Treatment Integrity

Categories: ASD and DD, Child-focused

Individuals with disabilities often rely on others to teach them the skills they need to enjoy meaningful and independent lives. The success of a young student with a learning disability in a school setting or an elderly adult with autism in a community-based residence, for example, often depends upon the quality of instruction provided by a teacher’s aide or a direct care staff member. It is crucial, therefore, that these paraprofessionals have the training and support they need to become effective teachers and caregivers.

Children with disabilities in school settings have Individualized Education Programs (IEPs). Similarly, adults with disabilities in day or residential settings have Individualized Support Plans (ISPs). Both IEPs and ISPs are likely to have goals to help individuals gain skills. In some cases, they will also have objectives aimed at reducing challenging behavior. In both cases, teachers and caregivers develop and implement “treatment plans” – sometimes referred to as instructional strategies or behavior support plans – in an effort to teach functional skills. These plans are the keystones to effective treatment.

How well an instructional strategy or behavior support plan is implemented as it was designed refers to its “treatment integrity.” There are several factors that should be considered when developing, teaching, and monitoring a treatment plan to ensure its implementation integrity and the subsequent success of teachers and students.

The way a treatment plan is developed is likely to influence how well it is carried out. Research on the effectiveness of behavioral consultation in schools has shown the importance of “change agents” – those who implement or oversee plans – in the planning process. Actively involving these people in the initial problem-solving and brainstorming makes it more likely that plans will be viewed as acceptable and feasible and will be implemented accurately.

How paraprofessionals are trained to implement treatment plans also impacts their future effectiveness as teachers and caregivers. Research findings in the areas of school-based prevention and staff training strongly support the use of active teaching methods, such as role playing, modeling, and coaching. These methods provide opportunities for prompting and reinforcement of specific skills, ideally under conditions similar to those paraprofessionals will actually encounter. More traditional or passive teaching approaches, such as didactic (lecture) instruction, are not as effective.

After paraprofessionals have learned the skills they need to correctly implement treatment programs, they should be monitored to ensure they are using these skills consistently. Many research studies show that newly acquired skills can change or fade over time – a consequence referred to as “drift.” To protect against drift, educators and clinicians often use “performance feedback” – direct observation, corrective feedback, and reinforcing selected skills. It is important that new staff members receive very clear information on how well they implemented treatment strategies. For example, giving them feedback about which steps they completed both correctly and incorrectly has been shown to be very effective in maintaining and improving high levels of treatment integrity.

Professionals working in the fields of education and human services understand that changing the behavior of individuals with disabilities starts with changing the behavior of the teachers or care providers who work directly with them. We can improve the lives of children and adults with special needs by teaching skills that foster and support greater independence. How well we do that depends on the quality of the treatment plans and how successfully we carry them out.

A collaborative approach, paired with staff training that includes active teaching methods and ongoing performance feedback, appears to be the most effective way to develop, teach, and monitor treatment programs that will have the greatest likelihood of success for teachers and for those they serve.

By Patrick F. Heick, Ph.D., BCBA-D?

May Institute is a nonprofit organization that is a national leader in the field of applied behavior analysis, serving individuals with autism spectrum disorder and other developmental disabilities, brain injury and neurobehavioral disorders, and other special needs. Founded more than 65 years ago, we provide a wide range of exceptional educational and rehabilitative services across the lifespan. For more information, call 800.778.7601  or visit