Reliable (measures the same: across time, people, and situations.)

Validity:  Be cautious about:

1.     Multiple variables.  (While you may have more than one variable, more always complicate the issue.  It is more difficult to know what has caused what, and it becomes more difficult to measure.)

2.     Maturation.  (Sometimes, quite often, children and adults change over time due to variables not associated with your intervention.  This can include simple maturation due to aging and natural association with peers.)

3.     Observer bias.  (If you are not especially cautious, it can be very easy for your bias, the bias of the interventionist, or others to impact the outcome and taint the data.  There are ample examples of this occurring in research, surveys, and other data collection.  There is a very old joke about a panel of interviewers hiring a statistician.  Each time at the end of the interview someone on the panel writes “2+2=” on a whiteboard.  The final interviewee and the one who gets the job, leans over and whispers: “what do you want the answer to be?”  Observer bias does not need to be that overt.  Simply having a desire for an outcome can cloud objectivity.)

All of these, WILL alter the validity of your data if you do not take appropriate precautions.  While the intervention may or may not be effective, altering the outcomes of the data or failing to mitigate the effect of potential confounders of validity, such as those listed above may make the intervention appear effective, but will not make it so.

What does it mean to be Contextually Mediated?

Goals without the right objectives is like trying to travel to a distant location where you have never been, without a map, guide, or gps. Objective.  A behavioral outcome statement, developed to address specific steps a participant will need to take to accomplish a goal.  An objective is written in measurable terms that specify: the learner, the desired behavior, the cue to signal the participant it is time to complete the behavior,  a target date for completion (no longer than six months in duration), and include criteria for successful attainment of the objective.

Contextually mediated is simply placing something in context.  In this case, placing the skill into the setting and within the natural routine and with the natural caregivers where it will be used.

Why is contextually mediated important… even essential for significant sustainable progress and change?

For any of us, most of our actions, most of our behaviors, are governed by our old brain.  Habits are controlled primarily by the basal ganglia.  Our autonomic nervous system works out of our old brain.  Heartbeat, breathing, etc. are all primarily functions of the old brain.  I say primarily because we can, using our cognition (new brain), stop our breathing for a time and slow or speed our heart rate; but the primary control still resides in the old brain.

Most of what any of us do from day to day is driven by habit.  Habits are primarily responses to cues or triggers within our environment and natural routine.  When you drive a car, most of what you do is through habit.  This is essential because it allows your cortex to focus on potential dangers, such as the child running into the street after a ball.  Most of our eating is also in response to cues and driven by habit.  I go into a great deal more depth in: Avoid or Reverse Type II Diabetes: Choose Health, Life, and Love: Food Addiction, Binge Eating, Addiction Recovery (Sixth Edition or later).

Most of our habits are context dependent or semi-dependent.  Many of us sleep better in our own bed than in a hotel or guest bed.  We typically function more efficiently in our own office, classroom, or other familiar environment.

Let’s take a sleep deprived parent as an example.  S/he may not be getting much sleep because the child who has autism (ASD) is not sleeping well.  A good therapist, providing excellent intervention, first response would be to look for setting events.  Things in the child’s life that may be keeping him or her from getting to sleep quickly and sleeping well through the night.  These may be routines in the home, medical conditions, diet, etc.  If there were no medical or dietary issues, this therapist would look to the routines in the home and work to condition child and parent towards better sleep hygiene and optimal sleep.

The therapist would understand there are or can be natural cues or triggers within the home which can help, both the child and parent.  The bath and bedtime routine, meal routine, ultradian rhythm, circadian rhythm, daylight and darkness, all present natural cues that can tell the child it’s time to go to sleep.  Within this natural routine are internal cues, such as fatigue, and external cues, such as smells, sights, sounds, and perhaps the warm, moist feel in the shower and the bathroom after the shower or bath.  There may also be natural physiological changes that occur after drinking a warm glass of milk or eating some white string cheese, banana, tart cherries, or consuming a small amount of melatonin.

Within this natural routine, some which an interventionist may help create or adjust with the parent, are potentially hundreds (no exaggeration) of cues which can help both the child and parent get a better night’s sleep.

The same is true of other routines in the home, shopping, at a restaurant, another family activity, and in the classroom setting.  The closer to matching the natural routine in the natural environment with the typical consistent caretakers, the easier it is for the child to learn new productive skills.  The more contextualized, the easier it is to develop new, healthier, productive, habits.

There are hundreds, sometimes thousands of cues associated with routines which help us navigate our world.  Some of these cues are nuanced and slight, some are powerful.  Disregarding these cues for the positive benefit of the child, significantly reduces the benefit of any intervention.

Yes, it is important to generalize, but first create positive productive habits contextualized within the child’s natural routines, in their natural environment, with consistent parents and caretakers.

Once a positive productive habit has been established, you can add variation.  This may be slowly or quickly.  As you do this, you will likely need to return to the old familiar routines, now habits, from time to time or perhaps frequently.  However; you can begin to stretch the child beyond their new zone of comfort, creating a wider and wider zone of comfort with variations on the routine and new skills.

(A much more expended view of setting events will be discussed in an appendix at the end.)

Writing Contextually Mediated Measurable Behavioral Objectives (MBOs)

What this book will provide:

1.     Basic information on the essential elements of a Measurable Behavioral Objective (MBO)

2.     A template to guide you in the creation of an individualized, effective, quality, contextually mediated Measurable Behavioral Objective

3.     Basic information on the importance of a Measurable Behavioral Objective (MBO)

4.     Basic information about the relationship between the MBO, Plan, Goal, Data, and Assessments.

5.     Why “contextualized” is essential for significant sustainable progress.

6.     Setting event essentials.

What this book will not provide:

Templates that will allow you to simply change the name and apply to your person (client, participant).

(MBOs must always be individualized to the person, situation, and objectives.  Anything less is a huge disservice to the individual and whoever is paying for the intervention.)

ALWAYS individualize for the person AND context.

The following is best understood by reading in order

What does it mean to be Contextually Mediated?

Why are Measurable Behavioral Objectives (MBOs) so important?

Goals and Objectives

Criterion data:

Plan Implementation Template

More on Goals

Working with parents and guardians

Foundational Setting Events

Parsimonious checklist for Family Centered Planning

Reinforcement and Crisis