Courtney Raia Instructional Program Student: AC Skill: Brushing teeth.

Initiator: Courtney Raia Context for Instruction: Instruction and assessment for this skill will be done in the restroom within the students classroom. This is a private bathroom that is not available to other students. The instruction will occur twice a day, once around 9 am following breakfast, and once around 11:30 am following lunch. This is a part of a naturally occurring routine because it is built in after meal times. It is typical for an individual to groom and brush their teeth following a meal. The students toothbrush and toothpaste will be used, although perhaps using toothpaste with a pull-lid would be an adaptation from her current screw-on lid because she does have difficulty with her fine motor skills trying to open it. Other learners and instructors will be present in the classroom, but they will not be present in the bathroom. Program Objective: When instructed to brush her teeth in the school bathroom and handed a bag with her toothbrush and toothpaste, AC will correctly complete 80% of the steps of the following task analysis on six consecutive trials. Task Analysis for Brushing Teeth: 1. Open Bag. 2. Take out toothbrush. 3. Put bag back on lap. 4. Remove toothbrush lid. 5. Put lid on sink. 6. Hold toothbrush under faucet (water will turn on automatically). 7. Wet bristles on toothbrush. 8. Place toothbrush on sink. 9. Pick up bag. 10. Remove toothpaste from bag. 11. Place bag back on lap. 12. Screw top off toothpaste.

13. Place lid on sink. 14. Squeeze toothpaste onto toothbrush bristles. 15. Put lid back on toothpaste. 16. Return toothpaste to bag. 17. Pick up toothbrush. 18. Move toothbrush bristles up and down on all areas of teeth. 19. Spit in sink. 20. Hold toothbrush under faucet. 21. Rinse bristles in the water. 22. Move toothbrush bristles up and down on all areas of teeth. 23. Spit in sink. 24. Hold toothbrush under faucet. 25. Rinse bristles in water. 26. Get paper towel. 27. Dry bristles on towel. 28. Throw towel in garbage. 29. Put lid on toothbrush. 30. Return toothbrush to bag. Generalization: The strategy of teaching in the natural setting will be used to ensure that AC is able to generalize the skill of brushing her teeth. This is because the skill will be taught in situations when the skill will actually be needed, which is after breakfast and lunch. It is natural for an individual to brush their teeth after eating a meal, so getting the student into this schedule will allow her to generalize the skill and schedule into other settings. Rationale: Teaching AC to perform basic tasks such as personal care skills will be very important for her later in life. In order for her to possibly live independently further in life, she needs to know how to take care of herself and do tasks such as brushing her teeth, combing her hair, and washing her face. These are basic skills that every individual should be able to do for him or herself so that they can live without being dependent on another individual. All three of these tasks are also goals on her IEP, which makes learning these skills a priority for AC. Assessment Procedures: The students skill in brushing her teeth will be assessed as follows: 1. Give student a bag containing her toothbrush and toothpaste. 2. Say to student brush your teeth.

3. Allow student to begin brushing her teeth independently. If the student does so correctly, mark + next to the step on the task analysis, and allow her to continue on to the next step. If the student does not respond or completes a step incorrectly or out of order, mark P for prompt and assist student with the step. Then allow the student to move on to the next step independently. 4. Continue this process until each step of the task analysis is completed. Assessment Schedule: AC should be assessed for baseline daily until the data shows consistent results. Once instruction begins, the student will be assessed every third day of instruction. Instructional Procedure: Lessons will occur each day following both in-school meals. There will be a picture schedule of the steps velcroed to the wall that the student will take off, look at the step for reminder, and move it to the left before doing the task. These lessons should last about five to ten minutes, and will use the system of least-to-most prompting as follows: 1. Provide the student with the Sd Brush your teeth. 2. Student should first reach for the first picture on the wall, pull it off, and move it over before beginning the step it depicts. 3. Allow 3 seconds for AC to complete the step independently. 4. If she performs the skill correctly within the three seconds, record a + on the data sheet. Provide verbal reinforcement. 5. If she does not respond within the three seconds or begins to respond incorrectly, provide an indirect verbal prompt paired with pointing, such as What do you do with this?

6. If the student performs the skill correctly, record an IV on the data sheet next to the step and verbally praise. Allow the student to move on to the next step, using the same 3 second time delay. 7. Continue in this form, next giving a specific verbal prompt (S) if there is an error or no response, followed by direct hand-over-hand assistance (A) if necessary after that. 8. Do this for all steps of the task analysis, always allowing the 3 second delay before initiating the prompting system. Reinforcement: For each correct step that the student makes in solving the problem, with or without prompting, direct and specific verbal praise will be provided to both reinforce and encourage her. Maintenance: Once a week following mastery, an observer will follow the student into the bathroom to watch as she brushes her teeth. If the student continues to show that she has maintained the skill, by correctly completing 80% or more of the steps independently for four consecutive weeks, this can ten be reduced to once a month, then every three months, and so on to ensure that the skill is maintained. If the student does not appear to have maintained the skill, the schedule can be increased again to be checking more often, along with reinstating instruction as needed (if she begins performing less than 80% of the steps independently).

Skill Sequence:

Independent SelfCare

Showering/Bathing

Brush Teeth

Shaving

Wash Face

Wash Hands

Comb Hair

Research Rationale: Gladstone, B. W., & Spencer, C. J. (1977). The effects of modelling on the contingent praise of mental retardation counsellors. Journal of Applied Behavior Analysis, 10(1), 75-84. Saloviita, T. J., & Tuulkari, M. (2000). Cognitive-behavioural treatment package for teaching grooming skills to a man with an intellectual disability. Scandinavian Journal of Behaviour Therapy, 29(3-4), 140-147. Both of these articles will be very beneficial in creating an instructional program to teach AC the skill of brushing her teeth. Because brushing ones teeth is such a complex process with many steps, both articles underlined the importance of breaking down the steps into a task analysis. This will make it much easier for taking data and instructing alike, and it will definitely be something that would benefit in instructing AC. The first article, from the Journal of Applied Behavior Analysis (1977), describes a method of reinforcement that can be used, verbal praise. This praise was response-contingent, and the students were praised for each correct response that they showed in brushing their teeth and other self-care skills. This could come in very useful for reinforcement in ACs program, because verbal reinforcement is a very positive form of attention that will encourage her to perform the behavior again in the future to get the same reaction. The other article, by Saloviita and Tuulkari (2000), describes teaching a 41-year-old man with an intellectual disability various grooming skills using pictorial cues. Each step was written and provided with a picture in a book for the man to study and practice before performing the actual skill. He did not bring the pictures into the bathroom with him. Using picture cues of each step of the task analysis could be very beneficial to teach AC the steps of brushing her teeth. Each step would be visually represented, so it would be a great cue to remind her of what

to do next. I do not think that studying the steps and then performing them without the picture cues would be a beneficial way to instruct this student, however. Adapting the ideas in this article and providing the student with the pictures while she is actually brushing her teeth would be far more effective because it can take her through it step-by-step.

Instructional Data on Brushing Teeth Key: + = Correct IV = Correct with indirect verbal prompt S = Specific Verbal Prompt A = Direct Assistance Steps are abbreviated - Refer to Task Analysis for full steps Date: Steps Open Bag Take Out Toothbrush Return Bag to Lap Remove Brush Lid Put Lid on Sink Hold Brush..Faucet Wet Bristles Place BrushSink Pick Up Bag Remove PasteBag Place Bag On Lap Screw Top Off Paste Place Lid On Sink Squeeze Paste..Bristles Replace LidPaste Return Paste to Bag Pick Up Toothbrush Brush BristlesTeeth Spit In Sink Hold BrushFaucet Rinse BristlesWater Brush BristlesTeeth Spit In Sink Hold brushFaucet Rinse BristlesWater Get Paper Towel Dry Bristles On Towel Put towelgarbage Put LidToothbrush Return Brush to Bag