Burbank Special Education: Behavior Change

Inappropriate behavior may be the greatest barrier that prevents those with disabilities from living, learning, working, recreating and socializing with nondisabled peers in community settings (Renzaglia, Karvonen, Drasgow & Stoxen, 2003, p. 146). As the inclusion philosophy and lifestyle becomes more widespread, it is even more urgent that those without disabilities, including those who may be gifted, behave in a way that not only is appropriate but also is exemplary and can serve as a model for those struggling with behavioral issues. Raymond has not been tested for giftedness, but by all informal accounts of those who know him best, Raymond is high functioning for his age and has the potential to be looked up to by his peers.

History

Raymond was born in April 2002 at Providence St. Joseph’s Hospital in Burbank, California. He was delivered by cesarean section, on time, and there were no complications. His birth weight was 7 pounds 7 ounces and his length was 20 inches. Raymond’s mother is White non-Hispanic and his father is African-American. English is his primary language. Raymond’s mother stayed home with him for the first year, and then returned to work. At the age of one, Raymond entered a day care facility. About the time that Raymond turned two, Raymond’s parents separated. At two and one-half years, Raymond was no longer eligible to attend the day care facility because of his age; he then entered preschool. Raymond’s normal schedule is to live Monday morning thru Tuesday afternoon with his father, and the rest of the week with his mother. Normally, Raymond attends preschool from seven in the morning to four-thirty in the afternoon on Wednesday, Thursday and Friday; he does not attend preschool on the two days a week that he is with his father. Raymond appears to be adapting reasonably well to his parent’s separation, pending divorce and split custody arrangement.

Personal Health

Raymond’s personal health is generally good, although he does have allergies that result in more that his fair share of nasal passage stuffiness. His height of just over 3 feet is average for a nearly three-year-old boy, as is his weight of 40 pounds. Raymond’s mother describes him as a boy of moderate physical strength, a solid build and a very good runner. Observations support her description.

Significant People

MAPS is commonly used for students with severe disabilities, but can be used to plan for non-disabled students as well (Rainforth & England, 1997). The process used in this project differs from a full-blown MAPS in that the process did not extend over a period of weeks, and the participants did not meet all together in a collaborative group to discuss the child. The writer of this project functioned as an ambassador who met with the participants separately, both in person and on the phone, to ask the questions and share the answers and concerns of the other members of the group. The most significant people in Raymond’s life considered for this group are his mother, his father, his maternal grandmother, his maternal uncles Ed and Alex, and his teacher at preschool. Interviews and sharing were done with these individuals except for Raymond’s father who was not interviewed because of concerns about legal and other matters related to the divorce proceedings.

Overall Academic and Behavioral Functioning

In order to get an idea about how Raymond compares to other children his age, Raymond’s significant people were asked about his curiosity, initiative, persistence, self-confidence, expressive language, receptive language, social skills and behavior. There was general consensus that Raymond functions at a high level in all these areas, especially in the language area. “He is very quick.” “He picks things up fast.” “You do have to watch what you say around him because he will repeat it at the most inopportune times.” To the question, “Does Raymond show respect for adults?” people said that he does respect adults, but his words can sometimes be hurtful to those he loves the most.

Dreams

Each of the interviewed significant people in Raymond’s life expressed what they wanted for him. Raymond’s mother expressed her dream for him as follows:

That he may come to have an understanding of his physical, spiritual and energy bodies. That he learn to nurture his life force, a growing self-love, a growing interest in ideas as a way of evolving the mind. That he may develop good communication skills, emotional maturity, good relationships, a respect for all life, awareness of his talents and a willingness to use them, and the ability to actively participate in his community and make a fulfilling life for himself. He may also want exposure to the world through travel, food, books, movies, people and education.

His preschool teacher focused on preparing him for elementary school. His grandmother’s dream is that Raymond figure out what he really wants to do with his life, and that he be willing to work hard at achieving it because opportunities come to those that work hard. She also hoped that she would always be there for him when he needs her. Raymond’s uncles felt that personal choices and self-determination would be important for Raymond, that he should not be overly influenced by always trying to do what others expected of him, and that he become a creative as well as a critical thinker.

It is noteworthy that the five essential goals of person-centered planning as identified by Kincaid (1996, p. 440) are all present in the collective dreams for Raymond: Community participation, satisfying relationships, choice-making, fulfill respected roles and develop personal competencies. Raymond is fortunate to have the support of his extended family, making it more likely that he will provide the same kind of support to others as he matures.

Fears and Nightmares

It is not unusual for parents to find it hard to answer questions about their fears and nightmares for their child (University of Kansas, Circle of Inclusion Project, n.d.). Raymond’s mother and other significant people were no exception. Everyone had difficulty in verbalizing fears and nightmares; they did not like to think of their Raymond facing difficulties. Even after identifying the target behavior for this project, they indicated that the target behavior didn’t rise to the level of a nightmare, and that Raymond was sure to overcome or outgrow this problem. However, family members did mention the school system and how the focus on test scores might turn Raymond off on education at a time when they would want him to be exploring education broadly. His uncles felt that their dream of Raymond becoming a creative and critical thinker might be at risk if his teachers spent too much of their time teaching test taking skills that simply made the teachers look good at Raymond’s expense.

Gifts

Raymond is highly verbal. His articulation, for a three year old, is especially clear; he is understandable and can express ideas and feelings. He has a special stuffed dog and an “Olive Oil” hand puppet acquired from his great-grandmother that he uses to express some of his feelings. If he is feeling sad, he may say that Olive Oil is sad, or if he is afraid, his dog is afraid.

Challenges

A challenge for Raymond is to continue to develop his receptive and expressive language skills while learning to use his language in a way that is always appropriate for the circumstances. People are impressed by Raymond’s language skills, so that when he comes out with a pointed comment directed at someone he loves, people can get hurt emotionally. People sometimes forget that he is not even three years old yet, and what he says may be a repetition of something he heard. Also, he may be communicating frustration with circumstances forced upon him.

Targeted Behavior

Raymond now is in a period when he is using the word “stupid.” For example, while riding in his car seat, when he sees someone cut in front of his uncle or mother, he may yell out “Stupid Driver.” That language may be appropriate under the circumstances. However, he also uses that language under circumstances that are inappropriate. For example, at school he may call his teacher’s legitimate request “stupid,” at home he may say to his mother “stupid mommy,” and so on.

The targeted behavior for this behavioral change project is: Raymond sometimes uses the word “stupid” in an inappropriate way towards the adults who are the significant persons in his life.

In summary, this behavior change project aims to combine the essential elements of person-centered planning and functional analysis in order “to provide a broad-based yet specific understanding of the variables influencing [Raymond’s targeted behavior]” (Artesani & Mallar, 1998), and to implement process changes that could be generalized for use in future behavioral support plans for Raymond.

Methodology and Functional Assessment

Interviews

The people interviewed for this assessment were Raymond’s mother, his maternal grandmother, his maternal uncles Ed and Alex, and his teacher and teacher’s aid at preschool. Raymond’s uncle Ed could not recall any specific instances where he directly observed the targeted behavior, and his Uncle Alex recalled that Raymond used the language “stupid Alex” when Alex teased Raymond or interrupted and interfered with an activity that Raymond was involved in. The most significant subject of Raymond’s inappropriate language was his own mother, and he used that language when he was stressed or frustrated as a result of being rushed, being neglected due to his mother’s tardiness in picking him up from school, and/or being denied his mother’s attention at a time where he expected that attention. His teachers did not recall any instances of Raymond using inappropriate language towards adults during the normal organized preschool activities, but did use the inappropriate language during early morning childcare and during late afternoon childcare. Raymond’s mother said that he uses the inappropriate language “stupid mommy” in her presence when she is late taking him to school, and his grandmother recalled him using the language when his mother drops him off quickly after school and rushes off to an appointment without having spent any quality time with him. Based on these interviews it was decided to collect baseline data over five consecutive school days during the following four time periods: (1) Going to school, (2) Early morning childcare after arriving at school and before scheduled school activities, (3) Late afternoon childcare after scheduled school activities before being picked up, and (4) After school activities with mother or grandmother.

Data Collection

Data card information was reviewed with Raymond’s mother, teachers and grandmother. For the going to school sessions, Raymond’s mother filled-in the data card, describing the interpersonal context, specific behavior problem and social reaction. Because contemporaneous recording while driving was neither practical nor safe, she completed these sections later each morning. I observed the early morning and late afternoon childcare sessions with two exceptions. Although I was able to observe the interpersonal context and social reaction, I was not physically close enough to actually hear Raymond use the inappropriate language. Raymond’s teacher and aid supplied the specific information to document the behavior problems during these sessions. The second exception was that I was not able to observe directly the early morning childcare session on January 31. This was an unscheduled school day for Raymond, but his father called at the last minute and asked Raymond’s mother to take Raymond to school that day because the father had to work. I was able to observe the late afternoon childcare session, and obtained the information for the morning session during that afternoon. During the after school sessions, Raymond’s mother recorded the information for three sessions, and based on post-session interviews with Raymond’s grandmother, I completed the information for the remaining two sessions.

Data Cards

Twenty baseline data cards are enclosed: four consistent time periods on each of five consecutive school days (Thursday, 1/27; Friday, 1/28; Monday, 1/31; Thursday, 2/3; and Friday, 2/4). Note that Monday is not a normal school day for Raymond because he is supposed to spend Monday and Tuesday with his father. During the baseline observation, Raymond’s father had to work and switched one of his two days with Raymond from Monday to Wednesday. As described above, each card was used to record the observed interpersonal context, specific behavior problem and social reaction to the behavior, then identified with the most likely and agreed upon purpose of behavior. Cards were then classified with the common theme for that behavior, as described below.

Themes

After the front side of each data card was completed, I had a discussion with Raymond’s mother, teacher or grandmother in order to determine the purpose of each behavior event. For all twenty sessions, we were able to agree on the general purpose the behavior served for Raymond on each individual card. All of the cards indicated a purpose related to Raymond’s need for attention. After all the cards were completed, in order to focus in on the intervention planning that would be needed, I reviewed the hypotheses that appeared on the cards with Raymond’s mother and identified common themes among the cards as suggested by Carr et al. (1997, p. 73). We found that the behavior to get attention involved three themes: Mother-rushing Raymond to get him to school (3 cards), Mother not spending enough transition time with Raymond (4 cards), and Mother-late picking Raymond up from school (2 cards). The remaining 11 cards showed no behavior problem. The theme categorizations were then reviewed with the teacher and grandmother, and they found them to useful. These themes will be helpful in designing specific interventions.

Baseline Measurement

Each observation card was annotated with the identified problem behavior, if any, the hypothesis regarding the purpose of the behavior, and the common theme for that behavior. The cards were then sorted by time period within date, and consecutively numbered from one to twenty. A Functional Assessment Observation Summary Form (see Appendix) was used to classify each observation according to the theme of the problem behavior. The classification of “no problem behavior” was used for sessions without a behavior problem. The number of each session was entered on the form under the applicable time period and either the behavior theme or the no problem behavior column. If a problem behavior occurred during one of the four time periods on any day, the number of that card was entered on the row for that time period in the appropriate column for the attention-seeking theme of that behavior. As noted above, all problem behaviors observed were for the purpose of seeking attention. A summary of baseline data by attention-seeking theme is given in this pop up table.

Summaries of observations by session and by day are included in the Appendix on the tables labeled “Summary of Baseline Data.”

Nine out of twenty observations (45%) showed that Raymond was either under stress caused by adults failing to take control of their schedules, denied adequate quality transition time with his mother, or stress, concern and possibly worry about his mother’s tardiness picking him up from school. The overall purpose of Raymond’s problem behavior was to gain attention. By theme of his attention-seeking behavior the antecedents, behavior and consequences are as follows:

The inappropriate language of Raymond’s targeted behavior was reinforced each time he used that language. Because of this reinforcement, Raymond has continued to use his inappropriate language.

Raymond must learn to use appropriate words to express his feelings and to get the attention, reassurance and sympathy that he needs. Raymond must find new ways of coping with his feelings when he is feeling sad, when he is anxious, when he is angry, and when he is worried or scared. It might be nice if his mother, teachers or other significant persons could instantly recognize when Raymond needed a little more nurturing so that he wouldn't resort to inappropriate language to fulfill his needs. But that is not the real world. Raymond must learn to assert himself and express his needs appropriately, and that, if his significant others also respond favorably to him, will help him realize that he can do something about those sad feelings, and that he does not need to feel so helpless. Using pictures or non-verbal symbols may help Raymond use his feelings in constructive ways to support his language, cognitive and social skills. The key idea in using augmentative communication strategies is to describe the quality of the feeling through use of body posture, facial expression and animation: How sad is he? How anxious is he? How angry is he? How worried or scared is he? Then Raymond's augmentative communication can be just like using his words (Greenspan, 2004).

One of Raymond’s gifts, described in the MAPS section above, is that he has used his hand puppet and stuffed animal to help him express his own feelings. The skill that will be taught to Raymond will be to use a picture card to help him express his feelings without resorting to using inappropriate language. One of Raymond’s favorite children’s storybook sets is the Thomas Train series. The trains in these books not only talk but also have faces that are used to express a range of emotions and feelings. A communication card was developed based on the Thomas the Tank Engine character (see Appendix for the layout of the Thomas is sad communication card). Raymond will be taught to use this card in order to help him express his feelings, along with his words, facial expressions, posture, and animation. His significant other adult communication partners will also be taught to respond to Raymond’s new form of communication. For example, when Raymond is very angry with his mother for rushing him to school when she is late, Raymond will hold up his Thomas is sad card and tell his mother that he is not happy, or that he is angry. His mother will then respond with the nurturing and verbal support that Raymond is seeking. Her reinforcement will encourage Raymond to use his new skill the next time he is feeling angry, anxious, fearful or sad.

The theme data will be very useful in modeling how Raymond can use the cards to help express his feelings. Sometimes he is very angry at being forced out of the house, down the street and into the car. Sometimes he feels neglected when just a minute or two of expressed understanding may have helped. Sometimes he is fearful that he will be left alone. The cards are not all-or-nothing labels. The cards will be used to augment Raymond’s communication, not to replace it. Raymond will be taught to use his words, tone, facial expression, body language and a certain degree of animation in order to express the quality of the feelings that he is having, and if his communication partners respond in a similar fashion, Raymond should soon get the hang of it (Greenspan, 2004).

Observation data cards and procedures will be followed, similar to those used during baseline in order to determine the effectiveness of the replacement behavior training and the behavior support plan.

This stacked line chart (pop up chart) shows the number of inappropriate language behavior incidents within each theme over the five observation days.

Carr et al. (1997, p. 113) suggest that in the beginning you provide situations that the person likes without conditions. The idea at this stage is for the person to learn that you are associated with “many positive, interesting, and valued experiences and are definitely worth paying attention to.” To help build rapport with Raymond, I purchased for him a LeapPad Learning System along with a preschool level “Thomas the Really Useful Engine” pre-reader talking book. One of the areas the book focuses on is social development--skills that Raymond could use to express his personality and feelings in a healthy manner and to interact in positive ways with family, friends, teachers, and other people. We spent over an hour using the system and getting acquainted with all that the interactive book contained. Then I decided that it was time to direct Raymond towards the portions of the book that addressed feelings. One of the early pages contained icons at the bottom of Thomas’ expressions—a happy face, sad face, and mad face. When Raymond touched an icon with the book’s wand, Thomas said, “I’m happy,” or “I’m sad,” or “I’m mad.” I believed that this exercise was a great way to introduce the “Thomas communication cards” that I had developed. We role-played three situations where Raymond could use the cards to help him express his own feelings, just like Thomas expressed his own feelings. The first situation that we covered was when Raymond might feel angry because his mom was rushing him to get ready for school and get into the car. He seemed to understand that situation well. I demonstrated that he could use his communication card to let his mom know that he was upset, and that showing her the card was something that he could do to get her attention and that would not make her feel bad. We then changed roles; he pretended to be his mom and I pretended to be him. We went back and forth changing roles until the situations seemed natural. We then went on to two other situations, one was where he was sad because his mom had to rush off to work or to an appointment and did not spend enough time with him, and the other was where he was afraid because his mom was late picking him up. I demonstrated how he could also use the cards with his teacher and with his grandmother. We role-played each of these situations too. Raymond then said that he wanted to use his cards with Olive Oil, the hand puppet that he had inherited from his great grandmother. Using my Olive Oil voice, we went through all the situations several times again in various pretend combinations. As Carr et al. (p. 114) recommended, we interacted with one another, shared a rewarding and entertaining experience and enjoyed each other’s company. During these sessions, his mother and grandmother were close by in the other room. Earlier I had shared this behavior support plan with them and with his pre-school teachers.

The above training was accomplished after school on Thursday, February 10^th. Raymond’s father had previously requested to change his schedule for the next week from Monday-Tuesday to Sunday and Wednesday. There were exactly five weekdays available to determine whether Raymond’s intervention plan would be successful. There were not enough days to risk leaving the antecedents to chance. It was agreed that we would set-up the situation to include his mother a) getting a late start so that Raymond would be rushed, b) dropping him off quickly without spending time with him, and c) being late picking him up from pre-school after all other children had been picked up. His Thomas communication cards were readily available in the car and at his grandmother’s house, but at school they were in a zippered pocket in his backpack that was kept in his cubby. On the days that he was in the car and rushed by his mom, Raymond showed his mom his card and she responded with apologies and sympathy. At his grandmother’s house he glanced at copies of his card on the coffee table and told his grandmother that he was sad that his mother was leaving so quickly. She responded by paying attention to him and involving him in helping her with dinner. At school in the morning, he still had his card in his hand, looked at it, and the teacher assistant involved him quickly with the other children. In the late afternoons when his mom was late picking him up, he did not go to his backpack and find his card, but he did go to his teacher and ask about his mom. His teacher told him that his mom just called and would be there soon. Raymond told his teacher that he was sad; she gave him a hug and played with him until his mom arrived. Raymond did not revert to his inappropriate language during any of these sessions. As an early indication of Raymond’s ability to generalize from his training and experience, on Thursday evening the 17^th, I requested Raymond’s uncle Alex to interrupt and tease Raymond while he was playing with his train and blocks. Raymond responded by telling his uncle, “Don’t tease me Alex, I am playing with Thomas. Do you want to build something with me?” It is possible, although not confirmed, that Raymond’s ability to understand and verbalize his own feelings has made him more assertive and willing to engage his uncle rather than verbally lashing out at him.

Based upon the data collected over the baseline and implementation phase of the behavior support plan (BSP), the Raymond’s BSP was successful: During the post intervention data collection phase there were no incidences of Raymond using inappropriate language in order to get the attention of adults. I believe that the key factors that contributed most to the plan’s success were the following: First, Raymond and each member of his primary support team were included in the development, implementation and evaluation of the plan. If we had left any significant person out, not only may we have not obtained the commitment that we needed, but we would have missed their valuable input as well. Next, the target behavior was defined very specifically. This factor was very important because it made the plan doable in a relatively short period of time. Third, considering the specificity of the target behavior, the data collection both during baseline and after intervention was complete. Also, along this line, because the target behavior was a low incidence behavior, the data collection cards worked especially well. A fourth factor that contributed to the success of Raymond’s BSP was the accuracy of the hypotheses. Dividing the attention hypothesis into themes not only made the hypothesis more accurate, but also helped everyone better understand Raymond’s behavior. A fifth factor was the appropriateness of the intervention. Raymond seemed to use the communication cards not just to replace his verbal lashing out with another attention getting scheme, but also to provide him with a cue to express what he felt inside his heart. And finally, a sixth factor was the presence of the skill and support needed to carry out the interventions. The skill came from the readings and in-class presentations recommended and provided by the instructor of this class, and the support came from Raymond’s family, preschool staff and from Raymond himself.

Raymond’s goals and objectives are structured along each of the three themes researched in this project:

Goal A. Raymond will use his communication cards and/or use his words appropriately to express his frustration and anger to his mother when she late and is rushing him to get to preschool.

Goal B. Raymond will use his communication cards and/or use his words appropriately to express his sadness when his mother leaves him to go to work or to an appointment without spending adequate time with him.

Goal C. Raymond will use his communication cards and/or use his words appropriately to express his sadness and fears when his mother is late picking him up.

Raymond’s mother will be the key person in gathering evaluation data for this next phase of Raymond’s behavior change project. She is the one person who will always know when she rushed Raymond because she was late, when she failed to spend adequate time with him before she rushed off to work or an appointment, and when she was late picking Raymond up. She will use the same data index cards that were used in the previous phases of this project. Although the data index cards require a commitment to thinking and writing, they are also appropriate to describe low incidence behavior. In fact, most of the situations that Raymond previously responded to with inappropriate language were situations that were under his parent’s control. The process that we started will be good for Raymond in that he is learning to use appropriate language to express his feelings, and it will also be good for his parents to realize how their own behavior can have direct behavioral consequences for their child. I will follow-up periodically to offer my services for overseeing this next phase of the project.

This stacked line chart (pop up chart) shows the number of inappropriate language behavior incidents within each theme over the five baseline observation days and over the five intervention days.

Reflections

The best part of this project was the building of rapport between Raymond and myself. Rapport building with Raymond for this project began during the initial interviews. The interview style that I used was open-ended rather than directly focused. I was not positive that this style would work well with a three year old, but Raymond appears to be highly verbal for his age. In a directly focused interview I would have asked questions such as “Do you like trains?” or “What are your favorite toys?” In my open-ended style I asked “Tell me about yourself, Raymond.” Raymond responded by showing me his stuffed dog, his Olive Oyl puppet that he had inherited from his great-grandmother, and one of his toy trains. He then went and picked out some of his favorite books, and took me to a corner of the living room he called his “work shop” that included writing and drawing materials, more books, toys and other collections. Roberts, Lamb, and Sternberg (2004) reported that rapport building using an open-ended approach helps transfer control from the interviewer to the child being interviewed. This shift in the balance of power helps children feel that they are in control. Because I used the open-ended style, Raymond saw himself as being trusted as an expert and felt empowered enough to become more assertive. I used Thomas the Tank Engine and Olive Oyl in the direct instruction of appropriate ways to communicate feelings not because I or someone else selected them but because Raymond, in effect, selected them. From the first interview on Raymond and I both felt that we were in this project together, and both of us were acquiring valuable experience.

The hardest part of this project was experimental design during the intervention stage. In order to determine if the intervention had a controlling influence on Raymond’s behavior, it was necessary to arrange the setting events so that the situational variables in each of the three themes would be present during intervention. This meant that we had to set things up so that Raymond would at times be afraid, frustrated, and angry. This set-up was necessary because during the design of the project Raymond’s mother became more aware of the potential harmful effects of rushing Raymond, not spending enough transition time with him, and being very late picking him up from school. These setting events are often either directly or indirectly under his mom’s control, and she could have modified the setting events at any time so that Raymond would not have had occasion to be afraid, frustrated or angry. By conducting the experiment, we may have put Raymond through another week of rushing, lack of transition time, and waiting for his mom, but at least we now know that he is more able to handle these situations.

References

Artesani, A. J., & Mallar, L. (1998). Positive behavioral supports in general education settings: Combining person-centered planning and functional analysis. Intervention in School & Clinic, 34(1). Retrieved in HTML format from EBSCOhost, Academic Search Premier.

Carr, E. G., Levin, L., McConnachie, G., Carlson, J. I., Kemp, D. C., & Smith, C. E. (1997). Communication-based intervention for problem behavior. Baltimore, MD: Brookes.

Greenspan, S. I. (2004, April 1). Coping with feelings. Web radio transcript retrieved on February 5, 2005 from http://www.floortime.org/downloads/
transcripts/april_1.pdf

Kinkaid, D. (1996). Person-centered planning, In Koegel, L. K., Koegel, R. L., & Dunlap, G. (Eds.). Positive behavioral support: Including people with difficult behavior in the community (pp. 439-466). Baltimore: Brookes. Chapter was downloaded from Northern Arizona University Website on January 9, 2005, from http://www.nau.edu/ihd/positive/library/
kincaid1.pdf

Rainforth, B. & England, J., (1997). Collaborations for inclusions. Treatment of Children, 20(1). Retrieved in HTML format from EBSCOhost, Academic Search Premier.

Roberts, Lamb, and Sternberg (2004). The effects of rapport-building style on children’s reports of a staged event. Applied Cognitive Psychology, 18, 189-202.

Renzaglia, A., Karvonen, M., Drasgow, E., & Stoxen, C. C. (2003). Promoting a lifetime of inclusion. Focus on Autism and Other Developmental Disabilities, 18(3), 140-149.

University of Kansas, Circle of Inclusion Project (n.d.). The MAPS process: seven questions. Retrieved January 8, 2005, from http://www.circleofinclusion.org/english/
guidelines/modulesix/a.html

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FOCUS ON SPECIAL EDUCATION

Behavior Change

Introduction

History

Personal Health

Significant People

Overall Academic and Behavioral Functioning

Dreams

Fears and Nightmares

Gifts

Challenges

Targeted Behavior

Methodology and Functional Assessment

Interviews

Data Collection

Data Cards

Themes

Baseline Measurement

Reflections

References

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