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Dental Health

A brief introduction to Dental Hygiene by Josie Costantiello, Community Outreach Mobile Dental Hygienist and Samantha Yarwood, Behaviour Services Consultant, Community Living Toronto.

Who amongst us has not felt that sense of dread when a visit to the dentist is imminent? Even simple checkups can be uncomfortable and mildly painful. One part of that experience is knowing that the dentist will Invariably ask the question….do you floss regularly? We even get that little grab bag with all the tools necessary to complete our dental hygiene routine. The dentist is very concerned about our teeth and so should we be.

We had the opportunity to Interview a dental hygienist who provides mobile care for individuals with a developmental disability. Josie has a wealth of experience providing care in all sorts of environments with mild to severe challenging behaviour. 

How Dental Health Affects the Body 

There are many different ways that dental health can affect the body and its wellbeing. Sometimes the mouth can be thought of as a different entity from the body as we go to the dentist for our mouth and the doctor for our body. This separation can cause people to disregard the importance of dental hygiene and how it is connected to many systems in the body. 

Heart disease, stroke, respiratory disorders, diabetes are all related to oral health. The mouth is an opening in our body where bacteria enter leading to cavities, gum disease, and untreated tooth decay. These bacteria can get into the bloodstream and can travel to different parts of the body and multiple organs. This can cause multiple health conditions. It is important to keep up the proper dental hygiene and preventative dental work to keep our teeth clean and healthy. 

For additional resources on the health implications of dental health visit this link by the College of Dental Hygienists of Ontario.  

Potential behaviours related to dental problem: 

  • Moodiness 
  • Irritability 
  • Vocalizations of distress or pain 
  • Crying 
  • Facial tension 
  • Sleep issues 
  • Loss of appetite 
  • Increase in self-injury (especially to the mouth or jaw) 

Laughter Yoga

Join Cathy Nesbitt while she leads a Laughter Yoga session. Laughter has profound benefits that can exercise our entire system which will increase one’s overall feeling of wellbeing while decreasing feelings of stress. Cathy shares her energy, passion, generosity and vast professional experience to help you take advantage of the natural health benefits of laughter yoga.

Recorded at the February 2021 Shared Learning Forum

Naturalistic Teaching

Naturalistic Teaching or Natural Environment Teaching (NET) involves using materials and other activities which an individual finds interesting or enjoyable and arranging the environment using those materials or activities to build new or improve skills. It is all about learning through interaction or play in a natural setting rather than in a structured teaching environment.

With naturalistic teaching, learning is not just occurring at a desk or table, but in a variety of environments and locations while the individual is going about their day. Teaching can occur at home, school, the playground or even in the grocery store, at the bank, or any setting that is directly related to the skills being taught. While structured teaching sessions are effective for building skills, naturalistic teaching is a great companion to help improve generalization, spontaneity, and contextual learning.

The goal is to look for “teachable moments.” when the individual displays interest and excitement about a particular person, item, or activity and take advantage of these moments to teach and build skills. These moments create more opportunities for learning which in turn improves the proficiency of any skills being taught.

Though naturalistic teaching is less structured in design it does require some planning and preparation, mainly around the environment itself. It is important to enrich the environment with a variety of items and activities that will peak the individual’s interest. If you are teaching a skill in the community, make sure to bring anything you will need to make the outing a successful learning experience.


Example:

Jessie has been learning to write letters and words. Overnight there was a snowstorm and one of Jessie’s favourite activities in playing in the snow.

Caregivers can prepare squirt bottles with dyed water which can then be
squirted on the snow colouring or writing on it. As Jessie colours on the snow Caregivers can start spelling words or letters and ask Jessie to do the same. Caregivers can change the colours as needed or have Jessie help mix new colours to keep things fun and interesting for her.

Always remember to keep your naturalistic teaching sessions fun, noisy, boisterous, full of language and movement, and stay flexible!

If you would like to learn more about naturalistic teaching watch this YouTube video by Autism Live.

Managing Your Direct Funding During COVID

By MyDirectPlan

In 2020, the Ontario provincial government announced temporary changes to the Passport and SSAH (Special Services at Home) Funding programs. These changes were put in place as a response to the COVID-19 pandemic to ensure that families and individuals can continue to access the supports and services they need.  New applications for SSAH are being waitlisted.

Changes were made to: 

  1. The list of eligible expenses
  2. The ways funding is delivered to recipients
  3. Important program deadlines

We know it can be confusing to keep track of all this information, so we want to break it down in one place and explain what we know so far! Read on to find out how to best take advantage of these temporary supports.

Note: The ‘fiscal year’ is from April 1st to March 31st. So, the 2019/20 fiscal year is from April 1st, 2019 to March 31st 2020. The 2020/21 fiscal year is from April 1st, 2020 to March 31st, 2021. 

Temporary Additions to Eligible Expenses 

On April 23, 2020, the government announced a temporary expansion to the list of expenses that are eligible for reimbursement for both the Passport and SSAH Funding programs. New additions to the list of eligible expenses include expenses such as laptops, exercise equipment, sensory equipment, and other entertainment items. As these changes are being implemented in response to COVID-19, you should be aware that they are temporary, and that the existing program terms and conditions do still apply. Though a date for any reversals of these new conditions has not yet been announced, the government has communicated that they will provide as much advance notice as possible before making any changes. 

Find full lists of the newly eligible expenses here:

SSAH: http://www.children.gov.on.ca/htdocs/English/specialneeds/specialservices.aspx

Passport: https://www.mcss.gov.on.ca/en/mcss/programs/developmental/serviceSupport/passport.aspx

MyDirectPlan users should submit these expenses under the ‘Other’ category. You should expect potential delays in reimbursement with expenses submitted under this category, as they require your invoices to be manually reviewed. MyDirectPlan does not review or approve your invoices but, to ensure the fastest possible processing times, we now “split” invoices for Passport Users. What this means is that any time MyDirectPlan detects ‘Other’ expenses (i.e., expenses submitted under the ‘Other’ category) within your submission, the system automatically splits your expenses into separate invoices. In these instances, MyDirectPlan will generate and submit two invoices on your behalf. One invoice will be created for expenses that fall under the ‘Other’ category, and one invoice will be created for expenses that fall under any remaining categories. This way, any delays in processing your ‘Other’ submissions will not affect the processing times of your regular submissions. 

Advance Funding 

Since the 2019/20 fiscal year, eligible Passport and SSAH recipients have received advance funding. Advance funding is funding you receive in advance of processing your expense claims so you can have more immediate financial assistance without having to wait for reimbursement. It is highly recommended that individuals continue to save as many receipts, proofs of payment, and supporting documents for their expenses as possible. 

The way advance funding works is that you continue to submit claims as you normally would, but will not be reimbursed for anything until your submissions have exceeded the advance funding amount that you received. If you submit an expense that is partly covered by your advance funding, you will be reimbursed for any amount that exceeds your advance funding amount. For example, imagine you received $500 in advance funding. The first $500 worth of expenses submissions are considered to be paid for by that advance funding. You would not receive any reimbursements until you have exceeded the $500 that you already received. In this same scenario, if you submitted an expense that cost $550, then you would be reimbursed for the $50 that exceeds your advance funding amount. 

This is why it is extremely important that you continue to submit claims as you normally would. You will not receive reimbursement until your submitted claims have exceeded your advance funding amount. 

How it Works for Passport Recipients 

For the 2019/20 fiscal year, all Passport recipients who self-administer and submitted a claim in the 2019/20 fiscal year should have received an advance payment of up to $1,000 (depending on what they had remaining in their 2019/20 budget). This funding would have been received by the end of June 2020 and should be used for expenses incurred during the 2019/20 fiscal year. Did you know that you can still submit expenses for the 2019/20 fiscal year? Scroll down to the section on Deadline Extensions for more info.  

For the 2020/21 fiscal year, self-administering Passport Funding recipients should have already received 25% of their total funding budget for this fiscal year in advance funding. 

If you did not receive your advance funding and feel you should have, please contact your local Passport Agency to enquire about your circumstances. 

How it Works for SSAH Recipients 

For the 2019/20 fiscal year, active SSAH recipients who were enrolled in the program by the end of the 2019/20 fiscal year may have been eligible to receive advance funding. Recipients enrolled after April 01, 2020, will not be eligible for this advance funding. Eligible families should have received up to $1000 in payment (depending on what they had remaining of their 2019/20 annual approved funding). Families who had less than $1000 left in their 2019/20 authorized amount should have been provided with that amount in full. Any advance funding payment for the 2019/20 year should have been received by the end of June 2020. 

For the 2020/21 fiscal year, eligible families should have received 25% of their annual approved funding in advance. Recipients who made an expense claim in 2019/20 should have automatically received their funding advance by the end of May 2020. 

If you haven’t received advance funding, but think you should have, please call your local Regional Office or agency.

Deadline Extensions 

For the 2019/20 fiscal year, the ministry announced that they would be waiving the deadline for 2019/20 expense submissions. This means that if you have expenses from the 2019/20 fiscal year that you have not yet submitted, you can still submit them! Please note that this does not mean that funding from your 2019/20 budget can be used for purchases you made during 2020/21 fiscal year. It means that eligible purchases made during the 2019/20 fiscal year can still be submitted for reimbursement if you have funds remaining in your 2019/20 budget. It has not yet been announced whether any expense submission deadlines for the 2020/21 fiscal year will be waived or extended. 

Please be aware that we are already seeing delays in reimbursement due to the pandemic, and the closer to the submission deadline you submit your expenses, the more likely you are to experience further delays. We encourage all who are able, whether you are submitting expenses through MyDirectPlan, email, fax, or eCLAIM, to submit your expenses as soon as possible

That’s what we know so far about the recent changes to the Passport and SSAH Funding programs. We hope you found this article helpful. The MyDirectPlan team will update this article with any new information as we become aware of it but in the meantime, if we missed anything, please do let us know in the comments below! 

Need more information? Please find details on how to contact the MyDirectPlan support team, your local agencies, and a list of resources where you can find further information on what we covered in this article:

Contact MyDirectPlan:

Email: support@mydirectplan.com
Telephone: Toll Free: 1-844-MDP-MDP1 (1-844-637-6371)
Support Hours: Monday – Friday: 10:00 AM EST – 6:00 PM EST
Contact your Ministry Regional Office 
Contact your Passport Agency

Resources: 

Understanding Self-Regulation in Young Children

What is self-regulation?

Self-regulation is our ability to manage and control our own attention, energy levels, and emotions in ways that help us build positive relationships and a sense of wellbeing. As adults, each of us have a variety of strategies that we use to respond to situations, remain calm and return to a regulated emotional state. At times we may have to manage our responses to situations and navigate through different states of regulation. 

States of regulation may include the following:  

  • Under-stimulated – For example; disappointed, sad, sick, lethargic, tired, bored
  • Regulated – For example; calm, happy, tolerant, interactive, content, co-operative
  • Heightened – For example; annoyed, irritated, overwhelmed, frustrated, anxious
  • Loss of control – For example; enraged, terrified, destructive, aggressive, overly excited

Typically, self-regulation develops gradually, from birth to young adulthood. During this time we strengthen our ability to self-regulate by building upon existing skills. Through early childhood and adolescence self-regulation skills continue to increase. 

What is dysregulation?

When we have difficulty responding to situations in a calm and emotionally flexible way this is known as emotional dysregulation. When this happens often, it can lead to difficulties with relationships, learning, wellbeing and the ability to cope in stressful situations.  

There are many biological, emotional, cognitive, social or sensory stressors that may lead to dysregulation such as: 

  • Disrupted or lack of sleep
  • Unhealthy diet 
  • Changes or unpredictable routines
  • Inconsistent modeling of emotions or support from adults
  • Sensitivity to environmental stimuli, such as sound or lights

If your child shows signs of having difficulty with regulation, a consistent, supportive and empathetic response is needed to help them manage and learn coping skills.

What is external regulation?

As the beginnings of self-regulation are still developing in young children, infants are not able to regulate on their own. They rely on responsive parenting to help them regulate. From birth, we watch and listen to our infant children for clues as to their emotional state (For example, frightened, happy and angry). By responding to our child’s needs, a trusting relationship is built.

What is co-regulation?

You can support your child to learn how to identify their own needs and when to look for help. This begins with modelling how to control and express our own feelings and actions appropriately. The development of self-regulation relies on a strong foundation of supportive relationships.

Helping children learn to self-regulate

You can help your child to recognize and process their own feelings by describing them (e.g., “you look sad”) and suggesting ways to work through it (For example, “Would you like to find another toy?” or “Do you need a hug?”). By learning to identify their emotions, your child can begin to practice ways to manage situations.

Here are some tips that you can use to help your child learn to self-regulate:

  • As much as possible, use a calm and composed manner
  • Be warm, responsive, and supportive. 
  • Be as calm and consistent as possible in your response to situations
  • Maintain a calm, safe and consistent environment
  • Label and acknowledge your own and your child’s emotions
  • Coach your child to use words or pictures to identify their emotions
  • Provide opportunities to practice self-regulation skills together at times when things are calm
  • Encourage and praise your child’s efforts

Observe your child through a variety of situations to get a better understanding of how they are regulating their emotions and responding to their environment. The following chart will help you to plan.

State Strategies for children Adult supports

Under-Stimulated

Disappointed, sad, sick, lethargic, tired, bored

  • Exercise
  • Get a drink
  • Chew crunchy foods
  • Listen to music
  • Encourage gross motor play
  • Provide a snack
  • Play upbeat music
  • Play a group activity

Regulated

Calm, happy, tolerant, interactive, content, co-operative

  • Play with a friend
  • Read or listen to a story
  • Eat a snack
  • Be a helper
  • Play with toys or read stories together
  • Provide a snack
  • Praise their efforts
  • Offer helper tasks

Heightened

Annoyed, irritated, overwhelmed, frustrated, anxious

  • Take deep breaths
  • Talk to a friend or a trusted adult
  • Ask for help
  • Take a break
  • Read a familiar social story on calming down
  • Count out deep breaths
  • Acknowledge emotions and body language
  • Dim the lights
  • Offer a drink of water
  • Provide a quiet area
  • Model calmness

Loss of Control

Enraged, terrified, destructive, aggressive, overly excited

  • Take deep breaths
  • Count to 10
  • Take a break
  • Squeeze a pillow/fidget
  • Ensure a safe physical environment
  • Be physically present but give them personal space
  • Limit talking and giving directions
  • Acknowledge emotions
  • Have a consistent approach with other adults
  • Give time and opportunity for self-calming
  • Allow them to approach you when they are ready
  • Model calmness

Remember…

A safe, secure environment and positive relationships create opportunities for your child to co-regulate along with you. Parents, caregivers and educators play a vital role in supporting a child’s social and emotional development, which includes their ability to manage and respond to stress appropriately. 

When children can self-regulate, they are able to navigate through challenges and make productive choices. Knowing how to self-regulate is an important skill that supports their physical, emotional, and social wellbeing. 

Emotional Literacy in Children

unhappy child

What is Emotional Literacy?

Emotional Literacy is one’s ability to recognize, understand, label and express feelings. This also includes the ability to identify others emotions expressed through spoken language, body language and facial expressions.  

Nurturing Emotional Literacy helps children:

  • Learn to self-calm and self-regulate
  • Develop resiliency
  • Express their feelings
  • Develop social skills such as empathy, sharing and turn-taking
  • Develop positive relationships with others

 Children learn Emotional Literacy through:

  •  Watching children and adults
  • Interacting with children and adults
  • Receiving guidance from caring adults

As caring, responsive adults we can help children learn emotional literacy by first understanding our own emotions and recognize how feelings and responses to situations impact others. Adults play a key role in modelling positive emotions and responses.

What are the keys to Emotional Literacy?

diagram self-awareness, Social Awareness, Self-management

Self-Awareness:

  • Recognize our thoughts, feelings, likes and dislikes
  • Understand our internal emotional state(s) 

Self-Management:

  • Show control over feelings and emotions
  • Control impulses and reacting in acceptable ways
  • Utilize strategies to help keep calm and regulated 

Social Awareness:

  • Awareness of our connection with others
  • Understand social expectations
  • Monitor interactions with others
  • Make independent decisions

Teaching Emotional Literacy

Before you decide what to teach, consider the skills and interests your child already has. Start at your child’s current skill level to help them build confidence and success in recognizing and labeling their own emotions.  You can teach your child emotional literacy using the following methods.

Use common language

  • Use clear, specific words paired with pictures of emotions / faces to help your child learn to recognize emotions
  • Name your feelings and your child’s and others’ as often as possible
  • Talk with your child about emotions and explain what you see and hear

Model

  • Acknowledge feelings and emotions, without judgement
  • Use kind, respectful language such as “I’m here for you” 
  • Offer open and positive body language. Avoid arm crossing or standing over your child.  Try to move down to your child’s eye level.
  • Practice self-calming techniques, such as deep breathing.  Avoid saying “breathe” to your child. Instead, model deep breathing and label your own actions.

Practice through stories and play

  • Read books, Social StoriesTM or tell real-life stories about feelings
  • Act out emotions through role/dramatic play during fun, relaxing times of the day
  • Play a game, such as “face charades” (facial expression guessing game) or “emotions dice”
  • Make funny faces in the mirror together.  Practice all emotions and label these together

Reflect and re-tell

  • Avoid extra talking when your child is having difficulty calming down; be present and available.
  • Ask your child what happened and listen when they tell their story. In turn, help your child listen to others as they tell their own version of the situation
  • Help your child label emotions for themselves; if your child is in the early stages of communication development, use ‘feelings cards’ or pictures to help them express what they are feeling
  • For older children or children with a larger vocabulary ask them what they could do differently next time. Give one or two suggestions if the child is unable to identify another solution on their own. Practice the strategy and language together. For example, if a child becomes angry when another child takes their toy, the alternate response would be to teach the child to go to the teacher or to tell the other child “that toy is mine right now”

What are the Benefits of Emotional Literacy? 

Early learning and care programs are key environments for children to practice emotional literacy and explore relationships with others. Emotional literacy supports children to have an increased social awareness and develop stronger bonds with others.

Emotional literacy benefits the greater community by encouraging people to appreciate both similarities and differences within others, which strengthens communal values and connectedness.

Remember…

Emotional literacy is important and helps young child learn about their feelings and the feelings of others, but this takes time! Be patient and let your child know that you value and appreciate their efforts.  Continue to practice emotional literacy with your child in all daily interactions.  

                           

                    

       

 

ACT Matrix Case Study

ACT Matrix

Trudy Is a 36-year-old single mom with two children. She works shifts in a long-term care facility as a nurse and then comes home to take care of her 14 and 15-year-old girls along with all the household chores that need to be done daily.

She finds herself to be over tired, endlessly agitated with her daughters, and just fed up with the constant cleaning at home. She dreads getting home at the end of her shift and recognizes that this is something that she needs to work on.

Through work, she has learned about ACT and decides to complete the ACT Matrix to get a better understanding of what she Is feeling and how to move in the right direction.

Who and what is important to you (values)

  • Spending quality time with my daughters
  • Being healthy
  • Spending time with friends
  • My family
  • My dogs
  • Being a good person
  • Being a happy person

Now that Trudy has identified her values, she is now considering what thoughts and feelings she has when the going gets rough. This has been occurring a lot of late and so she quickly notes all the negative thoughts she has been having.

Thoughts and feelings that show up when things get tough (fusion)

  • My daughters are hiding from me because they hate me
  • I’m lazy
  • No one likes being around me
  • I annoy everyone
  • I’m overbearing

Now Trudy focuses on what actions she takes when she feels these thoughts. What are the actual behaviours she exhibits when these thoughts take over her brain. She finds these actions difficult to write down. It Is quite an emotional experience.

Things you do when those thoughts and feelings show up (non-acceptance)

  • Go to bed
  • Watch a lot of TV
  • Stay home instead of going out
  • Don’t talk to my daughters or
  • Get frustrated with my daughters
  • Cry

Next Trudy Identifies the behaviours that will bring her towards her values. She thinks about those things that she wishes would happen naturally. How It would feel to be relaxed coming home? What would make her more relaxed? What would be an Ideal day? Week? This really helps her to Identify how to fill in the next quadrant.

Things you could do to get closer to the things that are important to you (committed actions)

  • Ask my daughters for help with chores
  • Do fun activities with my daughters
  • Eat a meal with my daughters
  • Go for walks with the dogs
  • Get enough sleep
  • Set time aside to see friends each week
  • Enjoy moments of peacefulness

Integrating ACT and the Matrix into Everyday Life

Now you may be wondering, what do I do with all this information?

Trudy takes a picture of the matrix so that she can view It on her phone at any time. Even If she Is having a good day, she looks at It to confirm for herself that she Is committing to the actions she made to move towards her values. There Is much more to learn but this has been a great start to Improving her quality of life.

ACT Template

We suggest that you practice filling out the ACT Matrix for yourself. Click here to download a fillable PDF version that you can save and print.

Step 1: Fill out the ACT Matrix
Step 2: Post it
Step 3: Notice your thoughts and behaviours
Step 4: Refer to the posted Matrix
Step 5: Choose to pivot towards what matters

Once you have filled it out, you can post it in an accessible location at your office or home. Whenever you notice that you are having unwanted thoughts or feelings or engaging in a behaviour that is moving you away from your values, refer to your posted Matrix to help you pivot towards what matters to you.

This is also a great time to start practicing mindfulness, which is an exercise widely used in ACT. Mindfulness is the act of purposefully observing, without judgment or struggle, your life as it is happening in the present moment.

Introduction to Acceptance and Commitment Therapy (ACT)

A short interview between Nicole Alphonse, Behaviour Services Consultant, Specialized Resource Home | Specialized Services Community Living Toronto and Kerry-Anne Robinson, M.Ed., BCBA, Clinical Director, Progressive Steps Training and Consultation.

What is ACT?

Acceptance and Commitment Therapy (ACT) is a set of tools and strategies that can be used to help people to accept and make peace with events that happen day to day that are out of their control or cause negative feelings. ACT is aimed at helping people to commit to behaviours (actions) that bring
them closer to the things that are important to them. ACT utilizes a variety of exercises to help people experience the 6 core processes and to develop psychological flexibility. See ‘The Hexaflex’ diagram.

Hexaflex diagram
“Psychological Flexibility is the ability to stay in contact with the present moment regardless of unpleasant thoughts, feelings, and bodily sensations, while choosing one’s behaviour based on the situation and personal values.” (Hoffmann D., Frostholm L., 2019)

What is the ACT Matrix?

The ACT Matrix is a simple exercise designed to learn how to discriminate between our internal and external experiences. It also helps us identify behaviours that we may engage in that are unhelpful resulting in moving further away from the things we care about (values). Additionally, the Matrix helps us to identify actions that we can take to be more aligned with our values. In a nutshell, the ACT Matrix is an exercise to teach you psychological flexibility using real-life scenarios.

ACT Matrix

Components:

  • The vertical line pointing up represents experiencing with the senses, also referred to as the present moment, and pointing down which represents our inner experiences, such as thoughts and feelings.
  • A horizontal line intersects with the vertical line at 90 degrees to create four quadrants. The horizontal line represents our behaviour which either moves us toward our values (the right side) or away from our values (the left side).
  • The lower right quadrant is for identifying who and what is important (your values)
  • The lower left quadrant is for identifying unwanted internal thoughts or feelings that show up when things get hard (fusion)
  • The top left quadrant is for identifying the specific behaviours that you do to avoid the unwanted internal thoughts and feelings (non-acceptance)
  • And the top right quadrant is for identifying the specific behaviours that you can do to move towards what Is important to you (committed action)

The Matrix outlines how the 6 core processes of ACT work at any
given time. Refer to the hexaflex diagram for a brief description of the 6 core processes.

Do not worry too much about understanding the hexaflex and core
processes, for now we want you to become familiar with what ACT is
and how to use the ACT Matrix. Click below for a brief video.
https://neshnikolic.com/hexaflex

The main goal of the ACT Matrix is to learn how to take notice of our
thoughts and behaviours, and to align that with what is important.
This means that we can choose to engage in the actions that move us
closer to what we care about despite the negative uncomfortable
thoughts or feelings that we have. Filling out the Matrix allows us to
identify and sort through our thoughts, behaviours, and experiences.
It is a tool to help build mindfulness, self-awareness, and valued
living.

This may sound overwhelming and that Is okay! This is a new skill
that needs to be learned and requires practice.

ACT Matrix template

Download our PDF template

This may sound overwhelming and that Is okay! This is a new skill that needs to be learned and requires practice. We will walk you through a case study and show you how to fill out the Matrix step by step.

Reinforcement

What is Reinforcement?

Reinforcement is what happens immediately after a behaviour occurs, which strengthens it.  When a behaviour is reinforced, it happens more often. Provide positive reinforcement whenever you notice that the individual is engaging in desired behaviours. If you praise an individual just as they finish hanging up their coat in the closet, the next time they take off their coat they will be motivated to hang up the coat again. In this case praise was the reinforcer. 

Everyone has different motivators, therefore what may be reinforcing for one person may not be appealing to another. 

Reinforcement Delivery

There are several components to consider when providing reinforcement:

1. Distinctiveness

  • The individual should be able to distinguish between your instructions, other things in the environment, and reinforcement. This is important to remember when providing verbal praise.
  • To make verbal praise more distinctive, vary the tone of your voice, be specific.

2. Immediacy

  • Reinforcement should be provided 3-5 seconds after the target behaviour occurs.
  • Waiting too long (e.g., seconds or minutes) might mean your attempt at reinforcing the target behaviour has no effect and you may have inadvertently reinforced another behaviour.

3. Reinforcer Variation

  • Use a variety of reinforcers, not just one. This helps slow down satiation. Satiation is when a reinforcer stops working because it is used too often.
  • When trying to reinforce a behaviour, alternate between preferred items or provide choices to the individual.

What To Do

Every time Scott sneezes into his elbow, we smile at him and say, “Great covering your sneeze”. Over the next two weeks he goes from rarely sneezing into his elbow to sneezing into his elbow every time. Smiling at and praising Scott has reinforced the target behaviour. 

What Not To Do

The goal is for Maria to wash her hands after every meal. You know that praise is particularly reinforcing for Maria. You notice that she washes her hands after eating, but you don’t say anything right away because you are busy. A few minutes later when she’s leaving the kitchen, you tell her, “Thanks for washing your hands, Maria”.

Token Economy 

A token economy is a form of behaviour modification designed to increase desirable behaviour and decrease undesirable behaviour with the use of tokens.  Individuals receive tokens immediately after displaying desirable behaviour.  The tokens are collected and later exchanged for a meaningful object or privilege. 

A token board is often used to track the progress of the individual and indicate how many tokens must be earned to exchange for the reinforcer.

Why Are They Effective?

Token economies are a more efficient way of delivering reinforcement. Tokens can be delivered with greater ease than giving an edible or preferred item after each occurrence of the target behaviour. Token economies can also be used with an individual or a group setting, such as a classroom. Delaying the item or activity that the individual wants (backup reinforcer), but contingently delivering the token (learned reinforcer) can teach waiting and maintain motivation during teaching. A token economy can also help prevent an individual from becoming satiated with a reinforcer. Delivery of the reinforcer, like with all other reinforcement methods, must be done frequently and immediately after the target behaviour occurs. The token can be paired with praise or another backup reinforcer.

What Type of Token/Token Board Should Be Used?

Selection of the type of tokens and token board to be used is critical to the implementation of the system.  The token itself should have some reinforcing value to the individual. For example, if the individual is interested in Ninja Turtles, each token could be a character from the show and the token board could be in the form of a slice of pizza. It is beneficial to have tokens that are easy to deliver, are durable and can be easily carried from one activity to another.

For more information and workshops on reinforcement check out this page.