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Answered step-by-step
MinisterIron94050
A step by step Integrity Checklist for Treatment Integrity form for…
A step by step Integrity Checklist for Treatment Integrity form for Mediator (example inserted), however this Checklist for Treatment integrity form for mediator is for Emma, a 5 year old with autism and severe intellectual disability who has one speech verbal ability who engages in self-injurious behaviour. Behavioural intevention plan is to reduce Emma Self-injurious behaviour to zero levels using DRA and NCR procedures
The following is an example of a checklist integrity form for mediator. This case for adult woman with down syndrome.
Step 1: once guest are gone, Give her a verbal prompt to check to see if tables are dirty (Verbal prompt – let’s go check the tables!)
Note: if table is clean go to a dirty table
Step 2: when at tables, verbally instruct/prompt Pamela to check for garbage on table, (verbal prompt- let’s get the garbage!) if there is garbage, dispose of garbage in garbage bin. If there is no garbage, then skip to the next step.
If problem behavior occurs, first give verbal praise/reassurance, then break down process by carrying smaller tasks. If problem behavior does not occur, praise, continue process
Step 3: verbally instruct Pamela to clear the dishes from the table by stacking smallest to largest dishes and utensils on top of one another and then place inside the sink
If problem behaviour occurs reassure Pamela of how well of a job she has been doing so far and then give a verbal prompt to break down the step by taking fewer dishes.
Step 4: upon having dishes in the sink, use video modelling to show Pamela how to wash dishes then afterwards, instruct her to wash the dishes (Verbal prompt- Ok let’s wash the dishes now!)
Step 5; Upon completion of washing the dishes verbally instruct/prompt Pamela to grab washcloth from sink, damp the cloth with soapy water from sink, bring to table (to wipe down/clean)
Step 6: Upon presence at table with wet cloth, verbally instruct Pamela to wipe table thoroughly (, wipe in circles clockwise, make sure every part of table is wet)
If Problem behaviour occurs at this step, use gestural prompt for the wiping hand motion, verbally prompt to grab cloth if she hasn’t already
Step 7: After table is cleaned, Instruct Pamela to bring cloth back to sink.
Now start process of resetting tables. We will assume that what is needed to reset table (ex. Already clean dishes and/or washcloth) are already present/ready – meaning no other cleaning process is necessary
Step 8: Start by giving Pamela a verbal prompt to start setting the table(s) (Ok, let’s go check the tables to make sure nobody put anything on them, then let’s set the table)
Step 9: If tables are clean and clear, give verbal prompt to grab plates and utensils, and bring them to the table.
If problem behavior occurs at this point, allow 20 seconds to break from the task, give praise/reassurance during this time (you’re doing so well, you are making great progress!), and break task down again (bring each dish independently). If problem behavior does not occur, praise, continue to the next step
Step 10: When dishes are brought to the table, verbally prompt Pamela to organize them appropriately, with plate first, dish second, and utensils to the right side of the dishes. (Ok Pamela, now it’s time to set the table! The plate goes first, then the dish on top of it, then the utensils go on the right side).
Step 11: when Pamela finishes all the tasks, give her a verbal praise (“you did so well” “good job”!)
