Total Task Chaining Procedure and Forward Chaining Procedure for Central Reach
Appointments
Heer Amin
Applied Behavior Analysis, Regis College
ABA 648: Practicum II
Dr. Keira Moore
Total Task Chaining Procedure and Forward Chaining Procedure for Central Reach
Appointments
Behavior Summary
The learners that will be focusing on acquiring the skills being taught in this Task
Analysis include RBT’s or aspiring RBT’s. Although some of these individuals have yet to
obtain their RBT credential they will likely be in the process of working towards attaining that.
Due to the minimal requirements of obtaining the RBT credential, new hires for the Behavior
Technician role come from various backgrounds with a variety of training levels—some having
been exposed to the field of Applied Behavior Analysis and others not. It is critical to ensure that
new hires are fully trained and competent in the skills needed to carry out the responsibilities
required by the Behavior Technician position. When responsibilities are not being adequately
carried out interventions can be implemented by upper management to target a specific behavior
for increase amongst staff or for a specific participant directly relating to the area of concern. For
center-based staff, a common area of concern that has been noted amongst many staff include the
timely conversion of billing appointments, the conversion of appointments with the correct code,
and billing for the correct client. Strengths include billing for correct number of hours. To
address these concerns a Chaining Procedure can be used to reteach skills related to creating and
converting Central Reach appointments.
Skill Identification
The skill being taught in this paper include creating a central reach appointment which
will following the forward-chaining procedure. The skill of converting Central Reach
appointments will also be taught in a total task chaining procedure. This skill is relevant to the
client because staff need to be able to adequately log the services that they are providing, for
ethical, professional, and personal reasons. First, if staff do not adequately log the services
rendered or if they log them inaccurately, this can be considered as billing-fraud. Such liability
that falls on each Technician can be mitigated by acquiring these skills being taught during
Central Reach training. Second, the hours that are billed for in Central Reach are used to
determine the amount of hours worked which is then inputted into PayChex database (a
processing system used to generate payroll). The hours billed for by the technician would
directly affect their own salary which means that incorrect billing could result in reduced
income. Third, there are professional considerations relating to making errors when billing for
services such as being perceived as an employee that does not possess a high level of attention to
detail. While these serve as potentially aversive events incentivizing employees to successfully
create and convert Central Reach appointments the behavior still does not occur at the rate of
100%. For purposes of being an ethical corporation that abides by all regulations and for
purposes of being able to easily manage the necessary components of complying with audits,
further training is provided to technicians regarding appropriate billing for services. For these
reasons this skill is not only highly relevant to the RBT’s but also relevant to the organization.
To teach the creation of billing appointments, a forward chaining procedure will be used. To
teach the conversion of billing appointments a total task analysis procedure will be used.
Steps in Chain
In this section, each step in the forward chaining procedure for creating appointments will
be described. However, it is important to note that being able to log into a Central Reach with
credentials is a task that is a perquisite requirement for this task analysis. The first step is to click
on the calendar icon, and select view my calendar. The second step is to select the blue ‘+ New
Event’ button. The third step is to ensure that the date for the appointment is correct next to the
‘Date & Time *’ section. The fourth step is to input the start time of the appointment next to the
‘Date & Time *’ section. The fifth step is to input the correct finish time of the appointment next
to the ‘Date & Time *’ section. The sixth step is to scroll down to the ‘Primary Provider *’
section and input your name. The seventh step is to input the name of the client to which services
were rendered, under the ‘Appointment with *’ section. The eighth step is under the
‘Appointment Type *’ section, select the drop down box and choose ‘Direct Service (*)’. The
ninth step is under the ‘Authorization * Billing’ section, select the blue ‘+ Add’ button. The tenth
step is to select the red ‘Use this’ button for the ‘Direct Service’ code found under the
‘Authorized Codes’ tab. The eleventh step is to ensure that the code covers the entire duration of
the service, select the two diagonal facing arrows button shaded in gray to adjust the duration of
the code. The twelfth step is to scroll up and ensure that the date and time of the appointment is
correct. Lastly, the thirteenth step is to scroll to the bottom and select the red ‘Create
Appointment’ button.
Now, each step in the total task analysis chaining procedure for converting appointments
will be described. However, it is important to note that being able to log into a Central Reach
with credentials and being able to create an appointment as described in the previous task
analysis procedure are both tasks that are perquisite skills for this total task analysis. The first
step is to click on the calendar icon and select view my calendar. The second step is to click on
the lightning bolt at the top left corner of the appointment ready for conversion. The third step is
to select the ‘Create Timesheet’ tab that pops up upon completion of step 2. The fourth step is to
select the grey box with the correct billing increment being converted, then press the blue
‘Convert Selected’ button. The fifth step is to select the teal ‘Direct Service’ button. The sixth
step is to scroll down to the ‘Place of service’ section and select the drop down box, then press
’11: Office’ (this is specific to center-based services). The seventh step is to press the blue button
under the ‘Session Note’ section that is labeled ‘New Note’. The eighth step is to scroll down to
the ‘Service Summary:’ section, select the red box labeled ‘Using objective language, please
describe your session. Are there any areas of concern, or any comments related to behavior
reduction or skill acquisition goals?’. The ninth step is to type or paste a brief summary of the
sessions that abides by the Session Note Rubric that has been provided in a previous component
of new-hire training. The tenth step is to select the gray box labeled ‘Select Learn Activity’
under the ‘Programs Run:’ section. The eleventh step is to ensure that the correct date is selected
in the pop-up box that populates upon completion of step 10. The twelfth step is to select the
grey box labeled ‘Select All’. The thirteenth step is to scroll to the bottom of the pop-up box and
select the red ‘Continue’ button. The fourteenth step is to scroll to the bottom of the ‘Edit Note’
pop-up box and select the red button labeled with your name found under the ‘Provider:’ section.
The fifteenth step is to type your name under the ‘Person Signing’ section in the pop-up box that
populates upon completion of step 14. The sixteenth step is to sign your signature in the blank
white field of the ‘Signature’ pop-up box. The seventeenth step is to hit the red ‘Continue’ button
at the bottom of the ‘Signature’ pop-up box. The eighteenth step is to hit the blue ‘Save & Close’
button at the bottom right corner of the ‘Edit Note’ pop-up box. The nineteenth step is to select
the blue ‘Provider Signature’ button at the bottom of the ‘Signatures’ section. The twentieth step
is to type your name under the ‘Provider name’ section in the pop-up box that populates upon
completion of step 19. The twenty-first step is to sign your signature in the blank white field of
the ‘Provider Signature’ pop-up box. The twenty-second step is to select the blue ‘Save’ button
at the bottom right corner of the ‘Provider Signature’ pop-up box. Lastly, the twenty-third step is
to scroll to the bottom of the page and select the blue ‘Submit’ button.
Teaching Procedure
For the forward chaining Task Analysis, the following teaching procedure will be used.
First and foremost, the task will be taught in sequential order. Verbal prompts and gestures will
to aid with the completion of each step in the task analysis. Video modeling will be used to teach
each task. The instructor will provide a video model of the task and then prompt the learner to
complete the first step in the task analysis. Reinforcement will be provided in the form of verbal
praise upon completion of step one. After this step is mastered, this process will be repeated with
the same prompting procedures, the same video modeling teaching procedures and the same
reinforcement procedures. The next step is added one at a time, with the mastered steps serving
as prerequisites for the task step or skill that is being taught. If any non-compliance occurs,
prompts are represented, and verbal praise will be withheld. At the end of the chain a ‘Got ya
Card’ will be provided to the employee. This is a reinforcement system that is already in place
for desirable target behavior. Such cards are placed in a box and a monthly drawing takes place
to select a winner. The winner earns a free lunch and a gift card from the company.
For the total task analysis, the teaching procedures are described here. In this task
analysis, video-modeling is also used. Each step in the entire task is presented through video
modeling prior to completing the task. Verbal prompts and gestures are also used to assist with
completion of each step with least-to-most prompting. Each step should be completed in
sequential order. Reinforcement in the form of verbal praise will be provided for the completion
of each step and upon completion of the total task, a ‘Got ya Card’ will be provided. If noncompliance occurs then the employee will be redirected to the task and verbal praise will be
withheld. This ‘Got ya Card’ reinforcement system incentivizes employees to display more
desirable behaviors in the workplace.
Prompting Procedure
Verbal or gesture prompts were used for both types of task analysis that were conducted.
The rational for using such prompting procedures are due to them being less intrusive than other
means of prompting such as full physical or partial physical. Least-to-most prompting
procedures are used due to the high degree of effectiveness of lesser intrusive prompts that has
been observed in the workplace environment. Criterion for least-to-most prompting procedure
involves only increasing the level of prompting that is provided upon non-emission of the target
response from the individual. The instructor should never reduce the prompt level, or prompt at a
level that is not necessary to emit the target response. This means that a four second opportunity
should be provided to emit the target behavior before moving to a more intrusive prompt.
Criteria for Mastery at Target Step
The forward-chaining task analysis for creating appointments will be considered
mastered when the staff scores greater than 100% of independent responses across two
consecutive sessions for each step. The total task analysis for creating appointments will be
considered mastered when the staff emits the correct independent response for each step across
one consecutive session. The reason for this structure is due to the overall requirement that there
must be a 100% of independent correct responses to receive a ‘Got ya Card.’ Verbal praise will
be faded out upon mastery of the task and the reinforcement of ‘Got ya Cards’ will eventually be
reduced to an intermittent schedule.
Error Correction
The error correction procedure will be described in this section. If the client errors, there
are multiple different potential courses of action that may occur based on the type of error. The
task will always be represented and there will naturally be an overcorrection procedure that is
implemented by the organization. If the wrong date or time is selected the instructor will prompt
the client to fix this. If a step was missed, then the staff will be prompted to go back and fix it
thus having to repeat any steps subsequent to the error. If incorrect information was converted
for the session, then the staff will have to e-mail billing to unconvert the appointment and the
total task analysis will need to be completed again. If the wrong button is pressed the instructor
will prompt the staff to return to the correct screen. If errors occur on the same step more than
once the video modeling training pertaining to that step in the forward-chaining task analysis will
be represented. Video modeling retraining will not occur for the total task analysis, prompting
should be sufficient to guide staff to skill mastery.
Nontargeted Step Procedure
Steps that were not targeted in this chain include accessing the Central Reach website and
logging into the database with independent account credentials. The rational for omitting this
step from the task analysis’ that were described in this paper was because it is a step that requires
the completion of other onboarding tasks such as new-hire paperwork or contacting the billing
department for the obtainment of credentials that access Central Reach. Additionally the task of
logging in to Central Reach is a useful tool for not just RBT’s but also for BCBA’s and other
individuals that are billing/supervising at an ABA organization. It’s critical to differentiate task
analysis procedures when there is a difference in audiences.
Behavioral Chain Mastery Criteria
The forward-chaining task analysis for creating appointments will be considered
mastered when the staff scores greater than 100% of independent responses across three
consecutive sessions. The total task analysis for creating appointments will be considered
mastered when the staff scores greater than 100% of independent responses across three
consecutive sessions. Verbal praise will be faded out upon mastery of the task and the
reinforcement of ‘Got ya Cards’ will be reduced to an intermittent schedule.
Clinical Impressions
My impression of this assignment was that there can be many more steps associated with
a task than initially thought, which is noticed upon going through each step and writing it out in a
task analysis. This allows us to understand the complexity of the task being learned. Having such
an understanding of the complexity of the task being learned aids us in implementing the
appropriate reinforcement and prompting systems that assist with acquisition. One thing that was
learned is how critical it is to be specific, as specificness helps with being able to easily identify
what specific step is necessary and what exactly the criteria is to move on to the next step. I think
this is not only useful but a necessary component of the intervention because it allows for greater
clarification regarding what the expectations are. A challenge faced in this assignment pertained
to being able to identify where and when then the task analysis should start and end. Then after
understanding more regarding the purpose of the training procedure the start and end was better
identified, in context of who the training is meant for. Overall, identifying each task and step
required for the total task aided in our understanding of how to teach and train for acquiring the
skill of billing for an appointment.