Progress Notes

Progress Note 1

BHT visited CLIENT in the home setting to focus on (goals and skill deficit). Present was CLIENT, his CAREGIVER and OTHER. BHT structured a variety of activities using CLIENT’s laptop and other activities/apps that could be utilized for creating opportunities to demonstrate desired outcomes.

This also included identifying words and pictures on various flash cards. CLIENT was also able to properly identify how to label corresponding pictures, spell each word, and comment on the environment through association with the specific flash card. In these activities, BHT incorporated the use of premack principles, visual aides, social stories, timers, positive reinforcement, shaping and fading to assist CLIENT familiarize the expectations (i.e., taking demands, waiting for desired items and transitioning to next activity or break).

During NAME_OF_ACTIVITY, CLIENT was able to identify most words on his flash card list for today with some assistance from BHT, he also had to be redirected twice to have remain seated. BHT reminded CLIENT that first his has to complete 3 badges before he can take a break. When client demonstrated increased levels of participation, BHT utilized positive reinforcement and exaggerated affect to highlight his success with remaining with the group. Error correction procedures were utilized when he gave incorrect responses. However, fading was also implemented when there were similar demands anticipating that he could respond correctly and independent of any additional prompts.

CLIENT then transitioned to a NAME_OF_ACTIVITY which required CLIENT to identify rhyming words that rhyme with his words of the day. BHT created opportunities for CLIENT utilize replacement behaviors such as using his words for help or to ask for a break when he needs one. He was also required to complete the activity within 0-2 prompts and or redirection. During times CLIENT demonstrated success, BHT immediately reinforced the desired behaviors through positive reinforcement and access to preferred tangibles.

When CLIENT's break was finished, BHT utilized a visual timer to remind him of an upcoming transition to the next activity. CLIENT then transitioned to practicing/using sentence structure (.,?,!) in sentences and ways to identify them. At times, CLIENT eloped to lay on the couch before it was time for it. BHT redirected him back to the activity while utilizing limit setting (redirection/prompt back to the activity while presenting consequences for future elopement).

After this, CLIENT transitioned to NAME_OF_ACTIVITY with a visual cue. BHT then scrolled throguh various flash cards that required CLIENT to spell each word and pronounce them correctly. He had to be redirected to his table to complete the activity before his timer went off. BHT also utilized pre-mack principles which included the demand of completing the task as a reminder for the reward in which he would have access to a break and preferred activity for a timed duration. BHT was proactive in ensuring the use of a timer to establish familiarity and expectations during transitions.

After giving client his final break, BHT transitioned CLIENT to a multiple-choice question activity about the story that was presented as a review. CLIENT did not want to finish he yelled “NO MORE”. BHT encourage modeled appropriate skills to assist client with communicating his desire for a break through modeled phrases to get his last badge of his lesson for today before giving him access on his tablet. BHT assisted the Grandmother familiarize ways to set limits and follow through to avoid CLIENT from following his own agenda or attempting to control the environment.

In the next session, BHT will model ways for teh CAREGIVER to apply the transfer skill and to start practicing the transfer skills for the home environment. BHT can establish routines to increase familiarity with the expectations of the school and home setting.

Progress Note 2

At arrival, CLIENT appeared to be in a content mood characterized by frequent smiles, laughs and engaging in a preferred activity. He then transitioned to Science/Social Studies where he sat at the table with peers for 15-20 minutes while working directly with BHT. He was calm and quiet for the duration of this time and did not engage in SIB (Self-Injurious Behaviors) at any point. BHT utilized transfer trials by assisting CLIENT point to images of various animals and types of transportation correctly about 80% of the time. He wrote his name, copied words, and matched items by drawing a line from one to the other with full physical prompts; during these activities, CLIENT became distracted by the environment characterized by him looking around the classroom rather than at his paper.

CLIENT then transitioned to gym where he spent the majority of the period walking/skipping around and bouncing on a large ball. He engaged with BHT by bouncing a ball back and forth for about 5 minutes. When he responded to the engagements initiated by the BHT, these instances were met with immediate positive reinforcement and exaggerated affect to ensure that he shared the social experiences. He then was transitioned to Teach Town with a verbal prompt. With edible reinforcers in his visual field, CLIENT was able to sit with BHT for 11 minutes and work on tasks in Teach Town. CLIENT consistently needed a gesture prompt from BHT in order to choose the correct response to the question, "Where is the arrow pointing?” CLIENT used a token board during these activities and was directed to leave the table and take a break after earning all 5 tokens.

After this activity ended, CLIENT transitioned to lunch and ate only items that are acceptable finger foods, so he did not practice using utensils today. CLIENT attempted to take food from a peer 2-3x and was redirected with a full physical prompt. CLIENT appropriately used his visual communication card throughout the day to request chips, candy, iPad, water, and plastic. CLIENT then transitioned to groups in which he was required to sit at the table while attending to peers. When left alone or no attention was provided, CLIENT attempted to elope but was able to be redirected through the use of limit setting with follow through. When elopement occurred, BHT redirected CLIENT back to the activity. In addition, BHT utilized “first, then..” statements specifically with offering access to tangible items and activities. During the remainder of the activity, BHT ensured the use of positive reinforcement and exaggerated affect when CLIENT remained with the group, responded to a question correctly and while attending to peers before giving access to the preferred activity.

After groups, CLIENT was given his scheduled break with the use of a visual timer to prepare him for the upcoming transition. From free-play, he then transitioned to centers within 2 prompts. After the transition was completed, he was provided with positive reinforcement. After 2 minutes, he eloped to the carpet to lay on the floor. BHT gave instructional guidance through “If, Then..” statements. After he transitioned to the centers activity, edible reinforcements were offered. He was then required to respond to various task demands in which BHT utilized a FR-3 reinforcement schedule and gradually reducing the amount of reinforcement to an FR-5. After a while CLIENT requested a break using his communication device. BHT immediately reinforced with positive reinforcement, exaggerated affect and access to the request to assist CLIENT familiarize the communicative expectations.

Throughout the day, CLIENT frequently engaged in stereotypic behavior (i.e., rocking, clapping, and tearing plastic wrap into small pieces). CLIENT required verbal prompts and redirection consistently to be able to sit down when instructed during transitions to non-preferred. He was able to transition to preferred activities with cues and visual aides. CLIENT remained seated during those instances for 5-10 minutes without access to preferred activities, and for 10-15 minutes while accessing preferred activities.

BHT will continue to utilize various intervention and preventative strategies. BHT will continue to anticipate triggers within the environment and reduce the frequency of instances in which CLIENT is left alone or waiting to transition to reduce stereotypical behaviors.

Progress Note 3

BHT visited CLIENT_NAME in the school setting to monitor and facilitate the behavior treatment session. Present was CLIENT_NAME, his teacher, BHT and his peers.

At arrival, CLIENT_NAME was transitioning from gym to his classroom and appeared to be in a playful mood characterized by laughing and repeating scripted phrases. It was also concluded that these were attempts to control the environment and elicit attention for negative interactions which often disrupted the instructional activity of the teacher. After arriving, the teacher indicated that he often sits at the table and purposefully disrupts others by grabbing materials and objects being used so that he can throw them across the room or at other people within the classroom. In anticipation of this happening, the BHT created space in the rear of the room with a mat to block the distractions within the environment and to increase control of the environment before facilitating any instructional activity. While doing so, CLIENT_NAME often yelled “you love me”, attempted to grab the BHT or leave the designated chair to elope.

Due to the disruption lasting in a duration exceeding 5 minutes, he was then transitioned into the hallway to complete the activity. Throughout this activity, the BHT assigned was utilizing mindfulness and neutrality in her tone and affect to avoid reinforcing negative attention seeking behaviors in combination with differential reinforcement of other behaviors. When CLIENT_NAME sat for a duration of 1 minute, he was given positive reinforcement. When he sat for a duration of 10 minutes, he was given a token on his economy board that outlined the reward for 5 tokens earned. The BHT actively ignored the yelling and screaming while consistently reinforcing positive or correct responses during the instructional period. After a duration of 15 minutes, CLIENT_NAME was given a scheduled break to play in the sensory room. The break was contingent on a 10-minute timer that he would transition.

During his time in the sensory room, CLIENT_NAME engaged positively with the BHT. He gave them hugs, high fives and presented materials he was using and activities that he was participating in. In addition, he refrained from throwing items or destroying and off the property inside of this room indicating that this was a highly preferred activity. He then transitioned back to the classroom in which he grabbed headphones from a peers desk and flung them across the room. He was the transitioned back to the hallway in an area closed off from distractions so that he could participate in the instructional activity using the same method he had success previously.

BHT will continue to establish instructional control and utilize error correction procedures when necessary. In anticipation of negative attention-seeking behaviors, BHT will continue to be mindful and utilize neutrality in tone/affect while reinforcing only desireable behaviors throguhout the day.

Progress Note 4

BHT visited CLIENT_NAME in the school environment to monitor and facilitate the attainment of all treatment plan goals. Present was Chris, his teacher and staff.

At arrival, CLIENT_NAME was utilizing magnetic toys. He was in a content mood characterized by frequent smiles, and showing the staff what he built with the toys. BHT utilized a cue to encourage CLIENT_NAME to show one of his peers the buildings. The peer approached CLIENT_NAME and complimented him. BHT extended the engagement by modeling high-fives and cuing CLIENT_NAME and his peer to build a house together to promote interaction, sharing, taking turns and developing positive peer relationships. During this interaction, BHT encouraged the teacher to provide positive reinforcement for taking turns and sharing. She then gave stickers and an edible to promote socially related skills in the area of reciprocity.

CLIENT_NAME transitioned to math in which he was expected to complete math work on the computer. BHT immediately presented the token board and reviewed the expectations. CLIENT_NAME was given a choice between a preferred activity or edible as a reward. During the activity, BHT implemented positive reinforcement during times CLIENT_NAME was observed participating and independently completing portions of the assignment. This increased his level of participation while referencing the remaining tokens required to obtain the scheduled break. The teacher also utilized exaggerated affect while acknowledging his completion of the task. During the scheduled break, BHT reviewed the methods utilized which included positive reinforcement, token economy, premack principles and scheduled breaks to assist CLIENT_NAME familiarize the expectations with task demands while encouraging the teacher to utilize these methods in the absence of additional supports.

Towards the end of the session, BHT utilized fading to encourage CLIENT_NAME to complete a reading assignment without the token board and visual aides. However, BHT continued acknowledging desired behaviors during the completion of the activity through non-verbal positive reinforcement (I.e., thumbs up, success “fist” and smiles). The teacher redirected him when he became off-task, however, he was able to finish the activity and independently requested a break from the teacher in which she allowed him access to a preferred activity for a specific duration of time.

BHT will continue to utilize outlined methods and engage the teacher in the transfer of skills.

Progress Note 5

RBT visited CLIENT in the home environment to monitor and facilitate the behavioral treatment session, transfer skills and identify various environmental variables. Present was CLIENT and his Mother.

At arrival, CLIENT was sitting at the couch during a free-play activity. He was looking around the room, starring at his communication device while twirling a straw. RBT greeted CLIENT and joined the activity to utilize transfer trials. To better assist CLIENT familiarize the demands and expectations with pointing to and showing the correct responses. As his mother instructed CLIENT to point to and show her different objects/items, RBT guided his hand to point at each item as it was recommended for the teacher to immediate reinforce these instances through the use of exaggerated affect and high-fives. After several trials, CLIENT was given a scheduled break in anticipation that he would become frustrated due to the duration of his cooperation exceeding beyond 10-15 minutes. He then transitioned to the carpet to engage in the desired free-play activities which were offered through if/then statements.

As CLIENT and his mother were preparing to transition to the couch for centers, RBT utilized a visual timer to assist CLIENT with the change in routine to avoid resistance when the transition is proclaimed. He was given a gestural prompt when the timer had a duration of 10 seconds remaining while utilizing visual cues to encourage an independent transition to the carpet. RBT delayed additional prompting techniques to avoid excessive verbal prompts and redirection. CLIENT then transitioned independently and sat in an available space on the carpet. RBT then faded proximity while allowing his Mother to give instructions and opportunities for him to demonstrate success without the use of transfer trials. While his Mother gave instructions, RBT also immediately reinforced his participation through a FR-3 (fixed-ratio) reinforcement schedule to fade his dependence on reinforcement for every individual correct response.

RBT utilized these interventions in activities such as tablet play, blocks, toys and free-play activities providing opportunities for CLIENT to utilize his communication device for access to tangible items and preferred activities. Before giving access to schedule breaks, RBT often told CLIENT to push the necessary request on his device but later fading it to a model for him to then choose the correct requests on the device. During successful opportunities, these instances were immediately reinforced verbally and with access to the highly preferred preferences. RBT then concluded the session with a review of the interventions that were identified as successful/productive and ways to fade prompting methods and using them only as teaching strategies.

RBT will continue to engage the caregiver in skills transfer to increase her ability to utilize suggested behavioral modification strategies.

Progress Note 6

RBT visited CLIENT in the school environment to monitor and facilitate the attainment of all treatment plan objectives. Present was CLIENT, his teacher, staff and peers.

Upon arrival, CLIENT appeared to be in a content mood characterized by frequent smiles, laughs and comments on the environment. He was watching a video during a relax activity. During this time, RBT utilized time to review progress with social skills training in the classroom during times that the children are given opportunities to engage in parallel play. She indicated that CLIENT continues to share his toys and materials during centers; he pairs with preferred peers to build structures with blocks and he joins reading groups at the carpet during centers to share and look at different pictures from a variety of books. These instances are reinforced with reinforcers and verbal praises throughout the day. This was effective in increasing CLIENT’s self-esteem and level of participation.

Moving into the session, RBT utilized opportunities for shaping through naturalistic teaching. During group activities, RBT encouraged the staff and teacher to sit CLIENT nearby preferred peers. When CLIENT or his peer demonstrated success with an instruction, RBT gave high fives. When the peer gave correct responses, RBT highlighted them through joint attention with CLIENT which led to him giving the peer high fives independently. When he successfully interacted with peers, RBT utilized positive reinforcement through praise and exaggerated affect.

CLIENT then transitioned to an independent math assignment. Initially, CLIENT required assistance to complete addition and subtraction tasks. However, RBT faded assistance and gave him opportunities to demonstrate success independently. These instances were immediately reinforced with positive reinforcement and exaggerated affect which increased his self-esteem and drive to continue completing the assignment. RBT also encouraged CLIENT to share and show his success with the teacher and staff for additional reinforcement.

CLIENT transitioned to a centers activity in which RBT faded positive reinforcement through exaggerated affect and praise and replacing it with gestural praises such as thumbs up or fist motions while utilizing a fall back approach for proximity control. RBT sat across the room allowing CLIENT to independently interact with peers by sharing, showing and participating together without having to structure the theme of play. RBT summarized the methods and protocols utilized throughout the session with the teacher and staff. Q&A was provided to ensure that the interventions were generalized and could be used in the absence of additional supports.

Progress Note 7

BHT visited CLIENT in the school environment to facilitate the attainment of all treatment goals. Present was a CLIENT, his teacher and the staff.

Upon arrival, CLIENT appeared to be in a pleasant mood characterized by frequent smiles, and responding to the teacher’s use of silly affect through eye contact and laughs. During the group activity, the teacher gave instructional guidance and explored alternative ways for CLIENT to utilize his speech device. When CLIENT used items on the device successfully, she gave CLIENT an edible reinforcer(skittle). There was distractions wi5in the environment which the teacher had to address. While doing so, there was a delay in the continuation of the activity. BHT anticipated that CLIENT would engage in stereotypical play with the straw he possessed characterized by twirling it, starring at it while making loud vocals. To avoid this, BHT utilized preferred engagements (I.e., tickles, hand games and peek-a-boo) to provide opportunities with responding to engagements. After several minutes, CLIENT began pushing the “go” button multiple times. It appeared he was attempting to ask for a break. BHT modeled the appropriate button to press in this instance while cuing him to transition to his seat. He warranted additional verbal prompts to transition to his desk to engage in centers.

While CLIENT was playing at his desk, he was also sitting next a peer at their desk playing with various toys. BHT prompted client to look at his peer playing with toys while also modeling representational play themes with them. BHT also gave CLIENT opportunities to engage in joint attention by utilizing a silly affect with the toys and pretend play such as the toys flying and falling off the table into a “pit”. During these opportunities, CLIENT demonstrated Joint attention 1/5 opportunities indicating that this may be an area in immediate need of addressing.

CLIENT then transitioned to a free-play activity at the carpet. He did so with a verbal prompt from the teacher. The transition was longer in duration lasting 2-3 minutes due to a ritual CLIENT demonstrated that included him standing 3x’s and sitting 2x’s in the seated chair before he then stood in the same spot waiting to be escorted to the carpet. BHT did not offer an upper arm to be escorted through the use of planned ignoring and waited until CLIENT transitioned independently. BHT immediately reinforced the transition with exaggerated affect and positive reinforcement as well as giving a preferred edible to assist CLIENT familiarize the expectations with transitioning independently.

Before the session was concluded, BHT consulted with the teacher to engage her in the transfer of skills highlighting instances in which prompts were faded and replaced with visual cues; immediate reinforcement of desired behaviors; following through when limits were set and active/planned ignoring behaviors related to negative attention-seeking.

Progress Note 8

BHT visited CLIENT in the school environment to monitor and facilitate the behavioral treatment session, transfer skills and identify various environmental variables. Present was CLIENT, his teacher, peers and staff.

At arrival, CLIENT was sitting at the table during a group activity. He was looking around the room, starring at his communication device while twirling a straw. BHT greeted CLIENT and joined the activity to utilize transfer trials. To better assist CLIENT familiarize the demands and expectations with pointing to and showing the correct responses. As the teacher instructed CLIENT to point to and show her different objects/items, BHT guided his hand to point at each item as it was recommended for the teacher to immediate reinforce these instances through the use of exaggerated affect and high-fives. After several trials, CLIENT was given a scheduled break in anticipation that he would become frustrated due to the duration of his cooperation exceeding beyond 10-15 minutes. He then transitioned to his desk to engage in the desired free-play activities which were offered through if/then statements.

As CLIENT the teacher was preparing the class to transition to the carpet for centers, BHT utilized a visual timer to assist CLIENT with the change in routine to avoid resistance when the transition is proclaimed. He was given a gestural prompt when the timer had a duration of 10 seconds remaining while utilizing visual cues to encourage an independent transition to the carpet. BHT delayed additional prompting techniques to avoid excessive verbal prompts and redirection. CLIENT then transitioned independently and sat in an available space on the carpet. BHT then faded proximity while allowing the teacher to give instructions and opportunities for him to demonstrate success without the use of transfer trials. While giving instructions, the teacher also immediately reinforced his participation through a FR-3 (fixed-ratio) reinforcement schedule to fade his dependence on reinforcement for every individual correct response.

BHT utilized these interventions in activities such as math , reading, art and group activities providing opportunities for CLIENT to utilize his communication device for access to tangible items and preferred activities. Before giving access to schedule breaks, BHT often told CLIENT to push the necessary request on his device but later fading it to a model for him to then choose the correct requests on the device. During successful opportunities, these instances were immediately reinforced verbally and with access to the highly preferred preferences. BHT then concluded the session with a review of the interventions that were identified as successful/productive and ways to fade prompting methods and using them only as teaching strategies.

BHT will continue to assist the teacher identify and utilize prompting techniques that are necessary for specific task instruction. Based o the familiarity of the task/activity, BHT will assist the teacher through coaching her on when to fade prompts and when to utilize error correction procedures.

Progress Note 9

BHT visited CLIENT_NAME in the school setting to monitor and facilitate the attainment of all treatment plan objectives. Present was CLIENT_NAME, his teacher and the staff.

At arrival, CLIENT_NAME appeared to be busy characterized by him completing an independent math exercise. His staff was assisting him to complete the task through the use of redirections, verbal prompts and question prompts. BHT utilized opportunities to provide immediate positive reinforcement as he was working to complete the assignment in attempt to fade prompting given to him for become off-task or engaging in stereotypical behaviors such as rocking back and fourth, hand flapping and loud vocalizations.

BHT modeled use of familiar engagement themes after he completed the assignment before transitioning him to the next task as a scheduled break to avoid resistance to transitioning. BHT set a visual timer in a duration of 5 minutes while using if then statements. When it was time to transition, BHT utilized a gestural cue in which CLIENT_NAME transitioned to the group to complete an instructional activity with the teacher. While in the group, CLIENT_NAME attended to his peers by establishing eye contact, but no initiation of any engagements or interaction. The teacher was coached to instruct CLIENT_NAME to give a peer a high-five. When he did so, the teacher and BHT provided verbal praise and exaggerated affect. This intervention led to the same peer spontaneously offering additional high-fives throughout the activity in which CLIENT_NAME responded to independently by completing the engagement and smiling while doing so indicating he shared to social experiences.

CLIENT_NAME then transitioned to the carpet for a circle activity in which the teacher asked “wh” questions related to the story being read. BHT modeled ways to cue “wh” questions such as rephrasing the statement to “I wonder where the dog is” or “I wonder what the cat is doing” in which CLIENT_NAME was able to do so initially with a verbal model. After additional opportunities were given, he began to respond to the cues given independently indication familiarity with the task expectations.

BHT discussed the intervention methods utilized that the teacher can implement in the absence of additional supports. It was also suggested to fade the use of verbal prompts that the staff use when redirecting CLIENT_NAME back to the activities when he becomes distracted to limit and gradually eliminate prompt dependency.

BHT will continue to monitor and facilitate the transfer of skills while identifying additional intervention methods that are necessary for fading prompts in the next scheduled session.

Progress Note 10

RBT visited CLIENT in the home environment to monitor and facilitate the attainment of all treatment plan objectives. Present was RBT, his mother and sibling.

At arrival, CLIENT appeared to be in a content mood characterized by frequent smiles, laughs and comments on the environment. His Mother indicates that CLIENT was having difficulty in the home setting completing homework and transitioning from playing on the tablet to a task or chore. RBT structured an activity schedule with sequenced order of preferred and non-preferred activities. RBT also incorporated a token board and the use of pre-mack principles to assist with the transitions and increase his familiarity with the demands throughout the session.

Moving into the session, RBT began with a preferred activity of playing tablet games. CLIENT was given several opportunities to respond to familiar interaction themes. When CLIENT initiated a positive and appropriate engagement, it was met with silly and exaggerated affect to ensure that he shared the social experiences and to highlight his use of appropriate themes. This also increased his self-esteem and level of participation. RBT utilized visual timers to countdown activities before concluding them unexpectedly. This increased his willingness to transition to a writing activity.

During the non-preferred activities such as math, writing and coloring, the token board was effective with increasing his willingness to remain at the activity and complete the tasks given to him by his Mother. Later in the session, the token board was faded and RBT relied exclusively on pre-mack prinicples. RBT also utilized follow through when giving choices to ensure that familiarity was provided. Throughout the activities, RBT maintained neutrality in tone/affect to avoid any unexpected changes in CLIENT's mood and to model the appropriate methods of giving prompts and redirection in the absence of additional supports.

RBT will continue to address concerns with transitions, lack of participation and motivation to complete tasks independently in the next scheduled session.

Progress Note 11

Community Note 1

RBT visited CLIENT in the community setting to create various opportunities for communication, social interaction and skill acquisition. Present was CLIENT, his peers and the staff.

At arrival, CLIENT was greeted at the door while redirecting him to hang up his backpack and food items. He transitioned to breakfast where he sat and was served by the staff. While he was eating BHT read a story about "the Runaway Pancake". While reading the story, BHT utilized animated and exaggerated affect to establish opportunities for Joint attention. When CLIENT demonstrated success with this, he was reinforced through positive reinforcement (i.e., high-fives and " good Job"). CLIENT then transitioned to a circle activity in which he was given several opportunities to attend to his peers and greet them. CLIENT attended to others by establishing eye contact with them and waving "hi" with a verbal prompt. error correction procedures were utilized when he became distracted with the materials within the activity while reinforcing desired responses after the interventions and teaching strategies were applied.

Client then transitioned to centers in which he did worksheets. During this activity, CLIENT required hand over hand to color and fill in the blanks. initially, CLIENT had difficulty transitioning to the activity as he constantly requested for "milk", however; Premack principles were applied to assist CLIENT familiarize "first, then" prompts to complete the designated tasks before getting a reinforcer. After he completed the worksheets, he was immediately given access to a scheduled break and requested edible reinforcer. CLIENT then transitioned to a movement activity in which he pretended to move like various animals. While he imitated the various animal actions, RBT immediate reinforced these instances through the use of verbal praise and exaggerated affect. This led to increases in his level of participation and self-esteem characterized by him smiling, laughing and wanting to consistently participate.

CLEINT then transitioned to lunch in which he was offered various choices based on what he brought in for lunch. Before he was given food items, RBT utilized naturalistic teaching opportunities for him to mand. After he pointed to the items he desired, RBT verbally praised him for using functional communication. He then transitioned to the park with the other children. While walking, RBT created social opportunities for him to engage by playing "red light, green light", marching while signing "Ants go marching" & jumping over objects on the ground to avoid elopement during the transition.

When CLIENT arrived to the park, RBT initiated a chase game. while running away from CLIENT, he smiled, laughed and established eye contact. He was then redirected to chase multiple peers and given light physical prompts to tickle them when he caught them. He was also given additional opportunities to communicate his wants and needs independently by placing him on the swing and modeling gestures for him such as "help" when he needed to get on and "more" when he needed additional pushes on the swing. RBT gradually faded the model to cues to allow CLIENT to demonstrate success with communicating through gestures independently. When CLIENT demonstrated success with this, RBT immediate reinforced with pushes on the swing and verbally saying "good job asking for more or help".

RBT will continue to limit delays in transitioning, reinforce social engagements with staff and peers & create several opportunities for FCT (Functional Communication Training) in the next session.

Community Note 2

BHT visited CLIENT in the community setting to target goals and skills acquisition. Present was CLIENT, his peers and the staff.

At arrival, CLIENT appeared to be in a content mood characterized by frequent smiles, laughs and comments on the environment. CLIENT was eating breakfast at the table with his peers. He then independently cleaned his eating area in which BHT immediately reinforced through praise and exaggerated affect. CLIENT became visually happy and seemed ready to transition to circle time. At circle time, CLIENT was given opportunities to greet peers, engage with songs & dances & listen to a story while given him opportunities for joint attention. Whenever he demonstrated success doing so, BHT reinforced these instances with verbal praise & high-fives to ensure that he shared the social experiences.

CLIENT then transitioned to Centers without demonstrating any maladaptive behaviors. BHT reinforced the transition through acknowledgement and praise to assist CLIENT familiarize the expectations of transitioning between preferred to non-preferred activities. In the centers activity, CLIENT was expected to complete various worksheets. He did so with minimal prompts indicating that he could independently complete them. After he completed them, CLIENT was given a scheduled break to engage in a preferred activity as a reward.

Client then transitioned to a movement activity at the park. BHT facilitated compliance training on the way to the park. This included issuing safety commands “stop”, “go”, “look for cars” & “cross the street” to improve environmental and safety awareness. Once we arrived at the park, BHT facilitated social skills training by moving CLIENT closer to peers to comment on what they are doing, encouraging client to join facilitated games of chase and tag & immediately reinforcing social engagements/interaction through positive reinforcement and exaggerated affect. This positively impacted CLIENT’s self-esteem, self-efficacy and level of participation during the movement activity.

Client then transitioned into free-play activity in which he opted to utilize play-doh. BHT joined his play to create opportunities for engagements. This included making various play-doh creations such as snakes, balls, pretend foods, pretend accessories and different shapes. CLIENT was able to expand play themes by taking BHT’s creations and adding more to them. BHT provided positive reinforcement and exaggerated affect when CLIENT presented his play-doh crafts which led to him continuously making various projects and showing peers who were in close proximity. BHT also structured trading of play-doh colors to reduce rigidity and demand for sameness of colors.

BHT will continue to create opportunities for communication, social skills and compliance training. CLIENT will be expected to participate in a variety of activities to address skill deficits and acquisition.

Community Note 3

BHT visited CLIENT in the community setting to facilitate behavioral treatment and skills acquisition. Present was CLIENT, the staff and his peers.

At arrival, CLIENT appeared to be in a content mood characterized by frequent smiles, laughs and comments on the environment. He was eating breakfast during arrival. After he finished eating, he independently cleaned his eating area. BHT reinforced this with high-fives and verbal praise. BHT also modeled ways to collect trash from other areas to model ways to assist others. When he cleaned other areas, he was also provided with positive reinforcement and exaggerated affect.

CLIENT then transitioned to morning meeting where BHT facilitated a circle activity. During this time, BHT gave CLIENT opportunities to engage, interact and respond to various themes initiated by other peers. During this time, CLIENT responded to peers greeting him and giving him materials to share. When he established eye contact, laughed or smiled, BHT immediate reinforced these instances through exaggerated affect and verbal praise. BHT structured sing alongs and freeze dance while commenting on other peers to promote initiations of engagements. This led to CLIENT attending to various peers and moving closer in proximity to them.

CLIENT then transitioned into an arts/craft activity. He was given cut outs, glue and markers to design a waving hand. He independently used the scissors, glue and colored the sheets necessary for completing the craft. BHT then modeled ways for him to show other peers his finished craft. With a cue he was able to show multiple peers his finished work. During these instances, BHT immediately reinforced through the use of verbal praise and exaggerated affect to ensure that he shared the social experiences. He was then given a scheduled break to use the iPad for a short duration before transitioning to movement.

BHT concluded the scheduled break and utilized a visual prompt to transition to the park. While walking, BHT created opportunities to increase environmental and safety awareness through compliance training. BHT gave safety commands such as “stop”, “wait” , “cross” & “go” while looking at various places along the way. When arriving to the park, BHT structured various movement activities such as tag, chase and races with other peers to provide opportunities for engagements. When he participated in the activities and displayed increased eye contact with peers, BHT immediately reinforced these instances with verbal praises and high-fives.

BHT will continue to facilitate skills acquisition, utilize compliance training and social skills training in the next scheduled session.

Progress note 15

BHT visited CLIENT in the school setting to facilitate behavioral treatment and skills acquisition. Present was CLIENT, the staff and his peers.

At arrival, Client appeared to be in a content mood as evidenced by characterized by frequent smiles, laughs and positive comments on the environment. BHT acknowledged him sitting at his designated seat with a high-five. He then transitioned to morning meeting. While the teacher was giving instructions, Client was using his cell phone. BHT then provided a cue by saying “It’s morning meeting time. Technology class is later”. Client then put his phone in his pocket. BHT immediately provided verbal praise “good job”. Client then participated in the activity without looking at his phone.

Client then transitioned to biology where he was instructed to sit and take out his book. The teacher then asked a question related to his current mood. He replied by saying “He is feeling like an alien”. BHT provided a cue by saying “It looks like your feeling optimistic about the lesson/It looks like your excited to begin learning”. Client then laughed and responded by using the modeled phrase given by the BHT. The teacher then gave immediate verbal praise to his response.

BHT and Client transitioned to gym to begin the sports/movement activities. During the available activities which included basketball, football, exercising and running laps, Client and his peer began playing a game that involved touching and pushing. BHT modeled various appropriate play themes such as running, jumping, chasing and shooting the basketball into the hoop. Client and his peer then switched their play them to basketball which significantly reduced the need for touching and pushing each other.

After gym, Client transitioned to lunch with his peers. He sat at the designated table while waiting to get his lunch. He was then told to get in the line to receive his lunch. While standing in line, he constantly touched and grabbed a peer standing in front him. The staff gave Client 3 verbal prompts before he stopped. BHT praised Client for stopping but also utilized social skills training of conversation topics he could use instead of touching and pushing.

Plan:

BHT will continue to provide reinforcement for desired behaviors to assist client familiarize the social and task expectations within the classroom.

Progress Note 16

BHT visited CLIENT in the school setting to focus on replacement behaviors and skill acquisition. Present was CLIENT, his teacher and peers.

When CLIENT arrived via the school bus, BHT greeted him and used a familiar engagement theme as a pairing technique. BHT modeled for CLIENT how to put his belongings in the correct spaces rather than him putting his bags on the floor and moving directly to play areas. When CLIENT put his belongings in the appropriate places, BHT immediately reinforced his success through verbal praise and high-fives. CLIENT moved into an activity being facilitated by the teacher which included students describing their emotions, identifying the days of the week and counting their tokens they earned from participating and following classroom rules. CLIENT was observed calling out when the teacher was asking questions. BHT modeled ways for CLIENT to raise his hand before yelling out answers and responses. The teacher gave CLIENT an opportunity to raise his hand to be called on so that he could give his response. BHT immediately reinforced these instances through high-fives and verbal praise.

CLIENT transitioned to walking into the hallways. After he lined up correctly, which was characterized by walking to his place in line and waiting for further instructions, BHT immediately provided acknowledgments and high-fives which motivated CLIENT to remain in his place in line throughout the transition. There were times while walking to lunch that CLIENT required a verbal prompt or redirection. However, after the prompt was provided, he remained in line until being seated at the lunch table. BHT verbally praised CLIENT for sitting at the table and gave him high-fives. While CLIENT was eating his lunch, he began to play with the food items characterized by [whatever play themes he was using with the food rather than eating it]. BHT gave CLIENT options which included him eating preferred items from the lunch while discarding non-preferred food items. He then threw away various food items while BHT follow-up with immediate reinforcement via praise and high-fives.

CLIENT then transitioned to art in which he was required to complete a painting project with others at the group. During times, he was observed becoming off-task characterized by talking with other peers, drawing pictures on other sheets rather than completing the designated tasks and leaving his seat to wander the room. He was verbally prompted and redirected during these times. BHT then utilized proximity control to assist CLIENT complete the group project while reinforcing his ability to remain with the group and engage with nearby peers. At this time, there was 30-minutes remaining in the session in which CLIENT was given a scheduled break to participate in a preferred free-play activities while talking to the teacher to review effective/ineffective intervention techniques that were utilized to engage the teacher in skills transfer for the remainder of the session.

Plan:

BHT will continue to work on skill acquisitions while providing immediate reinforcement for positive and desired behaviors observed throughout the day.

Progress Note 17

BHT Met with April in the school environment to work on skills acquisition and replacement goals. Present at the time, was April, peers, teacher, staff and BC.

Upon BHT arrival, April was in a happy mood characterized by frequent smiles and laughter. BHT greeted April with a smile, high-five and “good morning’. April responded to the engagement by replying with “good morning’. The teacher was facilitating a morning meeting exercise which included reviewing alphabets, sing-alongs, days of the weeks, number and weather review. While the teacher was singing the days of the week, April left the table to go roam around the room without permission. BHT utilized premack principal which included “first, sitting and completing the exercises, then receiving a scheduled break”.

The teacher then transitioned the class to the carpet area to participate in a circle time activity. While transitioning to the carpet area, a peer bumped into April and he then punched the peer in her arm. BHT walked April over to the peer he punch and Modeled a “sorry” gesture to the peer. After April utilized the modeled gesture, BHT utilized verbal praise and high-fives to assist April familiarize the social expectations.

The teacher gathered the class to prepare for lunch by cleaning up the environment, getting their lunch belongings and lining up in a line. April transitioned to the line independently without any additional prompting. BHT then gave April positive reinforcement via high-fives, verbal praise and exaggerated affect. April transitioned to the lunch table and began eating her food. While April was eating her lunch, a peer came and snatched her fruit chews away. April began crying, yelling and screaming and kicking. BHT utilized FCT by providing a modeled gesture of help. After April utilized the gesture, BHT reinforced this instance with verbal praise, high-fives and exaggerated affect.

It was then time to transition to centers. Before the transition, the BHT utilized a visual aide to show April the upcoming transition. April entered the classroom and was directed to centers. April went over to the kitchen area to play with kitchen toys. A peer was already utilizing the vegetable & fruit set. April then attempted to take the fruit and vegetable set from the peer. Peer moved away from the April to avoid the encounter. April began yelling, screaming and falling to the floor. BHT modeled active/planned ignoring to empower the staff to refrain from complaining and constantly commenting on the tantrum. After April became calm, BHT then utilized “if, then” statement “If you stop crying, then you can try again”. April then stopped crying and was escorted by the staff to continue playing in the centers activity. BHT also facilitated social skills training by inviting a peer to play with the toys while modeling various play themes, ways to share, take turns and trade.

PLAN:

BHT will assist April work towards learning, practicing, and developing social and communicative skills while continuing to transfer effective interventions to the teacher and staff.

Progress Note 18

During today’s session, CLIENT_NAME_GOES_HERE participated in a structured environment with both the teacher and school staff, where the focus was on enhancing his play skills, communication abilities, and social interactions. The Registered Behavior Technician (RBT) facilitated the session, targeting specific objectives to support CLIENT_NAME_GOES_HERE's progress in play, communication, and social skills. Play activities were initially introduced, incorporating a variety of play themes. The RBT utilized the Pre-Mack principle to encourage CLIENT_NAME_GOES_HERE to engage in preferred activities after completing less preferred tasks, which supported his transition between different play scenarios.

Throughout the session, the RBT observed several moments where CLIENT_NAME_GOES_HERE demonstrated the ability to share and take turns during play. However, there were missed opportunities where CLIENT_NAME_GOES_HERE sought inappropriate attention by abruptly running around the room when peers became loud or overly active. These behaviors led to disruptions in group play, and CLIENT_NAME_GOES_HERE avoided participating in some activities by laying his head down on the table or staring at objects unrelated to the task. In such instances, the RBT applied response blocking to limit these behaviors and redirected CLIENT_NAME_GOES_HERE back to the group with a verbal prompt. The behavior consultant also modeled the use of positive reinforcement by praising CLIENT_NAME_GOES_HERE immediately after appropriate play actions, such as when he successfully traded toys with a peer and responded to their request.

Communication was a central focus of the session, with CLIENT_NAME_GOES_HERE being prompted to communicate his wants and needs using five or more words. While CLIENT_NAME_GOES_HERE initially relied on shorter phrases or gestures to indicate his preferences, the RBT used visual aids and verbal modeling to encourage more complex sentence structures. For instance, when CLIENT_NAME_GOES_HERE pointed to a toy he wanted, the RBT prompted him by saying, "I want the red truck, please." Over time, CLIENT_NAME_GOES_HERE began to use longer verbal utterances with teacher support. There were missed opportunities where CLIENT_NAME_GOES_HERE opted for silence or gestures in place of verbal communication, particularly when he became disinterested in certain activities. These moments were addressed by incorporating scheduled breaks to maintain his engagement and energy throughout the session.

In terms of social skills, CLIENT_NAME_GOES_HERE demonstrated some initial hesitance in responding appropriately to peer engagements. During a peer-led activity where toys were traded, CLIENT_NAME_GOES_HERE hesitated and showed signs of frustration, though he did not escalate to maladaptive behaviors. The RBT intervened by modeling appropriate responses and using a token system to reinforce positive social interactions. Each successful engagement was followed by a token reward, which was later exchanged for a preferred item. This system helped sustain CLIENT_NAME_GOES_HERE’s motivation to participate in the group activity, though moments of peer distraction occasionally caused him to disengage.

The RBT made concerted efforts to consult with school staff and the teacher during the session. This consultation aimed to promote the consistent use of interventions across different school settings, making it easier for CLIENT_NAME_GOES_HERE to generalize these skills. Staff were encouraged to use the Pre-Mack principle to manage transitions between tasks, apply positive reinforcement to strengthen desired behaviors, and provide scheduled breaks when CLIENT_NAME_GOES_HERE showed signs of task avoidance. Additionally, visual aids were introduced as a useful tool for promoting communication, especially when CLIENT_NAME_GOES_HERE struggled to verbalize his needs. The teacher expressed interest in integrating these strategies into the daily classroom routine to better support CLIENT_NAME_GOES_HERE’s development.

Clinical data indicated that CLIENT_NAME_GOES_HERE had multiple missed opportunities due to seeking attention inappropriately and being easily distracted by peer behavior. These behaviors led to brief instances of task avoidance, particularly during moments of heightened noise or when CLIENT_NAME_GOES_HERE found the activity less engaging. Despite these challenges, the combination of interventions was effective in maintaining CLIENT_NAME_GOES_HERE’s overall participation and improving his social interactions with peers.

For the next session, the plan is to increase the focus on sustaining CLIENT_NAME_GOES_HERE’s engagement during group activities by adjusting the reinforcement schedule and incorporating additional structured play themes to minimize his task avoidance behaviors.

Progress Note 19

The session took place in a structured school setting with CLIENT_NAME_GOES_HERE, the teacher, and school staff. The focus was on addressing play skills, communication, and social interactions. The Registered Behavior Technician (RBT) facilitated the session, using specific interventions aimed at promoting skill acquisition and behavioral improvements. Play activities were introduced with clear instructions, and CLIENT_NAME_GOES_HERE was prompted to engage with peers in turn-taking and sharing tasks.

CLIENT_NAME_GOES_HERE showed mixed responses to the interventions throughout the session. During a play activity that involved sharing toys with peers, CLIENT_NAME_GOES_HERE was prompted to take turns. At first, he engaged in the activity without issue, following instructions to trade toys with another student. He briefly maintained eye contact and completed the exchange. Positive reinforcement was given in the form of verbal praise and tokens to acknowledge the appropriate behavior. CLIENT_NAME_GOES_HERE accepted the praise and continued to participate in the play session. The token system was consistently applied to reinforce his appropriate actions during the session. After receiving several tokens, CLIENT_NAME_GOES_HERE remained compliant and participated in subsequent activities.

There were moments, however, when CLIENT_NAME_GOES_HERE exhibited behaviors that interfered with the session's objectives. At one point, when the activity shifted to a less preferred task, CLIENT_NAME_GOES_HERE became disengaged and avoided participation by putting his head down on the table. This behavior appeared after the task was introduced, and it became clear that CLIENT_NAME_GOES_HERE was avoiding the activity. The RBT implemented scheduled breaks in response to this avoidance, allowing CLIENT_NAME_GOES_HERE to leave the task momentarily before returning to the group. After the break, CLIENT_NAME_GOES_HERE returned to the activity but remained somewhat disengaged. He stared at objects in the environment and did not respond to peer prompts or interactions.

During communication activities, CLIENT_NAME_GOES_HERE was encouraged to express his wants and needs using five or more words. Several opportunities arose where CLIENT_NAME_GOES_HERE was prompted to request items or express preferences. In some cases, he responded by using appropriate verbal expressions, such as “I want the ball.” These responses were reinforced with positive praise, and CLIENT_NAME_GOES_HERE showed increased willingness to communicate verbally. However, there were instances where CLIENT_NAME_GOES_HERE resorted to gestures or remained silent. These missed opportunities were addressed with prompts and visual aids. The RBT modeled appropriate verbal responses, but CLIENT_NAME_GOES_HERE sometimes appeared unmotivated to follow through with longer sentences, especially as the session progressed.

In terms of social interactions, CLIENT_NAME_GOES_HERE was placed in peer-related activities to encourage exchanges and appropriate responses. During one such activity, he initially participated by responding to a peer’s request to trade toys. However, when the peer interaction became more frequent, CLIENT_NAME_GOES_HERE showed signs of frustration and withdrew from the activity. The RBT intervened by offering a token for each appropriate social response. While the token system was effective in the short term, CLIENT_NAME_GOES_HERE continued to show signs of frustration as the social exchanges increased. At one point, he refused to engage further and chose to watch the other children without participating. The RBT applied a break and then reintroduced the task with a new set of instructions, which helped him re-engage for a limited time.

The RBT also consulted with school staff during the session, demonstrating the implementation of the Pre-Mack principle and how to structure tasks to support CLIENT_NAME_GOES_HERE’s engagement. Staff were shown how to use positive reinforcement consistently to reinforce desirable behaviors and maintain task engagement. The use of visual aids was modeled to support CLIENT_NAME_GOES_HERE’s communication when verbal responses were limited. The staff were encouraged to integrate these strategies into the daily classroom routine to increase CLIENT_NAME_GOES_HERE’s ability to generalize these skills across multiple environments.

Data collected during the session showed that CLIENT_NAME_GOES_HERE responded positively to structured activities when reinforced with tokens and verbal praise. However, task avoidance behaviors, such as disengagement and inattention, emerged when less preferred activities were introduced or when peer interactions became overwhelming. The scheduled breaks provided some relief and helped reset engagement, though his motivation fluctuated. Missed communication opportunities were also noted when CLIENT_NAME_GOES_HERE avoided verbal interactions.

The next session will focus on further developing CLIENT_NAME_GOES_HERE’s communication skills by increasing the frequency of verbal prompts and reducing reliance on gestures.

Progress Note 20

During the therapy session facilitated by the Registered Behavior Technician (RBT) in the school environment, CLIENT_NAME_GOES_HERE was observed engaging in structured and unstructured play scenarios to target his developmental goals. The session began with the RBT providing a variety of toys and materials, each aimed at encouraging different play themes. CLIENT_NAME_GOES_HERE initially gravitated toward solitary play, selecting a set of building blocks. The RBT provided verbal prompts to encourage turn-taking with peers, facilitating an interaction where CLIENT_NAME_GOES_HERE was required to alternate between constructing his part of the block structure and waiting for a peer to add to it. Initially, CLIENT_NAME_GOES_HERE exhibited some hesitation in relinquishing control over the materials, but with continued prompting and reinforcement, he demonstrated the ability to allow the peer to engage in the activity as well. By the end of the session, CLIENT_NAME_GOES_HERE showed improvement in taking turns without displaying frustration or maladaptive behaviors.

In parallel to developing his play skills, CLIENT_NAME_GOES_HERE's communication goals were emphasized throughout the session. The RBT focused on encouraging CLIENT_NAME_GOES_HERE to use more complex verbal expressions to request items or express his needs. For instance, when CLIENT_NAME_GOES_HERE wanted to use a toy that was already being played with by another student, the RBT used a verbal prompt to guide him in forming a complete sentence. Instead of simply pointing or using a single-word request, CLIENT_NAME_GOES_HERE was encouraged to say, "Can I please play with the car when you are done?" This process was repeated across multiple activities, where CLIENT_NAME_GOES_HERE had to articulate his desires in five or more words before gaining access to the item. Although CLIENT_NAME_GOES_HERE sometimes reverted to more basic forms of communication, the RBT provided immediate feedback and reinforcement when he succeeded in using the target phrase structure. By the end of the session, CLIENT_NAME_GOES_HERE had independently initiated a few five-word requests, a marked improvement in his verbal communication.

The social skill objectives were addressed through guided interactions with peers, with a focus on trading toys and responding appropriately to social cues. In one instance, the RBT facilitated a scenario in which CLIENT_NAME_GOES_HERE had to trade a toy with a peer. The peer was initially hesitant to make the exchange, and CLIENT_NAME_GOES_HERE briefly displayed signs of frustration, attempting to grab the toy back. The RBT intervened by modeling an appropriate request, "Can we trade toys, please?" CLIENT_NAME_GOES_HERE repeated the phrase with guidance and successfully waited for his peer to respond. After a brief negotiation facilitated by the RBT, CLIENT_NAME_GOES_HERE completed the trade and continued to engage with the new toy. This interaction was crucial in helping CLIENT_NAME_GOES_HERE understand the concept of delayed gratification and mutual exchange, as well as responding appropriately to the social cues from his peer.

Throughout the session, the RBT consistently implemented the interventions aimed at supporting CLIENT_NAME_GOES_HERE’s success in these areas. Positive reinforcement was applied whenever CLIENT_NAME_GOES_HERE exhibited appropriate communication or social engagement. For instance, when he used a full sentence to request a toy or allowed a peer to take a turn in a game, the RBT provided verbal praise or a token as part of the token economy system. This system appeared to be effective in motivating CLIENT_NAME_GOES_HERE, as he visibly increased his efforts to comply with the task demands once he saw the tokens accumulating.

The RBT also utilized visual aides to support CLIENT_NAME_GOES_HERE in understanding transitions between activities. A visual schedule was provided to help CLIENT_NAME_GOES_HERE anticipate the upcoming tasks, which minimized anxiety and facilitated smoother transitions from one play theme to another. This method proved beneficial in maintaining his engagement throughout the session.

Overall, the session demonstrated progress in CLIENT_NAME_GOES_HERE’s ability to engage in more cooperative play and social interactions, as well as his growing capacity to communicate his needs in a more structured and appropriate manner. While there were instances where additional prompts and guidance were required, CLIENT_NAME_GOES_HERE's progress, particularly in his communication skills, was evident by the end of the session.

Plan: The RBT will continue to target these objectives in future sessions, with the goal of further reducing the need for prompts and enhancing CLIENT_NAME_GOES_HERE's independent engagement in these areas.

Progress Note 21

The session facilitated by the RBT took place in the school setting with the teacher, peers and CLIENT_NAME_HERE present.

During the session, CLIENT_NAME_GOES_HERE was introduced to structured play activities that focused on turn-taking and sharing with peers. The RBT presented materials such as cars, blocks, and puzzles to facilitate interactions. CLIENT_NAME_GOES_HERE demonstrated an initial interest in playing with a set of toy cars, but when another child requested to join, CLIENT_NAME_GOES_HERE resisted, clutching the toy tightly. The RBT intervened, providing a verbal prompt to guide him in sharing the car. CLIENT_NAME_GOES_HERE refused initially, pulling the toy closer. The RBT utilized a token economy system to reinforce positive behavior, offering a token if CLIENT_NAME_GOES_HERE allowed his peer to take a turn. After brief hesitation, CLIENT_NAME_GOES_HERE handed over the toy and was rewarded with a token, which prompted a slight increase in his willingness to share moving forward.

The session continued with an emphasis on communication skills, particularly focusing on CLIENT_NAME_GOES_HERE using five or more words to express his needs. During a block-building activity, CLIENT_NAME_GOES_HERE attempted to grab additional blocks from another peer without using any verbal request. The RBT stopped the action and modeled the appropriate sentence, "Can I have the blocks, please?" CLIENT_NAME_GOES_HERE repeated the sentence with prompting, though in a softer tone and hesitantly. Despite his reluctance, he did receive the blocks, which led to a positive reinforcement. When later attempting to retrieve more blocks, CLIENT_NAME_GOES_HERE again reverted to a non-verbal grab, signaling some regression in skill retention. A verbal prompt was used once more, but this time CLIENT_NAME_GOES_HERE responded with frustration, knocking over his own structure. The RBT paused the activity, using a brief scheduled break to reset the situation before encouraging CLIENT_NAME_GOES_HERE to try again. He eventually did make a verbal request but only after several moments of refusal.

Social skills were addressed throughout interactions with peers, with particular attention to CLIENT_NAME_GOES_HERE’s response to peer engagement and item trading. When engaged in a puzzle-building task, another child suggested trading a piece to complete the puzzle. CLIENT_NAME_GOES_HERE initially ignored the request, continuing to hold onto the piece. When the peer insisted, CLIENT_NAME_GOES_HERE pushed the piece toward the child with visible frustration. The RBT guided him in using a more appropriate response, verbally prompting, "You can have this one." CLIENT_NAME_GOES_HERE repeated the phrase, though with reluctance, but complied with the trading request. Following the interaction, CLIENT_NAME_GOES_HERE's engagement improved, and he was able to continue participating in the task. The RBT reinforced this behavior through tokens, adding to his token count for the day.

Negative responses emerged during transitions between activities. When instructed to move from block play to a storytime activity, CLIENT_NAME_GOES_HERE resisted, sitting down and refusing to leave the play area. The RBT implemented a visual schedule to indicate the upcoming change, but CLIENT_NAME_GOES_HERE continued to remain seated, pulling a toy closer. The RBT applied a verbal prompt and provided a countdown to ease the transition. After the countdown, CLIENT_NAME_GOES_HERE reluctantly stood up but stomped toward the next area. He remained disengaged during the start of the new activity, requiring additional verbal prompts to re-engage in the group setting. This sequence was repeated during subsequent transitions, indicating a need for continued focus on supporting CLIENT_NAME_GOES_HERE through these moments.

CLIENT_NAME_GOES_HERE responded well to positive reinforcement strategies when successful in completing tasks or sharing with peers. The token system proved motivating during parts of the session, particularly when CLIENT_NAME_GOES_HERE saw his accumulation of tokens increase following successful interactions. He responded positively to verbal praise after completing a task, looking toward the RBT for acknowledgment. However, during moments of frustration or when tasks did not align with his preferences, CLIENT_NAME_GOES_HERE exhibited negative responses such as pushing objects or refusing to verbally engage, requiring the RBT to reset expectations and implement breaks.

By the end of the session, CLIENT_NAME_GOES_HERE demonstrated some progress in sharing and communication, though there were noticeable moments of resistance and frustration, particularly during transitions and peer interactions. The token economy provided a clear framework for reinforcing successful behaviors, but more consistent application of verbal prompting and visual aides is required to support smoother transitions and reduce instances of task refusal.

Plan: Moving forward, the RBT will focus on refining CLIENT_NAME_GOES_HERE’s ability to navigate transitions with less resistance and promote more consistent use of verbal communication during peer engagements.

Progress Note 22

The session began with CLIENT_NAME_GOES_HERE engaging in a block-building activity alongside peers. The focus was on turn-taking and sharing, as the task required cooperation between participants. Initially, CLIENT_NAME_GOES_HERE attempted to complete the structure independently, without offering any of the blocks to his peers. The RBT provided a verbal prompt, instructing CLIENT_NAME_GOES_HERE to pass the blocks to another child. CLIENT_NAME_GOES_HERE hesitated, holding the blocks tightly. The RBT repeated the prompt, and after some time, CLIENT_NAME_GOES_HERE handed one block to his peer. This action was reinforced with a token, which CLIENT_NAME_GOES_HERE accepted. He continued the activity, though further instances of sharing required additional prompts from the RBT. CLIENT_NAME_GOES_HERE did not initiate sharing independently, but responded to the guidance with minimal resistance.

Throughout the session, communication skills were targeted by encouraging CLIENT_NAME_GOES_HERE to use five or more words to express his wants and needs. When CLIENT_NAME_GOES_HERE wanted a specific toy car that another child was using, he initially pointed without speaking. The RBT intervened, prompting him to ask, "Can I have the car when you’re finished?" CLIENT_NAME_GOES_HERE echoed the sentence with significant verbal support, receiving the car after the peer had finished. Positive reinforcement was provided, but CLIENT_NAME_GOES_HERE continued to rely on prompting for similar situations. During another activity, CLIENT_NAME_GOES_HERE again attempted to retrieve an item without asking. The RBT blocked the behavior, offering a prompt, but CLIENT_NAME_GOES_HERE displayed frustration, turning away from the task. A short break was introduced, and the activity was reintroduced afterward. CLIENT_NAME_GOES_HERE complied with the verbal prompt following the break, though his responses remained hesitant.

Social skills were addressed through peer interactions during play. In a toy-trading exercise, CLIENT_NAME_GOES_HERE was given an opportunity to exchange toys with a peer. When presented with a trade request, CLIENT_NAME_GOES_HERE avoided eye contact and held the toy closer to himself. The RBT prompted him to say, "Let’s trade toys." CLIENT_NAME_GOES_HERE repeated the phrase with guidance, though his body language remained resistant. The peer completed the trade, and the RBT reinforced CLIENT_NAME_GOES_HERE’s behavior with a token. The RBT facilitated another trade later in the session, and CLIENT_NAME_GOES_HERE engaged with less resistance. He completed the exchange after a single prompt, though he did not initiate any trades on his own. Social engagement increased slightly by the end of the session, though consistent support from the RBT remained necessary for successful interactions.

CLIENT_NAME_GOES_HERE’s negative responses were most evident during transitions between activities. When the RBT signaled the end of the block-building task and prompted a move to a new play area, CLIENT_NAME_GOES_HERE ignored the instruction and continued building. The RBT provided a visual schedule and a verbal reminder of the upcoming transition. CLIENT_NAME_GOES_HERE resisted, refusing to leave the area. The RBT implemented a countdown, followed by a firm verbal prompt, which led to CLIENT_NAME_GOES_HERE reluctantly following the instruction. However, upon reaching the new activity, CLIENT_NAME_GOES_HERE sat passively and did not engage without additional support. The RBT repeated the visual cue, guiding CLIENT_NAME_GOES_HERE into the activity. These transition-related difficulties were a recurring challenge throughout the session, with CLIENT_NAME_GOES_HERE requiring multiple prompts and clear visual aides to shift from one task to another.

CLIENT_NAME_GOES_HERE’s response to interventions was mixed. He accepted tokens for completed tasks, which motivated him to some extent, but he continued to exhibit resistance during moments that required cooperation or communication without support. When successful, CLIENT_NAME_GOES_HERE engaged in the activities after prompting and reinforcement. For example, when he successfully shared or used a full sentence to ask for an item, his compliance led to reinforcement, and he showed brief periods of increased participation. However, negative behaviors emerged when tasks became more challenging or when he was asked to give up control of materials or activities. During these times, CLIENT_NAME_GOES_HERE either withdrew from the task or displayed frustration through passive resistance.

By the end of the session, CLIENT_NAME_GOES_HERE showed some progress in using verbal communication with support, as well as engaging in peer interactions when prompted. The token system provided a clear incentive for positive behavior, though it did not entirely prevent resistance during transitions or unpreferred tasks. CLIENT_NAME_GOES_HERE’s social engagement improved slightly with continuous intervention, though his ability to initiate communication or social exchanges without prompts remained limited.

Moving forward, a continued focus on supporting transitions and encouraging more independent communication is recommended. Interventions will need to maintain a balance between reinforcement and structured guidance to address ongoing challenges in cooperation and task compliance.

Plan: RBT will continue to assist client meet and exceed the treatment objectives related to improving social and communication skills.

Sample Session Notes