SKILL BUILDING PLAN Plan Effective Date January 23, 2016

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1 Provider/Staff Name: Caring Inc./ Samantha Green Participant Name Shawn Howell SKILL BUILDING PLAN Plan Effective Date January 23, 2016 Name of Person Completing SBP Samantha Green Service Start Date February 25, 2016 Email Address for Person Completing SBP Who is implementing this plan? sgreen@gmail.com Initial SBP Development Date Dates of SBP revisions, when applicable March 14, 2016 Skill Building Specialist Community Support Staff Parents/Natural Support Other: Goal and Objective: Goal Phrase Goal Category Goal Goal Statement Condition Behavior Objective Criteria Meal Prep Social/Communication ADL Behavior Employment/Education Shawn will prepare a meal from a recipe card following a task analysis When it is dinner time and the daily dinner alarm goes off, Shawn will prepare a meal from a recipe card following a task analysis 8/11 steps completed needing no more than gesture for one quarter.

Instructional Strategies Setting(s) Baseline (Current Level of Performance Natural Cue(s) Materials and Environmental Arrangements Description of Strategies Generalization and Maintenance Home In the kitchen at his own apartment For dinners, Shawn primarily prepares frozen microwave meals or purchases a fast food meal. He is capable of using the stove and oven without supervision, but chooses not to because it requires more steps. Although he can perform each step on the task analysis, he requires model prompts and performs 0 steps independently When in his apartment when it is dinner time (Shawn will be triggered by his daily dinner alarm going off around 4:45) Copy of task analysis (taken off the fridge and put on counter for easy reference) Recipe card of his choosing Ingredients to prepare meal (staff will ensure he has ample ingredients ahead of time) TV turned off to minimize distractions Prompting Task Analysis/Data Collection Form Reinforcement 1. Prompts: Gesture: Pointing to next step Indirect Verbal: You just completed step 2, what do you do now? Direct Verbal: We are on step 3 Model: Show him what the next step should look like 2. Latency: Time- delay Constant: wait 30 seconds in between prompts. If continued prompting is needed, give 2 gestural prompts before indirect verbal. Give 3 indirect verbal prompts before direct verbal. Then give 2 direct verbal prompts before See Attached Positive acknowledgment (must be subtle and specific to the step he completed. For example, Correct, the next step is_ or Nice job remembering the step to complete Natural Reinforcement- Provide opportunities in new settings Use new materials/prompts Use skill with different people Change criteria level in objective Change the goal Change the objective Selfmonitoring Other: Decrease the number of steps in the task analysis

Error Correction Interrupt and re-direct if he does not complete the correct next step; Follow prompt

5 Goal Attainment Scaling Chart Level of Attainment Quarter 1 Dates: 2/1/16-4/30/16 Quarter 2 Dates: 5/1/16-7/31/16 Quarter 3 Dates: 8/1/16-10/31/16 Quarter 4 Dates: 11/1/16-1/31/17 Much less than expected -2 0/11 steps completed independently (all steps need no more than model 2/11 steps completed verbal 4/11 steps completed verbal prompts 6/11 steps completed Somewhat less than expected -1 1/11 step completed need no more than model 3/11 steps completed verbal 5/11 steps completed verbal 7/11 steps completed Expected level of outcome 0 2/11 steps completed need no more than model 4/11 steps completed verbal 6/11 steps completed verbal 8/11 steps completed for one quarter Somewhat more than expected +1 2/11 steps completed verbal 4/11 steps completed verbal prompts 6/11 steps completed 9/11 steps completed Much more than expected +2 3/11 steps completed verbal 5/11 steps completed verbal 7/11 steps completed 10/11 steps completed Level of Attainment per quarter Comments Instructional Decision

6 G: Gesture IV: Indirect verbal +: Independent Coding System DV: Direct verbal M: Model Skill (Behavior from Objective): Shawn will prepare a meal from a recipe card following a task analysis Mastery (Criteria from Objective): 8/11 steps completed At the beginning of each day, record the date at the top of the column. Then, within each that column, you will record a G, IV, DV, M, or + using the coding system above to document the type of prompt/ lack of prompt needed for Shawn to complete each task. Task Analysis Date 11. Once dinner is done, check to make sure the oven is turned off 10. Put rinsed dishes into the dishwasher 9. Rinse all dirty dishes off in sink 8. Wipe down table with washcloth 7. Put away all ingredients 6. Continue completing steps until all of the steps on the recipe card are complete 5. Complete step one on the recipe card 4. Check and make sure you have all of the ingredients 3. Read the ingredients and pull them out of the cabinet 2. Obtain recipe card from the box and place on table 1. Turn off TV Natural Cue: When Shawn s daily dinner alarm goes off % completed independently

7 Please maintain a hard copy of the current Skill Building Plan in the participant s files. The following individuals have been trained to implement the Skill Building Plan Name Signature Role Date