Running head: BEHAVIORAL CONSULTATION

MA/CAGS School Psychology Portfolio

Behavioral Consultation Case Study

Kelsey Evans

William James College

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Behavioral Consultation Case Study

Problem Identification

The consultation process was first introduced to Adam’s fifth-grade homeroom teacher following

a formal 504 Plan request by Adam’s mother, who is also a first-grade teacher at ABC Elementary

School. Similar to Adam’s mother, the fifth-grade team had expressed some behavioral concerns related

to work completion and time spent outside of the classroom (i.e., taking advantage of granted “breaks”).

In addition to the general consultative process being outlined, Adam’s teacher, Ms. White, was asked to

identify her expectations in working together. She expressed a desire to problem solve and offer support

for Adam within the general education setting. Following that discussion, several other details were

addressed including our meeting schedule, the logistics of data collection, expected outcomes, and an

explanation of the non-evaluative collaborative approach. It was agreed that Ms. White, the consultee,

would be the primary person to implement the intervention and collect data and I, the consultant, would

regularly check in to address any unforeseen problems that arise and to best support Adam. We would

meet weekly on Thursdays at 10 A.M. to ensure consistent communication throughout the process.

Relevant background information. Adam is a ten-year-old student in Ms. White’s fifth-grade

class at ABC Elementary School. Ms. White described Adam as a bright and clever student. Notably,

Adam’s mother shared that he has a significant medical history that appears to adversely affect his

academic and behavioral performance. His medical diagnoses include eczema, asthma, and severe food

allergies, for which he is prescribed several medications. According to Ms. White, he often complains

of being physically uncomfortable and experiences considerable side effects as a result of his prescribed

medications including a suppressed appetite and increased anxiety. This year, he has experienced two

panic attacks, one of which took place at school. He has also expressed having obsessive, perseverative
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thoughts. In January of 2017, he was diagnosed with Attention Deficit Hyperactivity Disorder (ADHD)

by a private evaluator.

Consultee concerns and problem behavior. Once the expectations and logistics of the

consultative process were clarified, the problem was identified. Ms. White was asked to share her

insights regarding Adam’s areas of strength and challenge in her classroom. She explained that Adam is

a bright student who often needs clear limits in order to complete his work and demonstrate his abilities.

While expressing her initial concerns, Ms. White explained that Adam struggles to express himself and

often seeks out his mother, a teacher at the school, for comfort during the school day. She believes that

he seeks out his mother during times of heightened anxiety or physical discomfort stemming from his

medical ailments. Adam struggles to maintain focus and take responsibility for his mistakes. At times,

he behaves or speaks disrespectfully to authority figures (e.g., school principal, teachers), which results

in disciplinary action (e.g., sent to the principal, being reprimanded). In general, however, Ms. White

believes that Adam is a kind student who benefits from positive encouragement and praise.

When considering what behavior would be most helpful to target, Ms. White and I first discussed

an intervention focused on decreasing the amount of time that Adam spends out of the room while

taking a “break.” Adam is permitted to take breaks throughout the day because he struggles to maintain

focus (e.g., is off-task, talks with classmates) and often acts impulsively (e.g., calls out). However, his

breaks often last from 10-20 minutes and several other teachers have reported seeing Adam in the first-

grade wing, where he is presumably visiting his mother. While we continued our conversation, Ms.

White also identified the morning to be a difficult time for Adam. He struggles to adhere to his morning

routine and rarely completes the seven-step routine. Instead, Adam is distracted by other students, walks

around the room, or makes inappropriate comments, for example. He sometimes enters the classroom

and then asks to go get breakfast from the cafeteria; a task that Ms. White has encouraged him to do
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before coming to class for the day. Within the problem identification stage, the idea of a keystone

variable (i.e., a variable that, if changed, may impact multiple aspects of Adam’s presentation) was

introduced to Ms. White. Together, we agreed that Adam’s morning routine would become the focus of

the consultation. Ms. White shared that it would be important for Adam to feel a sense of

accomplishment since he often has to deal with the consequences of his misbehaviors. Having a

successful morning will hopefully jumpstart his day to begin on a positive note and allow an opportunity

to build self-esteem. This information was considered when identifying which intervention would be

implemented.

Throughout the problem identification phase, several potential behaviors were identified;

however, it was collaboratively determined that the completion of Adam’s morning routine is an

essential component of his daily success. By starting his day off in a productive, successful manner, he

will hopefully feel a sense of accomplishment and be prepared for the rest of his day. Adam’s problem

behavior is operationally defined as any refusal or failure to comply with the established morning

routine, including not following directions, talking with peers, ignoring teacher requests, failing to

complete assigned work, and/or making inappropriate comments/vocalizations. To see charted baseline

data, please refer to the Baseline Data and Current Performance section.

Baseline data and current performance. Daily baseline data was collected to identify Adam’s

current performance as it related to the daily morning routine. Baseline data was collected over the

course of four days following the initial consultation session. The class’ morning routine consists of

seven steps. Ms. White recorded the number of steps that Adam completed each day as well as the

number of prompts required for Adam to accomplish those steps. See Figure 1 and Figure 2 for a line

graph of Adam’s baseline performance.

The data shown in Figures 1 and 2 show that Adam was able to complete 2-4 steps of his seven-
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step routine. In order to complete those steps, he required 4-6 teacher prompts. As the line graphs

demonstrate, Adam required at least one teacher prompt per step completed during the baseline data

collection phase.

Baseline: Number of Steps Completed Baseline: Number of Prompts

# Steps Completed Trendline # Prompts Trendline
No. Steps Completed

No. Required Prompts

6 6

4 4

2 2

0 0
1 2 3 4 1 2 3 4
Days Days

Figure 1. Baseline number of steps completed. Figure 2. Baseline number of prompts per day.

Problem Analysis

Before deciding upon an intervention to put in place, Ms. White and I considered several

hypotheses that may be contributing to Adam’s current difficulties related to following his morning

routine. Multiple hypotheses were collaboratively developed to explain the current problem. One

considerable factor that may be impacting Adam’s behavior in the classroom is his diagnosis of ADHD

and the impact of its related characteristics on his performance, including distractibility and impulsivity.

His medical diagnoses (i.e., eczema, asthma, food allergies) may also have unintended side effects.

Another potential factor is his current level of anxiety. His thoughts and actions may be impacted by his

worries which manifests in avoidance behaviors (e.g., work avoidance, seeking out his mother). With

his mother being a teacher at the school, he may be treated differently than other students in Ms. White’s

class. At this point, it’s also possible that Adam does not see the value in completing his morning

routine as he has consistently made it through his day without consistently completing this task. This

was certainly a consideration of ours in developing an appropriate, motivating intervention for Adam.
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Finally, it may be that Adam is lacking appropriate skills that are required to complete his morning

routine such as self-monitoring and prioritizing. While discussing potential hypotheses, Ms. White and I

also took into account the impact of issues of diversity on Adam’s behavior as well as on the chosen

intervention. Two aspects of diversity that were considered in the consultation were the impact of

Adam’s medical issues as well as his diagnosis of ADHD. Adam’s cultural background is syntonic with

the mainstream culture of the class and did not appear to have a strong impact on his behavior.

In addition to the consideration of multiple hypotheses to explain Adam’s current performance,

Ms. White and I also discussed a potential “mismatch” between the student and various factors such as

the class expectations or environment. There may be a mismatch between Adam and his environment in

that there are many distractions as his classmates settle into the classroom for the day. Additionally,

Adam may not possess the skills required to independently attend to and complete all seven steps of the

morning routine, thus illustrating a mismatch between his behavior and what is expected of him.

Typically, Ms. White provides oral instructions as her students enter her classroom and perform their

morning routines. An instructional mismatch may be present, which could be minimized by providing a

visual reminder to supplement Ms. White’s oral prompts.

Taken together, there are several possibilities as to the function of Adam’s behavior that may be

associated with one of the identified hypotheses or potential mismatches. The data collected throughout

the intervention will help determine which functions may be impacting Adam’s behavior. Based on the

baseline data, it is believed that his behaviors are likely a result of many factors at play.

Intervention Design

As the baseline data shows, Adam is not successfully completing his daily morning routine and

as a result, a goal was developed to target Adam’s seven-step routine. Specifically, the short-term goal

is for Adam to complete 75% of his morning routine (i.e., 6 out of 7 listed steps) with the assistance of a
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visual checklist each morning, measured over a two-week period (as compared to his current

performance of no more than five steps). While the SMART (i.e., specific, measurable, attainable,

realistic, and timely) goal is focused on Adam’s ability to complete his morning routine, Ms. White also

recorded how many prompts were required in order for Adam to complete those steps, with the hope that

the number of required prompts will decrease with the presence of the checklist. To increase Adam’s

motivation, he was able to earn a daily reinforcer of his choosing (e.g., Way to Go! card) if he

accomplished his goal. A future long-term goal will be for Adam to complete all seven steps of the

class’ morning routine on a daily basis with no more than two prompts.

Research supports the use of self-monitoring tools to increase or decrease behaviors (Rafferty,

2010). Checklists are a method of self-monitoring that are particularly helpful when monitoring multi-

step behaviors (“How To,” 2013). Loftin, Gibb, and Skiba (2005) state that “students with behavioral

and academic difficulties typically have limited awareness and understanding of their own behavior and

its effects on others” (p. 12). Through the implementation of a self-monitoring checklist, it is the hope

of both the consultant and consultee that Adam will learn to recognize, keep track, and ideally increase

his positive, desirable behaviors while simultaneously building up his self-confidence.

Based on the research findings, Ms. White and I collaboratively discussed the logistics of the

intervention. Ms. White described the morning routine from start to finish and a checklist was created

with each step of the process listed (see Appendix A). A daily data collection chart was also created and

shared with Ms. White via Google Docs to facilitate the data collection process (see Appendix B). Once

baseline data was collected, Ms. White introduced the checklist to Adam and described each step of his

routine in clear, simple terms. She also explained the motivational strategy that we had decided upon in

which Adam would be able to earn a reinforcer, or “reward,” for each day he reached his goal. For each

subsequent day after Adam was introduced to the checklist, Ms. White taped a copy of the checklist to
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his desk each morning. When he reached his goal, or it was time for class to begin, Ms. White checked

in with him and reviewed how many of the seven steps he completed. If he accomplished six or more,

he would receive his reward for the day. If not, he was reminded that he could try again the next day.

During this time, Ms. White also recorded the number of reminder prompts she gave to him. The

required materials for this intervention include the paper checklist, data collection sheet, and the

reinforcer of Adam’s choosing. As previously mentioned, Ms. White was responsible for the direct

implementation of the intervention and recording of the data. I was responsible for the development of

the checklist and data tracking form. The data collected by Ms. White included the date, the number of

morning routine steps completed (out of seven), the number of given prompts, and any additional notes.

This data was collected daily during the first 20 minutes of the school day (8:40 to 9 A.M.)

Prior to and during the implementation process, it was important for me and Ms. White to

consider unintended outcomes or limitations of the intervention. The first potential limitation discussed

had to do with Adam’s ability to control his behaviors, with particular consideration of his ADHD

diagnosis. It was also important to consider Adam’s level of motivation and to ensure that he viewed his

reward as one that is valuable. Throughout the intervention, the treatment integrity was monitored, and

data was collected daily (see Appendix B).

Intervention Evaluation

Intervention data was collected on the following: the total number of completed morning routine

steps that Adam completed each morning and the number of prompts required for Adam to complete

these steps. From this information, I was also able to compute the average number of prompts required

per step (see Appendix C). In other words, I was able to identify how many prompts Adam needed in

order for him to complete each step of his routine, whether he reached his goal or not. Figures 3 and 4

represent the progress-monitoring data that was collected throughout the intervention. This data
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includes baseline data, a goal line (i.e., red horizontal line) that was determined in consideration with

Adam’s baseline performance and the allotted timeframe, as well as a trendline following Adam’s post-

intervention performance (i.e., black dotted line).

Adam's Compliance to the Morning Routine: Number of Steps Completed

# Steps Completed Goal Line Baseline Trendline Intervention Trendline
7
Number of Steps Completed

6
5
4
3
2
1
0
1 2 3 4 5 6 7 8 9
Baseline Intervention

Figure 3. Baseline and post-intervention data showing the number of completed morning routine steps.

Adam's Compliance to the Morning Routine: Number of Required Prompts

# Prompts Goal Line Baseline Trendline Intervention Trendline
6
Number of Prompts

5
4
3
2
1
0
1 2 3 4 5 6 7 8 9
Baseline Intervention

Figure 4. Baseline and post-intervention data showing the number of required adult prompts.

The progress-monitoring data above shows that Adam is completing 6-7 steps with no more than

two adult prompts as measured by Ms. White on a daily basis. Of note, the two days in which Adam

completed six steps, he simply chose not to get breakfast, so he still completed his morning routine (i.e.,

six of six steps as compared to his typical seven-step routine). To better reflect the variation in total

steps, another graph was created to illustrate the percentage of morning routine steps completed, which
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would credit Adam for completing the six-step routine as well (see Appendix D). Previously, he

required at least four adult prompts to complete no more than five steps of his morning routine.

Compared to the collected baseline data measuring the number of steps completed, the progress-

monitoring data are demonstrated to be effective. Based on the percentage of nonoverlapping data

points (PND), this intervention has proven to be effective with a PND of 100%.

Given the effectiveness of the chosen intervention, Ms. White and I consulted once again to

discuss the continuation or modification of the self-monitoring intervention. Together, it was decided

that the checklist would be implemented for another week to ensure Adam’s consistency with the

routine and then it will be condensed from a seven-step list to a single question cue, “Have I completed

my morning routine?” By condensing the visual prompt, Adam’s self-monitoring checklist will be

streamlined and simplified to encourage independence while monitoring his own behavior. To compare

each prompt, Ms. White will continue collecting data in the same manner as the checklist. Once she has

collected a week’s worth of new data, we will briefly consult to problem solve and determine next steps.

Ms. White shared that she planned to share the effectiveness of the intervention at an upcoming meeting

with Adam’s mother.

Finally, Ms. White and I discussed strategies to support the transfer and generalization of

Adam’s self-monitoring abilities to other settings. Based on the positive outcomes of the current

intervention, it is clear that Adam has the ability to monitor his behavior with the support of a visual aid.

By fading the current intervention (i.e., condensing checklist to one question), the hope is that Adam’s

ability to self-monitor becomes sustainable in settings and circumstances outside of his morning routine.

In the first few weeks of the single question prompt being presented, Ms. White will randomly select

one day per week to present his former checklist to reinforce each step of his routine. Ms. White and I

will communicate regularly to support the ongoing development of Adam’s self-monitoring skills.
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References

How To: Teach Students to Change Behaviors Through Self-Monitoring. (2013). Retrieved from

https://www.interventioncentral.org/self_management_self_monitoring.

Loftin, R. L., Gibb, A. C., & Skiba, R. (2005). Using self-monitoring strategies to address behavior and

academic issues. Impact, 18(2), 12-13. Retrieved from the Web site of the Institute on

Community Integration, University of Minnesota (http://ici.umn.edu)

Rafferty, L. A. (2010). Step-by-step: Teaching students to self-monitor. Teaching Exceptional Children,

43(2), 50-58.
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Appendix A
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
12
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
Every morning, I will...
 1. Get breakfast before class
 2. Unpack my backpack
 3. Mark my lunch choice
 4. Sharpen pencils
 5. Write homework in planner
 6. Gather materials for math
 7. Do morning work or read
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Appendix B

Daily Morning Routine

Goal: With a checklist on his desk each morning, Adam will accomplish his morning routine goal (i.e.,
complete at least 6 of 7 listed steps) with no more than two verbal prompts. If he successfully completes
his morning routine, Adam will receive a daily reinforcer of his choosing (e.g., Way to Go! card)

★ If the goal is not completed, please still mark the # of prompts given and make note of how many
steps he was able to complete.

# Prompts # Steps Completed

Day Date Notes
Given (Out of 7)

1 1/31 6 3 Baseline (no checklist)

n/a 2/1 n/a n/a Substitute

2 2/4 4 4 Baseline (no checklist)

3 2/5 4 5 Baseline (no checklist)

4 2/6 3 4 Baseline (no checklist)

5 2/7 2 6 (of 6) Chose not to get breakfast, left planner at home

(used paper)

6 2/8 1 7 Calm and focused!

Chose not to get breakfast, reminded to read

7 2/11 1 6 (of 6)
silently

Reminded to get breakfast before coming down

8 2/12 2 7
and read silently

Reminded to get breakfast before coming down,

9 2/14 2 7
and wrote in planner thoroughly

n/a 2/14 n/a n/a Valentine’s Day (change in morning routine)

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Appendix C

Adam's Compliance to the Morning Routine: Number of Prompts Per Step

# Prompts Per Step Goal Line Baseline Trendline Intervention Trendline
2
No. of Required Pompts Per Step

0
1 2 3 4 5 6 7 8 9
Baseline Intervention

Figure 5. Baseline and post-intervention data showing the number of required prompts per step.
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Appendix D

Adam's Compliance to the Morning Routine: Percentage of Routine Completed

Percentage Completed Goal Line Baseline Trendline Intervention Trendline
100%
Number of Prompts

80%

60%

40%

20%

0%
1 2 3 4 5 6 7 8 9
Baseline Intervention

Figure 6. Baseline and post-intervention data showing the percentage of morning routine completed.
Note: The Intervention Trendline is hidden underneath the Percentage Completed solid line.