When should parents be included in the implementation of a behavior intervention plan?

I have spent a lot of time researching best practices and consulting with my supervisor to develop my first official behavior intervention plan (BIP) for a home therapy case. I interviewed the family during assessment and have their consent to implement the plan. I know that including the family is crucial for the overall success of the plan, but I just don’t know the best time to do that. Should I include the family in the intervention process from the beginning or wait until we are successfully implementing the plan in session?

Answered by Megan Miller, MA, BCBA, EMT
Graham Behavior Services, LLC

Graham Behavior Services - Behavior Intervention Plan You raise an important question about when to include parents in the implementation of the behavior intervention plan (BIP). As a rule, Board Certified Behavior Analysts (BCBAs) should interview parents or caregivers during the functional behavior assessment, or FBA. Parents or caregivers need to give consent for implementation after the BCBA has reviewed the BIP with them. This is outlined in the Professional and Ethical Compliance Code for Behavior Analysts 4.02 and 4.04 (Behavior Analyst Certification Board [BACB], 2014). BCBAs should also seek the parents’ feedback on how they think the learner will respond to strategies outlined in the plan. For example, if a BCBA writes a plan that uses ice cream as a reinforcer, but the learner is allergic to dairy products, the plan clearly needs to be changed.

Including the family in the implementation of a behavior plan is crucial for the plan’s ultimate success. “Parental involvement is the one invariable factor and an integral part of the success of early intervention programs for children with autism. The collaboration between the parent and the professional working with the child in the program is critical to the effectiveness of programs (Bennett, 2012, p. 2).”

Strategies developed using applied behavior analysis are always customized to meet the needs of the individual which makes a response to your question a complex one. Just like every BIP is unique to the individual learner, there are a lot of factors that should be considered when determining how to include parents in the implementation of the plan. How do you know the optimal time to include the family in the intervention process? Should parents implement the plan from the beginning or join the process after the learner has shown progress? Your team needs to carefully consider the timing of when families should start implementing the plan to maximize the benefit for the learner. Outlined below are some things to think about when making this important decision.

Include the family in the intervention of the behavior plan from the beginning when…

⇒…target behaviors don’t occur during home-based teaching sessions. Parents are with their children all the time and can better implement behavior strategies outside of therapy sessions. They also can communicate how the plan is generalizing into multiple settings. Involving parents in the BIP from the beginning will help parents know what to do in situations when professionals are not present. This could also help the learner to gain skills more quickly.

⇒…programming for generalization is challenging. If generalizing skills has been difficult in the past, program for it by including parents from the beginning. They will be able to implement the BIP across multiple people in a variety of settings and throughout different situations. Hailstone (2014) points out that parents have critical input about areas in which their children need more help.

⇒…parents are very involved in programming or if they have a strong background in ABA. Collaborating with parents from the beginning can create buy-in. It may validate and empower parents (Callahan, 2019). They will recognize the power they hold to create a more positive home environment. They will understand what is causing challenging behavior and know how to address it. Parents or caregivers will be able to share strategies with other family members. Hailstone (2014) indicates that parental involvement gives children significantly more learning opportunities.

⇒…the behavior serves a different function with the parents than it does during session. For example, during session, a learner may be trying to escape demands. Outside of session, they may be trying to get the parents’ attention. BCBAs should realize that the function of the behavior varies in different settings by having frequent conversations with parents and by continually monitoring the learner in an unstructured, out of session environment. It may be necessary to conduct an additional functional analysis. If this is the case, plan to coach the parent to implement a BIP geared towards helping the family.

⇒…parental stress is a barrier for providing their child with the best care they can provide. Bennett (2012) found that stress was the main reason parents participated less in their child’s early intervention program. Implementing a behavior plan at any point is challenging but working as a team will create a collaborative and more meaningful experience for parents. In Dr. Kate Fiske’s book, Autism and The Family (2017), she explains that when parents’ interventions help their child, they feel more successful and confident in their parenting skills. As a result, they can better manage their child’s challenging behavior. This leads to lower levels of anxiety and depression (p. 183).

⇒…if a learner will have difficulty when their behavior is reinforced in one setting and not another. Some behaviors get more challenging when people pay attention to them. The behavior plan may be to minimize attention to the challenging behavior while teaching a replacement behavior. The learner may have difficulty differentiating between how they should act in different settings. They may also struggle with learning the new skill if the challenging behavior continues to be reinforced at home. In these cases, implementing the BIP in the school, clinic, or therapy setting at the same time as the home setting should yield the best results.

⇒…if services are being delivered via telehealth. In the telehealth model, parents run everything under your guidance. Plan ahead of time to review the entire plan with them. Parents should ask any questions they have. Deliver feedback before, during, and after every session. Ask parents for their feedback. Make the process as collaborative as possible so that the learner

Wait to include the family in the actual implementation of the behavior plan until after the plan is successful during session when…

⇒…an intervention is implemented in a setting outside of the home. What happens in a clinic or school setting is completely different than the home setting. More structured settings allow staff to have better control over what happens. Schools and clinics don’t have to account for siblings, pets, visiting relatives, or other variables that homes do. This allows the staff to successfully and consistently implement the BIP and then transfer it to the home setting.

⇒…the plan contains unique details that have not been probed. Professional collaboration and brainstorming are often necessary for successful implementation. BCBAs can provide input in the moment and adapt to situations that may have been overlooked during the initial writing of the plan. After the plan has been proven to produce the desired results, professionals can confidently incorporate parents to help the learner generalize the skills they are acquiring.

⇒…it may be difficult to maintain treatment fidelity at home. It is crucial that the plan is consistently implemented the way it was intended. This is called treatment fidelity. If staff and the family are implementing the BIP differently, this will make it difficult for the learner to be successful. Fiske states, “Small errors can become patterns and in no time, treatment could begin to look vastly different from what was intended.” (2017, p. 235). The learner may receive reinforcement or punishment that will likely affect their progress. As Fiske points out, you won’t know why a plan was or wasn’t successful (2017, p. 231). Correct, consistent, implementation is crucial to making decisions about whether to continue, change, or discontinue treatment. After you incorporate the family in the implementation of the BIP to the family, continually follow up.

⇒…the family says they will have difficulty implementing the plan. Stocco and Thompson (2015) state that when parents have difficulty implementing the plan, their child has a harder time changing his/her behavior. During implementation, you may have to simplify the plan in order to make that transfer easier. Make the BIP easy to implement for everyone including grandparents and siblings. This will help a learner reduce his/her challenging behavior and increase replacement behaviors.

⇒…it is difficult for the family to set aside time for training. Parents are dealing with their own stress on top of parenting a child that has challenging behavior. Some parents may work long hours, come home exhausted, and not have the time or energy to spend working with their children (Bennett, 2012). Create buy-in by showing parents how successful the BIP is during session. Then, schedule time to thoroughly review it. Using a well established procedure such as behavioral skills training will reduce the amount of time needed to teach busy parents.

⇒…parents prefer to see the benefits of implementation prior to implementing We can’t expect parents to have the knowledge and skills that professionals bring to the table. It may be challenging for them to implement a behavior plan that they have not watched you successfully implement. Have them observe a plan that you have proven works. This will give them the confidence and buy-in to implement all aspects of the plan. It will also make delivering a behavior skills training model much easier and more meaningful.

If severe and dangerous problem behavior is involved, decide on a case by case basis.

When beginning to implement a BIP, professionals and families may be injured. This is especially true if severe or dangerous behavior is targeted. Putting parents into volatile situations may open them up to unnecessary risk. However, the risk may be already occurring for a large part of the family’s day (Callahan, 2019). Once you have written the BIP, schedule a meeting with the family. Review it and discuss if they think they could implement it. To keep everyone safe, therapy hours should be significantly increased, and parents should be trained on safety procedures. Parent coaching should occur frequently to ensure the learner is able to generalize skills across settings. Conducting behavior skills training with families is the most effective way to teach them how to implement a plan (Stewart, Carr, & LeBlanc, 2007).

In summary, getting parents and families involved in their child’s ABA therapy is essential. It is crucial to help the learner generalize the BIP and create socially significant behavior change. Consider the above factors to ensure that you include parents in the implementation of the behavior plan at the most optimal time.

If you want to hear more discussion about this topic, listen to Round 2: When to Include Parents as Active Participants in Implementing the Behavior Plan of the podcast ABA Ultimate Showdown.

References

Bennett, A. (2012). Parental involvement in early intervention programs for children with autism. Retrieved from Sophia, the St. Catherine University repository website: http://sophia.stkate.edu/msw_papers/113

Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts.

Callahan, A. E. (Debater). (2019, July 3). Round 2: When to Include Parents as Active Participants in Implementing the Behavior Plan [Audio podcast episode]. In ABA Ultimate Showdown. Graham Behavior Services. https://www.grahambehaviorservices.com/podcast/#round2

Fiske, K. E. (2017). Autism and the family: Understanding and supporting parents and siblings. Norton.

Hailstone, P. (2014). “Parent involvement in ABA/IBI: How, why, & what for?” Autism Asperger’s Network Magazine. https://abia.net.au/web/wp-content/uploads/2016/07/ABIA-Jan-2014-Article-Parent-Involvement-in-ABA.pdf

Stewart, K. K., Carr, J. E., & LeBlanc, L. A. (2007). Evaluation of family-implemented behavioral skills training for social skills to a child with Asperger’s disorder. Clinical Case Studies, 6(3), 252–262. https://doi.org/10.1177%2F1534650106286940

Stocco, C. S., & Thompson, R. H. (2015). Contingency analysis of caregiver behavior: Implications for parent training and future directions. Journal of Applied Behavior Analysis, 48(2), 417–435. https://doi.org/10.1002/jaba.206

Citation for this article:

Miller, M. (2020). Clinical Corner: When should parents be included in the implementation of a behavior intervention plan? Science in Autism Treatment, 17(8).

Other ASAT articles that may be of interest:

#BehaviorAnalysts #ChallengingBehavior #MedicalProviders #Parents #Teachers