Skill-Based Treatment:
Teaching the Skills That Make Severe Problem Behavior Unnecessary
SBT works because it teaches the individual new, safe ways to communicate the same messages and access the same outcomes that problem behavior used to. It's a shift from interventions focused on suppressing behavior to one focused on skill development and empowerment.
FTF believes that all children and young adults can live free of severe problem behavior when they are explicitly taught communication, tolerance for frustration, and contextually appropriate skills to manage the situations that have historically triggered problem behavior.
Skill-based treatment (SBT) is a research-based intervention delivered within a positive, trusting therapeutic relationship. It's designed to address severe problem behavior including self-injury, aggression, and property destruction. Skill-based treatment is based on ABA principles, individualized for each learner, and prioritizes safety, dignity, and rapport for the person receiving the services and the person delivering them.
Skill-based treatment is based on the understanding that problem behavior usually does not happen for just one reason, and so lasting behavior change is more likely when treatment takes into account these complexities. New skills must meet all of the needs that problem behavior used to, if the skills are to endure.
In SBT, the individual's experience matters. Progress can be peaceful, even joyful. Unlike compliance-based or suppression-focused behavior intervention programs, SBT emphasizes the active and willing participation of the individual.
SBT Teaches Three Main Types of Skills:
1 Communication
Problem behavior tends to communicate something. Our first teaching step is to show the individual new, safer ways to communicate those same messages.
2 Toleration
Unfortunately, it's a fact of life that even if we ask for something, it can't always be delivered immediately. This means that communication is an important starting point but not the whole intervention. Once communication has been strengthened, the individual learns a new way to respond safely when the answer is "not right now."
3 Contextually Appropriate Behaviors (CABs)
This step is about teaching the individual how to succeed with personally challenging activities or tasks. This is taught gradually, so that the amount of challenge is always "just right."
Practitioners teach several contextually appropriate behaviors, including:
- Putting aside preferred items, such as toys or tablets.
- Transitioning to a new area.
- Starting manageable amounts of personally challenging tasks, gradually increasing duration and complexity.
Just as a tennis star practices their backhand over and over, repeated practice opportunities help learners build strong skills. In SBT, we build in enough personalized practice opportunities to foster success. And we make sure that all of the skills pay off, at least some of the time. In other words, the outcomes (or reinforcers) that the learner used to access via problem behavior are now offered when skills are used.
With an assent-based, open-door structure, skill-based treatment emphasizes the individual being willing, engaged, and participating in a context of trust. The goal is for the learner to be happy, relaxed, and engaged, while also making progress towards learning goals.
Practitioners treat the individuals they work with as individuals, offer variety in tasks, and respect their choices when they want to end an activity. Relationship-centered practices, such as SBT, minimize the risk of escalated problem behavior.
Building skills produces more lasting change than approaches primarily focused on suppressing behavior. As the skills learned in SBT are generalized, relationships begin to sustain engagement, and individuals who learn to communicate and tolerate difficulty no longer need problem behavior to produce outcomes.
Practitioners learn specific strategies to promote the generalization and maintenance of SBT skills. Whether in a clinical setting or in a park, the goal is for the individual to be able to apply their new skills, and for these skills to endure over time.
FTF was founded by Dr. Greg Hanley, who developed the PFA-SBT methodology, which prioritizes safety, rapport, and outcomes. FTF trains each practitioner to ask the right questions, build strong relationships, and make peaceful progress. We understand that adopting a new assessment and treatment approach is a big undertaking, and we are here to support you and your team.
SBT is informed directly by the PFA. The PFA provides information that allows for the personalization of SBT. This is why PFA and SBT are best used together.
PFA-SBT emphasizes building meaningful skills in a positive, trusting therapeutic relationship. PFA-SBT is an applied behavior analysis-based approach that can be learned by a range of professionals, implemented in a variety of settings, and can help learners with diverse needs.
FTF's consultation process trains practitioners across both phases of PFA-SBT, the assessment phase (PFA) and the treatment phase (SBT), using a three-step training model throughout:
1 Foundational Training
On-demand courses and workshops on SBT procedures, values, and the research and reasoning behind each element of the treatment phase.
2 Synchronous Implementation Support With Real Cases
Practitioners implement SBT with real cases in real time. We even coach you as you do so, usually via videoconference and an earbud that allows your consultant to speak right to you. Professionals we have trained report that this experience is supportive, comforting, and highly valuable for their learning.
3 Ongoing Consultation
FTF provides real-time, direct guidance and support through weekly video calls. Our consultants help you monitor your progress and make performance-based decisions until you're able to run the treatment phase independently.
Making the shift to a new way of assessing and treating problem behavior is significant. FTF is structured to support you as you make that transition. Whether you're in education, ABA therapy, or inpatient behavioral health (or somewhere else!), FTF will help you implement PFA-SBT within your organization.
Tell Us How We Can Help
To help us design an organizational training, provide on-site implementation support for your staff, and schedule follow-up video conferencing, tell us about you, your organization, and your goals.
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