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Troy Fry
Professional
Colleen Cornwall Practitioner’s
Handbook
‘More than just a list of skills... for
it’s when and how
you teach those skills’ Children and Adults
with
Moderate-to-Severe
Disabilities

Patrick McGreevy Troy Fry

patrick@[Link] troy@[Link]
407-415-5241 952-412-6206

[Link]
! 1 Essential for Living: An Introduction and User Guide

EL IVINGSSENTIAL
FOR the most innovative and comprehensive curriculum, assessment, and
skill-tracking instrument of its kind on the market today...

Examine your current curriculum for learners with moderate-to-severe disabilities and
the advantages of Essential for Living that are highlighted below. How many of these
advantages does your curriculum include?

Includes ‘functional skills that matter’ in the lives of learners with moderate-to-
severe disabilities
Includes the Essential Eight Skills that are often absent when problem behavior
occurs
Includes skills that are linked to the Common Core State Standards
Reaches learners with very limited repertoires
Provides a method for selecting and testing the effectiveness of an Alternative
Method of Speaking for non-verbal learners
Permits the seamless inclusion of skills into IEP, ISP, program plan and support plan
goals and objectives
Provides a platform for transdisciplinary interactions
Includes easy-to-follow, evidence-based teaching procedures
Permits the effortless tracking of small increments of learner progress
Permits the tracking of skill acquisition, fluency, maintenance, and generalization
Permits the effortless tracking of problem behaviors and the supports these
behaviors require over extended periods of time
Permits teachers to become comfortable using this sophisticated instrument with
1-2 days of training and a few days of practice
Provides a platform for fair, outcome-based teacher evaluations

Join the increasing number of school districts,

private schools, ABA programs, and supported
living and supported employment programs

who are using

ELSSENTIAL
FOR
IVING
1- to select and prioritize functional skills that ‘matter’
for their IEPs, ISPs, program plans, and support plans,
2- to increase the effectiveness and efficiency of
their instruction and behavior management, and
3- to improve the quality of life for the children and adults
they serve…
 Essential for Living: An Introduction and User Guide 2
!

EL IVING
SSENTIAL
FOR was designed for children and adults of all ages with moderate-to-severe
disabilities and limited skill repertoires, specifically…

young children with Down Syndrome, Angelmann Syndrome, Microcephaly,

Cornelia de Lange Syndrome, Hunter Syndrome, and other congenital disorders
that consistently result in moderate-to-severe disabilities;
children who are struggling to become vocal;
non-verbal children or adults who have no effective method of speaking;
children with limited skill repertoires and/or severe forms of disruptive, aggressive, or
self-injurious behavior;
children with autism or related disorders, who, after 2-3 years of intensive, behavioral
intervention, have not acquired matching or imitation skills, are not answering simple
questions without scripts, are not experiencing generalization, are not beginning to
exhibit novel responses, and are no longer making progress on a developmental
curriculum, such as the VB-MAPP, the Early Start Denver Model (ESDM), or the ABLLS;
adults with congenital disorders and acquired conditions that result in moderate-to-
severe disabilities;
children or adults who require extensive supports or 1:1 supervision; or
children or adults who cannot be instructed or integrated with peers or taken into
the community without severe problem behavior.
The Purpose of ‘Essential for Living’ is to help teachers, curriculum coordinators, speech-
language pathologists, QIDPs, behavior analysts, and support coordinators…
select functional skills for instruction and problem behaviors for management, and
include these selections in IEPs, ISPs, program plans, and support plans;
manage these problem behaviors and teach these functional skills;
teach learners who are echolalic or who have limited vocal skills;
select and confirm appropriate, alternative methods of speaking for non-verbal
learners or learners with a limited spoken-word repertoire that endure throughout
their adult lives
track learner progress with respect to skills selected for instruction and problem
behaviors selected for management, measure and document very small incre-
ments of that progress through skill acquisition, maintenance, and generalization,
and provide reasonable and fair measures of teacher performance based on
that progress; and,
document specific supports that learners currently require, keep documentation
of learner progress and required supports in one place, and make certain that this
documentation ‘makes it’ to the learner’s next classroom, residence, or program.
‘Essential for Living’ can be used along with developmental curricula, such as the VB-MAPP,
the Early Start Denver Model, and the ABLLS...
when young learners exhibit severe problem behavior; and
when these learners have not acquired basic listener and daily living skills -- e.g.,
when they do not follow basic directions and are not toilet-trained.
! 3 Essential for Living: An Introduction and User Guide

The Structure and Content of Essential for Living

As shown below (and in NTK: chapter 1 of the practitioner’s handbook), Essential for Living includes
seven skill domains and one domain on problem behavior. These domains are centered around The
Essential Eight Skills, which are described on the following page. Essential for Living also includes a
chapter on Facilitating and Teaching Spoken-word Communication and Selecting, Confirming, and
Maintaining an Alternative Method of Speaking for non-verbal learners, a Quick Assessment, the first
activity of an assessment for new users and for learners with severe problem behavior, and an array
of Teaching Protocols.

The Essential Eight Skills

Facilitating and Teaching Spoken-word Communication

and
Selecting, Confirming, and Maintaining
an Alternative Method of Speaking
The Essential for Living Quick Assessment

How Children and Adults

Interact with The Domains of Essential for Living
the World Around Them
Speaking and Listening
Domain 1: Requests and Related Listener Responses (R)
Domain 2: Listener Responses, Names, and Descriptions (LR, LRND)
Domain 3: Answers to Questions and Conversations (AQ, C)

Doing Domain 4: Daily Living and Related Skills (DLS)

Domain 5: Functional Academic Skills
• Responding to Text as a Listener and Reading (RTL, Rdg)
• Schedules, Lists, and Time (SLT)
• Math Skills (Mth)
• Writing or Typing Skills (WT)

Tolerating Domain 6: Tolerating Skills and Eggshells (T)

Inappropriate Behavior Problem Behavior Domain (PB)
Tool Movements Domain 7: Tool Skills and Component Skills (MM, M, Im)
Teaching Protocols

Skills are sequenced within skill domains from less to more difficult and more to less functional and
designated as:
must-have,
should-have,
good-to-have, and
nice-to-have.
While assessment and teaching should generally begin with must-have skills, the individual education,
intervention, and habilitation plans of many learners will also include should-have and good-to-have
skills.
 Essential for Living: An Introduction and User Guide 4
!

The Essential Eight Skills

As shown below (and in NTK: chapter 1 of the practitioner’s handbook), the must-have skills are
included in only four domains — Domain 1, Domain 2, Domain 4, and Domain 6, and are also known
as The Essential Eight. These skills are absolutely essential for a happy, fulfilling, and productive life as
an older child or an adult, and are the central focus of Essential for Living. In the absence of these
skills, children and adults with moderate-to-severe disabilities will almost certainly exhibit forms of
problem behavior, limiting their access to preferred items, activities, places, and people, limiting their
participation in family activities, and limiting their interaction with the community in which they live.

Skill Domain and the Must-have Skills within that Domain The Essential Eight

Domain 1. Requests and Related Listener Responses (R)

R7. Makes requests for highly preferred snack foods, One. Making Requests for Access to
drinks, nonfood items, or activities... Highly Preferred Items and Activities and
and 13 other skills that include making requests for the Removal or Reduction in intensity
of Specific Situations

R9. Waits after making requests for each of the items Two. Waiting
and activities in R7 and R8 for... increasing periods of
time
R13. Makes transitions from preferred items and activities Three. Accepting Removals -- the
to required tasks... Removal of Preferred Items and
and 2 other skills that include accepting removals Activities, Making Transitions, Sharing,
and Taking Turns
R11. Completes 10 consecutive, brief, previously Four. Completing Required Tasks -- 10
acquired tasks Consecutive, Brief, Previously Acquired
Tasks
R15 & R16. ‘Accepts no’ after making requests... Five. Accepting ‘No’

Domain 2. Listener Responses, Names,

and Descriptions (LR, LRND)
LR2. Moves toward and stands or sits next to an Six. Following Directions Related to
instructor, care provider, or parent when directed to do Health and Safety
so...
and 10 other skills that include following directions

Domain 4. Daily Living and Related Skills (DLS)

DLS-HS4. Fastens and remains in a seat belt... Seven. Completing Daily Living Skills
and 38 other skills that are part of daily living Related to Health and Safety

Domain 6. Tolerating Skills and Eggshells (T)

T-BHI5. Tolerates touch, physical guidance, or prompts... Eight. Tolerating Situations Related to
and 70 other skills that include tolerating specific Health and Safety
situations
! 5 Essential for Living: An Introduction and User Guide

Conducting an Assessment
When to conduct an assessment. Conduct an assessment with Essential for Living (EFL) when you first
begin working with a child or an adult. This assessment will permit you to identify deficits in functional
skills and problem behaviors, and to develop goals and objectives for an IEP, ISP, behavior plan, pro-
gram plan, or support plan. Conduct additional assessments when the learner has acquired several
skills or when priorities change, necessitating the selection of additional skills or problem behaviors
and the development of new goals and objectives.
How to conduct an assessment of skill deficits. Begin conducting an assessment
for a learner by obtaining a copy of The Assessment and Record of Progress [ARP] ELSSENTIAL
FOR
Manual (with the blue band on the left), also known as the All Skills Learner Scoring IVING
The Assessment

Manual, which includes all of the skills in Essential for Living. If the learner has an
and
Record of Progress [ARP] Manual

extremely limited skill repertoire or exhibits severe forms of problem behavior, you for ___________________________

may want to a copy of The Essential Assessment and Record of Progress [EARP]
Manual (with the red band on the left), also known as the Essential Eight Skills
Patrick McGreevy
Troy Fry and Colleen Cornwall

Learner Scoring Manual, which includes only the Essential Eight Skills and Problem ELSSENTIAL
IVING
FOR

Behavior. Then, proceed to pages 28-29 of the EFL Handbook and complete the The Essential Assessment
and
Record of Progress [EARP] Manual

activities of a skills assessment: for the Essential Eight Skills

and
Problem Behavior

Activity 1 -- Complete The Essential for Living Quick Assessment (QA: page 39 of the
for ___________________________

EFL Handbook) in the ARP Manual (pp. 18-20 of the EFL Handbook) or
Patrick McGreevy
Troy Fry and Colleen Cornwall

the abbreviated form in the EARP Manual (pp. 5-6); or, complete Activity
3; this will suggest ‘possible skills deficits’ in the learner;
Activity 2 -- Using Chapter 6 of the EFL Handbook, determine the learner’s vocal profile, that is, the
extent and intelligibility of the learner’s spoken-word repertoire; if necessary, select
and confirm an alternative, primary method of speaking; indicate this method on the
inside front cover of the ARP or EARP Manual;
Activity 3 -- If you are familiar with the learner and EFL, skip Activity 1; and, using the ARP or EARP
Manual, scan the Must-have Skills, which are part of Domain 1, Domain 2, Domain 4,
and Domain 6 and circle ‘possible skill deficits’; if there are no apparent ‘must-have
skill deficits’, obtain an ARP Manual and proceed to the ‘should-have’ and ‘good-to-
have skills’ in each of the seven Skill Domains;
Activity 4 -- Confirm and determine the extent of the ‘possible kill deficits’ suggested by Activities
1 or 3, using the procedures described and illustrated on pages 28-29 of the EFL Hand-
book; and, indicate the learner’s performance as shown on these pages and on
page 13 of this User Guide.
Activity 1 — Complete The Essential for Living Quick Assessment (QA: page 39 of the EFL Handbook)
in the ARP Manual (pp. 18-20 of the EFL Handbook) or the abbreviated form in the EARP Manual (pp.
5-6); or, complete Activity 3; this will suggest ‘possible skills deficits’ in the learner
The EFL Quick Assessment assists you in conducting your first assessment for a learner, especially a
learner with severe problem behavior. This activity involves interviewing one or more people who
know the learner. Responses during this interview suggest ‘possible deficits’ in functional skills and
problem behaviors and direct you to those specific deficits or to sections within EFL which address
those deficits. An item from the Quick Assessment is provided below, which has been filled out for a
specific learner.
One. Making Requests – the tendency to make requests for highly preferred items and activities
4 Makes requests for 10 or more preferred items or activities without prompts using an effective
method of speaking 7a. Domain 1. R14, R17-21, R22-24, R27-28, R30-31
3 Makes requests for 1-3 preferred items or activities with or without prompts 7a. Domain 1. R7-8
2 Makes requests by leading others to items 7a. Domain 1. R1-5, R6, R7-8
1 Makes requests by exhibiting problem behavior 7a. Domain 1. R1-5, R6, R7-8
 Essential for Living: An Introduction and User Guide 6
!

Paraphrasing the description of this item, ask one or more interviewees, “Does this learner make
requests for highly preferred items and activities”. Then, determine which of the four options most
closely resembles their responses. For our learner, two interviewees said, “He takes you to what he
wants” and option 2 was circled as shown. Then, the teacher was directed to Chapter 7a.,
Domain 1, Skills R1-5, R6, R7-8, which represent ‘possible skill deficits’ for our learner. To determine
other possible deficits, complete the remaining items in the Quick Assessment. These items were
completed for our learner. As you become familiar with Essential for Living, you may want to
bypass this activity, in favor of Activity 3.
Activity 2 — Using Chapter 6 of the EFL Handbook, determine the learner’s vocal profile, that is,
the extent and intelligibility of the learner’s spoken-word repertoire; if necessary, select and con-
firm an alternative, primary method of speaking; indicate this method on the inside front cover of
the ARP or EARP Manual
This activity was designed for children and adults with a limited repertoire of spoken words or no
spoken words at all. This includes learners who are often described as either echolalic or non-
verbal. This also includes learners who have been provided with an alternative method of speak-
ing which is ineffective, that is, which does not permit them to easily, efficiently, and continuously
make requests for preferred items, activities, places, and people.
Chapter 6 of the practitioner’s handbook and Activity 2 were co-authored by Janine Shapiro, a
speech-language pathologist and behavior analyst. Essential for Living is the only curriculum or
assessment instrument on the market today that includes such a chapter.
Activity 2 will help you determine…
When to select ‘saying words’ as a learner’s primary method of speaking and when to select an
alternative primary method
Making this decision is accomplished by aligning your learner with one of six Vocal Profiles based
on that learner’s repertoire of spoken words and spoken-word repetitions and the extent to which
these repertoires are understandable. And, when an alternative method is necessary, these pro-
files help you decide how to allocate resources between increasing the learner’s spoken-word
repertoire and selecting, confirming, and maintaining an alternative method of speaking.
Two of the six Vocal Profiles are provided below.
Vocal Profile 2 -- Uncontrolled and Controlled Spoken-word Repetitions
This profile describes learners who exhibit many understandable spoken words and phrases,
but only as repetitions of what others have said. Some of these repetitions are controlled, that
is, if an instructor says “say, car”, these learners will say “car”; more often, however, these
repetitions are uncontrolled, that is, learners will say “say, car”.
If your learner can be aligned with this profile, you should use a specific teaching procedure
that is part of Teaching Protocol 1 (see the echoic-to-request transfer procedure on page 265
of the practitioner’s handbook), and ‘saying words’ should be selected and confirmed as the
learner’s primary method of speaking. And, all resources should be committed to a goal, for
the learner, of spontaneous requests with spoken words.
Vocal Profile 3 -- Occasional Words and Phrases
This profile describes learners who exhibit a limited number of spoken words and phrases,
which are understandable but which occur infrequently across situations, inconsistently within
the same situation, and rarely as spoken-word repetitions.
Unless learners already exhibit at least some tendency to repeat what they hear, there is no
consistently effective way to prompt them to say sounds or words. In other words, there is no
way to ensure that sounds or words occur in response to prompts. As a result, if your learner
can be aligned with Vocal Profile 3, you should use procedures that are part of Teaching
! 7 Essential for Living: An Introduction and User Guide

Protocol 1a. If spoken-word repetitions begin to occur often, the learner should be aligned
with Profile 2 and all resources should be committed to spoken-word communication.
If repetitions do not begin to occur within 2-3 months, an alternative method should be
selected and confirmed as the learner’s primary method of speaking. Then, as you teach the
learner to make requests, you should use all of the procedures that are part of Teaching
Protocol 1, in other words, select and begin to use an alternative method of speaking, but do
not abandon the quest for spoken words.
Activity 2 will also help you learn...
How to select an alternative, primary method of speaking
Selecting an alternative method of speaking is accomplished by matching a learner with
specific, alternative methods of speaking based on the learner’s sensory, skill, and behavioral
repertoires and the extent to which these same repertoires tend to occur when specific
methods of speaking are effective.
These repertoires include:
H -- hearing S -- sighted
HI -- hearing impaired VI -- visually impaired HVI -- hearing & visually impaired
Am -- ambulatory NAm -- non-ambulatory
A -- active I -- inactive
FM -- fine motor coordination <FM -- limited or no fine motor coordination
MI -- motor imitation <MI -- limited or no fine motor imitation
M -- matching <M -- limited or no matching
PB -- moderate or severe problem behavior -PB -- no moderate or severe problem behavior
This matching task is accomplished with a device, called ‘The Selection Diagram’, which is
enclosed with the practitioner’s handbook. These repertoires for our learner are depicted on
this diagram, which is shown below.
The Selection Diagram

The Learner’s Current Sensory, Skill, and Behavioral Repertoires

H S HI VI HVI Am NAm A I FM <FM MI <MI M <M PB -PB

As the diagram indicates, our learner is:

hearing and sighted,
ambulatory and active,
with good fine motor coordination,
limited or no motor imitation,
limited or no matching skills,
and moderate or severe problem behavior.
 Essential for Living: An Introduction and User Guide 8
!

The Selection Diagram is then superimposed on diagrams for each of 46 alternative methods
of speaking, which depict the repertoires that tend to occur when each of these methods is
effective, along with the advantages of spoken words that each method retains. As shown
on the next page, The Selection Diagram for our learner was superimposed on the diagram
for Alternative Method of Speaking 2 (AMS 2), Forming Standard Signs. An alternative method
of speaking can also be selected by entering the learner’s sensory, skill, and behavioral reper-
toires into a computer program, is available at: [Link] (cannot be acces-
sed with Internet Explorer).

The Learner’s Current Sensory, Skill, and Behavioral Repertoires

H S HI VI HVI Am NAm A I FM <FM MI <MI M <M PB -PB

Alternative
Method AMS 2: Forming standard signs (e.g., Signed English)
of Speaking

The Repertoires that Tend to Occur When AMS 2 is Effective

H S HI VI HVI Am NAm A I FM <FM MI <MI M <M PB -PB

The Advantages of ‘Saying Words’ Retained by AMS 2

Speaker P E 1S -CD Rq ND AQ Con Rd RA Large Audience LA

As indicated by the boxes in bold, there were seven ‘repertoire matches’, suggesting that this
method should be set aside for consideration as an alternative, primary method of speaking
for our learner. Then, after superimposing The Selection Diagram on the remaining alternative
methods of speaking, several other methods with a similar number of ‘matches’ should also
be set aside for further consideration.
Then, with the methods that have been set aside, a second step in the selection process is
added, which examines the extent to which these methods retain the advantages of ‘spoken
words’ with respect to the speaker and the audience. These advantages are listed below
and shown in the diagram above:
P -- Children and adults can convey messages at any place and time without need for
environmental supports
E -- Information can be conveyed with very little effort
1S -- In the beginning, only one-step (i.e., single-word) responses are required
-CD -- In the beginning, complex discriminations are not required
Rq -- Many requests can be easily conveyed
ND -- Many items, activities, people, & places can be clearly named and described
AQ -- Answers to questions can clearly and easily occur
Con -- Conversation can easily occur
Rd -- Reading can be taught
RA -- Requests can be conveyed in the absence of what is being requested... and,
LA -- The speaker can be understood by a large audience of instructors, care providers,
parents, and peers with and without disabilities who do not require training
As shown in the diagram on this page, ‘AMS 2: Forming standard signs’ retains all ten advan-
tages of spoken words with respect to functioning as a speaker, but results in a much smaller
audience.
! 9 Essential for Living: An Introduction and User Guide

From the methods that have been set aside, the one that retains the greatest number of
advantages of spoken words, with respect to both the learner and the learner’s audience, is
generally selected as the learner’s alternative, primary method of speaking.
For our learner, AMS 3 — Forming a Repertoire of Standard, Adapted, & Idiosyncratic Signs —
was selected as his alternative method.
Activity 2 will also help you learn...
How to confirm an alternative, primary method of speaking
In order to confirm an alternative, primary method of speaking for a learner, Essential for Living
(EFL) describes eight steps that should be used to test the effectiveness of this method. Three
of these steps are provided below.
providing a minimum of 2-3 months of daily instruction;
teaching a learner to ‘make requests’ for specific, highly preferred items, activities, and
persons, NOT to ‘name or describe’ items or persons, NOT ‘to comment’ on experiences, and
NOT to ‘answer questions’;
teaching requests for specific items, activities, and persons (see R6, R19, R20, and, for some
learners, R13, R15, R16, R17, and R18); NOT requests for ‘more’, ‘food’, or ‘eat’ and NOT
requests with ‘please’, ‘yes’, or ‘no‘;
When you have used the eight steps and collected data for 2-3 months, you should begin
to estimate the effectiveness of the selected, alternative, primary method of speaking
using the following criteria:
the requesting repertoire...is improving rapidly (8-10 requests for new items or activities per
month)...or...is continuing to improve gradually (1-2 requests for new items or activities per
month, or in some cases, per year)...or...includes most of the learner’s preferred items and
activities;
the audience responds appropriately to the learner’s requests (i.e. provides what the learner
requests);
the learner makes frequent, spontaneous requests throughout the day; and
the frequency of self-injurious, aggressive, destructive, or disruptive behavior has decreased
significantly.
If any of these four criteria are not met, this method should be rejected and another method
should be selected. Our learner’s selected alternative method of speaking was confirmed.
Activity 2 will also help you learn...
How to maintain, expand, and extend the use of an alternative, primary method of speaking
In order to make certain that a learner’s alternative method of speaking endures into the
future, expands the learner’s speaking repertoire, and extends that repertoire to several envi-
ronments, five goals must be accomplished. Two of these goals are provided below.
to make certain that the learner’s method of speaking is as portable as possible, insuring
frequent and continuous responding as a speaker, and
to capture and contrive many opportunities each day for the learner to respond as a
speaker,
These five goals were achieved with our learner.
Activity 2 will also help you learn...
How to select, confirm, & maintain concurrent, back-up, & secondary methods of speaking
Some learners will require concurrent methods, that is, two methods at the same time; others
will require back-up methods to increase the size of their audience, and still others will require
secondary methods that increase the extent of the speaker repertoire. Procedures for
selecting, confirming, and maintaining these methods are also described in EFL.
Our learner did not require concurrent, back-up, or secondary methods of speaking.
 Essential for Living: An Introduction and User Guide !10

Activity 3 -- If you are familiar with the learner and EFL, skip Activity 1; and, using the ARP or EARP
Manual, scan the Must-have Skills, which are part of Domain 1, Domain 2, Domain 4, and Domain
6 and circle ‘possible skill deficits’; if there are no apparent ‘must-have skill deficits’, obtain an
ARP Manual and proceed to the ‘should-have’ and ‘good-to-have skills’ in each of the seven Skill
Domains
If you completed Activity 1, and have assembled a list of ‘possible skill deficits’ for your learner,
you may bypass Activity 3 or add to this list by completing this activity. If you did not complete
Activity 1, complete Activity 3 now.
Using one of the learner scoring manuals, begin scanning the must-have skills, circling skills with a
pencil that, your experience with the learner suggest are ‘possible skill deficits’ (as shown below,
this activity was completed for our learner)…
Domain 1 (R) — Requests and Related Listener Responses

R1-5. Interests of the learner...as determined by instructors, parents, and care providers,
and... as indicated by the learner
R1 R2 R3 R4 R5
R6. Exhibits a reliable motor movement that permits a learner to use an alternative
method of speaking which includes selecting photographs, pic-symbols, printed
words, or letters
R7. Makes requests for highly preferred snack foods, drinks, non-food items, or activities
that can be made frequently and immediately available
R8. Requests the opportunity to entertain themselves or to reduce anxiety by making
stereotypic movements with highly preferred items or engaging in highly preferred
stereotypic activities
R9. Waits after making requests for each of the items and activities in R7 and R8 for
gradually increasing periods of time
R10. Accepts the removal of access to 10 items or activities from R7 and R8 by a person in
authority
Domain 2 (LR, LRND) — Listener Responses, Names, and Descriptions
LR1. Holds and maintains contact with the hand of an instructor, care provider, or parent
when directed to do so
LR2. Moves toward and stands or sits next to an instructor, care provider, or parent when
directed to do so
LR3. Moves toward and stands or remains in a line when directed to do so
Domain 4 (DLS) — Daily Living and Related Skills

DLS-EDF1. Consumes thick or thickened liquids orally

DLS-Slp1. Goes to sleep at bedtime
DLS-MT1. Transported from/to a bed, the toilet, a gait trainer, a walker, a wheelchair,
or a MOVE device with a hoist
DLS-AHS1. Does not pick up knives, scissors, and razors without supervision or training
DLS-HS1. Performs required exercises or therapeutic activities
! 11 Essential for Living: An Introduction and User Guide

Domain 6 (T) — Tolerating Skills and Eggshells

T-BHI1. The sight, sound, or scent of an unfamiliar person

T-EDF1. A gastrostomy or nasogastric tube
T-DM1. Medication hidden in food
T-Slp1. Parents’ bed
T-Toil1. Someone changing your diaper
T-PRM1. A bed chair
T-PTA1. Glasses or contact lenses
T-PEMR1. A helmet
T-BPH1. Someone washing your hands
T-DD1. Someone brushing your teeth

If there are no apparent ‘must-have skill deficits’, proceed to the ‘should-have’ and ‘good-to-
have skills’ in each of the seven Skill Domains.
Activity 4 -- Confirm and determine the extent of the ‘possible kill deficits’ suggested by Activities
1 or 3, using the procedures described and illustrated on pages 28-29 of the EFL Handbook; and,
indicate the learner’s performance as shown on these pages and on page 12 of this User Guide.
From the ‘possible skill deficits’ suggested by Activity 1 and/or those circled in Activity 3, begin to
complete the assessment process by completing Activity 4, that is, by selecting some of these
‘possible deficits’ and placing the learner in the situations in which the corresponding skills are
expected to occur and recording the learner’s initial performance.
You can use your own method of recording the learner’s performance or the method suggested
by Essential for Living, an example of which is shown below and on the next page. This method
permits the tracking of small increments of learner progress with respect to problem behavior,
resistance to prompts, prompt-fading, skill acquisition, fluency, generalization, and maintenance.
Activity 4 was conducted with our learner, who has a history of self-injurious behavior. During
Activity 1, Skills R1-R5, and R7 were indicated as ‘possible skill deficits’.
First, Activity 4 was completed with R1-R5 (see pages 115-118 of the EFL Handbook). The circles on
the Data Recording Form shown below indicate that crackers and grape juice were indicated as
preferred items by this learner and these preferences were confirmed across all five skills.

R1: Items and R2: when items or R3: when items or R4: when items or R5: when items
activities are ranked activities are activities are activities are or activities are
from most favorite made available given one at a presented one presented two
to least favorite one at a time time at a time or more at a time

All items and All interests that When interest is When interest is All interests that are
activities on this list are indicated go indicated in four or indicated in four or indicated go to R7
go to R2 or R4 to R3 more items or more items or
activities go to R4 activities go to R5
or R7

1- crackers 1 2 3 4 5 ✔ 1 2 3 4 5 ✔ 1 2 3 4 5 ✔ 1 2 3 4 5 ✔

2- grape juice 1 2 3 4 5 ✔ 1 2 3 4 5 ✔ 1 2 3 4 5 ✔ 1 2 3 4 5 ✔
 Essential for Living: An Introduction and User Guide !12

Then, in order to confirm R7 and items within R7 as ‘skill deficits’, and to determine if AMS 3 was an
effective method of speaking for our learner, Activity 4 was begun with crackers and grape juice.
The teacher sat down with our learner and several of his classmates during snack time. She
began by making preferred items and activities available for each of her students, including
crackers and grape juice for our learner. She waited until our learner indicated that he wanted
the crackers by reaching for them. When he did so, she waited a few more seconds before
prompting the designated sign. Despite his history, our learner did not exhibit self-injurious behav-
ior (indicated by shading the -SA box in yellow). He also did not exhibit disruptive behavior,
complaining, or resistance to prompts (indicated by shading the -DC and -RP boxes in yellow).
Since he had no previous experience with signs and he did not imitate motor movements, he
required a full, physical prompt in order to form the idiosyncratic sign for crackers (indicated by
shading the FP box in yellow). This concluded Activity 4 for this item. In other words, this conclud-
ed the initial assessment of requesting crackers (indicated by shading the IA box in yellow).
R7. Makes requests for highly preferred snack foods, drinks, non-food items, …
1 crackers IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
2 grape juice IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
When motivating events occur, learners request specific items, activities, or persons, or
request specific information consistent with those events on three consecutive occasions...
IA [ the initial assessment of this skill has been completed ]
IM [ instruction or management has begun ]
-SA without self-injurious, aggressive, or destructive behavior
-DC without disruptive behavior or complaints
-RP without resistance to prompts and without leaving the area
FP with a full physical, full demonstration, or full echoic prompt
PP with a partial physical, partial demonstration, or partial echoic prompt
MP with a minimal touch, minimal gestural, or minimal echoic prompt
Ind without prompts, without scrolling, and within two seconds
2S in two or more settings
2P in the presence of either of two people
<M when motivating events have occurred, but are weak
NI when the learner does not have sensory contact with the requested item or
activity (does not apply to some requests)
Det [ requests are no longer occurring consistently ]
Since our learner did not reach for the grape juice, Activity 4 for this item was conducted later.
Meanwhile, the teacher conducted Activity 4 for items within Skill R7 for other students at the
snack table. For our learner, the teacher completed Activity 4 with 8 of the 20 ‘possible skill defi-
cits’ that emerged from Activities 1 and 3. She did not continue Activity 4 with other ‘possible defi-
cits’, as she felt that the confirmed deficits would keep her busy for some time. She planned to
continue with Activity 4 and the other ‘possible skill deficits’ at a later date.
How to conduct an assessment of problem behavior. Begin conducting an assessment of problem
behavior by completing Activity 1 and noting the responses of interviewees during the Quick Assess-
ment and subsequent interviews. Then, observe the learner, define problem behaviors as instances or
episodes of specific movements, and designate each as self-injurious (SIB), aggressive (Agg), destruc-
tive (Des), disruptive (Dis), or repetitive (Rep). Using The Problem Behavior Direct Observation and
Interview Form, as shown below for our learner, or a data sheet of your choice…
record the daily frequency of instances or episodes of these behaviors for part or all of the day
record the intensity of these behaviors (Sev, Mod, Mild);
determine if the learner is taking psychoactive medications, along with the name of the medications
and the current dosage (Med);
record the extent to which protective equipment or mechanical restraints are used and specify
whether either is continuous (PEA or MRA) or contingent (PEC or MRC);
record the extent to which crisis stabilization procedures(CS) are used; and,
record the extent to which the learner exhibits self-restraint (SR).
! 13 Essential for Living: An Introduction and User Guide

As shown below, our learner, on the first day of the assessment, exhibited 12 episodes of self-injurious
behavior, specifically, hitting his own head with his fist, and wore a protective helmet throughout the
day. Episodes were recorded during a six-hour day, rather than instances, as ‘hits’ often occurred in
rapid succession, making instances difficult to record. Each episode was severe in intensity, but only
four episodes required crisis stabilization procedures, ranging in duration from 6-12 minutes.

ESSENTIAL FOR LIVING

Problem Behavior Direct Observation and Interview Form
Learner: (our learner) _____________________ Environment(s): (classroom) _______________________________
Date: (March 11) Observer or Person Interviewed: (teacher)_________________ Counting Period: (6 hrs.)___

Definition of Problem Behavior 1 -- hits his own Definition of Problem Behavior 2 --

head with his fist

Instance Episode SIB Agg Des Dis Rep Instance Episode SIB Agg Des Dis Rep

Medications: Risperdal (.5 mg) and Tenex (1.0 mg)

Direct Observation
PB1 Intensity MRA MRC PEA PEC CS (min) SR PB2 Intensity MRA MRC PEA PEC CS (min) SR

1 Sev-Mod-Mild helmet 11 min. 1 Sev-Mod-Mild

2 Sev-Mod-Mild helmet 2 Sev-Mod-Mild
3 Sev-Mod-Mild helmet 3 Sev-Mod-Mild
4 Sev-Mod-Mild helmet 8 min. 4 Sev-Mod-Mild
5 Sev-Mod-Mild helmet 6 min. 5 Sev-Mod-Mild
6 Sev-Mod-Mild helmet 6 Sev-Mod-Mild
7 Sev-Mod-Mild helmet 7 Sev-Mod-Mild
8 Sev-Mod-Mild helmet 8 Sev-Mod-Mild
9 Sev-Mod-Mild helmet 12 min. 9 Sev-Mod-Mild
10 Sev-Mod-Mild helmet 10 Sev-Mod-Mild
11 Sev-Mod-Mild helmet 10 Sev-Mod-Mild
12 Sev-Mod-Mild helmet 10 Sev-Mod-Mild
13 Sev-Mod-Mild 10 Sev-Mod-Mild
Interview
This behavior occurs 6-8 per day ? ___ per week This behavior occurs per day ___ per week
___ per month ___ per year ___ per month ___ per year
and the intensity is: ___ sev X mod ? ___ mild and the intensity is: ___ sev ___ mod ___ mild
The learner wears, requires, or exhibits: The learner wears, requires, or exhibits:
MRA or MRC: none MRA or MRC:
PEA or PEC: soft, karate helmet ! PEA or PEC:
CS: ____ minutes per day 3 hours per week ? CS: ___ minutes per day ____ hours per week
SR: none SR:

Continue collecting these data and, after 6-10 days, transfer the frequency data to a graph like
the one shown on the next page, or the Standard Celeration or the Adapted Standard Celeration
Chart. Also, transfer the remainder of the data to the diagram shown on the next page, which is
also on page 17 of the ARP Manual and page 4 of the EARP Manual.
 Essential for Living: An Introduction and User Guide !14

20
Hits his own head with his fist

Per School Day (6 hours)

15

Number of Episodes
10

0
Successive Calendar Days

PB1 occurs in the absence of — Skills R7 and R9

IA IM Instance Episode SIB Agg Des Dis Rep

Sev Mod Mild

Med3+> Med3+ Med3+< Med2> Med2 Med2< Med1> Med1 Med1< -Med

MRA MRC MR>2 MR>1 MR MR<1 MR<2 MR<3 -MR

PEA PEC PE>2 PE>1 PE PE>1 PE<2 PE<3 -PE

CS CS CS CS<30m
CS>5hW -CS
2-5hW 1-2hW 30m-1hW W
SR>2 SR>1 SR SR<1 SR<2 SR<3 -SR

>100D 50-100D 20-50D 10-20D 1-10D <1D <1W <1M <1Y

Type of Problem Behavior: Psychoactive Medications:

SIB: Self-injurious Med 3+> 3 + medications with some increases in dosage
Agg: Aggressive Med 3+ 3 + medications
Des: Destructive Med 3+< 3 + medications with some reductions in dosage
Dis: Disruptive Med 2> 2 medications with some increases in dosage
Rep: Repetitive Med 2 2 medications
Med 2< 2 medications with some reductions in dosage
Intensity of Problem Behavior: Med 1> 1 medication with some increases in dosage
Sev: Severe Med 1 1 medication
Mod: Moderate Med 1< 1 medication with some reductions in dosage
Mild: Mild -Med No medications

Mechanical Restraints: Protective Equipment:

MRA- continuous MRC- contingent PEA- continuous PEC- contingent
MR>2 have been increased twice PE>2 has been increased twice
MR>1 have been increased once PE>1 has been increased once
MR at the time of the initial assessment PE at the time of the initial assessment
MR<1 have been partially faded once PE<1 has been partially faded once
MR<2 have been partially faded twice PE<2 has been partially faded twice
MR<3 have been partially faded 3 times PE<3 has been partially faded 3 times
-MR are not required -PE is not required

Crisis Stabilization Procedures: Self-restraints:

CS>5hW are used more than 5 hrs./week SR>2 have been increased twice
CS2-5hW are used 2-5 hrs./week SR>1 have been increased once
CS1-2hW are used 1-2 hrs./week SR at the time of the initial assessment
CS30m-1hW are used 30 mins. -- 1 hr./week SR<1 have been partially faded once
CS<30mW are used < 30 mins./week SR<2 have been partially faded twice
-CS are not required SR<3 have been partially faded 3 times
-SR self-restraints are not occurring
! 15 Essential for Living: An Introduction and User Guide

Then, after collecting these data, begin conducting a formal, functional assessment or a functional
behavioral assessment. Or, begin using an approach we prefer — assessing problem behavior in
the context of skill development (see page 249 of the practitioner’s handbook). This approach
involves estimating which of the Essential Eight Skills are not occurring when the problem behavior
occurs. As shown in the table below, this approach, which was used with our learner, may indirectly
estimate the function of problem behavior and suggest appropriate replacement skills.
The Essential Eight and the Likely Functions of Problem Behaviors
that Occur in the Absence of These Skills
The Essential Eight: Eight Must-have Skills that are part of Skill Domains 1, 2, 4, and 6
One. MAKING REQUESTS for an One. MAKING REQUESTS for the One. MAKING REQUESTS for
audience removal or reduction in intensity preferred items and
of non-preferred situations activities
One. MAKING REQUESTS for Two. WAITING
companionship
One. MAKING REQUESTS for Three. ACCEPTING REMOVALS -- the
affection Removal of Preferred Items
and Activities, Making
Transitions, Sharing, and
Taking Turns
One. MAKING REQUESTS for Four. COMPLETING REQUIRED TASKS --
feedback, approval, or 10 Consecutive, Brief, Previously
confirmation Acquired Tasks
One. MAKING REQUESTS for Five. ACCEPTING ‘NO’
acknowledgment

Six. FOLLOWING DIRECTIONS Related

to Health and Safety
Seven. COMPLETING DAILY LIVING
SKILLS Related to Health and
Safety
Eight. TOLERATING SITUATIONS
Related to Health and Safety

The Likely Functions of Problem Behaviors that Occur in the Absence of The Essential Eight
attention avoidance or escape from demands, access to tangible items or
and, possibly, attention as well activities, and, possibly,
attention as well

The results of the assessment of problem behavior for our learner are depicted in the chart and the
diagram on the previous page. During the assessment, the intensity of the behavior was generally
severe (Sev) and episodes occurred from 10-20 times per day (10-20D). The learner was taking two
psychoactive medications — Risperdal (.5 mg) and Tenex (1 mg) — each day (Med2), wore a
protective helmet continuously (PEA, PE), did not require mechanical restraints (-MR), and did not
exhibit self-restraint (-SR). He did, however, require the use of crisis stabilization procedures from 2-5
hours per week (CS 2-5hW). And his teacher estimated that our learner typically hit his own head
with his fist in the absence of ‘making requests’ and ‘waiting after doing so’ (skills R7 and R9).
 Essential for Living: An Introduction and User Guide !16

Teaching and Recording Learner Progress

Teaching Functional Skills and Managing Problem Behaviors. After conducting an assessment of skill
deficits and problem behavior, begin reducing the extent of those deficits, along with the intensity
and frequency of specific behaviors, by using the Teaching Protocols that begin on page 265 of the
practitioner’s handbook. Each of these protocols includes procedures that have been validated in
the scientific literature. The first four steps of Teaching Protocol 1 are provided on this page.
Teaching Protocol 1. Making Requests (R7-8, R14, R17-21)
[this protocol includes the echoic-to-request teaching procedure
and can be used with any skill that includes making requests]
What to Do What Not to Do
1. Make items and activities available that are highly preferred; wait 1. Say, “What do
for the learner to indicate by gesturing what he ‘wants’ at that you want?”
moment; proceed to step 2 or 3
2. For learners aligned with Vocal Profiles 1 or 2 (i.e., learners who reli- 2. Say part of the
ably repeat spoken words), immediately provide an echoic prompt word or phrase…
-- say the word or phrase that corresponds to the item or activity
the learner wants (e.g., cookie); if a learner’s repetitions are control-
led, also provide a vocal cue to do so (e.g., “say, (pause) cookie”)
For learners who use an alternative method of speaking, provide an or, provide a
immediate full demonstration prompt or a full physical prompt of partial demon-
the sign, picture or word selection, or typed word until the learner stration or partial
makes the appropriate response; then, proceed to step 4 physical prompt
3. If the learner makes the appropriate response several consecutive
times, begin to fade the prompts; fade echoic prompts all-at-once,
fade demonstration prompts all-at-once or gradually, and fade full
physical prompts gradually; proceed to step 4
4. If the learner exhibits the appropriate word, forms the appropriate
sign, selects the appropriate picture or printed word, or types the
appropriate word, say the word and provide access to the request-
ed item or activity; if a learner who uses an alternative method of
speaking, says part or all of the word, provide an additional amount
or duration of the item or activity; proceed to steps 1 and 3 until all
prompts have been completely faded; continue returning to step1
until the learner is making 10 requests from R7, R8, R14, and R17-21
Recording Learner Progress on Functional Skills. As mentioned earlier, you can use your own meth-
od of recording learner progress on functional skills or the method suggested by Essential for Living.
This method includes a rigorous performance standard and permits the tracking of small increments
of learner progress with respect to problem behavior, resistance to prompts, prompt-fading, skill
acquisition, fluency, generalization, and maintenance.
Shown below are the results of a completed assessment of R7 for our learner, previously depicted on
page 12 of this guide. When instruction was begun, the IM box was shaded, in this case in green, indi-
cating a specific time period (the first school year) after the initial assessment was completed.

R7. Makes requests for highly preferred snack foods, drinks, non-food items, …
1 crackers IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
2 grape juice IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det

Several days each week, the teacher conducted one or more instructional sessions during snack and
lunch time using Teaching Protocol 1. Before the first instructional session of the day, she conducted a
first-opportunity of the day probe. That is, she provided our learner with an opportunity to respond
! 17 Essential for Living: An Introduction and User Guide

without prompts and only added prompts when they were necessary for him to make a specific
request or make that request in a specific situation. Our learner’s performance on this first opportunity
was recorded on a self-graphing data sheet downloaded from [Link]. Then, the
teacher proceeded with an instructional session and no other data on this skill were recorded that
day. A portion of this data sheet is shown below.

Day/Date and First Opportunity of the Day Probe

Specific Request
S M T W T F S S M T W T F S

R7. Requesting NI NI NI NI NI NI NI NI NI NI NI NI NI NI
<M <M <M <M <M <M <M <M <M <M <M <M <M <M
crackers
2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P
2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S
Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind
MP MP MP MP MP MP MP MP MP MP MP MP MP MP
PP PP PP PP PP PP PP PP PP PP PP PP PP PP
FP FP FP FP FP FP FP FP FP FP FP FP FP FP
-RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP
-DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC
-SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA
0 0 0 0 0 0 0 0 0 0 0 0 0 0

As shown, our learner continued to require a full prompt (in his case, a full physical prompt) on the
first three days of instruction. On the first day of the following week, however, on the first opportunity
of that day, he requested crackers with only a partial, physical prompt. Then, on Wednesday and
Thursday of that week, he repeated that same performance. As a result of three consecutive instan-
ces of improved performance on the first opportunity of the day (a rigorous performance standard),
his teacher recorded this performance in his scoring manual (the ARP manual) by shading the PP box
in green as shown below.

R7. Makes requests for highly preferred snack foods, drinks, non-food items, …
1 crackers IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
2 grape juice IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
When motivating events occur, learners request specific items, activities, or persons, or
request specific information consistent with those events on three consecutive
occasions...
IA [ the initial assessment of this skill has been completed ]
IM [ instruction or management has begun ]
-SA without self-injurious, aggressive, or destructive behavior
-DC without disruptive behavior or complaints
-RP without resistance to prompts and without leaving the area
FP with a full physical, full demonstration, or full echoic prompt
PP with a partial physical, partial demonstration, or partial echoic prompt
MP with a minimal touch, minimal gestural, or minimal echoic prompt
Ind without prompts, without scrolling, and within two seconds
2S in two or more settings
2P in the presence of either of two people
<M when motivating events have occurred, but are weak
NI when the learner does not have sensory contact with the requested item or
activity (does not apply to some requests)
Det [ requests are no longer occurring consistently ]

Additional improvements in performance on this and other skills during the same school year were
indicated by the color green on the data sheets and the learner scoring manual. Improvements in
performance in subsequent years were indicated by other designated colors. Additional assessments
continued to be indicated in yellow.
 Essential for Living: An Introduction and User Guide !18

Sometimes learners experience a deterioration in their performance. As shown in the data sheet
below, our learner, who was responding with a partial physical prompt, waited on Friday for a full
physical prompt. As shown below, the teacher circled the Det box in the learner scoring manual with
a pencil and drew an arrow from that box to the box that indicated the deteriorated performance.

Day/Date and First Opportunity of the Day Probe

Specific Request
S M T W T F S S M T W T F S

R7. Requesting NI NI NI NI NI NI NI NI NI NI NI NI NI NI
<M <M <M <M <M <M <M <M <M <M <M <M <M <M
crackers 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P
2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S
Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind
MP MP MP MP MP MP MP MP MP MP MP MP MP MP
PP PP PP PP PP PP PP PP PP PP PP PP PP PP
FP FP FP FP FP FP FP FP FP FP FP FP FP FP
-RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP
-DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC
-SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA
0 0 0 0 0 0 0 0 0 0 0 0 0 0

R7. Makes requests for highly preferred snack foods, drinks, non-food items, …
1 crackers IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
2 grape juice IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det

Our learner’s performance then returned to its previous level and, in fact, exceeded that level for
three consecutive days. As shown below, the teacher erased the pencil marks in the scoring manual.

Day/Date and First Opportunity of the Day Probe

Specific Request
S M T W T F S S M T W T F S S M T W

R7. Requesting NI NI NI NI NI NI NI NI NI NI NI NI NI NI NI NI NI NI
<M <M <M <M <M <M <M <M <M <M <M <M <M <M <M <M <M <M
crackers 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P 2P
2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S 2S
Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind Ind
MP MP MP MP MP MP MP MP MP MP MP MP MP MP MP MP MP MP
PP PP PP PP PP PP PP PP PP PP PP PP PP PP PP PP PP PP
FP FP FP FP FP FP FP FP FP FP FP FP FP FP FP FP FP FP
-RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP -RP
-DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC -DC
-SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA -SA
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

R7. Makes requests for highly preferred snack foods, drinks, non-food items, …
1 crackers IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det
2 grape juice IA IM -SA -DC -RP FP PP MP Ind 2S 2P <M NI Det

Recording Learner Progress on Problem Behavior. As shown below, you can record learner progress
on problem behavior and the supports this behavior requires over extended periods of time using
your own graphs or the Standard Celeration or Adapted Standard Celeration Chart and the diagram
that is found on page 17 of the ARP Manual and page 4 of the EARP Manual.
! 19 Essential for Living: An Introduction and User Guide

20

Hits his own head with his fist

Per School Day (6 hours)

15

Number of Episodes
10

0
Successive Calendar Days

PB1 (Problem Behavior 1): hits his own head with his fist

IA IM Instance Episode SIB Agg Des Dis Rep

Sev Mod Mild

Med3+> Med3+ Med3+< Med2> Med2 Med2< Med1> Med1 Med1< -Med
PEA PEC PE>2 PE>1 PE PE<1 PE<2 PE<3 -PE

MRA MRC MR>2 MR>1 MR MR<1 MR<2 MR<3 -MR

CS CS CS
CS>5hW CS<30mW -CS
2-5hW 1-2hW 30m-1hW

SR>2 SR>1 SR SR<1 SR<2 SR<3 -SR

>100D 50-100D 20-50D 10-20D 1-10D <1D <1W <1M <1Y

By the end of the first school year, our learner was exhibiting fewer episodes of head-hitting per day
(indicated by the 1-10D box shaded in green), but with the same intensity (indicated by no box
shaded in green in the second row of the diagram). He continued to wear the same helmet
continuously (indicated by no box shaded in green in the fourth row of the diagram) and required
the same two medications, but with a dosage reduction (indicated by the Med2< box shaded in
green). In addition, he required only 30 minutes to one hour of crisis stabilization procedures per week
(indicated by the CS 30m-1hW box shaded in green).
By the end of the second school year (indicated by the boxes shaded in pink), our learner was exhi-
biting less than one episode of head-hitting per day with less intensity, was taking only one medi-
cation, and was wearing the helmet continuously, although it had been reduced in size 3 times. And,
our learner no longer required crisis stabilization procedures. In summary, over a two-year period of
time, our learner demonstrated substantial improvement with respect to both problem behavior and
the supports that behavior required.
Summarizing Learner Progress across All Targeted Skills. As has been shown in the past few pages,
the learner’s performance on all skills that have been assessed can be precisely documented. And,
on4 skills in whichofinstruction
A Summary has
the Learner’s begun, small
Assessments increments
and Subsequent of progress
Progress (SAP) or deterioration can also be
documented. In each of the learner scoring manuals, performance on these skills can also be
summarized by skill number or by skill number and current performance level. Small segments of each
of these summary pages are shown below. The first is a summary by skill number.
ESSENTIAL FOR LIVING
A Summary of the Learner’s Assessments and Subsequent Progress
on The Essential Eight Skills (SAP)
Must-have Indications of interest, Requests, and Related Listener Responses.... Part of Domain 1 (R)
Indications of Interest and Initial Requests R1 R2 R3 R4 R5 R6 R7 1 2 3 4 5 6 7 8 9 10

Special Requests and Waiting R8 1 2 R9 1 2 3 4 5 6 7 8 9 10

Accepting Removals R10 1 2 3 4 5 6 7 8 9 10

Completing Required Tasks, Sharing and Taking Turns R11 R12 1 2 3 4 5 6 7 8 9 10

Making Transitions R13 1 2 3 4 5 6 7 8 9 10

 Essential for Living: An Introduction and User Guide !20

As you can see in this summary diagram, only one box is provided for each skill and the scoring is yes/
no (binary). As a result, our learner’s performance on Skill R7, item 1, requesting crackers, can only be
summarized during an assessment or during skill acquisition when prompts are not required. The
occurrence of problem behavior (if any), the extent to which prompts are required, the extent to
which generalization has occurred, and the extent to which deterioration may have occurred, will all
be absent from this summary.
The second is a summary by skill number and current
A Summary performance
of the level and isand
Learner’s Assessments shown below. This
Subsequent Progress (SAP
time, the learner’s performance during an assessment and after instruction has begun, can easily be
summarized before, during, and after prompts are required. And, as shown below, this summary will
include all of the components absent from the first summary.
ESSENTIAL FOR LIVING
A Summary of the Learner’s Assessments and Subsequent Progress
on Specific Performance Levels of The Essential Eight Skills (SAP)
Must-have Indications of Interest, Requests, and Related Listener Responses.... Part of Domain 1 (R)
R1 R2 R3 R4 R5 R6 1 2 5 10 R7 1 -SA-DC-RP FP PP MP Ind 2S 2P <M NI 2
3 -SA -DC -RP FP PP MP Ind 2S 2P <M NI 4 5 6
7 8 9 10
R8 1 -SA -DC -RP FP PP MP Ind 2S 2P <M NI 2 -SA -DC-RP FP PP MP Ind 2S 2P <M R9 1 1s 2s 5s 10s 20s 1m 2m 5m 10m20m 2
3 4 5 6
7 8 9 10
R10 1 -SA -DC -RP FP PP MP Ind 2S 2P >M 2 3 4
5
Some of the Skills of Essential for Living 6 7 8
9 10 R11 1 2 5 10 R12 1 -SA-DC -RP FP PP MP Ind 2S 2P >M
There are many hundreds of must-have, should-have, good-to-have, and nice-to-have skills which
2 3 4 5
are included in the seven skill domains of Essential for Living. Some of these skills are listed below:
6 7 8 9
Domain
10 1: Requests and RelatedR13 Listener Responses
1 -SA-DC-RP FP PP MP Ind 2S 2P >M 2 3
4R1-5. 5 6
Interests of the learner... as determined by instructors, parents, and care providers, 7
8 and... as indicated9by the learner 10 R14 -SA -DC -RP FP PP MP Ind
R15 1R7. 2P >M 2 requests for highly
-SA -DC 2S Makes 3 4 5 6
preferred snack foods, drinks, non-food items, or activities 7
9 10 R16 1 -SA-DC 2S 2P >M 2
that can be made frequently and immediately available 3 R17 -SA -DC -RP FP PP MP Ind 2S
R18 1 -SA -DC -RP FP PP MP Ind 2S 2P <M 2 3 R19 -SA -DC -RP FP PP MP Ind
R9. Waits after making requests for each of the items and activities in R7 and R8 for
R20 -SA -DC -RP FP PP MP Ind 2S 2P <M NI R21 -SA -DC-RP FP PP MP Ind 2S 2P
gradually increasing periods of time
Must-have
R15. Listener
‘Accepts no’Responses:
after making Following Directions
requests for itemsRelated to Health
and activities and
that Safety....
were taught Part
andof Domain
are 2 (LR)
LR1 1s 2s 5s 10s often honored
20s 1m 2m 5m 10m20m(R7,
LR2 R8, and
-SA -DC -RPR14)
FP PP MP Ind 2S 2P LR3 LR4 1s 2s 5s 10s 20s 1m 2m 5m
LR5 -SA -DC -RP
Domain FP PP MP Ind and
1: Requests LR6
2S 2PRelated LR7 10s 20s 1m 2m 5m LR8 20s 1m 2m 5m 10m20m
Listener Responses (cont.)
LR9 -SA -DC -RP FP PP MP Ind 2S 2P LR10 LR11 20s 1m 2m 5m 10m20m
R17. Makes very forceful and repeated requests for a stranger, an intruder, a person
Must-have
teasing, Daily Living
threatening, SkillsorRelated
bullying, to Health
instigating a fight,andor Safety....
a personPart of Domain
making sexual4 (DLS)
DLS- EDF1 -SA -DC-RP
advances to ‘go away’
FP PP MP Ind PPA APD CO 2S 2P EDF2 1 -SA-DC-RP FP PP MP Ind PPA APD CO 2S 2P 2 -SA-DC-RP FP PP MP Ind PPAAPD CO 2S 2P
3R18. EDF3 1
Makes a generalized request for help in a threatening or dangerous situation, by 2
3 yelling “help”, screaming, EDF4or 1otherwise making contact with an 2 audience, calling
3 EDF5 1
‘9-1-1’, or activating a medical alert device 2
3R19. EDF6 1
Makes a generalized request for an audience, followed by requests 2 for items or
3 activities in R7 and R8 EDF7 1 2
3R23. Makes requests for highly EDF8
preferred
-SA-DC-RP FPitems
PP MPand activities
Ind PPA 2P EDF9
APD CO 2S that cannot be made either
Slp1 -SA -DC-RP
frequently or immediately available
FP PP MP Ind PPA APD CO 2S 2P Slp2 MT1 1st 1/4 1/2 3/4 Ind _m PPA APD CO 2S 2P
MT2
R28. MT3
Says “thank you” when requests are honored MT4
MT5
R38. -SA -DC-RP
Makes
FP PP aMPrequest
Ind PPA APDto 2S 2P AHS1
COdelay AHS1-SA-DC-RP
the onset ofFPa PP required APD CO 2S 2P AHS2
MP Ind PPAactivity
AHS3
R44. Makes requests from peers AHS4 AHS5
AHS6
R47. AHS7
Makes a request for assistance during menstruation AHS8
AHS9
R49. AHS10
Makes a request for privacy and to increase personal space AHS11
AHS12
R54. AHS13
Makes a request for others to clarify something they have said AHS14
AHS15 HS1 1st 1/4 1/2 3/4 Ind _m PPA APD CO 2S 2P HS2
HS3 HS4 -SA-DC-RP FP PP MP Ind PPA APD CO 2S 2P HS5
HS6 HS7 HS8 1st 1/4 1/2 3/4 Ind _m PPA APD CO 2S 2P
Must-have Tolerating Skills Related to Health and Safety.... Part of Domain 6 (T)
T- BHI1 Egg -Egg 10s 1m 1/4 1/2 3/4 Ind BHI2 BHI3 BHI4 BHI5
! 21 Essential for Living: An Introduction and User Guide

R59. Makes a request to perform an activity without assistance

R72. Makes requests that require 2 words, 2 signs, or 2 pictures and that include a specific
item or activity, for which a request was previously acquired, along with a feature or
a specific quantity
R84. Makes requests for information, with 2-4 key words or signs, regarding the location of
items, people, or places, some with features [‘where’ questions]
Domain 2: Listener Responses, Names, and Descriptions
LR1. Holds and maintains contact with the hand of an instructor, care provider, or parent
when directed to do so
LR2. Moves toward and stands or sits next to an instructor, care provider, or parent when
directed to do so
LR10. Turns toward others when her/his name is called and makes two consecutive listener
responses from LR1-9
LR11. Fastens a seat belt while in a car, a car seat, or a mobility device and remains in the
seat belt for gradually increasing periods of time when directed to do so
LR12. Completes five activities of dressing and personal hygiene when directed to do so
LRND1.1 Breakfast — Recognizes a spoon, a bowl, and a cup; Retrieves a spoon, a bowl, and
a cup; Relocates a spoon, a bowl, and a cup (to the dishwasher);
LRND1.2 Breakfast — Names a spoon; wipes the table; describes wiping the table
Domain 3: Answers to Questions and Conversations
AQ.1.1 Breakfast -- When a spoon, bowl, or cup is missing, answers the question ‘What do
you need’
C1.1 Breakfast -- Participates in a conversation with two exchanges
Domain 4: Daily Living and Related (Leisure and Vocational) Skills
DLS-EDF1. Consumes thick or thickened liquids orally
DLS-EDF4. Chews three soft foods
DLS-EDF18. Wipes mouth and hands with a napkin
DLS-EDF21. Feeds self cereal
DLS-MM4. Administers own pills or vitamins using a weekly pill sorter
DLS-Slp5. Remains in own bed throughout the night
DLS-MT8. Walks with a gait trainer
Domain 4: Daily Living and Related (Leisure and Vocational) Skills (cont.)
DLS-MT16. Rides a train, bus, or taxi to 5 specific locations
DLS-Toil6. Urinates and defecates in the toilet
DLS-BPH1. Washes hands
DLS-BPH8. Applies and changes a sanitary napkin or tampon during menstruation
DLS-AHS10. Does not plug in or touch an iron
DLS-AHS12. Does not put harmful, non-nutritive items in their mouth
DLS-D25. Puts on socks, stockings, or leggings
DLS-SIT15. Returns to tasks after significant interruptions
DLS-SIT16. Participates in instruction with 2-4 peers
DLS-V3. Participates in supported employment
DLS-RDA5. Cleans own room
DLS-HS4. Fastens and remains in a seat belt for the duration of specific trips
DLS-HS8. Engages in safe, personal, sexual behavior in an appropriate setting
 Essential for Living: An Introduction and User Guide !22

Domain 5: Functional Academic Skills

Responses to Text as a Listener and Reading Skills
RTL2. Responds appropriately to public safety, street, and emergency signs (e.g.,
‘Walk’, ‘Don’t Walk’, ‘Wet Floor’)
RTL11. Selects items from restaurant menus that include printed-words or Braille letters,
such as, ‘blueberry waffles’, ‘scrambled eggs and bacon with toast’,
‘cheeseburger and french fries’, and others
Rdg4. Reads the text on containers of common food and non-food items that
represent some risk of safety (e.g., ‘Ant and Roach Spray’, ‘Furniture Polish’)
Rdg14. Reads text from simple, printed-word or Braille recipes, for example, ‘mix the flour
and water’, and others
Schedules, Lists, and Time
SLT1. Participates in events and activities slated to occur later that same day using a
personal, daily, picture or tactile schedule
SLT11. Names times on an analog or digital clock or watch to the nearest quarter hour
Math Skills
Mth1. Counts a specified number of items from 1-10 using an inset counting jig
Mth10. Makes purchases using a debit or credit card
Mth12. Makes purchases with coins using a vending machine
Writing or Typing Skills
WT7. Writes, types, or Braille writes words that often appear on shopping lists
Domain 6: Tolerating Skills and Eggshells
T-EDF1. A gastrostomy or nasogastric tube
T-EDF3. Thickened liquids
T-DM9. Ventilation and suction
T-BHI5. Touch, guidance, or physical prompts
T-PTA9. AFOs
T-C1. Someone putting on your clothes
T-DD1. Someone brushing your teeth
T-Trp3. Seat Belt
T-Toil9. Public restrooms
T-PRM3. A corner chair
T-BHI7. The word “no” or other indications of disapproval or incorrect responding
Domain 6: Tolerating Skills and Eggshells (cont.)
T-BDA5. Not being first or first in line
T-HC2. Vacuum cleaners
Domain 7: Tool Skills and Component Skills
MM2. Reaches for items
MM7. Grasps items
M3. Matches items to corresponding containers or locations
Im2. Imitates motor movements with items
! 23 Essential for Living: An Introduction and User Guide

Getting Started with Essential for Living

To get started using Essential for Living, the following 7 steps are suggested:
Step 1 -- Read chapters 1-4 of the Professional Practitioner’s Handbook;
Step 2 -- Select a child or an adult with moderate-to-severe disabilities and problem behavior or
a limited skill repertoire, and obtain a copy of the Assessment and Record of Progress
[ARP] Manual or the Essential Assessment and Record of Progress [EARP] Manual; also,
download the EFL Intro and User Guide from [Link]
Step 3 -- Conduct an Assessment of Skill Deficits: Activities 1-4 as described on pages 28 and 29
and chapters 5 and 6 of the practitioner’s handbook;
Step 4 -- Conduct an Assessment of Problem Behavior, including the supports these behaviors
may require as described on pages 30-32 of the handbook;
Step 5 -- Select 5-8 skill deficits and problem behaviors for inclusion in the learner’s IEP, ISP, behav-
ior plan, or support plan, and begin instruction and behavior management using the
Teaching Protocols in chapter 12 of the handbook;
Step 6 -- Track learner progress using your own data sheets or self-graphing data recording forms
from [Link] and transfer data to the ARP or the EARP Manual (see
pages 33-37 of the practitioner’s handbook); and,
Step 7 -- As the learner acquires skills that have been assessed, or priorities change in the life of
the learner, conduct additional assessments (Steps 3 and 4) and confirm new skill defi-
cits or identify new problem behaviors.

The ELSSENTIAL
FOR
IVING
Speaker Initiative

There are many thousands of children and adults

with moderate-to-severe disabilities and
No Effective Method of Speaking.
As a direct result, many of these individuals exhibit problem behavior,
which limits their participation in community activities.
The goal of ‘The Essential for Living Speaker Initiative’ is to provide a method of speaking for
as many of these children and adults as possible and to expand their speaking repertoires
to include requests for a wide variety of preferred items and activities.
To accomplish this goal, we need to...
1- Identify these children and adults one at a time,
2- Select a method of speaking for each of them, and
3- Teach each one of them to make requests for their most preferred items and activities.
Essential for Living will help you ```accomplish these goals and become part of this
initiative.
[Link]