Backward Chaining Case
Annie is a 40-year-old schizophrenic female who resides in a heath care facility. Annie has been exhibiting difficulty with her daily care routines; including brushing her teeth and making her bed in the morning. Currently, she has a newly implemented token system in place in which she may earn one token for each completed activity and then collect a reward such as extra time in the courtyard once 10 tokens are obtained. Hospital Administrator Rodriguez reports that Annie is not completing the tasks and then, as a result, not earning any tokens. Ms Rodriguez has asked for a re-evaluation of the program to determine what is not working. Annie participates in a token economy system which is relatively new. There is a potential for an array of problems when starting a new program. In Annie's case, the identified reinforcer may not be strong enough. Although she might find spending time in the courtyard a rewarding event, it may not be rewarding enough to complete the
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non-rewarding acts of making her bed or brushing her teeth. The cost of spending time in the courtyard may be too high. When starting a behavior modification program, we typically want to encourage behavior by providing easily attainable rewards. It may be that 10 tokens are too many to earn at the beginning, and a lower cost might be in order. Additionally, when implimenting a token economy, we need to use reinforcers that not available at any other time except through purchase (Miltenberger, 2012); it could be that Annie has access to the courtyard during her free time. Further, it may not be being implemented correctly. The token must be delivered immediately following the desired behavior; any failure to do so will not reinforce the desired behavior but rather the behavior the token followed, or it could be that behaviors are not reinforced at all. If Annie did, in fact brush her teeth but it was unseen by any staff member, unless she told someone, she would not be reinforced for the behavior. There are numerous places where this program could have potential problems. In order to determine what factors are involved an observation must be performed. In order to better serve Annie, we need to determine the value of back-up reinforcers and identify multiple items to be used. Because the token system relies on the back-up reinforcers they must be tailored to her specifically (Miltenberger, 2012). Although we have identified one rewarding item, sitting outside, because it is not always going to be the case that she wants to sit outside, there needs to be several options from which she can choose. Based on her interests, she could have the opportunity to buy TV time, computer time, work on a hobby, go to the park, ect... with offerings that can be easily attained in a day and others of a higher value that must be earned through multiple attempts and saving of tokens. The ability to earn the smaller rewards along with access to higher level rewards will encourage her to perform at a higher level. Upon observation of Annie and interviewing hospital staff, it is my recommendation that Annie participate in a program that involves backward chaining in the required self help skills in order to allow her to be successful at these tasks.
Backward chaining is a procedure in which the last part of the chain is taught first; in this case putting the pillow on the bed and brushing her teeth. Once the last response in the chain is consistently occurring, the next to last piece is taught, and the client performs last two parts of the chain occur together (Miltenberger, 2012). This training progresses backwards through all steps until the client has learned all the components in the chain and is able to perform them independently. Backward chaining has a natural reinforcer of being finished and allowed to go on to more enjoyable tasks; further in Annie's case, it will be met with a token for completion which will further reinforce the behavior and strengthen the token system already in
place. In a study published in 2001, backwards chaining was proven to be more effective than video modeling and allowed one participant to successfully reach mastery while another approached mastery (Rayner, 2011). The study involved 3 participants who were diagnosed with ASD. Through live modeling and verbal cues, the participants received ongoing feedback as they performed each step which led to better generalization of skills and overall results (Rayner, 2011). By using chaining we increase Annie's ability to use independent living skills which will allow her to function at a higher level. Through breaking the steps into smaller pieces she will be allowed to learn the task at a level that is more conducive to her level of understanding and the pieces can be put together to form a larger end result. The reinforcement of each larger piece will encourage her to continue through the complex sequence. Finally, chaining can be combined with BST which will enable her to generalize the task. One of the benefits of backward chaining is the immediate reward and a functional relationship between completion and reinforcement begins to emerge (Cooper, Heron, & Heward, 2007). The overall goal for Annie is her independent completion of both making her bed and brushing her teeth. Ultimately Annie will complete these items when she arises in the morning without being prompted to do so. Additionally, she will do so in a positive manner, with lack of negative commentary or behavior in the way of throwing objects. Throwing is defined as any object leaving the hand with enough force to cause it to strike and bounce off another object. Through a program that involves prompting, shaping and fading, along with backward chaining of the required steps, it is expected that Annie will be able to accomplish these tasks in their entirety by August 6th, 2015. Initial instruction will be given to staff members by me in how to complete each step of the required plan. Staff members will be responsible for instructing Annie and completing data on a daily basis. Backward chaining involves only doing the last step of the sequence; in the case of Annie, she will be performing making her bed and brushing her teeth. Therefore, the staff will perform all necessary tasks associated with these two tasks up until the last steps. Annie will be required to place the pillow on her bed, and do the actual brushing of her teeth. Because Annie finds brushing her teeth aversive; shaping is necessary. Staff will begin by reinforcing Annie for touching her toothbrush, as she becomes more accustomed to this behavior, staff will then reinforce Annie only if she touches the toothbrush to her mouth. Working forward in this manner, we will shape the behavior until she is brushing her teeth and then backward chain it to putting the toothpaste on the brush. In the case of making her bed, will perform necessary tasks up to placing the pillow. Annie will place the pillow at which point staff will deliver a token and allow her to return to her daily schedule. As she becomes successful and there is no longer a need for prompting, she will be expected to pull the blankets up and place the pillow. Staff will instruct, model, and have Annie perform the task one time each day until she is proficient for 3 days before moving to the next step in the chain. Staff will continue in this manner until she is completing the entire task from putting a sheet on the bed to the final step of putting the pillow on. Further, staff will, at 4:00 every day, offer Annie the opportunity to choose to trade her tokens in for an item from her secondary reinforcer options. Staff will record her successes each time the task is performed. Data will be completed daily on each occasion of her completion of each individual step. The staff supervising the behavior will record whether she completed each step in the procedure correctly, incorrectly, and what type of prompt was necessary if any. These will be turned in weekly so progress toward the ultimate goal can be monitored along with if there is a need for changes to her program. Through compilation of data compared with baseline in graph form, along with interviewing staff and supervisory personnel at the hospital and weekly observations of Annie's performance, I will be able to monitor the program and make any necessary changes in an expedient manner which will best serve both Annie and the hospital. Through regular observations I will further be able to ensure the plan is being implemented as designed and offer assistance in any areas of concern.
non-rewarding acts of making her bed or brushing her teeth. The cost of spending time in the courtyard may be too high. When starting a behavior modification program, we typically want to encourage behavior by providing easily attainable rewards. It may be that 10 tokens are too many to earn at the beginning, and a lower cost might be in order. Additionally, when implimenting a token economy, we need to use reinforcers that not available at any other time except through purchase (Miltenberger, 2012); it could be that Annie has access to the courtyard during her free time. Further, it may not be being implemented correctly. The token must be delivered immediately following the desired behavior; any failure to do so will not reinforce the desired behavior but rather the behavior the token followed, or it could be that behaviors are not reinforced at all. If Annie did, in fact brush her teeth but it was unseen by any staff member, unless she told someone, she would not be reinforced for the behavior. There are numerous places where this program could have potential problems. In order to determine what factors are involved an observation must be performed. In order to better serve Annie, we need to determine the value of back-up reinforcers and identify multiple items to be used. Because the token system relies on the back-up reinforcers they must be tailored to her specifically (Miltenberger, 2012). Although we have identified one rewarding item, sitting outside, because it is not always going to be the case that she wants to sit outside, there needs to be several options from which she can choose. Based on her interests, she could have the opportunity to buy TV time, computer time, work on a hobby, go to the park, ect... with offerings that can be easily attained in a day and others of a higher value that must be earned through multiple attempts and saving of tokens. The ability to earn the smaller rewards along with access to higher level rewards will encourage her to perform at a higher level. Upon observation of Annie and interviewing hospital staff, it is my recommendation that Annie participate in a program that involves backward chaining in the required self help skills in order to allow her to be successful at these tasks.
Backward chaining is a procedure in which the last part of the chain is taught first; in this case putting the pillow on the bed and brushing her teeth. Once the last response in the chain is consistently occurring, the next to last piece is taught, and the client performs last two parts of the chain occur together (Miltenberger, 2012). This training progresses backwards through all steps until the client has learned all the components in the chain and is able to perform them independently. Backward chaining has a natural reinforcer of being finished and allowed to go on to more enjoyable tasks; further in Annie's case, it will be met with a token for completion which will further reinforce the behavior and strengthen the token system already in
place. In a study published in 2001, backwards chaining was proven to be more effective than video modeling and allowed one participant to successfully reach mastery while another approached mastery (Rayner, 2011). The study involved 3 participants who were diagnosed with ASD. Through live modeling and verbal cues, the participants received ongoing feedback as they performed each step which led to better generalization of skills and overall results (Rayner, 2011). By using chaining we increase Annie's ability to use independent living skills which will allow her to function at a higher level. Through breaking the steps into smaller pieces she will be allowed to learn the task at a level that is more conducive to her level of understanding and the pieces can be put together to form a larger end result. The reinforcement of each larger piece will encourage her to continue through the complex sequence. Finally, chaining can be combined with BST which will enable her to generalize the task. One of the benefits of backward chaining is the immediate reward and a functional relationship between completion and reinforcement begins to emerge (Cooper, Heron, & Heward, 2007). The overall goal for Annie is her independent completion of both making her bed and brushing her teeth. Ultimately Annie will complete these items when she arises in the morning without being prompted to do so. Additionally, she will do so in a positive manner, with lack of negative commentary or behavior in the way of throwing objects. Throwing is defined as any object leaving the hand with enough force to cause it to strike and bounce off another object. Through a program that involves prompting, shaping and fading, along with backward chaining of the required steps, it is expected that Annie will be able to accomplish these tasks in their entirety by August 6th, 2015. Initial instruction will be given to staff members by me in how to complete each step of the required plan. Staff members will be responsible for instructing Annie and completing data on a daily basis. Backward chaining involves only doing the last step of the sequence; in the case of Annie, she will be performing making her bed and brushing her teeth. Therefore, the staff will perform all necessary tasks associated with these two tasks up until the last steps. Annie will be required to place the pillow on her bed, and do the actual brushing of her teeth. Because Annie finds brushing her teeth aversive; shaping is necessary. Staff will begin by reinforcing Annie for touching her toothbrush, as she becomes more accustomed to this behavior, staff will then reinforce Annie only if she touches the toothbrush to her mouth. Working forward in this manner, we will shape the behavior until she is brushing her teeth and then backward chain it to putting the toothpaste on the brush. In the case of making her bed, will perform necessary tasks up to placing the pillow. Annie will place the pillow at which point staff will deliver a token and allow her to return to her daily schedule. As she becomes successful and there is no longer a need for prompting, she will be expected to pull the blankets up and place the pillow. Staff will instruct, model, and have Annie perform the task one time each day until she is proficient for 3 days before moving to the next step in the chain. Staff will continue in this manner until she is completing the entire task from putting a sheet on the bed to the final step of putting the pillow on. Further, staff will, at 4:00 every day, offer Annie the opportunity to choose to trade her tokens in for an item from her secondary reinforcer options. Staff will record her successes each time the task is performed. Data will be completed daily on each occasion of her completion of each individual step. The staff supervising the behavior will record whether she completed each step in the procedure correctly, incorrectly, and what type of prompt was necessary if any. These will be turned in weekly so progress toward the ultimate goal can be monitored along with if there is a need for changes to her program. Through compilation of data compared with baseline in graph form, along with interviewing staff and supervisory personnel at the hospital and weekly observations of Annie's performance, I will be able to monitor the program and make any necessary changes in an expedient manner which will best serve both Annie and the hospital. Through regular observations I will further be able to ensure the plan is being implemented as designed and offer assistance in any areas of concern.