Context For Instruction



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Student: “M”

Skill: Tooth Brushing

Initiator: Scott Hovorka

Context For Instruction: Instruction for this skill will take place in the student’s special education classroom by the sink. This will take place five days a week for about 10-15 minutes at the beginning of fifth hour when the student is coming back from lunch. At this time, there is a paraprofessional and two other students in the room. The materials necessary for instruction include a toothbrush, toothpaste, and a tooth brushing picture task analysis.

Program Objective: When the student is told to brush her teeth, she will correctly perform all of the necessary steps 100% of the time on 3/3 consecutive trials.

Generalization: “M” will work on brushing her teeth by the classroom sink, while it is a natural time to brush her teeth (after a meal), it is not in an environment where the student would typically brush her teeth, therefore it is a concern that the student will have trouble transferring the skill over into other environments where she typically brushes her teeth.

A generalization strategy that will be used to address this concern is programming common stimuli. This will be used by using a typical toothbrush and toothpaste that the student would use at home, and by doing it in a common location where tooth brushing would occur, a sink. Weekly assessment probes will be given to see if the generalization strategy is effective.



Monitoring: At the end of every week assess the student to see what progress is being made, and to also make sure that the student is moving towards mastery.

Rationale: After previously assessing the student, she showed that she was only able to complete between 23.8%-38.1% of the skills in the tooth brushing task analysis. Also, the skills that she was able to perform were only basic skills such as putting the toothpaste on the toothbrush and turning the water on and off. When the actual action of brushing her teeth was performed she did not show any knowledge of brushing techniques. Tooth brushing is a skill that is necessary for personal hygiene and independent living, therefore it is an important skill for the student to learn.

Assessment Procedures “M’s” tooth brushing ability will be addressed in the following manner:

1. Write up a task analysis that includes all of the steps involved in brushing teeth.

2. Use the task analysis to assess the student’s accuracy of the skill.

3. Call the student over to the sink with the toothbrush and toothpaste sitting on the counter.

4. Once the student is by the sink, tell her “Its time to brush your teeth”.

5. Without giving any prompts, allow the student to independently brush her teeth.

6. Observe the student and on the task analysis mark a + in the box if the student correctly completes the step or a – if the student incorrectly performs the step.

7. If the student does not initiate the next step within 10 seconds of completing the previous step, mark a -, and assist her in completing the step. Move onto the next step of the task analysis.



Assessment Schedule: Before starting the program baseline data should be collected from at least 3 separate probes. During the program, assessment probes will be given to the student at the end of each week.

Instructional Procedures:

-At the beginning of 5th hour everyday instruct the student that it is time to brush her teeth. Instruct her to gather the necessary supplies (toothbrush and toothpaste) and come to the sink. Give necessary prompts to help the student get through the task analysis and complete the skill successfully and have the picture task analysis available for the student to look at.

-Instruction will occur 5 times a week and a most to least intrusive prompting procedure will be used as follows:

Full physical prompt:

Immediately after cue for step provide full physical/verbal assistance to “M” to ensure correct completion of the step. (e.g. providing hand-over-hand assistance to “M” to brush her back left teeth while saying “Brush your back left teeth.”)

Use this most intrusive prompt level for each step of the task analysis for the first 5 trials. Then move to the next prompt in the hierarchy.

Indirect Verbal: Immediately after cue/Sd for step (e.g., initial cue or completion of previous step) provide indirect verbal prompt to the student (e.g., show me what you should do next)

-If the student completes the step correctly within 3 seconds of the prompt, record and provide specific verbal praise (e.g. “Good job, you spit the toothpaste in the sink when you were done!) Move on to the next step of TA and begin with indirect verbal prompt.

-If the student does not complete the step correctly within 3 seconds of the prompt, tell him he made an error and then provide full physical/verbal prompt as error correction

-As the student completes the step correctly, record (FP) and provide specific verbal praise. Move on to next step of TA and begin with indirect verbal prompt.

Use this prompt for each step in the task analysis. When “M” has completed each step of the task analysis with this prompt for 3 consecutive trials, move to allowing the student to respond independently to the Sd for each step.

-Allowing independent response: Immediately after cue/Sd for step (e.g. initial cue or completion of previous step) allow the student 3 seconds to respond independently to natural Sd

-If the student completes the step correctly within 3 seconds of Sd, record (+) and provide specific verbal praise. Move on to the next step of the TA.

-If student does not complete step correctly within 3 seconds of the cue/Sd, tell him he made an error and then provide full physical/verbal prompt as error correction

-As the student completes the step correctly, record (FP) and provide specific verbal praise. Move on to the next step of the TA and allow the student the opportunity to respond independently.

When the student has completed 100% of the TA independently (+) for 3 consecutive trials, begin to probe daily until criterion is met or performance falls below 100% for two days in a row. At that point, reinstitute training at direct verbal level and continue with program as written.



Reinforcement: The student will receive positive reinforcement such as verbal praise every time she gives a correct response. The student will also be given computer time as reinforcement twice a week.

Maintenance:

-When the student shows an increase towards mastery, begin to fade reinforcement. Once the student is able to complete more than 50% of the task analysis without any prompting, fade computer time rewards to once a week.

-Once mastery is reached, assess the student once a month using the same assessment procedures as before. If the student maintains 90%-100% mastery for three consecutive probes discontinue.

-If the student falls below 90%, resume instruction until mastery is reached.



Skill Sequence

Brush back teeth

Brush front teeth

Put toothpaste on toothbrush

Wet toothbrush

Wipe face with paper towel

Rinse mouth out

Spit Water into sink

Fill cup with water

Turn water on/off

Open Toothpaste

Close Toothpaste

Get Toothbrush

Get Toothpaste

Put away toothbrush/paste

Research Rationale

In the article by Pilbero and Backman, they discussed using visual representations to represent different steps in the tooth brushing routine. I will incorporate this into my instructional program by using a visual task analysis to represent all the steps in the tooth brushing process. Just like in the study I will have the visual aid available for the student to look at when toothbrush instruction is taking place and hopefully it will produce similar results. In the other article by Matson, Taras, Sevin, Love, and Fridley they discussed using different prompting strategies as well as modeling to teach a variety of skills including tooth brushing. In my program I will use full physical prompts along with verbal prompts to guide my instruction. I will also model the correct tooth brushing skills for the student so they know what it looks like.



Brushing Teeth Task Analysis

Date
















1. Get tooth brush
















2. Get tooth paste
















3. Open toothpaste
















4. Put toothpaste on brush
















5. Close tooth paste
















6. Wet toothpaste/toothbrush
















7. Brush teeth
















-left back top (outside then inside)
















-left back bottom (outside then inside)
















-Front top (outside then inside)
















-Front bottom (outside then inside)
















-Right back top (outside then inside)
















-Right back bottom (outside then inside)
















8. Spit toothpaste into sink
















9.Turn on water
















10. Rinse toothbrush under water
















11. Fill cup up with water
















12. Rinse mouth out with water
















13. Spit water into sink
















14. Wipe face with paper towel
















15. Put toothpaste and toothbrush away
















Percentage
















-Instruct the student to brush her teeth. On the task analysis data sheet, mark and record the student’s responses as follows:

-mark a + if the student completes the step correctly



-mark a – if the student does not complete the step correctly or if the student does not initiate the next step within 10 seconds of completing the previous step.


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