#2 Skill Based Treatment Education and Training
For many staff and parents, Skill Based Treatment (SBT) may be a novel and even confusing approach, particularly when they may be accustomed to a focus on extinction and reinforcer deprivation. This guide provides resources to explain the process of PFA and SBT as well as provide training to others.
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For many staff and parents, SBT may be a novel and even confusing approach, particularly if they are accustomed to a focus on extinction and reinforcer deprivation. Here are some resources that can help you in explaining the process and providing training. In addition, you can check out our guide on the Basic Overview of the process to find more visuals and presentations!
Do you have visuals I can share?
- Here is a cute visual you can show to explain the process
How can I be trained to implement SBT with clients?
Check out the Overview Guide to find podcasts, videos, and research articles.
A few different options include:
- FTF’s Practical Functional Assessment and Skill Based Treatment (10 CEUs) by Dr. Hanley
- FTF’s A Training on the PFA/SBT for Implementors (10 CEUs) by Drs. Hanley, Ruppel, and Cammilleri
- Sendan Center’s Practical Functional Assessment and Skills-Based Treatment Workshop (14 CEUs) by Hillary Laney & Liisa Podosek
The FTF Practical Functional Assessment and Skill Based Treatment course:
- Focuses heavily on WHY we do PFA/SBT and the history of the field that has led us to this point.
- Uses more terminology in explaining the mechanics of PFA/SBT
- Discusses research that shows how effective this process is
- Discusses the IISCA and PFA in depth
- Presents multiple successful case studies
- Goes over the CABs and branch planning (not a deep dive)
The Sendan Center’s Practical Functional Assessment and Skills-Based Treatment Workshop:
- Focuses heavily on HOW to do SBT. There is a lot of time spent practicing decision making, problem solving and data collection within each step of the process.
- Spends enough time on the PFA to understand it, and moves into SBT and CABs
- Uses Hillary’s data sheets which are flexible and rely on clinician decision making as opposed to the FTF pre-planned sheets, and includes many opportunities to practice collecting data and how to decide how to count each trial.
- Talks about different ways to plan branches and different idiosyncratic skills that can be taught
So many terms, what do they mean?
| Acronym/Term | Defined | What it means |
| PFA process | Practical functional assessment process | This is the new (and improved #notsorry) name for the IISCA. It includes an open-ended interview and a functional analysis to demonstrate functional control over problem behavior. Just so happens to be way more practical than the traditional FA. |
| IISCA | Interview-informed synthesized contingency analysis | This is the old acronym for the functional analysis explained in the process above. Some people like this acronym more than the PFA. |
| Open-ended interview | This is a set of open-ended questions that were published by Dr. Hanley in 2012. Check out the PFA website for access to it | This is where the magic starts. The interview is designed to get qualitatively rich information to design your functional analysis with. We are done with those generic conditions and moving on toward the good idiosyncratic stuff. |
| SBT | Skill-based treatment | The PFA gives you a good understanding of the problem behavior… now what? There are a million different approaches you can take. The SBT process boils down the most commonly used and effective interventions (e.g. FCT & schedule thinning) and puts it together in a nice package that will reliability get great socially valid results. |
| Synthesized Reinforcement (SR) | Combining reinforcers as a whole reinforcement context instead of looking at individual reinforcement contingencies | It is not worth it to go to the movies just to watch a movie. I have to have a large tub of popcorn, large coke, and my wife for me to actually make the trip. People usually do not just want to escape to nothing, this term just helps us focus on the big picture with all of the fine details instead of only the fine details. |
| HRE | Happy, relaxed, and engaged | This describes client behavior and affect when you have the right SR condition. Producing HRE in the SR condition is the goal because we want to be teaching from a place of joy instead of suckiness. |
| Eng | Engaged | You will see this on the SBT data sheet. Circle this if the learner was engaged (or HRE) for over half of the SR condition. This measure is important because it helps us know that the reinforcers are still valuable to the client, and its absence prompts us to re-examine SR. |
| EO | Establishing Operation | Uh oh. Feels like you are back in school again eh? EOs are the things that create a motivating context for behavior to occur. The teacher saying “it is time to clean up” makes behaviors that avoid cleaning up and extend play more probable. If the teacher didn’t say anything, those behaviors would never occur. |
| Progressing the EO | Continuing to “poke the bear” because the SBT chain is not evoked yet and no PB has occurred. | This is what we do when targeted behavior is not occurring when it is supposed to. You might tell your learner to pick up… but they just keep on playing without saying the FCR or emitting PB until you progress to the EO to the point that you block play while repeating the instruction. |
| PB | Problem behavior | This might not be your favorite terminology to describe behaviors that are targeted to decrease but it is what is currently being used regularly by the FTF team and in the literature. These are the behaviors that interfere with one’s daily functioning, and they are concerning to important people in the client’s life. |
| SPB | Severe problem behavior | It’s like PB but severe. It is usually distinguished by its capacity to harm people and/or property. |
| R1 | Dangerous behavior | This is the reason why we are doing the full blown PFA/SBT process in the first place. These are the behaviors we ideally never want to see because it’s all about Safety, Televisability (Dignity), and Rapport. |
| R2 | Non-dangerous behavior (often precursors) | These are the behaviors that are reported or observed to reliably precede or co-occur with the problem behavior. Sounds crazy that we can target these behaviors instead of the R1 bxs but research has backed this up (e.g. Heath & Smith, 2019) |
| R3, Precursors | Precursor behavior | These are generally the R2s being targeted but sometimes you can talk about precursors to the precursors (R3s if you will). |
| FCR | Functional communicative response | The thing we teach in functional communication training (FCT). This is an alternative behavior to the PB that will get the learner back into the SR condition. |
| TR | Tolerance response | This moves past FCT and teaches the leaner an appropriate response to denials and being told no. |
| CAB(s) | Contextually appropriate behavior | This is what we want the learner to do when it is teacher-led time (EO condition) rather than learner-led time (SR condition). Essentially, this is teaching the learner how to cooperate with the expectations of others when they are not in charge in a context that is super worth it for them. |
| CAB 1 | First step of CAB | This is teaching the learner to relinquish positive reinforcers. |
| CAB 2 | Second step of CAB | This is teaching the learner to transition to a “table of high expectations” (or equivalent) and to get ready to learn without distraction. |
| CAB 3 | Third step of CAB | This is teaching the learner to do a short amount of easy work while at the table of high expectations. |
| CAB 4-6 | Fourth, fifth and sixth step of CAB | This is progressively making the work harder while keeping expectations high. |
| Branch(es) | Different target areas to work on during SBT | CAB(a) can be manding skills, CAB(b) can be daily living skills, etc. The branches are usually distinguished by the transition from the SR to the CAB expectation to allow for different chains to be shaped. For example, a transition to the gym may require different shaping than a transition to academic work |
| CBPD | Contingency-based progressive delay | A fancy acronym (with some great research to back it up) that means we need to do some work before we get back to playing instead of just waiting for a certain amount of time. |
| Idiosyncratic variables | Individualized things that matter to the specific individual, so much so that they may contribute to PB. | This a big thing that separates the PFA from the traditional FA. From the start we identify the specifics, such as a learner wanting his mother to speak in a high tone of voice, side-eyeing him, and giving him a bite of pizza with a dab of ranch on each bite instead of just saying the kid wants attention and/or access. |
| Keeping a lid on it | Making it super unlikely that SPB will occur outside of practice by reinforcing PB right away, lowering motivation to emit the PB (NCR), and/or removing super evocative stimuli if you can | The PFA/SBT is a process. We want to make sure the learner remains safe while in the early stages of the process. It might be a weird thing to recommend to parents and teachers but they were probably doing a lot of this stuff in the first place because people learn how to adapt pretty well. |
| Acquiesce | Accept something reluctantly but without protest | Fancy word for giving in. This is another way to describe “keeping a lid on it”. Don’t give that demand right now because you know it will lead to SPB. Go ahead and give that candy bar over because you know the R2s will lead to R1s in that moment. |
| Too hot to handle | Progressing the EO too quickly | Turning off the video game without a warning might be something we want our learner to be able to tolerate in the future, but right now is it probably too hot to handle when you are working on him just looking away for a split second. |
| Low & loose | Describes the teacher’s demeanor. We should be low to the ground if possible and body language is relaxed. | This indicates that it is the SR condition. We are going along for the ride with whatever the learner wants (within reason). |
| Hight & tight | Describes the teacher’s demeanor. We should be standing up straight and body language is saying we mean business. | This indicates that it is the EO condition. The learner is going to be held to high expectations and should be following the teacher’s lead. |
| Motivational distance travelled (MDT) | Hints at the notion that we may be more motivated to behave (and learn) when there is greater discrepancy between the EO and SR conditions | Imagine that I want to teach a learner to say “Water” and attempt to do so by putting a 1-oz cup of water in front of them, prompting “Water,” and reinforcing the utterance by giving water. This may be an effective teaching arrangement, but the learner may not be super motivated to learn the new word. Now imagine that I turn up the heat to 120 degrees and have the learner eat 3 biscuits from Popeye’s and do 50 burpees before presenting a large glass of water…the learner is more likely to learn “water” under these conditions, right? This is MDT: a useful consideration in designing motivating teaching contexts and a reminder to synthesize EOs and SRs. Note: do not turn the heat up to 120 degrees in order to teach FCRs |
What about a quick overview for staff and caregivers?
These overviews can help you develop an “elevator pitch” to quickly and succinctly explain the SBT process.
Should parents give consent to begin this process?
Yes! Here is a template you can use!
I need more formal training materials!
How do I track treatment integrity?
Here are some great documents for tracking implementer fidelity.
Please note that the second document has SBT specific sections intermixed with general RBT expectations.
What if I want to roll out SBT across an organization?
Enjoy these free presentations on shift within an organization!
You’ve made it to the end of this guide, but this is only the beginning! These tools and resources are a great starting point, but you can also utilize our other guides, resources, mentors, and partners to help you along your PFA & SBT journey. Didn’t see your question answered? Want to connect with others? Come join us on our FaceBook community by clicking here. (And don’t forget to answer the membership questions when you join! 😉)