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Take 'HOH' (Hand Over Hand) Out of BIPs

BIPs should not reference the use of 'HOH' (Hand Over Hand) but Prompt Fading, or Most to Least prompting. This is going to the maximum prompt level necessary to the minimal degree required then fading back as soon as possible.

The 'maximum' prompt level necessary also does not mean full physical or, necessarily, physical contact at all. Prompting can range from gestural to a light tough on the shoulder. Both, Least to Most and HOH models also consistently create a higher probability for prompt dependence

'HOH' shapes a different kind of prompt dependence as kids learn to tolerate - even accept - the adult's interference. But the child can also learn that the adult will do the task for them just using using their arms not unlike a puppet. Kids don't progress because they're not being taught

The Least to Most model can create increased response delays and the need for direct contact with physical guidance. Kids learn to wait the adult out who will then ultimately have to engage the child more directly. This can be more likely still for children who are already showing oppositional tendencies

'HOH' continues far too often utilized. When I have been a clinical director/supervisor or doing clinical consulting, I teach more appropriate and positive alternatives starting with prompt fade techniques. But please be clear I am not inferring to unconditionally discontinue properly used minimally intrusive physical prompt fading and guidance

Holding a child's hand while walking on a busy street is minimal physical prompting. Touching a child on the shoulder to get their attention is minimal physical. Support through a tough or new task can also be minimal physical prompting. The problem is that physical prompting is often overdone, overly intrusive, and sustained.

If sustained physical guidance is being used with any child, something is wrong. The program has failed. Even Errorless Learning, which requires initial contact, doesn't require ongoing 'HOH.' And when a child is more resistant to physical prompting, there's lots of alternatives.

Connecting overly intrusive and/or sustained physical guidance to preferred foods and tangibles like iPads is a problem beyond just the misuse of edibles and electronics.

Besides poor behavioral, instructional and reinforcement practice, the risk of shaping serious misrules around body autonomy is real. And though this is a higher risk for any child, we know that children and adults with disabilities are, sadly, at higher risk still.

The misuse of edibles as reinforcement teach other other mistaken instructional relationships to include prioritizing food access over the skills attempting to be taught. As one who has also worked with kids with significant feeding needs, I've tracked the misuse of edible reinforcement as at least one relevant variable more than a few times.

I've never used edibles or electronics as part of any reinforcement schedule. Ever. You don't have to either...


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