Assisting with Individualized Assessment Procedures

Objectives:

  • Discuss why clients, students, or patients (particularly those within an ABA treatment program) need assessments (on a regular basis).
  • Review common assessments that clients may experience throughout the course of their treatment
  • Discuss how the therapist, RBT, or direct care staff can assist in the assessment process
  • Discuss best practices

Assessment

  • Assessment is the process of gathering information about the client, student or patient to determines what he or she knows, or in other words what is their current skill level and what are their current struggles and weaknesses and additionally to determine what their needs are. The assessment allows BCBAs to better design a client’s treatment program.
  • It is generally recommended that individuals diagnosed with ASD and receiving ABA services are assessed on a regular basis. Typically they recommend that individuals receive a thorough battery of assessments on a yearly basis because they want to make sure that they track their progress regularly enough that they can tell how well they are actually achieving skill growth and also we want to make sure that we are keeping a record of their progress to ensure that the treatment is indeed effective.
    • Ongoing informal assessment: This is essentially the data that is collected each session throughout every lesson and intervention.
    • Quarterly performance assessments: Insurance and/or legal requirements may make more thorough quarterly assessments of a clients program necessary. Rather like a progress report that documents a students progress throughout the school year.
    • Yearly formal, standardized assessments: This intensive assessment measure is simply to measure the particular skill strengths and deficits of a client as they move through their ABA program. As both skills an problem behaviors are likely to change over time.

Why Assess Clients?

  • It is important to have baseline testing to know what skills students or clients have: This allows the program design to maximize precious time by teaching skills the student or client needs and doesn’t know instead of wasting time teaching skills already known. This tells the therapy team what a clients current skill level is, where their strengths are and what weaknesses exist. Having a baseline also allows for measurement. Meaning that progress cannot be measured if there is no starting point.
  • Assessments often help schools, teachers, supervisors/BCBAs, and parents have a better understanding of the client’s skills and deficits: And understanding creates better relationships, and more individualized and effective programs
  • Follow up assessments help to measure if the treatment is working: in other words is the program working? Are the lessons building skills? Are the interventions modifying problem behavior? Is the client becoming better able to function within their natural environments? In addition these assessments can also uncover continuing or new deficits that a client may have which can lead to program modifications and more successful teaching strategies.
  • Follow up assessments further show the Teacher or Supervisor/BCBA what steps to take next in a clients program: In other words this is where modifications to an existing program are made based on assessment outcomes.

Types of Assessments?

Below are common assessments given to those diagnosed with an ASD in an ABA program.

  • Cognitive: A client may be assessed in terms of cognitive development.
  • Educational: What are they capable of in the academic environment? Speech and Language, Mathematics, Science, etc.
  • Language: This isn’t necessarily just an ability to verbalize but rather the ability to communicate in such a way as to get their needs met and function within their natural environment. Additionally, an ability to be coherent with enunciation as well as to make sense of words and sentence structure as used in the natural environment to include an understanding of idioms, sarcasm, and even body language.
  • Social: This is how the client interacts with other individuals.
    • Vineland Adaptive Behavior Scales – 2nd Edition (VABS-II):
      • Example Questions:
        • Does the learner follow instruction requiring an action and an object?
        • Does the learner feed self with fork?
        • Does the learner brush teeth without assistance?
        • Participate in at least one game or activity with others?
    • Social Behavior Assessment Inventory (SBAI):
    • Social Skills Improvement System (SSIS) Rating Scale:
  • Behavioral: What behaviors hold them back from being more successful in their environments?
  • Developmental: Commonly used developmental assessments follow but the list is not exhaustive.
    • Brigance Assessment: has several different assessment tools:
      • Early childhood development inventory II
      • Comprehensive Inventory of Basic Skills (CIBS II)
      • Example Questions follow:
        • Can the student verbally respond to simple yes/no questions related to visual information?
        • Does the student use possessive nouns?
        • Can the student perform a certain skill <?> ? Which is than answered as either Not Assessed, Set as Objective, or Mastered
    • Bayley Scales of Infant Development III:
    • Developmental Profile II:
  • Curriculum-based: What are the clients adaptive needs? IEP There are several types of curriculum based assessment developed for those diagnosed with ASD or other types of specialized curriculums that are used for students with special needs and include the following:
    • Skills Assessment: Questions below are all answered with either yes, no or I don’t know and the I do not know answer essentially means that this skill needs to be probed. Some example questions from the skills assessment include:
      • In the area of social skills: Can your child explain what various facial expressions mean when demonstrated by other in vivo, in pictures, or in video clips?
      • In the are of language skills: Can your child spontaneously ask a “what” question about an action occurring?
      • In the area of executive function: Can your child generate new strategies and rules to complete a task when his/her current method is unsuccessful (e.g. does not work, is unacceptable to someone, etc.)?
    • VB-MAPP Assessment:
      • In the area of manding: Does the child mand for 20 different missing items without prompts? Here the therapist would contrive the scenario for the child to mand for the 20 items. The child is then scored 1 point if they can perform the skill, 1/2 point for demonstrating ability to mand for 10 different items.
    • ABLLS-R Assessment:

Administration of Assessments

  • Licensed Psychologists: Any type of cognitive assessment that generates an IQ score requires an LP to administer the assessment.
  • MFTs, BCBAs, Etc.:
  • Language Pathologist: Speech and language assessment
  • Teacher’s: Educational assessments
  • Therapist/RBT: A therapist may assist with a curriculum based assessment, developmental assessment, or social skills assessment
  • Other: Some assessments (such as the VINE assessment) are completed my multiple people within the clients environment, such as parents, teachers, ABA assistants, BCBA, etc. And some assessments can be completed by more than one specific qualified individual, in other words a particular assessment can be completed by a BCBA or an MFT and not specifically one or the other or both.

IMPORTANT TO NOTE: For any assessment that is happening for a learner should never be the responsibility of the therapist or direct staff. In other words the RBT/Therapist should never be ultimately responsible for any type of assessment. It should always be lead by another professional (i.e., other qualified individual). The role of the RBT/Therapist may be to probe skills, check skill generalization, ask questions, or other.. but it is NEVER administering a test alone. In addition the RBT/Therapist should receive training and instruction from the BCBA on how to assist with student/client assessment.

Assisting with Assessments

RBT/Therapists may be asked to assist with assessments  such as working with the client during the assessment. In some cases the RBT may have to conduct a probe for a particular skill being assessed and in this case it is crucial that the RBT:

  • Follow the specific instruction provided by the BCBA
  • Make sure to understand the target skill and what is supposed to be demonstrated
  • Ask questions of the BCBA if there are any doubts or confusion
  • Be clear when speaking to the student
  • Be sure to have the client’s attention prior to giving the instruction
  • Follow all instructions for properly recording data
  • Minimize environmental distractions
  • Give the client/student/child/patient adequate time to respond
  • May have to plan for frequent breaks to keep the client motivated throughout the assessment
  • Have a keen understanding of the particular assessments specific rules and requirements regarding the assessment (such as, can the instruction or question be repeated or reworded?)
  • Are there any types of prompts that can be used? Which ones yes? Which ones no?
  • Can the assessment be broken up with given breaks at certain times?
  • Can only certain assessment materials be used?

All of these measures of being careful are to help ensure that the child’s skill is being measured accurately and not being influenced by the therapist working with the child.

***AGAIN IMPORTANT: MAKE SURE THAT THE THERAPIST/RBT RECEIVES CLEAR, DETAILED INSTRUCTIONS REGARDING HOW THE PROBES SHOULD BE ADMINISTERED AND RECORDED***

Additionally an RBT/Therapist may be asked to complete a questionnaire or a survey. If this occurs than the therapist should understand clearly the criteria for the specific assessment.

  • Such as does a skill have to be mastered to be considered a Yes response on the questionnaire?
  • Make sure to understand what the question is asking (sometimes the questions are not as obvious as one would think).
  • In addition all questions should be answered accurately and honestly to the best of one’s knowledge.
  • Use language that is professional, objective and behavioral
  • Complete all specified data collection procedures according to instructions
  • Have data sheets out and available at all times
  • Responsibility is to report the information, not make opinions or judgements about it

Lastly, the RBT/Therapist may be asked to assist with behavior management and motivation during assessments:

  • Some assessments are more formal and require a specifically trained psychologist, SLP, or other professional to administer, however
  • Therapists/RBTs may be asked to assist with client behavior management during assessments and this could include:
    • redirecting problematic behaviors (such as tantrums or stereotypy) and implementing the intervention plan in place when these behaviors occur
    • redirecting attention to tasks (staying in seat, eye contact)
    • implementing a reinforcement/token system for the learner (if allowed by assessment)
    • providing breaks for the learner (if allowed by the assessment)

***When assisting during a more formal assessment it is EXTREMELY important to follow the specific directions of the assessor***

It is important for the RBT/Therapist to know their role:

  • What types of situation should be handled by the therapist? By the assessor?
  • What types of redirection/prompts are allowed?
  • Perhaps having a more hands off role for the therapist until the assessor “signals” for predetermined involvement.
  • What type of reinforcement is allowed? And at what frequency?

Overall Considerations

  • The purpose of the assessment is to gain an accurate picture of the child’s current levels of ability to include skill strengths and deficits and behavioral excesses and deficits.
  • This will help determine what types of intervention is provided to the client, which goals will be developed, which procedures need to be modified/changed
  • Appropriate level of support: It is vital to the long term success and wellbeing of the client to get as accurate information as possible, however, some individuals with ASD do not perform well during formalized assessments (which in and of itself suggests that learning has not generalized)
  • While we want the client to perform to the best of their ability, it is critical that the client is not assisted too heavily or that testing practices are modified to the point that results are not valid
  • If a therapist is asked to assist in the assessment process, it is imperative that the rules, structure and content of the assessments are followed and implemented appropriately.
  • It is NOT in the best interest of the client to over prompt or change the procedures to unfairly improve performance.
  • Confidentiality and Professionalism: As with any other client-related intervention, therapists are expected to maintain high levels of professionalism and respect client confidentiality at all times.
  • Remember, a students particular assessment score may not be an accurate reflection of their true abilities/skills.
  • Stay positive for all throughout the process! Be respectful. Follow all instructions given by the assessor.

Learn More…

Mand-Training: Teaching Basic Requesting Skills

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