Supercharge Your Clinical Programming with Multi-Tiered Measurement: Part 2

Tuesday, August 11, 2020

Behavior analysts have many job responsibilities including supervising staff, developing instructional stimuli for programming, parent training, data analysis, and more. To successfully incorporate a three-tiered system of measurement into a client’s intervention program, follow these five steps: 

  1. Purposefully Select Macro-Level of Measures During Formal Assessment Periods (Macro-Level Measurement)
  2. Develop Meta-Level Measures During Treatment Plan Development
  3. Make Macro, Meta, and Micro Measures the Foundation of All Programming
  4. Select Measures that Are Meaningful – “Do Not Measure for Measurement’s Sake”
  5. Create Systems for Accountability

Step 1: Purposefully Select Macro-Level of Measures During Formal Assessment Periods (Macro-Level Measurement)

During assessment (either an initial assessment or reassessment), begin by selecting macro-level assessments to implement, and specify how frequently these will need to be re-implemented to appropriately demonstrate progress. The selection of these assessments should be data-based and client verified.

  • Data-Based: based on the client’s presenting strengths and deficits. This can be accomplished through utilizing qualitative assessment- through direct observation/interaction with the client or through a caregiver report.
  • Client-Verified: verified as appropriate by the client’s performance on the assessment.

After implementing the assessment, use the client’s data to determine the appropriateness of the assessment for evaluating ongoing progress. For example, if a client’s performance on the VB-MAPP placed them halfway through Level 3 on all skills, it is likely not an appropriate assessment because there is not much room to demonstrate continued progress.

Remember- assessment should be unique to each client based on their skills and age. Assessments should not be selected on the premise that “this is what we do with all clients”!

Step 2: Develop Meta-Level Measures During Treatment Plan Development

After completing an assessment, behavior analysts use the data to select client-specific treatment goals. Support the creation of meta-level measures at the onset of treatment by embedding a template, similar to the one below, in the treatment plan template. This helps clinicians to plan for these data and holds them accountable for reporting data during the next treatment plan update.

Suggested Skill Meta-Level Measure Macro-Level Measure
  Measure Frequency of Data Collection Measure Frequency of Data Collection
Answer personal and preference questions # of total mastered questions Weekly Vineland Adaptive Behavior Scales Yearly

Step 3: Make Macro, Meta, and Micro Measures the Foundation of All Programming

Embed this measurement system into clinical practice and organizational culture. Create the necessary job aids and templates, and obtain resources to implement various measures (e.g., assessments).

Examples:

  • Add a 10-minute data share to your company’s staff meetings in which clinicians can share their meta and macro-level data
  • Offer a prize (reinforcer) for the most meaningful new and/or different meta and macro-level measures created by clinicians

Step 4: Select Measures that Are Meaningful- “Do Not Measure for Measurement’s Sake”

When designing intervention, behavior analysts create instructional protocols that function as road maps for each individual skill. These protocols often include the following: features of instruction that will need to be controlled, how stimuli will be introduced, and ways in which instruction will become more complex. When developing these protocols, support clinicians in answering some really important questions about the purpose of the skill- specifically, how it will link directly to client outcomes.

  • What exactly is the goal of the skill or program?
  • How will instruction on this skill improve the client’s happiness and/or quality of life?
    • How are you going to explain this progress to caregivers and other providers?
    • How will you include the client in identifying meaningful measures, terminal criteria, and goal-setting?
  • What is the most simplistic, but effective way you can show progress toward more complex/composite skills?

Considering these questions encourages the clinician to have a ‘big picture’ perspective. For example, telling a parent “Tommy got 80% on set 4 in his labeling program” holds no context. However, telling them the following highlights meaningful change:

  • “Tommy’s mastered 87 out of 100 targets we’ve introduced, so far in his labeling program”
    • Meta-level measure: Number of cumulative labels mastered per week
      • This cumulative or “total” report of progress gives the listener some context as to where Tommy is- mastering 87 of 100 targets is a lot of work!
  • “Tommy takes 5 days to master a set now, instead of the 10 it took him when we started intervention”
    • Meta-level measure: Number of cumulative labels mastered per week, or Number of Days to Meet Criterion
  • “Tommy generalizes the labels we teach him at home to the preschool setting 5-10 times per day”
    • Meta-level measure: Twice monthly generalization probe- Number of labels generalized to preschool context during an observation

Step 5: Create Systems for Accountability

The goal of a behavior analyst is to provide high-quality services to as many clients as ethically possible. The most common barriers to utilizing multiple levels of measurement are resources (time) and consistency of data collection. To combat these barriers, it is important the systems are built into client programs to promote both data collection and analysis on these meta-level measures. Consider incorporating the following clinical supports:

Facilitate data analysis, by: 

  • Having clinicians create a weekly or twice monthly calendar appointment (or reminder) for reviewing these data
  • Establishing a monthly caregiver/provider meeting, in which these meta-level data are shared
    • Bonus! This ensures the data are meaningful and are demonstrating progress toward larger treatment goals.
  • Start a company-wide meta-level measure to track the number of changes made to client programs as a result of the meta-level measures

Ensure implementation and data collection, by:

  • Assigning a senior registered behavior technician (lead therapist, clinician, etc.) the responsibility of collecting all meta-level data
  • Creating session schedules, checklists, etc. that can function as textual reminders to implement, graph, or chart meta-level measures

About the Author

Kristin Smith, M.Ed., BCBA, LBA
CentralReach, Instructional Designer

Kristin Smith, M.Ed., BCBA, LBA is a Licensed Behavior Analyst, and Board Certified Behavior Analyst. She began her career in the field of behavior analysis in 2002 and received a master’s degree in Special Education from the University of Washington. Kristin has experience implementing and designing intervention programs across a variety of contexts, with learners ranging in age from 18 months to 40 years. She works with a wide variety of learners, including, but not limited to those with autism, chromosomal deletions, cognitive impairments, learning disabilities, social-emotional and/or behavioral problems, significant challenging behavior, blindness, and children with multiple disabilities. Her areas of expertise include Precision Teaching, instructional design, assessment, and data analysis.

References
Johnson, K., & Street, E. M. (2004). The Morningside model of generative instruction. Cambridge Center for Behavioral Studies. 

Johnson, K., & Street, E. M. (2013). Response to intervention and precision teaching: Creating synergy in the classroom. Guilford Press.

Kubina, R. M.(2019) The precision teaching Implementation manual. Greatness Achieved Publishing Company.