Rock Star Parent Training: BST

If you're an ABA professional then you're likely already familiar with BST (Behavior Skills Training). 

The 4 basic steps of BST are as follows: Instruction, Modeling, Rehearsal, & Feedback.
Lather, rinse, and repeat as needed.

I LOVE utilizing BST with supervisees and direct staff, but also when intensively targeting parent training. Such as with a case that has low hours, so instead of traditional therapy we utilize more of a parent coaching model.
BST is super effective, and makes you look like a genius who can teach anything to anyone. If it sounds like I'm overselling, shut up. No I'm not. BST really is that amazing.

If your parent training strategies could use some help, or aren't always super effective (particularly in producing long lasting change) then keep reading for some rock star parent training tips!

Here is each BST step explained in a bit more detail:

Instruction – You are most likely already doing this. Put simply, this is telling the parent what to do. The problem is, many professionals start and end at this step. As in, "Well I told the parent what to do like 8 times already, but they still aren't doing it!". Effective teaching should include more than just telling. 

Modeling – Put simply, this is SHOWING the parent what to do. I need to go beyond just putting up a visual, or walking the parent through a transition, as much as possible I need to show the parent what to do with their actual child, in the actual target situation. Meaning, if I am teaching the parent how to reduce meltdowns at Publix, then we need to go to Publix. 

Rehearsal – How often do we (I'm including myself here) forget about this step? This is one I have to remind myself to do, because my tendency is to jump in and model, but then I neglect to allow the other person to practice while I watch. If you're like me, you have already learned that skipping this step is no bueno. We all like to practice new behaviors to ensure mastery, especially complex behavior chains. And most of the things you teach to parents will meet the criteria of a complex behavior chain. 

Feedback – This last step also can be overlooked, or forgotten. I find that most of my supervisees struggle with giving immediate feedback. Meaning, tell the person what to correct while they can still change it. Don't wait until the parent has completed the entire toileting procedure with their child to tell them they did the 1st step wrong. That's extremely frustrating! It also makes it more unlikely that the parent will perform the behavior correctly when you are not around, because you just let them practice errors. Just like we do with our clients, be sure to provide both positive praise statements and corrective feedback. 

Here are a few examples of BST in action:

Behavior: Transitioning child to therapy table

Instruction: Explain to the parent exactly what they need to do. Be sure to ask for questions, and answer them fully

Modeling: Show the parent exactly how you want them to transition the child

Rehearsal: Say to the parent "Your Turn". Observe closely

Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

Behavior: Implementing a Manding Trial with the child

Instruction: Explain to the parent exactly what they need to do. Identify needed materials. Be sure to ask for questions, and answer them fully

Modeling: Show the parent exactly how to run a Manding Trial

Rehearsal: Say to the parent "Your Turn". Observe closely

Feedback: Both in the moment and once they are done, give the parent specific information about what went great and what needs improvement. Skip the jargon, or define any terms used. Also be sure to ask the parent where they need more help, or if any part is confusing

If BST makes parent training ridiculously easy, then its always effective all the time, right? Wrong. Here are some common parent training pitfalls I see all the time, that can hinder the effectiveness of your BST procedures - 

Common Parent Training Errors

1. Not enough training examples: The child regularly has meltdowns at grocery stores, so you spend 2 hours inside a Publix with the parent. Whew....they should never have that problem again. Ummm, no. What about when the child has problem behaviors at Kroger, or Sams Club, or Whole Foods? Each store is different and may have differing maintaining variables, so the parent will likely need practice in each store. If this is not possible then at least during the instructions phase talk the parent through how to address the behavior across different settings.
2. Not enough practice: Very closely related to the previous point, is letting the parent briefly jump in for rehearsal and then immediately you take over the session again. When I see this with my staff, I usually say to them: "YOU are not the one who needs to learn this. You already did that". Remember who the student is in parent training (the parent). They need lots and lots of practice under the watchful eyes of the team, on an ongoing basis. 
3. Letting the parent practice errors: Would you let your client practice errors? No, right? Well then why would you sit back and let the parent practice errors? Errors impede learning. Sometimes staff allow this because they feel too awkward or hesitant to correct the parent. Again, would you correct your client? Then what is the difference? You are teaching the parent a new behavior, and in order to learn effectively they need error correction procedures.
4. Failure to teach concept of Reinforcement: This is a big one. Many times when I follow up with a parent about their parent training I hear, "He/she just won't do (target behavior) when you guys aren't around!". Further digging usually reveals what the actual problem is....their child expects to contact (gasp!) some reinforcement for their behavior. Many parents do not understand this, and so they approach the child outside of therapy sessions with a complex and difficult demand, that can earn...nothing. Not surprisingly, the child immediately kicks off problem behaviors. Take the time to make sure the parent understands reinforcement is the glue that makes behaviors stick. It needs to be immediate, differential, and valuable to be most effective.
5. Failure to select socially valid parent training goals: Yes, parent training should have goals like any other intervention. This is the #1 error I see, so I'll discuss it last. As the BCBA/supervisor do you tell the parents what their parent goals are? I hope not. Social validity basically means that the individuals/stakeholders requesting the treatment agree that the treatment is important and helpful to them. In order to do that, I have to work together with the parents to create parent training goals. This also provides opportunity to identify unrealistic goals ("I want her to always be happy"), or to help parents understand how concretely a skill needs to be broken down to intervene on it. If the parent you are working with has no input on parent goals, or refuses to participate in the goal selection process, then unfortunately, you have a bigger problem on your hands.

Bottom line: If the parents cannot produce the same, or at least similar, behavior change results as the ABA team when they are alone with their child then parent training needs to be modified. It needs to be revised, increased, or a common pitfall has not been addressed yet. The same way you wouldn't blame the learner for not learning, you shouldn't blame the parent for ineffective parent training. Review the BST guidelines, and come up with a new plan that works for the parent.