PS498 Unit 8 Caregiver Training Paper Example

Four Adults, Two Kitchens, One Checklist: A PS498 Unit 8 Caregiver Training Paper

[Student Name]

Purdue University Global

PS498: Bachelor's Capstone in Applied Behavior Analysis

Unit 8 Caregiver Training Paper

[Instructor Name]

[Date]

The writer, the clinic, the families and every figure are composite and illustrative; the articles cited are real.

Why Caregivers Need Training

The toilet training in my capstone began at the clinic, where trained technicians run the protocol from 8:30 to 2:30. But most of each child's waking hours are at home. LeBlanc et al. (2005) found in their outpatient program that parent training was essential for gains made in the clinic to carry over to home. A child who stays dry at the clinic and wet every evening has not learned to use the toilet; she has learned to use the clinic's toilet.

Four caregivers needed training: Leo's mother and father, who work rotating nursing shifts and rarely overlap at home, and Amara's mother and grandmother. Amara's grandmother speaks mostly Somali, so a clinic interpreter joined her sessions.

A Baseline for Caregivers

Before training, each caregiver received the protocol's one-page home summary and was asked to run a practice sit with their child during a home visit while I scored a nine-step checklist: offer a drink at the right time, take the child to the bathroom on schedule, help with clothing using least prompts, wait up to three minutes, deliver the reinforcer immediately after a void, honor a request immediately, respond calmly to an accident, record the sit and return the child to activity.

Average accuracy across the four caregivers was 45 percent. The most common errors were delivering the reinforcer late, after hand washing rather than right after the void, and responding to accidents with disappointment, such as "Oh no, not again."

Every caregiver had read the summary; none of them had practiced it.

Behavioral Skills Training

Parsons et al. (2012) described a six-step approach to training: describe the skill and its rationale, provide a brief written summary, demonstrate the skill, have the trainee practice it, give feedback during practice and repeat until the trainee meets a mastery criterion. DiGennaro Reed et al. (2018) offered guidelines for using behavioral skills training to support teachers, including teaching a few skills at a time, using a checklist that matches the steps, practicing in realistic conditions and following up in the actual setting. Both apply naturally to parents.

The Training Sessions

Each caregiver received one training session of about an hour in their own home, scheduled around shifts. I described the protocol's purpose and each step, reviewed the summary, and demonstrated a full sit with the child, narrating the decisions, especially the timing of the reinforcer. The caregiver then ran a sit while I scored the checklist and gave feedback right after each step, praising correct steps and modeling any that were missed. We practiced the accident response with a role play, since real accidents could not be scheduled. Training continued until the caregiver ran two consecutive sits at 100 percent.

For Amara's grandmother, the interpreter translated each step, and we practiced with her own phrasing; she preferred to praise in Somali, which was fine. For Leo's parents, each trained separately, and both learned to use a shared phone note to record sits and pass information between shifts.

Results

All four caregivers reached criterion within three to five practice sits. One week later, during unannounced home visits, accuracy ranged from 89 to 100 percent. Reinforcer timing, the most common baseline error, was correct in nearly all observed sits. Accident responses remained the hardest step; two caregivers still sighed or spoke with disappointment on their first real accident, and a short follow-up conversation and a second role play addressed it.

Caregivers' Views

At the end of training, each caregiver rated the training and the protocol on a short scale and answered two open questions. All four rated the training as useful and the protocol as acceptable. Leo's father wrote that watching the demonstration once taught him more than reading the summary three times. Amara's grandmother said, through the interpreter, that she had raised five children and doubted a young woman could teach her anything about toilets, but that the timing of the crackers had surprised her: Amara now ran to the bathroom when she heard the bag. Amara's mother asked for one change, that the summary use pictures of their own bathroom, which we added the following week. Those answers mattered as much as the fidelity scores. A caregiver who finds a protocol strange or demeaning will stop using it the first evening no one is watching, whatever her score was during training.

Choosing What to Train First

With limited time, the order of training mattered. My supervisor and I chose to train reinforcer timing and the accident response first, because baseline showed those were the most frequent errors and because each affects learning directly: a late reinforcer may strengthen hand washing instead of voiding, and a disappointed reaction may make the bathroom unpleasant. Clothing prompts and recording came second, since errors there slowed the routine but were unlikely to undo it.

Effects on the Children

Home data, recorded by parents, showed evening accidents falling for both children after their home phase began. Amara's evening accidents fell from about two to fewer than one per evening within two weeks, and Leo's from three to about one. These are parent-reported data and less reliable than clinic data, but they moved in the same direction as the clinic results.

Maintaining Caregiver Fidelity

Fidelity can drift over weeks, especially once the trainer stops visiting. I scheduled two follow-up visits a month apart, with brief feedback and the same checklist. The clinic's supervisor will continue monthly checks after my capstone ends. Leo's parents asked for a short video of a correct sit, recorded with their child, to watch when a new babysitter started, which became part of their routine.

Limits

Training took about four hours of my time per family, plus travel, which may not be possible for every clinic. Role play was a weak substitute for real accidents. And parent-reported data at home lack agreement checks, though the clinic and home data agreed in direction.

Conclusion

A written summary produced 45 percent accuracy among four caregivers. Behavioral skills training based on Parsons and colleagues and DiGennaro Reed and colleagues brought each to criterion within a few sits, adapted to language and shift schedules, and accuracy held at follow-up. Home accidents fell after training, consistent with LeBlanc and colleagues' finding that home gains depend on parents.

References

DiGennaro Reed, F. D., Blackman, A. L., Erath, T. G., Brand, D., & Novak, M. D. (2018). Guidelines for using behavioral skills training to provide teacher support. Teaching Exceptional Children, 50(6), 373-380. https://doi.org/10.1177/0040059918777241

LeBlanc, L. A., Carr, J. E., Crossett, S. E., Bennett, C. M., & Detweiler, D. D. (2005). Intensive outpatient behavioral treatment of primary urinary incontinence of children with autism. Focus on Autism and Other Developmental Disabilities, 20(2), 98-105. https://doi.org/10.1177/10883576050200020601

Parsons, M. B., Rollyson, J. H., & Reid, D. H. (2012). Evidence-based staff training: A guide for practitioners. Behavior Analysis in Practice, 5(2), 2-11. https://doi.org/10.1007/BF03391819