One of my favorite things to do with a client is Community Outings. Think of these as a way to generalize what is taught during therapy sessions, to real life settings, or another environment.
A critique of ABA therapy is that due to the structured nature (1:1,highly structured setting) children become "robotic", meaning they will learn a skill but not actually display the skill unless asked in a specific way. This lack of generalization can sometimes be an issue, but if the ABA program your child or client is in teaches for generalization then this shouldn't be a concern. Generalization can be incorporated into instruction by varying stimuli, doing post checks on mastered targets, using targets the child sees every day (for example, if you are teaching the child to label "cat", use a photo of the family pet), and incorporating Community Outings or NET into the program. It is not enough to teach a child skills until they obtain mastery, and then move on to new targets. What will happen is as the child progresses through their programs, older skills will be forgotten. A successful and well run ABA program always plans for ways to generalize skills the child is learning.
This is an example of poor generalization that I see often: I meet with a family for consultation, and I greet their child by saying "How are you?" or "Whats your name?". What happens most often if the child responds at all, is they reply by saying "Hi". Right away I know that this child needs to work on generalization of skills. If the child was taught how to respond to greetings, without proper generalization they can get to a point where when anyone approaches them they tune out what the person says and just respond with a "Hi".
The purpose
of doing Community Outings is to take skills from the therapy sessions out into
real -life settings to strengthen the skill, expand upon the skill, and/or
promote generalization. Community Outings also may be necessary with certain
clients if the child consistently struggles in a specific place, such as the doctor’s
office, Burger King, or at church. Perhaps the family has stopped visiting
a certain playground because every time they visit their child becomes aggressive
with other children and tries to run off.
The
treatment team could go with the family to a public location to address
challenging behaviors or provide hands-on caregiver support.
In addition,
every Community Outing is also working on social skills. Transitioning in a public
place, speaking to others with an appropriate tone of voice, staying near a
known adult, etc. These are all important social skills to learn both to stay
safe, and to function in society.
I enjoy spending time with my clients and taking them to various places in the community. Its almost like a field trip away from the table. These children need to learn how to successfully navigate different public settings, and the younger you start the better for the child. What we as therapists teach at the table is very important, but it is also important that these children can be appropriate in public as well.
Sadly, I have had clients who don't take their child out in public beyond what is necessary because it is very difficult due to the child's behavior. I have had parents tell me "Oh no, we don't take her to the park", or "We haven't eaten inside a restaurant in years". That must be so stressful for a family to have to completely avoid certain places or locations, and to reduce their lives to just the home. Particularly around the holidays, social outings and interactions with family members will happen very frequently and shouldn't be panic or anxiety inducing.
Here are a few tips that I usually share with families who avoid taking their child out in public:
- Firstly, and this is very important: Do not avoid a place or location because your child is disruptive when you go there. If you have a BCBA Consultant or a Lead Therapist you are working with, see if they will go to the location with you and provide help. Ask your Consultant for a behavior plan to address the behaviors in public. If every time you go to the park your child has a meltdown when it is time to leave, look at that as a learning opportunity. If you stop going to the park, how will the child learn how to be appropriate at the park? What you should do is go to the park MORE, so the child can have many opportunities to practice being appropriate at the park.
- Be prepared and organized before you ever leave the house: Have a game plan, and a schedule. Know where you are going, for how long, and either tell your child the game plan or use a picture schedule if possible. Some children enjoy holding a fidget in the car, or you can play calming music.
- Once you are in the store, understand the difference between Reinforcement & Bribery. I see this playing out all around me in stores, malls, and restaurants at least once a week. The difference between bribery and reinforcement is bribery is offering something to the child to stop a behavior once the behavior has already begun. Such as, "If you stop screaming you can have a Snickers bar". Bribery does not work long-term.
- So I'm sure you are wondering, "If bribery doesn't work, what do I do if the child acts up in the store/mall/restaurant/etc". Firstly, if your child has a current behavior plan in place then ask the Consultant or Lead Therapist how to modify it for public settings. The first rule is, you don't leave the public setting. The reason why is this could actually reinforce the problem behavior if the function is escape. The second rule is to minimize all attention to the behaviors. If your child begins to cry, falls to the floor, etc, ignore these behaviors. Block as many of the behaviors as you can without giving the child eye contact or making statements such as "Don't do that!". If the child quiets down, even for a second, you can give attention then.
Dealing with behaviors in public can be very difficult, especially nowadays where people have no problem making rude comments or asking questions.
Below are some specific examples of Community Outings. Remember, a Community Outing is an opportunity to generalize the child's learning in a real life setting. It is not "hanging out", or simply taking the child with you while you run errands.
Examples of Community Outings:
- Skill: Math/Money. Go to the store and buy something that costs $1. At the register, give the child enough change to equal $1 (such as four quarters) and have them count it out to the cashier.
- Skill: Social Skill/Greetings. Go to Wal -Mart (or any store with greeters). Explain your situation to the greeter there and ask if your child can help greet customers.
- Skill: Community Signs. If the child is verbal, go for a walk and have them identify various signs in the community by name. If the child is nonverbal, go for a walk and bring a few pictures of community signs with you. When you see a sign, stop and have the child point to the picture that matches the sign in front of them.
- Skill: Gross Motor Skills. Take the child to a park or sensory play center. Have the child run, skip, climb, bend, squat, gallop, etc., depending on the specific skills you are targeting.
- Skill: Eating Skills/ Self Help. Take the child to a restaurant and order some food. If you are targeting using a straw, order them a drink. If you are targeting using a knife, order them something that can be cut. Prompt the child to keep their area clean while eating, and use napkins as needed.
- Skill: Waiting Appropriately/Transitions. Go to a place or setting that the child really loves, such as a favorite toy store. Tell the child before you go in the store that you are going in for 2 minutes only (bring a timer if necessary). Enter the store, and give the child transition warnings that you will be leaving soon, such as "We are leaving in 1 minute". Once 2 minutes has passed, tell the child it is time to go, and leave the store.
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