Template or questions for problem behaviors:

Answer in writing:

What is the problem behavior?

What is the function of the problem behavior?

1.     What benefit is the person getting from this behavior?

2.     What might the person be avoiding because of this behavior?

A good functional behavioral assessment FBA by a BCBA will answer these and additional questions.

Go here for tools for an FBA http://weight-lossnewsandresearch.blogspot.com/2018/05/tools-for-conducting-functional.html

Remember the same problem behavior may derive different benefit in different settings, over time, with different people, and with satiation.  You can learn more about this in my book: Autism (ASD) Intervention: The Very Basics.

Answer questions in writing:

What are the Setting Events that may impact this behavior?

Quite often, understanding and resolving issues around setting events is all or more than half of the solution.  Medical, stress, dietary, environmental, schedule, and sleep issues, all can have a profound impact / effect on behavior.  (Aggression is often a symptom of either depression or fear.)  Additional information will be included in the appendix.

Also:  What are the immediate antecedents that may impact this behavior?

What will you do about the setting events and antecedents?

Do It!

What is currently reinforcing the problem behavior?

What will you do about this reinforcement?

Do It!

Remember: An MBO answers 4 questions:

1.     Who? (The individual receiving the intervention)

2.     What? (What this individual is supposed to do?)

3.     When? (When will the person know it is time to do the behavior? What is the target stimulus or cue?)

4.     How?  (How will you know the objective has been met?  What are the criteria for success?)

Example:

When (or Upon entering) Charlie enters his home, if he is wearing his coat, Charlie will remove his coat and hang it on the coat rack, beside the front door, without any additional prompts, within two minutes of entering, four out of five trials for three consecutive weeks.

Now:  Write your MBO.  Test it on coworkers or colleagues first.  Do not give them a verbal explanation, only what you have written.  In almost any situation, from time to time, others will need to be able to pick up your objectives and follow them correctly and consistently without any verbal explanation or the opportunity for questions and answers.  Make sure others can do this.  This will benefit them and the recipient of the service.  This also makes it easier for quality management and billing review.

For information on evidence-based practices, and many free resources for parents and providers, please see:

http://parentautismresources.blogspot.com/

Criterion data:

The more complex the MBO, the more complex the data.  The simpler the MBO, the simpler the data.

          Keep it as simple as possible, with as few variables as possible.

Data will: (if you have a good MBO and the data has been collected correctly).

1.     Tell you when the MBO has been met.

2.     Tell you when the goal has been met.

3.     Be graphed daily.

4.     Provide feedback to adjust the MBO and perhaps the entire plan as needed.

Plans and MBOs should be adjusted at least every six weeks.  If you are not making good progress, adjust, if you are making good progress and meeting objectives, adjust to the next steps.  Remember the saying attributed to Einstein: “Insanity is doing the same thing over and over again, expecting different results.”  This does not mean the entire plan needs to be rewritten.  A good plan will allow for and encourage adjustments to the plan and successive, progressive objectives, moving the individual closer to the goal(s).

Template or questions to ask yourself:  Answer in writing and before writing your MBO:

Who?  For example: Name of child or individual receiving the intervention.  If you are providing coaching to someone else, such as a parent, but the ultimate recipient of the intervention from the parent is the child, the who is still the child.

Who?

What?  For example: What specifically (in valid and reliably measurable terms) do you want the child or adult (if you are providing the intervention to an adult) to do?

What?

When?  For example:  When is the child/adult to do the desired behavior?  What is the target stimulus or cue for the child/adult that it is time to do the behavior?  (Whenever possible use or systematically adjust the MBO to use naturally occurring cues.  For example: when hungry, or when s/he enters the home, or when finished eating, --- or slightly less natural, when the alarm goes off in the morning.)

When? 

How?  How will you know the new or improved behavior is sufficiently consistent to move on to a next step?  (You may also want to consider and submit in writing in another part of the plan, how you will know when it’s time to adjust because of lack of progress). 

(How will you know that this objective has been met/accomplished?)  This needs to be specific and the data easy to collect and understand (graphed).  In the case of a safety issue, it must always be 100% (it is unacceptable to write that Joey will cross the street safely 50% of the time.  The only thing that should change is the assistance or prompt level).  For non-safety issues, an example would be 3 out of 4 trials for 3 consecutive weeks or 45% of the time for three consecutive weeks.  Be careful about saying an average over multiple weeks or months as this can paint a very inaccurate picture in your data collection and reporting.  If you use an average, someone may start out great and do poorly at the end of the specified period of time.  The average may still meet the required criteria, but the drop at the end is problematic and probably demonstrates a continued need.  Graph data daily to help you better understand trends.

How will you know the objective has been met? 

How (and when) will you know it’s time to adjust because of lack of progress?

Template or questions for data collection:

Answer in writing:

What is the person supposed to do?

For example: list everything the child is supposed to do according to the MBO.  This activity may be insightful and tell you the objective is too complicated.

What are the additional variables (if there are any)?

For example:  amount of time the person must start and/or complete the desired behavior (or task), how it is to be done, etc.

Data collection:

Good data collection will almost always… unless there is an incredibly compelling reason not to:

Track EVERY target behavior and EVERY variable within the MBO and some outside of the MBO i.e. setting events.

Graphing data:

1.   Data should almost always be graphed the same day it is collected.  This will help you understand trends, significant intervening variables, and needed adjustments.  For example: Joey may do better in the morning than afternoon.  Joey may do better with therapist A than therapist C.  Joey may do better when Susie is in the room and Sally is not.  All important information.

2.   Plans and interventions should be adjusted as soon as needed, not on a predetermined time schedule of one year or even six months.

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.