Faculty Articles

Multi-Faceted Uses of a Simple Time-Out Record in the Treatment of a Noncompliant 8-Year-Old Boy

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Education and Treatment of Children





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The use of data to monitor the progress of therapy has been a hallmark of behavior analytic treatment research. However, the many benefits of using easily obtained data to guide behavior change efforts may still be underappreciated by practitioners. The present case illustrates how the ongoing data-based monitoring of timeout use by parents enhanced the treatment of an 8-year-old boy, referred because of noncompliance in the home. Timeout was selected as the primary behavior change strategy and parents were instructed in implementing and recording each instance of timeout on a simple data form. In therapy sessions these data were reviewed and used to direct the course of treatment. Some of the benefits of the timeout record included, enabling rapid refinements in the timeout procedure by providing a feedback mechanism to the therapist, illustrating the need for adjunctive treatments and revision of case formulation, and more generally, by serving as a means of documenting treatment efficacy.

One of the most frequent complaints heard from the clinical research community is that "practitioners" in non-research settings do not conduct research or even systematically evaluate treatment (e.g., Barlow, 1981). Reasons given for the lack of research in "practice" settings have ranged from training deficits (e.g., poor knowledge of how to conduct research) to protocol difficulties (e.g., not enough time, too few clients to reach statistical significance)(Barlow, 1981). More recently, some authors have advocated a different approach to collecting data and conducting clinical research. The approach, alternately known as "accountable service delivery" or "Level 1 research" involves instructing the client in obtaining inexpensive data in a continuous fashion and using these data (usually in graphed form) to modify or alter treatment planning and intervention (Hawkins & Mathews, 1999). The benefits of this approach are to focus behavior change efforts, provide feedback on the efficacy of treatment, and to cue compliance with treatment recommendations (Hawkins et at, 1994). Most strikingly, Level 1 research removes many of the constraints which govern traditional research (e.g., controlling numerous confounding variables, maintaining a constant level of the independent variable, statistical sophistication) and thus may increase the likelihood that clinicians will use data to monitor treatment progress and inform clinical decision-making. The present case study will illustrate how Level 1 data derived from a simple timeout record was used in treatment planning, implementation, and evaluation at several steps during intervention.

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