When a full program is implemented, intervention consists of 4-6 hours of intervention each day, for 5-6 days each week. However, therapy hours are gradually "ramped up" to increase the child's endurance and likelihood of success.

Each teaching session or shift is typically conducted by a single Instructional Assistant and usually lasts for 3-4 hours. During this time frame, 10-20 different programs involving particular drills or stimuli are presented. Typically, children receive between 400-800 learning opportunities or trials each day of treatment. Children typically require several weeks to develop the tolerance needed to participate in 25-40 hours of therapy each week.

Ongoing training is provided to Instructional Assistants, school personnel, and family members during weekly clinical staffings to update behavior and language programs. At these meetings, data (discrete trial data, hours of treatment, etc.) are reported, program modifications communicated, and upcoming changes previewed. Occasionally, the child is brought to the staffing in order to demonstrate programs or to better diagnose specific treatment difficulties.

In order to promote generalization, treatment is varied from location to location within the child's home, as soon as possible. Discrete trial teaching also takes place "out-of-the-chair" and during "downtime" where social skills and play skills are emphasized and incidental language opportunities are structured.

Once a sufficient foundation has been established, the treatment program begins to include procedures, which measure generalization and maintenance of skills outside structured therapy contexts. In addition, social experiences, beyond interacting with Instructional Assistants and family members are integrated into the child's program. These include peer play dates, participation in a group learning experience such as preschool or gymnastics, and community outings.

Continuation of intensive behavioral treatment is driven by the IFSP/IEP process and reviewed every 3-6 months. Data sources include results from standardized testings, discrete trial summaries, direct observation in a variety of environments, and videotape.



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