What about maintenance programs?

I am a relatively new provider, working towards my Registered Behavior Technician (RBT)™. I am a bit confused about the different portions of programming. We have something called a “maintenance section,” but I am not really sure what that means?

Bobby Newman, PhD, BCBA-D, LBA
Proud Moments ABA

Photographed by Mikhail Nilov (pexels.com)

When I was first learning about implementing Applied Behavior Analytic (ABA) programming, we had paper and pencil “program books.” These were generally large looseleaf binders with sections for various programs, graphs, instructions regarding how to carry out the programs, behavior treatment plans, etc. Each program book was generally accompanied by large, sometimes rolling, bins of materials that were needed for carrying out the designated programs. Of course, many program books are electronic these days, but I go back to basics for concrete illustration and ease of understanding purposes.

Within the book, or perhaps as a separate, smaller book, there was a section called “Maintenance.” Generally speaking, this section included skills that had been mastered, which we practiced (worked on) following some interval time schedule to make sure the student did not “lose the skill(s).” There was a fear that if the student did not practice the skill, they would not be able to “maintain” the skill and all the previous teaching efforts and time would have been wasted. It was regarded by many as a standard operation procedure then, and perhaps still is, but I have always had a big problem with the concept of having or needing a “Maintenance” book or section. This is particularly the case when targeted skills were not well assessed in the first place, not developmentally appropriate, or if “maintenance” practice only constituted review and did not reflect well conceptualized efforts to promote generalization.

Allow me to elaborate. We as a behavioral teaching community have come a long way since our early days in teaching new skills to children on the autism spectrum. We were less focused on maintenance and other forms of generalization, and we were frankly thrilled our teaching methods (i.e., usually taught in discrete trial format) were producing new repertoires of behavior in our students. At the same time, we were challenged by the reality that our students seemed to need frequent review sessions lest they lose the information we had taught them. Now, many years later, whenever I look at any individual skill being targeted for teaching, my central question is always: “if the student masters this skill we are attempting to teach, how will it make the person more independent, more able to function independently, or better able to acquire more complex skills within that curricular progression?” In other words, the skills being taught should be practical and help the person live more autonomously and have more independent opportunities to make decisions for their own lives.

Inherent in this idea is that the skills should be useful and functional in the student’s life, with each new mastered skill being used and incorporated in everyday life as the person develops greater and greater independence. This brings me to my problem with the concept of having a “maintenance book/section”: if the student needs to practice the skill “in maintenance,” that suggests to me that it is not a skill they are practicing in their everyday lives. If it were, practicing “in maintenance” would be superfluous.

There are, of course, exceptions to this idea. Not every skill needs to be practiced every day. Hopefully one does not get lost so frequently that one must practice asking for directions every single day, to take just one concrete example. On balance, there are many areas of academic learning that require frequent review. While we may not need to address asking for directions, we surely want to maintain academic gains such as reading and math that might be critical skills for many of our students. Such examples aside, education teams should look carefully at targeted skills and subject them to the critical questions of functionality and real-world use and adjust the IEP as needed.

That being said, there are also times when one might use previously mastered skills as part of a teaching strategy. For example, in public school settings, maintenance programs may be in place as a “go to” when more seasoned staff are out. These are often easier to implement and both substitute instructor and student will be successful. Many providers also draw from maintenance programs when running interspersed trials, mixing both mastered and unmastered material, and some use maintenance programs as a behavioral momentum strategy prior to moving to more difficult targets.

In order to support maintenance of acquired skills, basic and applied research suggests the following:

1. Teach skills that will be useful and frequently practiced in everyday life. This would include everyday applications of academic skills (e.g., counting money to make a purchase from a vending machine). These efforts would then create opportunities for the skill to be reinforced naturally and in a sustainable manner. Consider looking at the Essentials for Living for guidance in this area (McGreevy, Fry & Cornwall, 2014).
2. Teach for both stimulus and response generalization, ensuring that the skill is practiced across a variety of settings and conditions and the skill can be performed in a variety of ways. The instructional team would need to think carefully about what this might look like from skill to skill rather than using a cookie-cutter approach. For example, it would be important for a student to be able to answer questions posed by an array of askers who may also use varied wording. Mesmer et al. (2013) provide a really nice example of such generalization training.
3. Implement an intermittent reinforcement system/schedule during teaching, as behaviors that are reinforced intermittently tend to resist extinction better than those maintained by continuous reinforcement. Consider the common example of a slot machine versus a broken soda machine. Slot machine users are typically going to spend far more time inserting coins then soda machine users, who will likely walk away when reinforcement ceases. We want our students to use their skills for years to come even if the reinforcement is not always abundant.
4. Make sure not to thin the schedule too quickly or one can create something called “ratio strain” wherein the level of reinforcement is not sufficient to maintain the skills.

I don’t know about you, but hearing “he used to be able to do that” makes me sad. It makes me frustrated that someone “lost” a skill they had, which may be a function of the skill not being taught well in the first place (i.e., acquired at a suitable level of mastery and practiced to fluency in natural conditions and varied settings and situations). It also suggests that perhaps we spent a fair amount of precious time teaching something that turned out not to be useful and meaningful for the student who would then not use it after all. In the suggested readings, there are two excellent articles from the Journal of Applied Behavior Analysis that demonstrate the process.

References

McGreevy, P., Fry, T., & Cornwall, C. (2014). Essential for living: A communication, behavior and Functional Skills Assessment, curriculum and teaching manual for children and adults with moderate-to-severe disabilities. Patrick McGreevy, PhD, PA.

Mesmer, E. M., Duhon, G. J., Dodson, K. G. (2007) The effects of programming common stimuli for enhancing stimulus generalization of academic behavior. The Journal of Applied Behavior Analysis, 40, 553-557. https://doi.org/10.1901/jaba.2007.40-553.

Podlesnik, C. A., Kelley, M. E., Jiminez-Gomez, C., & Bouton, M. E. (2017). Renewed behavior produced by context change and its implications for treatment maintenance: A review. Journal of Applied Behavior Analysis, 50(3), 675–697.

Citation for this article:

Newman, B. (2023). Clinical Corner: What about maintenance programs? Science in Autism Treatment, 20(10).

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